Experiences in the development of electronic care plans for the management of comorbidities

Recent studies have shown that care plans with comprehen- sive home interventions can be effective in the management of chronic patients. Evidence also exists about the importance of tailoring these care plans to patients, by integrating comorbidities. In this context, the de- velopment, implementation, outcome analysis, and reengineering of care plans adapted to particular patient groups earn relevance. We are con- cerned with the development and reengineering of electronic care plans dealing with comorbidities. Our hypothesis is that a library of reusable care plan components can facilitate these tasks. To confirm this hypoth- esis we have carried out an experiment consisting in developing a library of care plan components for the management of patients with COPD3 or CHF4, and next building a care plan for stable COPD&CHF patients by (re)using these components. In this paper we report on this experimen

Organizational factors and depression management in community-based primary care settings

Abstract Background Evidence-based quality improvement models for depression have not been fully implemented in routine primary care settings. To date, few studies have examined the organizational factors associated with depression management in real-world primary care practice. To successfully implement quality improvement models for depression, there must be a better understanding of the relevant organizational structure and processes of the primary care setting. The objective of this study is to describe these organizational features of routine primary care practice, and the organization of depression care, using survey questions derived from an evidence-based framework. Methods We used this framework to implement a survey of 27 practices comprised of 49 unique offices within a large primary care practice network in western Pennsylvania. Survey questions addressed practice structure (e.g., human resources, leadership, information technology (IT) infrastructure, and external incentives) and process features (e.g., staff performance, degree of integrated depression care, and IT performance). Results The results of our survey demonstrated substantial variation across the practice network of organizational factors pertinent to implementation of evidence-based depression management. Notably, quality improvement capability and IT infrastructure were widespread, but specific application to depression care differed between practices, as did coordination and communication tasks surrounding depression treatment. Conclusions The primary care practices in the network that we surveyed are at differing stages in their organization and implementation of evidence-based depression management. Practical surveys such as this may serve to better direct implementation of these quality improvement strategies for depression by improving understanding of the organizational barriers and facilitators that exist within both practices and practice networks. In addition, survey information can inform efforts of individual primary care practices in customizing intervention strategies to improve depression management.http://deepblue.lib.umich.edu/bitstream/2027.42/78269/1/1748-5908-4-84.xmlhttp://deepblue.lib.umich.edu/bitstream/2027.42/78269/2/1748-5908-4-84-S1.PDFhttp://deepblue.lib.umich.edu/bitstream/2027.42/78269/3/1748-5908-4-84.pdfPeer Reviewe

Needs Assessment for a Patient Centered Medical Home Model of Care at the Providence Alaska Cancer Center

Presented to the Faculty of the University of Alaska Anchorage in Partial Fulfillment of the Requirements for the Degree of MASTER OF PUBLIC HEALTHIn order to better understand the needs of cancer patients and allocate resources, the Providence Alaska Cancer Center requested a needs assessment for an oncology focused patient centered medical home (PCMH). A PCMH allows for coordinated and comprehensive care through the use of a teamwork model that centers on the primary care physician. The Providence Alaska Cancer Center staff randomly selected the records of 200 cancer patients between 2010 and 2011, using the cancer tumor registry. Data were analyzed to answer four specific questions that addressed the 1) presence of a Primary Care Physician (PCP), 2) number and type of comorbidities, 3) cancer diagnosis and 4) insurance status impacted emergency room utilization. Individuals tended to utilize the emergency room more if they 1) had a PCP, 2a) had three or more comorbidities, 2b) were diagnosed with hyperlipidemia, chronic obstructive pulmonary disease (COPD) or hypertension, 3) were diagnosed with an “other” cancer as opposed to breast, lung or gynecological cancers or 4) had federal insurance. These data in particular show expected trends such as patients who have more medical complications have higher emergency room utilization rates than patients with less complicated medical history and that certain comorbidities (hyperlipidemia, hypertension and chronic obstructive pulmonary disease) may be predictors of emergency room utilization. These trends may allow providers to create more specialized treatment and care plans for patients at greater risk of emergency room utilization.Signature Page / Title Page / Abstract / Table of Contents / List of Figures / List of Tables / List of Appendices / Introduction to Cancer and its Treatment / Introduction to the Patient Centered Medical Home Model / Treatment of Cancer in Alaska / Study Goals, Rationale, Research Questions and Hypotheses / Methods / Sample Demographics and Description / Results and Discussion / Strengths and Limitations / Future Directions / References / Appendice

The Medicare Physician Group Practice Demonstration: Lessons Learned on Improving Quality and Efficiency in Health Care

Discusses the experiences of ten large practices earning performance payments for improving the quality and cost-efficiency of health care delivered to Medicare fee-for-service beneficiaries

Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED).

BackgroundRecurrent strokes are preventable through awareness and control of risk factors such as hypertension, and through lifestyle changes such as healthier diets, greater physical activity, and smoking cessation. However, vascular risk factor control is frequently poor among stroke survivors, particularly among socio-economically disadvantaged blacks, Latinos and other people of color. The Chronic Care Model (CCM) is an effective framework for multi-component interventions aimed at improving care processes and outcomes for individuals with chronic disease. In addition, community health workers (CHWs) have played an integral role in reducing health disparities; however, their effectiveness in reducing vascular risk among stroke survivors remains unknown. Our objectives are to develop, test, and assess the economic value of a CCM-based intervention using an Advanced Practice Clinician (APC)-CHW team to improve risk factor control after stroke in an under-resourced, racially/ethnically diverse population.Methods/designIn this single-blind randomized controlled trial, 516 adults (≥40 years) with an ischemic stroke, transient ischemic attack or intracerebral hemorrhage within the prior 90 days are being enrolled at five sites within the Los Angeles County safety-net setting and randomized 1:1 to intervention vs usual care. Participants are excluded if they do not speak English, Spanish, Cantonese, Mandarin, or Korean or if they are unable to consent. The intervention includes a minimum of three clinic visits in the healthcare setting, three home visits, and Chronic Disease Self-Management Program group workshops in community venues. The primary outcome is blood pressure (BP) control (systolic BP <130 mmHg) at 1 year. Secondary outcomes include: (1) mean change in systolic BP; (2) control of other vascular risk factors including lipids and hemoglobin A1c, (3) inflammation (C reactive protein [CRP]), (4) medication adherence, (5) lifestyle factors (smoking, diet, and physical activity), (6) estimated relative reduction in risk for recurrent stroke or myocardial infarction (MI), and (7) cost-effectiveness of the intervention versus usual care.DiscussionIf this multi-component interdisciplinary intervention is shown to be effective in improving risk factor control after stroke, it may serve as a model that can be used internationally to reduce race/ethnic and socioeconomic disparities in stroke in resource-constrained settings.Trial registrationClinicalTrials.gov Identifier NCT01763203

What does it take to make integrated care work? A ‘cookbook’ for large-scale deployment of coordinated care and telehealth

The Advancing Care Coordination & Telehealth Deployment (ACT) Programme is the first to explore the organisational and structural processes needed to successfully implement care coordination and telehealth (CC&TH) services on a large scale. A number of insights and conclusions were identified by the ACT programme. These will prove useful and valuable in supporting the large-scale deployment of CC&TH. Targeted at populations of chronic patients and elderly people, these insights and conclusions are a useful benchmark for implementing and exchanging best practices across the EU. Examples are: Perceptions between managers, frontline staff and patients do not always match; Organisational structure does influence the views and experiences of patients: a dedicated contact person is considered both important and helpful; Successful patient adherence happens when staff are engaged; There is a willingness by patients to participate in healthcare programmes; Patients overestimate their level of knowledge and adherence behaviour; The responsibility for adherence must be shared between patients and health care providers; Awareness of the adherence concept is an important factor for adherence promotion; The ability to track the use of resources is a useful feature of a stratification strategy, however, current regional case finding tools are difficult to benchmark and evaluate; Data availability and homogeneity are the biggest challenges when evaluating the performance of the programmes

Sharing Resources: Opportunities for Smaller Primary Care Practices to Increase Their Capacity for Patient Care

Outlines findings linking shared resources with use of health information technology, care coordination, self-management, and quality monitoring, and strategies to increase resources among small and midsize practices by expanding shared resource models

Memorial Hermann Memorial City Medical Center: Excellence in Heart Attack Care Reduces Readmissions

Highlights the factors and strategies behind low readmission rates for heart attack and pneumonia patients, including a focus on quality, concurrent review, extensive training, discharge planning, patient education, and use of risk assessment software

Digital technologies and chronic disease management

Raises awareness of the potential benefits of using digital technologies for improving practice efficiencies and patient health outcomes. Background Digital technologies will become a major part of our healthcare system, with particular impact in primary care. However, many healthcare professionals are not sufficiently informed of the digital technologies available today and how they and their patients can gain substantial benefit from adoption of these technologies. Objective To raise awareness of the potential benefits of using digital technologies for improving practice efficiencies and patient health outcomes. Discussion Implementing best practice care for patients with chronic and complex conditions is one of the greatest challenges facing gen-eral practice and other primary care providers. It has been suggested that digital technologies could assist by decreasing the administrative burden of care delivery, improving quality of care, increasing practice efficiencies and better supporting patient self-management. In this paper, we consider some areas in the management of chronic and long-term conditions where digital and mobile health solutions can make a difference today