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

Organizing for Higher Performance: Case Studies of Organized Delivery Systems

Offers lessons learned from healthcare delivery systems promoting the attributes of an ideal model as defined by the Fund: information continuity, care coordination and transitions, system accountability, teamwork, continuous innovation, and easy access

Integrating Technology to Support and Maintain Glycemic Control in People With Diabetes

Presented to the Faculty of the University of Alaska Anchorage in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCEType II diabetes is a chronic disease state that leads to increased morbidity and mortality and impacts the lives of millions of Americans. This quality improvement project explored the use of a free smartphone application, Glucose Buddy, in aiding people with Type II diabetes to achieve and maintain glycemic control. The project was conducted through the involvement of patients at the Creekside Family Health Clinic in Ketchikan, Alaska over a three month time period. Pre-intervention hemoglobin A1c (HA1c) was compared with post-intervention HA1c. The project, due to the small sample size and high withdraw rate, was not statistically significant. However, there was clinical significance as it showed a decrease in HA1c levels in 60% of the participants.Abstract / Introduction / Literature Review and Synthesis / Problem Statement / Research Question / Methodology / Results / Limitations / Conclusions / Outcomes / Impact on Practice / Dissemination / References / Appendix A / Appendix B / Appendix C / Appendix

Educational programme for patients with type 2 diabetes at community health centres : what is the evidence?

With increasing prevalence of diabetes mellitus type 2, more patients will require intensive management with diet, exercise, oral hypoglycaemic medication, and insulin replacement therapy in the primary care setting. The true challenge of diabetes care is to help patients balance short- and long-term quality of life against the burden of daily intensive self-management. Many guidelines refer to patient diabetes education (PDE) as the way people are enabled to maintain glycaemic control and experience the best possible quality of life. PDE programmes are often offered on an ad hoc basis and are not ongoing, nor are they based on any proven educational or behavioural principles which limit their effectiveness. PDE interventions are very complex and it is difficult to identify the active ingredients with any precision.peer-reviewe

General practitioners' and nurses' experiences of using computerised decision support in screening for diabetic foot disease:implementing Scottish Clinical Information - Diabetes Care in routine clinical practice

<strong>Objective</strong> The Scottish Care Information - Diabetes Collaboration (SCI-DC) developed a computer- based information system to create a shared electronic record for use by all involved in the care of patients with diabetes mellitus. The objectives of this study were to understand primary care practitioners' views towards screening for diabetic foot disease and their experience of the SCI-DC system. <strong>Method</strong> We conducted an exploratory study using qualitativemethods. Semi-structured interviews were audiotape-recorded, transcribed and subjected to thematic analysis. Seven practice nurses and six general practitioners (GPs) with special responsibility for diabetes care inNHS Lothian participated. <strong>Results</strong> Primary care clinicians reported good systems in place to screen for diabetes-related complications and to refer their patients to specialist care. Foot ulceration was rarely observed; other diabetesrelated conditions were seen as a higher priority. Most had heard of the SCI-DC foot assessment tool, but its failure to integrate with other primary care information technology (IT) systems meant it was not used in these general practices. <strong>Conclusions</strong> Adoption of the SCI-DC foot assessment tool in primary care is not perceived as clinically necessary. Although information recorded by specialist services on SCI-DC is helpful, important structural barriers to its implementation mean the potential benefits associated with its use are unlikely to be realised; greater engagement with primary care priorities for diabetes management is needed to assist its successful implementation and adoption

On the Road to Accurate Biomarkers for Cardiometabolic Diseases by Integrating Precision and Gender Medicine Approaches

The need to facilitate the complex management of cardiometabolic diseases (CMD) has led to the detection of many biomarkers, however, there are no clear explanations of their role in the prevention, diagnosis or prognosis of these diseases. Molecules associated with disease pathways represent valid disease surrogates and well-fitted CMD biomarkers. To address this challenge, data from multi-omics types (genomics, epigenomics, transcriptomics, proteomics, metabolomics, microbiomics, and nutrigenomics), from human and animal models, have become available. However, individual omics types only provide data on a small part of molecules involved in the complex CMD mechanisms, whereas, here, we propose that their integration leads to multidimensional data. Such data provide a better understanding of molecules related to CMD mechanisms and, consequently, increase the possibility of identifying well-fitted biomarkers. In addition, the application of gender medicine also helps to identify accurate biomarkers according to gender, facilitating a differential CMD management. Accordingly, the impact of gender differences in CMD pathophysiology has been widely demonstrated, where gender is referred to the complex interrelation and integration of sex (as a biological and functional marker of the human body) and psychological and cultural behavior (due to ethnical, social, and religious background). In this review, all these aspects are described and discussed, as well as potential limitations and future directions in this incipient field

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

Review: Self-management Support Program on Dietary Behaviors in Patients with Type 2 Diabetes Mellitus

Background: Dietary behaviors are the cornerstone in diabetes management. Diabetes self-management support program in which patients play an active role to determine their health care is an important strategy to improve dietary behaviors in type 2 diabetes mellitus (T2DM) patients. Its elements which contribute to the successfulness of the program need to be identified.Purpose: To review and identify the elements of self-management support program to improve dietary behaviors in T2DM patients.Method: An integrative review was conducted. Relevant studies published in English language during last 10-year, measured dietary behaviors in T2DM patients, and retrieved from CINAHL and PubMed were included.Results: 13 experimental studies and 3 meta-analysis studies were reviewed. Goal setting and action planning combined with other strategies (brief counseling and problem solving) seemed more effective to improve dietary behaviors. Either trained lay people or clinicians could lead the program although clinician-led programs were common. Contents and materials of the education vary across the studies. The effects on dietary behaviors could be detected in short term duration of program (<6 months). Continuing follow-up was essential element which face-to-face follow-up as the most common strategy. The utilization of technology such as telephone-call and internet based follow-up might provide more benefits for patients.Conclusion: Diabetes self-management support program is effective to improve dietary behaviors in T2DM patients. Further research is needed to test the effectiveness of goal setting strategy and technology utilization for follow-up strategy such telephone call in Indonesian T2DM population