Comparative effectiveness of asthma interventions within a practice based research network

<p>Abstract</p> <p>Background</p> <p>Asthma is a chronic lung disease that affects more than 23 million people in the United States, including 7 million children. Asthma is a difficult to manage chronic condition associated with disparities in health outcomes, poor medical compliance, and high healthcare costs. The research network coordinating this project includes hospitals, urgent care centers, and outpatient clinics within Carolinas Healthcare System that share a common electronic medical record and billing system allowing for rapid collection of clinical and demographic data. This study investigates the impact of three interventions on clinical outcomes for patients with asthma. Interventions are: an integrated approach to care that incorporates asthma management based on the chronic care model; a shared decision making intervention for asthma patients in underserved or disadvantaged populations; and a school based care approach that examines the efficacy of school-based programs to impact asthma outcomes including effectiveness of linkages between schools and the healthcare providers.</p> <p>Methods/Design</p> <p>This study will include 95 Practices, 171 schools, and over 30,000 asthmatic patients. Five groups (A-E) will be evaluated to determine the effectiveness of three interventions. Group A is the usual care control group without electronic medical record (EMR). Group B practices are a second control group that has an EMR with decision support, asthma action plans, and population reports at baseline. A time delay design during year one converts practices in Group B to group C after receiving the integrated approach to care intervention. Four practices within Group C will receive the shared decision making intervention (and become group D). Group E will receive a school based care intervention through case management within the schools. A centralized database will be created with the goal of facilitating comparative effectiveness research on asthma outcomes specifically for this study. Patient and community level analysis will include results from patient surveys, focus groups, and asthma patient density mapping. Community variables such as income and housing density will be mapped for comparison. Outcomes to be measured are reduced hospitalizations and emergency department visits; improved adherence to medication; improved quality of life; reduced school absenteeism; improved self-efficacy and improved school performance.</p> <p>Discussion</p> <p>Identifying new mechanisms that improve the delivery of asthma care is an important step towards advancing patient outcomes, avoiding preventable Emergency Department visits and hospitalizations, while simultaneously reducing overall healthcare costs.</p

The Future of Healthcare is in the Cloud

"Cloud" is a symbolic definition of Internet storage that can be accessed everywhere. This technology is swiftly gaining fame.1 Cloud computing is the state-of-the-art modernization in Information Technology (IT) and has provided a substitute mode for managing and accessing health data. It caters to various computing services such as intelligence, servers, storage, databases, networking, software, and analytics. Cloud computing administers fast modernization, flexible resources, and a range of economies. It is a colossal change from the traditional method due to its cost-effectiveness, high speed, security, global scale, performance, productivity, and reliability.2 Nowadays, hospitals/clinics successfully address patients needs through the cloud, and tech-savvy healthcare professionals are switching to this advancement for its benefits.3 Furthermore, it is an important step to move health systems and data to the cloud as it has achieved popularity during the pandemic. Cloud computing is accomplishing innovative systems to attain patient portals, offering interoperability and a protective way for important data to be transmitted quickly and efficiently anytime and everywhere. 4 Moreover, experts have predicted that cloud computing can improve services in healthcare and assets in healthcare research that have changed the appearance of information technology (IT).5 Because of these gains, there is a boost in the adoption of cloud computing to establish more satisfaction among patients and healthcare providers with low costs.6 Many healthcare systems still rely on old software systems. Healthcare workers' access to data such as electronic health records (EHR), patients' prescriptions, test results, and images/scans are more equipped to diagnose and identify the good management course. Decisions regarding large amounts of information help researchers and healthcare professionals identify patterns, and clues, uncover insights and provide evidence-based management.7 As a result of the cloud, the healthcare industry is regulated, and it makes sense that the first wave of moves to the cloud is those that have no direct impact on patient care. Healthcare providers are now comfortable with the impressive benefits of the cloud. The next wave of migration of information seems to be quicker and easier. Furthermore, telemedicine is the next strong contender for modernization in the future. A survey estimated that approximately 70 per cent of face-to-face interactions with the medical care provider did not require a routine appointment. A fraction of these interactions, telemedicine, would end in significant cost-effective healthcare delivery. It is a key objective for healthcare providers as insurers, and consumer costs would continue to arise. Another significant rise is patient empowerment tools which are cloud benefits as cloud-based applications (CBA) on smartwatches that help those with health-related chronic diseases, regular monitoring, and daily management. These are nutrition, exercise, medication reminders, and blood glucose monitoring that can be easily tracked through CBA, providing a platform for doctors to improve patient’s management further. Bettering outcomes, increased efficiency, and cost-effectiveness via CBA are important components that impact the healthcare system.8 Compliance and security are the main barriers to implementing community cloud in Pakistan’s healthcare system, and the challenges are fat.9 Pakistan’s medical system is still in the initial stages of shifting to this new technology. Healthcare information, X-Rays, medications, and patient history of government and non-government health services are increasing significantly in size, diversity, and rate in this country. 10 The demand for cloud services in Pakistan is improving daily.11 To sharpen and enhance the healthcare model of the health system, cloud-based solutions provide flexibility. Today, hospitals and physicians are gathering more information from patients and places due to this advancement. Virtual care services have grown over the past year when and where patients receive care. Doctors and physicians now have regular access to patient’s information from smartwatches that help update a patient’s treatment. Health information systems (HIS) and Health Management systems (HMS) have all the data for improving patient healthcare delivery connected across the healthcare continuum, and almost all healthcare providers have moved to the cloud. Historically it was a challenging process. The command of the cloud in healthcare is innovative in storing health information. It regards permission for the right care at the right time and place. CBS also provides a secure, integrated, and scalable foundation that supports a patient's health information within healthcare premises to develop the changes needed for tomorrow. HMS will provide a cost-effective and secure platform that will be important for data integrity and high-performance data replication for evidence-based decision and management

Encouraging Integrated Care for Dual Eligibles

Outlines examples and elements of integrated care models for those eligible for both Medicare and Medicaid, including multidisciplinary care teams, comprehensive provider networks, and data sharing, that would eliminate inefficiencies and reduce costs

Telemedicine in chronic disease management: a Public Health perspective

Introduction In 2014, the School of Hygiene of the University of Padua carried out an evaluation of home telemonitoring (HTM) programs for the management of chronic diseases. Our aims were to verify their efficacy, and to identify a model of care that could be integrated into the current health system. Our analysis addressed both organizational and clinical matters. Methods Our evaluation involved 19 reviews and 53 randomized controlled trials (RCT). Main selection criteria were: papers published over the last 15 years, HTM performed through a sensor system, data sent remotely to physicians, health out-comes and monitored parameters clearly stated. Included diseases were: heart failure, hypertension, COPD, asthma and diabetes. Results Several critical issues were highlighted. Due to the general tendency in the scientific literature to report HTM efficacy, there is a lack of conclusive evidence whether telemedicine actually improves both clinical (e.g. decreased disease/all-cause mortality, drop in disease/all-cause hospitalization rates, improvement in biological parameters and quality of life) and organizational (decreased length of hospital stay, decreased emergency room/other service use, decreased costs) outcomes or not. Discussion From a Public Health perspective, discrepancies and weaknesses may affect published results, since the best method for organizing and delivering telemedicine programs has not yet been identified. There is still no consensus on the following topics: setting: which context expresses the potential of technology best? No studies were found comparing, e.g., rural with urban communities. Within urban scenarios, samples do not discriminate users by their capability to access the healthcare network (e.g. residents in peripheral areas with limited transportation resources, rather than users with reduced mobility); target: it is unclear which demographic or socioeconomic characteristics users should possess to gain most benefit from HTM; duration and frequency: there are significant differences in RCT (and HTM program) duration. It has not been established whether HTM is more effective when permanently implemented, or only in the early stages of disease (i.e. until stabilization). There is no agreement on the optimal HTM implementation frequency, nor whether the patients should also receive traditional interventions (e.g. nurse home visits);scope: it has not been determined whether measurements should be disclosed to patients as educational means to improve disease management. However, past literature does include some indications that the effectiveness of HTM programs may be attributable to care intensification (or to a perceived intensification by the patient, as per the \u201cHawthorne effect\u201d described in sociology) or to the empowerment process. Conclusions HTM management of chronic diseases is a promising and remarkable strategy, still flawed by the lack of evidence. Reported efficacy, although modest, probably has a multifactorial origin. Our hypothesis is that it may not result from the technology itself, but from the impact of such process on multiple components of care, emphasizing patients' involvement and autonomy, and improving monitoring intensity. Further studies are needed to clarify the role played by the different HTM components (target, setting, etc.). The application of HTM as a tool for prevention, empowerment and reduction of healthcare access remains little explored

Improving health and public safety through knowledge management

This paper reports on KM in public healthcare and public safety. It reflects the experiences of the author as a CIO (Chief Information Officer) in both industries in Australia and New Zealand. There are commonalities in goals and challenges in KM in both industries. In the case of public safety a goal of modern policing theory is to move more towards intelligence-driven practice. That means interventions based upon research and analysis of information. In healthcare the goals include investment in capacity based upon knowledge of healthcare needs, evidence-based service planning and care delivery, capture of information and provision of knowledge at the point-of-care and evaluation of outcomes. The issue of knowledge management is explored from the perspectives of the user of information and from the discipline of Information Technology and its application to healthcare and public safety. Case studies are discussed to illustrate knowledge management and limiting or enabling factors. These factors include strategy, architecture, standards, feed-back loops, training, quality processes, and social factors such as expectations, ownership of systems and politics

Addressing the Health Needs of an Aging America: New Opportunities for Evidence-Based Policy Solutions

This report systematically maps research findings to policy proposals intended to improve the health of the elderly. The study identified promising evidence-based policies, like those supporting prevention and care coordination, as well as areas where the research evidence is strong but policy activity is low, such as patient self-management and palliative care. Future work of the Stern Center will focus on these topics as well as long-term care financing, the health care workforce, and the role of family caregivers

Evaluation of complex integrated care programmes: the approach in North West London

Background: Several local attempts to introduce integrated care in the English National Health Service have been tried, with limited success. The Northwest London Integrated Care Pilot attempts to improve the quality of care of the elderly and people with diabetes by providing a novel integration process across primary, secondary and social care organisations. It involves predictive risk modelling, care planning, multidisciplinary management of complex cases and an information technology tool to support information sharing. This paper sets out the evaluation approach adopted to measure its effect. Study design: We present a mixed methods evaluation methodology. It includes a quantitative approach measuring changes in service utilization, costs, clinical outcomes and quality of care using routine primary and secondary data sources. It also contains a qualitative component, involving observations, interviews and focus groups with patients and professionals, to understand participant experiences and to understand the pilot within the national policy context. Theory and discussion: This study considers the complexity of evaluating a large, multi-organisational intervention in a changing healthcare economy. We locate the evaluation within the theory of evaluation of complex interventions. We present the specific challenges faced by evaluating an intervention of this sort, and the responses made to mitigate against them. Conclusions: We hope this broad, dynamic and responsive evaluation will allow us to clarify the contribution of the pilot, and provide a potential model for evaluation of other similar interventions. Because of the priority given to the integrated agenda by governments internationally, the need to develop and improve strong evaluation methodologies remains strikingly important

Norton Healthcare: A Strong Payer-Provider Partnership for the Journey to Accountable Care

Examines the progress of an integrated healthcare delivery system in forming an accountable care organization with payer partners as part of the Brookings-Dartmouth ACO Pilot Program, including a focus on performance measurement and reporting

Strengthening Primary Health Care Through Community Health Workers: Investment Case And Financing Recommendations

A report released this week at the Third International Conference on Financing for Development found that there is a strong case for investing in Community Health Worker (CHW) programs as part of integrated health systems. The report was released by leaders from the Federal Democratic Republic of Ethiopia, the Republic of Liberia, the U.N. Secretary General's Special Envoy for Financing the Health MDGs and for Malaria, Partners in Health, the Clinton Foundation, the African Leaders Malaria Alliance, and the MDG Health Alliance. The authors encourage domestic governments, international financers, bilateral and multilateral donors, and the broader global health community to finance and support the scale up of CHW programs as part of community-based primary health care through a set of specific recommendations. The authors participated in the crafting of the report and its recommendations as part of a distinguished panel chaired by Ray Chambers, the UN Secretary General's Special Envoy for Financing the Health MDGs and for Malaria, and Prime Minister Hailemariam Dessalegn, President of the Federal Democratic Republic of Ethiopia