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Oluyede L, Cochran AL, Wolfe M, Prunkl L, McDonald N. Addressing transportation barriers to health care during the COVID-19 pandemic: Perspectives of care coordinators. Transp Res Part A Policy Pract 2022. [PMID: 35283561 DOI: 10.1016/j.trip.2022.100565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Prior to the COVID-19 pandemic, transportation barriers prevented millions of Americans from accessing needed medical care. Then the pandemic disrupted medical and transportation systems across the globe. This research explored ways the COVID-19 pandemic changed how people experienced transportation barriers to accessing health care. We conducted in-depth interviews with social workers, nurses, and other care coordinators in North Carolina to identify barriers to traveling for medical care during the pandemic and explore innovative solutions employed to address these barriers. Analyzing these interviews using a flexible coding approach, we found that the pandemic exacerbated existing transportation barriers and created new barriers. Yet, simultaneously, temporary policy responses expanded the utilization of telehealth. The interviews identified specific advantages of expanded telehealth, including increasing access to mental health services in rural areas, reducing COVID-19 exposure for high-risk patients, and offering continuity of care for COVID-19 patients with other health conditions. While telehealth cannot address all medical needs, such as emergency or cancer care, it may be well-suited for preliminary screenings and follow-up visits. The findings provide insights on how post-pandemic telehealth policy changes can benefit individuals facing transportation barriers to accessing health care and support more accommodating and convenient health care for patients and their families.
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Affiliation(s)
- Lindsay Oluyede
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
| | - Abigail L Cochran
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
| | - Mary Wolfe
- UNC Center for Health Equity Research, 323 MacNider Hall, 333 South Columbia Street, Chapel Hill, NC 27599-7240, USA
| | - Lauren Prunkl
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
| | - Noreen McDonald
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
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Berinstein JA, Cohen-Mekelburg SA, Greenberg GM, Wray D, Berry SK, Saini SD, Fendrick AM, Adams MA, Waljee AK, Higgins PD. A Care Coordination Intervention Improves Symptoms But Not Charges in High-Risk Patients With Inflammatory Bowel Disease. Clin Gastroenterol Hepatol 2022; 20:1029-1038.e9. [PMID: 34461298 PMCID: PMC8882693 DOI: 10.1016/j.cgh.2021.08.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) is associated with substantial symptom burden, variability in clinical outcomes, and high direct costs. We sought to determine if a care coordination-based strategy was effective at improving patient symptom burden and reducing healthcare costs for patients with IBD in the top quintile of predicted healthcare utilization and costs. METHODS We performed a randomized controlled trial to evaluate the efficacy of a patient-tailored multicomponent care coordination intervention composed of proactive symptom monitoring and care coordinator-triggered algorithms. Enrolled patients with IBD were randomized to usual care or to our care coordination intervention over a 9-month period (April 2019 to January 2020). Primary outcomes included change in patient symptom scores throughout the intervention and IBD-related charges at 12 months. RESULTS Eligible IBD patients in the top quintile for predicted healthcare utilization and expenditures were identified. A total of 205 patients were enrolled and randomized to our intervention (n = 100) or to usual care (n = 105). Patients in the care coordinator arm demonstrated an improvement in symptoms scores compared with usual care (coefficient, -0.68, 95% confidence interval, -1.18 to -0.18; P = .008) without a significant difference in median annual IBD-related healthcare charges ($10,094 vs $9080; P = .322). CONCLUSIONS In this first randomized controlled trial of a patient-tailored care coordination intervention, composed of proactive symptom monitoring and care coordinator-triggered algorithms, we observed an improvement in patient symptom scores but not in healthcare charges. Care coordination programs may represent an effective value-based approach to improve symptoms scores without added direct costs in a subgroup of high-risk patients with IBD. (ClinicalTrials.gov, Number: NCT04796571).
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Affiliation(s)
- Jeffrey A. Berinstein
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| | - Shirley A. Cohen-Mekelburg
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | | | - Daniel Wray
- Twine Clinical Consulting, LLC Park City, UT, USA
| | - Sameer K. Berry
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
| | - Sameer D. Saini
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - A. Mark Fendrick
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA,Center for Value-Based Insurance Design, University of Michigan, Ann Arbor, MI, USA
| | - Megan A. Adams
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Akbar K. Waljee
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA,VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Peter D.R. Higgins
- Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA
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Oluyede L, Cochran AL, Wolfe M, Prunkl L, McDonald N. Addressing transportation barriers to health care during the COVID-19 pandemic: Perspectives of care coordinators. Transp Res Part A Policy Pract 2022; 159:157-168. [PMID: 35283561 PMCID: PMC8898700 DOI: 10.1016/j.tra.2022.03.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Prior to the COVID-19 pandemic, transportation barriers prevented millions of Americans from accessing needed medical care. Then the pandemic disrupted medical and transportation systems across the globe. This research explored ways the COVID-19 pandemic changed how people experienced transportation barriers to accessing health care. We conducted in-depth interviews with social workers, nurses, and other care coordinators in North Carolina to identify barriers to traveling for medical care during the pandemic and explore innovative solutions employed to address these barriers. Analyzing these interviews using a flexible coding approach, we found that the pandemic exacerbated existing transportation barriers and created new barriers. Yet, simultaneously, temporary policy responses expanded the utilization of telehealth. The interviews identified specific advantages of expanded telehealth, including increasing access to mental health services in rural areas, reducing COVID-19 exposure for high-risk patients, and offering continuity of care for COVID-19 patients with other health conditions. While telehealth cannot address all medical needs, such as emergency or cancer care, it may be well-suited for preliminary screenings and follow-up visits. The findings provide insights on how post-pandemic telehealth policy changes can benefit individuals facing transportation barriers to accessing health care and support more accommodating and convenient health care for patients and their families.
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Affiliation(s)
- Lindsay Oluyede
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
| | - Abigail L Cochran
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
| | - Mary Wolfe
- UNC Center for Health Equity Research, 323 MacNider Hall, 333 South Columbia Street, Chapel Hill, NC 27599-7240, USA
| | - Lauren Prunkl
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
| | - Noreen McDonald
- Department of City and Regional Planning, New East Building, CB# 3140, 223 E Cameron Ave, Chapel Hill, NC 27599-3140, USA
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Moore EF, Gephart SM. State of the science of care coordination, rurality, and well-being for infants with single ventricle heart disease in the Interstage period, an integrative review. Heart Lung 2021; 50:720-729. [PMID: 34107397 DOI: 10.1016/j.hrtlng.2021.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ensuring the quality of interstage management of infants with single ventricle heart disease (SVHD) residing in rural communities is difficult. Tailored care coordination through parental discharge education, formal and informal care team and family communication, adequate access to healthcare, and informed provider handoffs are crucial to the infant's well-being and survival. OBJECTIVE To discuss the state of the science related to care coordination factors and infant wellbeing during the interstage period. METHODS An integrative review approach to synthesize findings across studies was used. Through constant comparative analysis, all articles were read and coded, broken down into "data bits" or key phrases. RESULTS Four major themes were inductively derived: 1) education and confidence-building, 2) communication for building relationships, 3) social work and related mental health support, and 4) availability of resources. CONCLUSIONS Despite advances in cardiac surgery and related interventions, a clear gap exists regarding care coordination factors and infant well-being, especially in rural communities.
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Affiliation(s)
- Emily F Moore
- Seattle Children's Hospital 4800 Sand point Way NE, Seattle WA 98105 MS FA.2.114; The University of Arizona College of Nursing PO Box 210203 Tucson, AZ 85721.
| | - Sheila M Gephart
- The University of Arizona College of Nursing PO Box 210203 Tucson, AZ 85721
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Abstract
The Centers for Medicare and Medicaid Services continues to propose and implement alternative payment models (APMs) to shift Medicare payment away from fee-for-service and toward approaches that emphasize health care value. As APMs expand in scope, one critical question is whether they should engage providers on a voluntary or a mandatory basis. Clinicians and policy makers may view the benefits and drawbacks of these two modes of participation differently. In this Analysis we compare the benefits and drawbacks of mandatory and voluntary participation, based on clinical versus policy perspectives, and we argue that both modes are necessary for APMs to achieve the goal of improving value. Policy makers should match the mode of participation and related financial incentives to each clinical scenario in which an APM is implemented. We propose ways to coordinate mandatory and voluntary APMs based on clinical scenarios.
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Affiliation(s)
- Joshua M Liao
- Joshua M. Liao is medical director of payment strategy, director of the Value and Systems Science Lab, and an assistant professor in the Department of Medicine, University of Washington, in Seattle, and an adjunct senior fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania, in Philadelphia
| | - Mark V Pauly
- Mark V. Pauly is the Bendheim Professor in the Health Care Management Department at the Wharton School, University of Pennsylvania
| | - Amol S Navathe
- Amol S. Navathe ( amol. navathe@gmail. com ) is a core investigator at the Corporal Michael J. Cresencz Veterans Affairs Medical Center, in Philadelphia; an assistant professor in the Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania; and codirector of the Healthcare Transformation Institute, associate director of the Center for Health Incentives and Behavioral Economics, and senior fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania
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Abstract
OBJECTIVE Since late 2012, the Medicare Inpatient Psychiatric Facility Quality Reporting (IPFQR) program of the Centers for Medicare and Medicaid Services (CMS) has required inpatient psychiatric facilities to collect and publicly report a suite of quality measures. This study explored the association between facility-level 30-day risk-adjusted all-cause readmission (medical or psychiatric) after psychiatric hospitalization (READM-30-IPF) and care coordination process measures in the IPFQR program. METHODS The study used publicly reported IPFQR facility-level performance data of the Hospital Compare Web site for 1,343 inpatient psychiatric facilities, reflecting performance from July 2015 to June 2017. The authors used a cross-sectional design and linear regression models controlling for hospital and community characteristics and using state as fixed effect. RESULTS The mean±SD facility-level READM-30-IPF was 20%±3%, with substantial variation by facility type, ownership status, rurality, and percentage of racial-ethnic minority residents in the county. Regression results showed that facilities with performance in the top tercile on the measure of 7-day mental health follow-up after discharge had readmission rates significantly lower than facilities in the bottom tercile (coefficient=-0.58, p<0.01), although the magnitude of this difference was small. READM-30-IPF, however, did not vary by facilities' performance on measures of discharge plan creation and transmission. CONCLUSIONS Results suggest that facilities have substantial opportunities to reduce readmissions after psychiatric hospitalization. The association between hospital performance on care coordination process measures and the all-cause readmission measure currently included in the IPFQR program was minimal. The CMS should evaluate whether the IPFQR measures adequately capture compliance with evidence-based processes and desired outcomes.
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Affiliation(s)
- Ivy Benjenk
- School of Public Health, University of Maryland, College Park (Benjenk, Chen); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Shields)
| | - Morgan Shields
- School of Public Health, University of Maryland, College Park (Benjenk, Chen); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Shields)
| | - Jie Chen
- School of Public Health, University of Maryland, College Park (Benjenk, Chen); Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Shields)
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Peltonen LM, Kuloheimo A, Junttila K, Salanterä S. A Digital Service Logistics Information System for Emergency Department Care Coordination - Professionals' Experiences. Stud Health Technol Inform 2020; 270:1177-1178. [PMID: 32570567 DOI: 10.3233/shti200350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim was to describe nurses' and physicians' perceptions of a digital service logistics information system from an operative management perspective in emergency departments (EDs). A total of 24 professionals were interviewed. Based on the results the information systems support operative management of EDs but the professionals desire more detailed information about patients and staff to support situational awareness in the operative management of these units.
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Affiliation(s)
| | - Armi Kuloheimo
- Department of Nursing Science, University of Turku, Turku, Finland
| | | | - Sanna Salanterä
- Department of Nursing Science, University of Turku, Turku, Finland
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Kim C, Lehmann CU, Hatch D, Schildcrout JS, France DJ, Chen Y. Provider Networks in the Neonatal Intensive Care Unit Associate with Length of Stay. IEEE Conf Collab Internet Comput 2019; 2019:127-134. [PMID: 32637942 PMCID: PMC7339831 DOI: 10.1109/cic48465.2019.00024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We strive to understand care coordination structures of multidisciplinary teams and to evaluate their effect on post-surgical length of stay (PSLOS) in the Neonatal Intensive Care Unit (NICU). Electronic health record (EHR) data were extracted for 18 neonates, who underwent gastrostomy tube placement surgery at the Vanderbilt University Medical Center NICU. Based on providers' interactions with the EHR (e.g. viewing, documenting, ordering), provider-provider relations were learned and used to build patient-specific provider networks representing the care coordination structure. We quantified the networks using standard network analysis metrics (e.g., in-degree, out-degree, betweenness centrality, and closeness centrality). Coordination structure effectiveness was measured as the association between the network metrics and PSLOS, as modeled by a proportional-odds, logistical regression model. The 18 provider networks exhibited various team compositions and various levels of structural complexity. Providers, whose patients had lower PSLOS, tended to disperse patient-related information to more colleagues within their network than those, who treated higher PSLOS patients (P = 0.0294). In the NICU, improved dissemination of information may be linked to reduced PSLOS. EHR data provides an efficient, accessible, and resource-friendly way to study care coordination using network analysis tools. This novel methodology offers an objective way to identify key performance and safety indicators of care coordination and to study dissemination of patient-related information within care provider networks and its effect on care. Findings should guide improvements in the EHR system design to facilitate effective clinical communications among providers.
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Affiliation(s)
- Cindy Kim
- Department of Mathematics, Vanderbilt University, Nashville, TN
| | | | - Dupree Hatch
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | | | - Daniel J France
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - You Chen
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN
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Kinnucan J, Binion D, Cross R, Evans E, Harlen K, Matarese L, Mullins A, O'Neal B, Reiss M, Scott FI, Weaver A, Rosenberg J. Inflammatory Bowel Disease Care Referral Pathway. Gastroenterology 2019; 157:242-254.e6. [PMID: 30980795 DOI: 10.1053/j.gastro.2019.03.064] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 02/12/2019] [Accepted: 03/10/2019] [Indexed: 12/20/2022]
Affiliation(s)
| | - David Binion
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Raymond Cross
- University of Maryland School of Medicine, Baltimore, Maryland; Digestive Health Center, University of Maryland Medical Center, Baltimore, Maryland
| | - Elisabeth Evans
- Univeristy of California-San Diego IBD Center, San Diego, California
| | - Kevin Harlen
- Capital Digestive Care, Silver Spring, Maryland; Digestive Health Physicians Association, Silver Spring, Maryland
| | - Laura Matarese
- Brody School of Medicine, East Carolina University, Greenville, North Carolina
| | - Amy Mullins
- American Academy of Family Physicians, Washington, DC
| | - Bud O'Neal
- Our Lady of the Lake, Baton Rouge, Louisiana; Louisiana State University, Baton Rouge, Louisiana
| | - Marci Reiss
- IBD Support Foundation, Los Angeles, California; University of Southern California, Los Angeles, California
| | - Frank I Scott
- IBD Specialist, University of Colorado School of Medicine, Aurora, Colorado
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Abstract
Cancer patients interact with clinicians who are distributed across locations and organizations. This makes it difficult to coordinate care and adds to the burden of cancer care delivery. Failures in care coordination can harm patients. The rapid growth in the number of cancer survivors and the increasing complexity of cancer care has kindled an interest in new care delivery models. Information technology (IT) is an important component of care delivery. While IT can potentially enhance collaborative work among people distributed across locations, organizations and time, the current design and implementation of health IT adds to the human burden and often makes it a part of the problem instead of the solution. A new paradigm is needed, therefore, to drive innovations that reframe health IT as an enabler (and a component) of a “thinking system,” in which patients, caregivers, and clinicians, even when distributed across locations and time, can collaborate to deliver high-quality care while decreasing the burden of care delivery. In a thinking system, the design of collaborative work in health care delivery is based on an understanding of complex interplay among social and technological components. We propose six core design properties for a thinking system: task coordination; information curation; creative and flexible organizing; establishing a common ground; continuity and connection; and co-production. A thinking system is needed to address the complexity of coordination, meet the rising expectation of personalized care, relieve the human burden in care delivery, and to deliver the best quality care that modern science can provide.
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Zarafshan H, Mohammadi MR, Abolhassani F, Motevalian SA, Sharifi V. Developing a Comprehensive Evidence-Based Service Package for Toddlers with Autism in a Low Resource Setting: Early Detection, Early Intervention, and Care Coordination. Iran J Psychiatry 2019; 14:120-129. [PMID: 31440293 PMCID: PMC6702275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Objective: The number of children with autism, who have many unmet needs, is increasing dramatically. However, the existing evidence shows that early identification and intervention are effective in reducing the later costs and burdens of autism spectrum disorder (ASD). Thus, the present study aimed to develop evidence-based services for children with autism in Iran to reduce its impacts on the affected children and their families and to decrease its burden on the society. Method : A 3-step study was conducted based on a modification of the Replicating Effective Programs (REP) framework (step 1: need assessment and situation analysis; step 2: identifying current evidence-based services; step 3: designing the first draft of the package and its core elements). Each step was conducted by a specific methodology. Results: By considering the obtained data, it was found that a package of services with 4 core components to respond to the perceived needs in Iran was needed: (1) early detection of at-risk children; (2) care coordination and facilitation of access to current services; (3) implementation of an evidence-based early intervention program; and (4) training interventionists using an effective educational framework based on evidence-based material. Conclusion: REP framework was used in the present study, which has been shown to be effective in adapting and implementing health care services. By considering the preconditions of REP, a comprehensive package of services, with 4 components was designed for toddlers with autism in Iran. The next step will be to study this package using a multicenter hybrid effectiveness-implementation randomized control trial.
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Affiliation(s)
- Hadi Zarafshan
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farid Abolhassani
- National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Abbas Motevalian
- Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Vandad Sharifi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Address: Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Avenue, Tehran, Iran. Postal Code: 1333715914. Tel: 98-2155421959, Fax: 98-2155421959,
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McAllister JW, Keehn RM, Rodgers R, Lock TM. Care Coordination Using a Shared Plan of Care Approach: From Model to Practice. J Pediatr Nurs 2018; 43:88-96. [PMID: 30473161 DOI: 10.1016/j.pedn.2018.09.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/17/2018] [Accepted: 09/18/2018] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Children and youth with special health care needs (CYSHCN) need, but do not have, adequate care coordination (CC); CC leads to better pediatric care, improved family/professional experience of care, and enhanced population health. Current CC initiatives are promising but lack adherence to emerging definitions/standards. A Lucile Packard Report provides guidelines for using a Shared Plan of Care (SPoC) as a CC approach; studied implementation is needed. PURPOSE The studied implementation of the Riley Care Coordination Program (RCCP) set out to: 1) illuminate components of family-centered, interdisciplinary, team-based care/coordination and SPoC, use 2) underscore family participation/engagement 3) reveal implementation processes/lessons learned. METHODS Children (ages 2-10) with neurodevelopmental disabilities were referred by subspecialists; families agreed to participate in RCCP from a children's hospital ambulatory care setting. RCCP team used a five-phase workflow to implement CC: (1) Family Outreach/Engagement 2) Family and Team Pre-Visit Work, 3) Population-Based Teamwork, 4) Planned-Care Visits/SPOC "Co-Production", 5) Ongoing Care Coordination and Community Transfer. Family surveys and SPoC goals informed an evaluation. RESULTS Children (268) with neurodevelopmental disabilities enrolled/completed the 6-month RCCP; it was a feasible endeavor. The co-produced SPoC supported families/care neighborhood partners to meet goals/unmet needs. Team plan-do-study-act improvement cycles informed RCCP enhancements. DISCUSSION/CONCLUSION Eliciting/using family goals to drive CC emphasized family priorities; children/families gained interventions, treatments, confidence and navigation skills. Going beyond episodic, reactive care, RCCP achieved better CC with care neighborhood learning partnerships. Investing in this quality care coordination with fidelity to national standards holds promise.
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Affiliation(s)
- Jeanne Walker McAllister
- Indiana University School of Medicine, Children Health Services Research, Indianapolis, IN, United States of America.
| | - Rebecca McNally Keehn
- Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health: Riley Child Development Center, Indianapolis, IN, United States of America
| | - Rylin Rodgers
- Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health: Riley Child Development Center, Indianapolis, IN, United States of America
| | - Thomas M Lock
- Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health: Developmental Pediatrics, Indianapolis, IN, United States of America
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Bromley E, Figueroa C, Castillo EG, Kadkhoda F, Chung B, Miranda J, Menon K, Whittington Y, Jones F, Wells KB, Kataoka SH. Community Partnering for Behavioral Health Equity: Public Agency and Community Leaders' Views of its Promise and Challenge. Ethn Dis 2018; 28:397-406. [PMID: 30202193 DOI: 10.18865/ed.28.s2.397] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective To understand potential for multi-sector partnerships among community-based organizations and publicly funded health systems to implement health improvement strategies that advance health equity. Design Key stakeholder interviewing during HNI planning and early implementation to elicit perceptions of multi-sector partnerships and innovations required for partnerships to achieve system transformation and health equity. Setting In 2014, the Los Angeles County (LAC) Board of Supervisors approved the Health Neighborhood Initiative (HNI) that aims to: 1) improve coordination of health services for behavioral health clients across safety-net providers within neighborhoods; and 2) address social determinants of health through community-driven, public agency sponsored partnerships with community-based organizations. Participants Twenty-five semi-structured interviews with 49 leaders from LAC health systems, community-based organizations; and payers. Results Leaders perceived partnerships within and beyond health systems as transformative in their potential to: improve access, value, and efficiency; align priorities of safety-net systems and communities; and harness the power of communities to impact health. Leaders identified trust as critical to success in partnerships but named lack of time for relationship-building, limitations in service capacity, and questions about sustainability as barriers to trust-building. Leaders described the need for procedural innovations within health systems that would support equitable partnerships including innovations that would increase transparency and normalize information exchange, share agenda-setting and decision-making power with partners, and institutionalize partnering through training and accountability. Conclusions Leaders described improving procedural justice in public agencies' relationships with communities as key to effective partnering for health equity.
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Affiliation(s)
- Elizabeth Bromley
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; Desert Pacific MIRECC Health Services Unit, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Chantal Figueroa
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - Enrico G Castillo
- University of California, Los Angeles, David Geffen School of Medicine, Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Farbod Kadkhoda
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - Bowen Chung
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; Los Angeles Biomedical Research Institute; Healthy African American Families II, Los Angeles, CA
| | - Jeanne Miranda
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - Kumar Menon
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | | | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Kenneth B Wells
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; RAND Corporation; University of California, Los Angeles School of Public Health, Los Angeles, CA
| | - Sheryl H Kataoka
- Center for Health Services and Society, University of California, Los Angeles, David Geffen School of Medicine, Department of Psychiatry & Biobehavioral Sciences; UCLA Division of Child and Adolescent Psychiatry, Los Angeles, CA
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14
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Izquierdo A, Ong M, Jones F, Jones L, Ganz D, Rubenstein L. Engaging African American Veterans with Health Care Access Challenges in a Community Partnered Care Coordination Initiative: A Qualitative Needs Assessment. Ethn Dis 2018; 28:475-484. [PMID: 30202201 DOI: 10.18865/ed.28.s2.475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Little has been written about engaging potentially eligible members of a health care system who are not accessing the care to which they are entitled. Knowing more about the experiences of African American Veterans who regularly experience health care access challenges may be an important step toward equitable, coordinated Veterans Health Administration (VHA) care. This article explores the experiences of African American Veterans who are at risk of experiencing poor care coordination. Design We partnered with a community organization to recruit and engage Veterans in three exploratory engagement workshops between October 2015 and February 2016. Participants and Setting Veterans living in South Los Angeles, California. Main Outcome Measures Veterans were asked to describe their experiences with community care and the VHA, a division of the US Department of Veterans Affairs (VA). Field notes taken during the workshops were analyzed by community and academic partners using grounded theory methodology to identify emergent themes. Results 12 Veterans and 3 family members of Veterans participated in one or more engagement workshops. Their trust in the VA was generally low. Positive themes included: Veterans have knowledge to share and want to help other Veterans; and connecting to VA services can result in positive experiences. Negative themes included: functional barriers to accessing VA health care services; insensitive VA health care environment; lack of trust in the VA health care system; and Veteran status as disadvantageous for accessing non-VA community services. Conclusions Veterans living in underserved areas who have had difficulty accessing VA care have unique perspectives on VA services. Partnering with trusted local community organizations to engage Veterans in their home communities is a promising strategy to inform efforts to improve care access and coordination for vulnerable Veterans.
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Affiliation(s)
- Adriana Izquierdo
- Department of Medicine, University of California, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, CA
| | - Michael Ong
- Department of Medicine, University of California, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Loretta Jones
- Healthy African American Families II, Los Angeles, CA.,Charles R. Drew University of Medicine & Science, Los Angeles, CA
| | - David Ganz
- VA Greater Los Angeles Healthcare System, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, CA.,Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA.,Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.,RAND Corporation, Santa Monica, CA
| | - Lisa Rubenstein
- Department of Medicine, University of California, Los Angeles, CA.,VA Greater Los Angeles Healthcare System, Los Angeles, CA.,Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, CA.,RAND Corporation, Santa Monica, CA
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Wrathall J, Belnap T. Reducing Health Care Costs Through Patient Targeting: Risk Adjustment Modeling to Predict Patients Remaining High Cost. EGEMS (Wash DC) 2017; 5:4. [PMID: 29881748 PMCID: PMC5983005 DOI: 10.13063/2327-9214.1279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Context: The transition to population health management has changed the healthcare landscape to identify high risk, high cost patients. Various measures of patient risk have attempted to identify likely candidates for care management programs. Pre-screening patients for outreach has often required several years of data. Intermountain Healthcare relied on cost-ranking algorithms which had limited predictive ability. A new risk-adjusted algorithm shows improvements in predicting patients’ future cost status to facilitate identifying patient eligibility for care management. Case Description: A retrospective cohort study design was used to evaluate high-cost patient status for two of the next three years. Modeling was developed using logistic regression and tested against other decision tree methods. Key variables included those readily available in electronic health records supplemented by additional clinical data and estimates of socio-economic status. Findings: The risk-adjusted modeling correctly identified 79.0% of patients ranking among the top 15% of costs in one of the next three years. In addition, it correctly estimated 48.1% of the patients in the top 15% cost group in two of the next three years. This method identified patients with higher medical costs and more comorbid conditions than previous cost-ranking methods. Major Themes: This approach improves the predictive accuracy of identifying high cost patients in the future and increases the sensitivity of identifying at-risk patients. It also shortened data requirements to identify eligibility criteria for case management interventions. Conclusion: Risk-adjustment modeling may improve management programs’ interface with patients thus decreasing costs. This method may be generalized to other healthcare settings.
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16
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He S, Dintelman S, Sangster J, Mann DK, Guillerm T, Thornton SN. Who Is Your Doctor? Analysis of Patient-Reported and EHR-Imputed Primary Care Physician. Stud Health Technol Inform 2017; 245:103-107. [PMID: 29295061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Significant efforts have been made to improve physician-to-physician communication and care coordination during transition of care in order to reduce adverse events and readmissions. As electronic health records (EHRs) become widely available, many hospitals have implemented physician collaboration and hand-off tools to automatically send admission notifications, discharge summaries, and pending laboratory results to a patient's primary care physician (PCP). However, the effectiveness of such tools depends on a fundamental question that remains unstudied: who is the patient's PCP? Missing or outdated PCP information may become the bottleneck to effective patient-centered care coordination regardless of existing efforts on promoting interoperability among healthcare providers. In this paper, we characterized patient-reported PCPs and experimented with an imputation algorithm that automatically infers a patient's primary provider based on patient-provider encounter data. We compared the imputation results with patient-reported PCPs and suggested practical uses of our findings.
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Affiliation(s)
- Shan He
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA
| | | | - Jake Sangster
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Darren K Mann
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Thierry Guillerm
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA
| | - Sidney N Thornton
- Homer Warner Center for Informatics Research, Intermountain Healthcare, Salt Lake City, Utah, USA
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17
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Abstract
INTRODUCTION The Pathways Community HUB Model provides a unique strategy to effectively supplement health care services with social services needed to overcome barriers for those most at risk of poor health outcomes. Pathways are standardized measurement tools used to define and track health and social issues from identification through to a measurable completion point. The HUB use Pathways to coordinate agencies and service providers in the community to eliminate the inefficiencies and duplication that exist among them. PATHWAYS COMMUNITY HUB MODEL AND FORMALIZATION Experience with the Model has brought out the need for better information technology solutions to support implementation of the Pathways themselves through decision-support tools for care coordinators and other users to track activities and outcomes, and to facilitate reporting. Here we provide a basis for discussing recommendations for such a data infrastructure by developing a conceptual model that formalizes the Pathway concept underlying current implementations. REQUIREMENTS FOR DATA ARCHITECTURE TO SUPPORT THE PATHWAYS COMMUNITY HUB MODEL The main contribution is a set of core recommendations as a framework for developing and implementing a data architecture to support implementation of the Pathways Community HUB Model. The objective is to present a tool for communities interested in adopting the Model to learn from and to adapt in their own development and implementation efforts. PROBLEMS WITH QUALITY OF DATA EXTRACTED FROM THE CHAP DATABASE Experience with the Community Health Access Project (CHAP) data base system (the core implementation of the Model) has identified several issues and remedies that have been developed to address these issues. Based on analysis of issues and remedies, we present several key features for a data architecture meeting the just mentioned recommendations. IMPLEMENTATION OF FEATURES Presentation of features is followed by a practical guide to their implementation allowing an organization to consider either tailoring off-the-shelf generic systems to meet the requirements or offerings that are specialized for community-based care coordination. DISCUSSION Looking to future extensions, we discuss the utility and prospects for an ontology to include care coordination in the Unified Medical Language System (UMLS) of the National Library of Medicine and other existing medical and nursing taxonomies. CONCLUSIONS AND RECOMMENDATIONS Pathways structures are an important principle, not only for organizing the care coordination activities, but also for structuring the data stored in electronic form in the conduct of such care. We showed how the proposed architecture encourages design of effective decision support systems for coordinated care and suggested how interested organizations can set about acquiring such systems. Although the presentation focuses on the Pathways Community HUB Model, the principles for data architecture are stated in generic form and are applicable to any health information system for improving care coordination services and population health.
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Affiliation(s)
- Bernard P Zeigler
- Arizona Center for Integrative Modeling and Simulation and Rtsync Corp
| | | | | | | | - Cynthia Russell
- Arizona Center for Integrative Modeling and Simulation and Rtsync Corp
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18
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Affiliation(s)
- Elizabeth M Oliva
- VA Palo Alto Health Care System, Center for Innovation to Implementation (Ci2i), 795 Willow Road (152 MPD), Menlo Park, CA, 94025, USA.
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Jubelt LE, Volpp KG, Gatto DE, Friedman JY, Shea JA. A qualitative evaluation of patient-perceived benefits and barriers to participation in a telephone care management program. Am J Health Promot 2015; 30:117-9. [PMID: 25615709 DOI: 10.4278/ajhp.131203-arb-610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To examine why high-risk individuals targeted for a telephone care management program participated at low rates. DESIGN Study design consisted of qualitative, semistructured interviews. SETTING The setting was a large national insurer's telephone-based care management program. The program employed registered nurses to provide individually tailored education and counseling about health and health care. SUBJECTS Study subjects comprised members of a national insurer who were recruited to participate in a care management program but had either dropped out of the program after a short period of initial engagement or had never participated despite recruitment efforts. MEASURES Interview content was divided into four categories: knowledge of the case management program, barriers to program participation, perceptions of benefits of the program, and suggestions for program improvement. ANALYSIS Investigators conducted a directed content analysis. RESULTS The most commonly cited barriers to participation were a lack of perceived need and a sense of distrust toward the program and its staff. The most commonly cited benefits were psychosocial support and goal setting. CONCLUSION Care management programs may benefit from changes to how insurance plan members are selected for the program and from adjusting program content to address perceived needs among members.
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20
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Dykes PC, Samal L, Donahue M, Greenberg JO, Hurley AC, Hasan O, O'Malley TA, Venkatesh AK, Volk LA, Bates DW. A patient-centered longitudinal care plan: vision versus reality. J Am Med Inform Assoc 2014; 21:1082-90. [PMID: 24996874 PMCID: PMC4215040 DOI: 10.1136/amiajnl-2013-002454] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Revised: 06/08/2014] [Accepted: 06/17/2014] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE As healthcare systems and providers move toward meaningful use of electronic health records, longitudinal care plans (LCPs) may provide a means to improve communication and coordination as patients transition across settings. The objective of this study was to determine the current state of communication of LCPs across settings and levels of care. MATERIALS AND METHODS We conducted surveys and interviews with professionals from emergency departments, acute care hospitals, skilled nursing facilities, and home health agency settings in six regions in the USA. We coded the transcripts according to the Agency for Healthcare Research and Quality (AHRQ) 'Broad Approaches' to care coordination to understand the degree to which current practice meets the definition of an LCP. RESULTS Participants (n=22) from all settings reported that LCPs do not exist in their current state. We found LCPs in practice, and none of these were shared or reconciled across settings. Moreover, we found wide variation in the types and formats of care plan information that was communicated as patients transitioned. The most common formats, even when care plan information was communicated within the same healthcare system, were paper and fax. DISCUSSION These findings have implications for data reuse, interoperability, and achieving widespread adoption of LCPs. CONCLUSIONS The use of LCPs to support care transitions is suboptimal. Strategies are needed to transform the LCP from vision to reality.
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Affiliation(s)
- Patricia C Dykes
- Center for Patient Safety, Research, & Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Lipika Samal
- Center for Patient Safety, Research, & Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | | | - Jeffrey O Greenberg
- Center for Patient Safety, Research, & Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ann C Hurley
- Western Connecticut Health Network, Danbury, Connecticut, USA
| | - Omar Hasan
- American Medical Association, Chicago, Illinois, USA
| | - Terrance A O'Malley
- Harvard Medical School, Boston, Massachusetts, USA
- Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | | | - Lynn A Volk
- Partners HealthCare System, Boston, Massachusetts, USA
| | - David W Bates
- Center for Patient Safety, Research, & Practice, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Partners HealthCare System, Boston, Massachusetts, USA
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21
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Turvey C, Klein D, Fix G, Hogan TP, Woods S, Simon SR, Charlton M, Vaughan-Sarrazin M, Zulman DM, Dindo L, Wakefield B, Graham G, Nazi K. Blue Button use by patients to access and share health record information using the Department of Veterans Affairs' online patient portal. J Am Med Inform Assoc 2014; 21:657-63. [PMID: 24740865 DOI: 10.1136/amiajnl-2014-002723] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The Blue Button feature of online patient portals promotes patient engagement by allowing patients to easily download their personal health information. This study examines the adoption and use of the Blue Button feature in the Department of Veterans Affairs' (VA) personal health record portal, My HealtheVet. MATERIALS AND METHODS An online survey presented to a 4% random sample of My HealtheVet users between March and May 2012. Questions were designed to determine characteristics associated with Blue Button use, perceived value of use, and how Veterans with non-VA providers use the Blue Button to share information with their non-VA providers. RESULTS Of the survey participants (N=18 398), 33% were current Blue Button users. The most highly endorsed benefit was that it helped patients understand their health history better because all the information was in one place (73%). Twenty-one percent of Blue Button users with a non-VA provider shared their VA health information, and 87% reported that the non-VA provider found the information somewhat or very helpful. Veterans' self-rated computer ability was the strongest factor contributing to both Blue Button use and to sharing information with non-VA providers. When comparing Blue Button users and non-users, barriers to adoption were low awareness of the feature and difficulty using the Blue Button. CONCLUSIONS This study contributes to the understanding of early Blue Button adoption and use of this feature for patient-initiated sharing of health information. Educational efforts are needed to raise awareness of the Blue Button and to address usability issues that hinder adoption.
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Affiliation(s)
- Carolyn Turvey
- Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City, Iowa, USA Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Dawn Klein
- Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City, Iowa, USA Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Gemmae Fix
- Edith Nourse Rogers Memorial Veterans Hospital, Center for Healthcare Organization and Implementation Research (CHOIR), A VA HSR&D Center of Innovation, Bedford, Massachusetts, USA Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy P Hogan
- Edith Nourse Rogers Memorial Veterans Hospital, Center for Healthcare Organization and Implementation Research (CHOIR), A VA HSR&D Center of Innovation, Bedford, Massachusetts, USA Edith Nourse Rogers Memorial Veterans Hospital, eHealth Quality Enhancement Research Initiative, National eHealth QUERI Coordinating Center, Bedford, Massachusetts, USA Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Susan Woods
- Portland VA Medical Center, Health Services Research & Development, Portland, Oregon, USA Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
| | - Steven R Simon
- Veterans Affairs Boston Healthcare System, Section of General Internal Medicine, Boston, Massachusetts, USA Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Mary Charlton
- Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City, Iowa, USA Department of Epidemiology, The University of Iowa College of Public Health, Iowa City, Iowa, USA
| | - Mary Vaughan-Sarrazin
- Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City, Iowa, USA Department of Internal Medicine, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Donna M Zulman
- Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Menlo Park, California, USA Division of General Medical Disciplines, Stanford University, Stanford, California, USA
| | - Lilian Dindo
- Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Bonnie Wakefield
- Iowa City VA Health Care System, Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City, Iowa, USA University of Missouri Sinclair School of Nursing, Columbia, Missouri, USA
| | - Gail Graham
- Veterans and Consumers Health Informatics Office, Office of Informatics & Analytics, Veterans Health Administration, Washington, DC, USA
| | - Kim Nazi
- Veterans and Consumers Health Informatics Office, Office of Informatics & Analytics, Veterans Health Administration, Washington, DC, USA
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22
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Abstract
Hospital 30-day readmissions have become a major priority for hospitals. Hospitals face penalties for excessive readmissions for acute myocardial infarction (AMI) and heart failure (HF). Thus, it is important for hospitals to understand the transitions of care that occur for both of these conditions, and what tools are available to guide the processes involved. A multi-disciplinary team including Emergency Medical Service providers, Emergency Medicine providers, cardiologists, hospitalists, pharmacists, nurses, case managers, and outpatient physicians can all be involved in the process of safely transitioning a patient between care settings. Small-scale studies in the geriatric population have shown improved transitions of care and decreased readmissions with these care teams. The emergency department is a key transition point for patients with AMI and HF, yet it is rarely identified and utilized as such in transitions of care interventions. Future research and implementation projects will need to refine and expand the role of the emergency department in the process.
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