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Epstein JA, Lkhagvajav Z, Young T, Bertram A, Yeh HC, Taylor CO. Will the Doctor "See" You Now? The Development and Implementation of a Targeted Telemedicine System for Primary Care. ACI open 2023; 7:e71-e78. [PMID: 37900978 PMCID: PMC10610031 DOI: 10.1055/s-0043-1776038] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Objectives The coronavirus disease 2019 (COVID-19) pandemic led to a rapid adoption of telehealth. For underserved populations lacking internet access, telemedicine was accomplished by phone rather than an audio-video connection. The latter is presumed a more effective form and better approximation of an in-person visit. We sought to provide a telehealth platform to overcome barriers for underserved groups to hold video visits with their health care providers and evaluate differences between the two telehealth modalities as assessed by physicians and patients. Methods We designed a simplified tablet solution for video visits and piloted its use among patients who otherwise would have been completing audio-only visits. Patients consented to participation and were randomized in a 1:1 fashion to continue with their scheduled phone visit (control) versus being shipped a tablet to facilitate a video visit (intervention). Participants and providers completed communication and satisfaction surveys. Results Tablet and connectivity design features included removal of all functions but for the telemedicine program, LTE always-on wireless internet connectivity, absence of external equipment (cords chargers and keyboard), and no registration with a digital portal. In total, 18 patients were enrolled. Intervention patients with video-enabled devices compared to control patients agreed more strongly that they were satisfied with their visits (4.75/5 vs. 3.75/5, p = 0.02). Conclusion The delivered simplified tablet solution for video visits holds promise to improve access to video visits for underserved groups. Strategies to facilitate patient acceptance of devices are needed to expand the scope and potential impact of this effort.
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Affiliation(s)
- Jeremy A. Epstein
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Zoljargal Lkhagvajav
- Institute for Computational Medicine, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, United States
| | - Tempest Young
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Amanda Bertram
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Hsin-Chieh Yeh
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Casey Overby Taylor
- Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Institute for Computational Medicine, Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States
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Planas R, Yuguero O. Technological prescription: evaluation of the effectiveness of mobile applications to improve depression and anxiety. Systematic review. Inform Health Soc Care 2021; 46:273-290. [PMID: 33685325 DOI: 10.1080/17538157.2021.1887196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 10/22/2022]
Abstract
Several studies have shown that, due to their features, mobile applications have a great potential to address mental health in depression and anxiety. We carried out a systematic review of publications from the last 10 years: from 1 January 2010 until 31 March 2020. Systematic reviews and meta-analyses related to the research question were also selected to identify other potentially eligible studies. The literature search in selected databases returned a total of 3,011 records from which a total of 22 articles were finally selected. The main conclusion of the study is that most of the scientific evidence found supports the hypothesis that mobile applications significantly improve the symptoms associated with depression and anxiety. Therefore, their effectiveness as a digital tool in the treatment of such health problems is proven. However, further studies and further evaluations of mobile applications are required (also in other languages) to incorporate this resource into the healthcare context. In addition, since mobile applications allow reinforcing concepts such as patient empowerment, shared decision-making and health literacy, their use would be highly positive for depression and anxiety, where there is a strong element of self-managing the disease.
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Affiliation(s)
- Raquel Planas
- Primary Care Deparment, Catalan Health Institute, Badalona, SPAIN.,Faculty of Health Sciences, Universitat Oberta De Catalunya, Barcelona, SPAIN
| | - Oriol Yuguero
- Faculty of Health Sciences, Universitat Oberta De Catalunya, Barcelona, SPAIN.,Faculty of Medicine, Universitat De Lleida, SPAIN
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Imamura S, Tetsuhara K, Fujii S, Muraoka M. Respiratory failure caused by cardiac dysfunction triggered by bronchiolitis. BMJ Case Rep 2021; 14:14/7/e244448. [PMID: 34261637 DOI: 10.1136/bcr-2021-244448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Suzu Imamura
- Department of Critical Care Medicine, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Kenichi Tetsuhara
- Department of Critical Care Medicine, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Shunsuke Fujii
- Department of Critical Care Medicine, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Mamoru Muraoka
- Department of Critical Care Medicine, Fukuoka Children's Hospital, Fukuoka, Japan
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Naqvi D, Malik A, Al-Zubaidy M, Naqvi F, Tahir A, Tarfiee A, Vara S, Meyer E. The general practice perspective on barriers to integration between primary and social care: a London, United Kingdom-based qualitative interview study. BMJ Open 2019; 9:e029702. [PMID: 31434776 PMCID: PMC6707672 DOI: 10.1136/bmjopen-2019-029702] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE There is an ongoing challenge of effective integration between primary and social care in the United Kingdom; current systems have led to fragmentation of services preventing holistic patient-centred care for vulnerable populations. To improve clinical outcomes and achieve financial efficiencies, the barriers to integration need to be identified and addressed. This study aims to explore the unique perspectives of frontline staff (general practitioners and practice managers) towards these barriers to integration. DESIGN Qualitative study using semistructured interviews and thematic analysis to obtain results. SETTING General practices within London. PARTICIPANTS 18 general practitioners (GPs) and 7 practice managers (PMs) based in London with experience of working with social care. RESULTS The study identified three overarching themes where frontline staff believed problems exist: accessing social services, interprofessional relationships and infrastructure. Issues with contacting staff from other sectors creates delays in referrals for patient care and perpetuates existing logistical challenges. Likewise, professionals noted a hostile working culture between sectors that has resulted in silo working mentalities. In addition to staff being overworked as well as often inefficient multidisciplinary team meetings, poor relationships across sectors cause a diffusion of responsibility, impacting the speed with which patient requests are responded to. Furthermore, participants identified that a lack of interoperability between information systems, lack of pooled budgets and misaligned incentives between managerial staff compound the infrastructural divide between both sectors. CONCLUSION In this study, primary care staff identify intangible barriers to integration such as poor interprofessional relationships, in addition to more well-described structural issues such as insufficient funding and difficulty accessing social care. Participants believe that educating the next generation of medical professionals may lead to the development of collaborative, instead of siloed, working cultures and that change is needed at both an interpersonal and institutional level to successfully integrate care.
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Affiliation(s)
| | | | | | | | | | | | | | - Edgar Meyer
- Imperial College Business School, London, UK
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5
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Abstract
The prevalence of osteoporosis in postmenopausal women is about 35 to 50% and the mortality associated with hip fractures is about 20%. Despite these figures, osteoporosis continues to be under diagnosed in the primary care setting. One of the reasons for this is attributed to the poor availability of DXA (Dual Energy X-ray Absorptiometry) scanners in rural areas. The fracture risk assessment tool (FRAX) is an online web-based tool that takes into account multiple factors that help in predicting the 10-year risk of developing hip or major osteoporotic fractures. The tool was developed and validated in independent cohorts. The advantages of using the FRAX tool are that, it is inexpensive, easily available, and does not need the technical expertise that is required in the use of a DXA scanner. Besides these merits, it is a tool that is easy to use for the rural health care worker as well as the family physician in identifying those subjects at risk for developing osteoporotic fractures. These benefits make it a suitable fracture prediction tool in the primary care setting in India.
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Affiliation(s)
- Kripa Elizabeth Cherian
- Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Nitin Kapoor
- Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Thomas Vizhalil Paul
- Department of Endocrinology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Litchfield I, Hoye C, Shukla D, Backman R, Turner A, Lee M, Weber P. Can process mining automatically describe care pathways of patients with long-term conditions in UK primary care? A study protocol. BMJ Open 2018; 8:e019947. [PMID: 30518578 PMCID: PMC6286474 DOI: 10.1136/bmjopen-2017-019947] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/04/2018] [Accepted: 11/01/2018] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION In the UK, primary care is seen as the optimal context for delivering care to an ageing population with a growing number of long-term conditions. However, if it is to meet these demands effectively and efficiently, a more precise understanding of existing care processes is required to ensure their configuration is based on robust evidence. This need to understand and optimise organisational performance is not unique to healthcare, and in industries such as telecommunications or finance, a methodology known as 'process mining' has become an established and successful method to identify how an organisation can best deploy resources to meet the needs of its clients and customers. Here and for the first time in the UK, we will apply it to primary care settings to gain a greater understanding of how patients with two of the most common chronic conditions are managed. METHODS AND ANALYSIS The study will be conducted in three phases; first, we will apply process mining algorithms to the data held on the clinical management system of four practices of varying characteristics in the West Midlands to determine how each interacts with patients with hypertension or type 2 diabetes. Second, we will use traditional process mapping exercises at each practice to manually produce maps of care processes for the selected condition. Third, with the aid of staff and patients at each practice, we will compare and contrast the process models produced by process mining with the process maps produced via manual techniques, review differences and similarities between them and the relative importance of each. The first pilot study will be on hypertension and the second for patients diagnosed with type 2 diabetes. ETHICS AND DISSEMINATION Ethical approval has been provided by East Midlands-Leicester South Regional Ethics Committee (REC reference 18/EM/0284). Having refined the automated production of maps of care processes, we can explore pinch points and bottlenecks, process variants and unexpected behaviour, and make informed recommendations to improve the quality and efficiency of care. The results of this study will be submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ciaron Hoye
- Digital Transformation, Birmingham Solihull Clinical Commissioning Group, Birmingham, UK
| | - David Shukla
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ruth Backman
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alice Turner
- University Hospitals Birmingham NHS Foundation Trust and Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Mark Lee
- School of Computer Science, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, UK
| | - Phil Weber
- School of Engineering and Applied Science, System Analytics for Innovation, Aston University, Birmingham, UK
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Georgiadis A, Duschinsky R, Perez J, Jones PB, Russo D, Knight C, Soneson E, Dixon-Woods M. Coproducing healthcare service improvement for people with common mental health disorders including psychotic experiences: a study protocol of a multiperspective qualitative study. BMJ Open 2018; 8:e026064. [PMID: 30413522 PMCID: PMC6231599 DOI: 10.1136/bmjopen-2018-026064] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Some people, who have common mental health disorders such as depression and anxiety, also have some psychotic experiences. These individuals may experience a treatment gap: their symptoms neither reach the increasingly high threshold for secondary care, nor do they receive full benefit from current interventions offered by the Improving Access to Psychological Therapies (IAPT) programme. The result may be poorer clinical and functional outcomes. A new talking therapy could potentially benefit this group. Informed by principles of coproduction, this study will seek the views of service users and staff to inform the design and development of such a therapy. METHODS AND ANALYSIS Semistructured interviews will be conducted with IAPT service users, therapists and managers based in three different geographical areas in England. Our sample will include (1) approximately 15 service users who will be receiving therapy or will have completed therapy at the time of recruitment, (2) approximately 15 service users who initiated treatment but withdrew, (3) approximately 15 therapists each with at least 4-month experience in a step-3 IAPT setting and (4) three IAPT managers. Data analysis will be based on the constant comparative method. ETHICS AND DISSEMINATION The study has been approved by the London Harrow Research Ethics Committee (reference: 18/LO/0642), and all National Health Service Trusts have granted permissions to conduct the study. Findings will be published in peer-reviewed academic journals, and presented at academic conferences. We will also produce a 'digest' summary of the findings, which will be accessible, visual and freely available.
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Affiliation(s)
- Alexandros Georgiadis
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
| | - Robbie Duschinsky
- Applied Social Science Group, University of Cambridge, Cambridge, UK
| | - Jesus Perez
- CAMEO Early Intervention Services, Cambridgeshire andPeterborough NHS FoundationTrust, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, UK
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Stocks SJ, Donnelly A, Esmail A, Beresford J, Gamble C, Luty S, Deacon R, Danczak A, Mann N, Townsend D, Ashley J, Bowie P, Campbell SM. Development and piloting of a survey to estimate the frequency and nature of potentially harmful preventable problems in primary care from a UK patient's perspective. BMJ Open 2018; 8:e017786. [PMID: 29431124 PMCID: PMC5829776 DOI: 10.1136/bmjopen-2017-017786] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To design and pilot a survey to be used at the population level to estimate the frequency of patient-perceived potentially harmful preventable problems occurring in UK primary care. To explore the nature of the problems, patient-suggested strategies for prevention and opinions of clinicians and the public regarding the potential for harm. DESIGN A survey was codesigned by three members of the public and one researcher and piloted through public and patient involvement and engagement networks. SETTING Self-selected sample of the UK population. PARTICIPANTS 977 members of the public accessed the online survey during October and November 2015. PRIMARY OUTCOME MEASURES Respondent feedback about the ease of completion of the survey, quality of responses in terms of review by clinicians and members of the public, preliminary estimates of the frequency and nature of patient-perceived potentially harmful problems occurring in the last 12 months. RESULTS 638 (65%) members of the public completed the survey and few respondents reported any difficulty in understanding or completing the survey. 132 (21%) respondents reported experiencing a potentially harmful preventable problem during the past 12 months and 108 (82%) of these respondents provided a description that was adequate for at least one clinician to form an opinion about the potentially harmful problem. Respondents were older than the UK generally, more likely to work or volunteer in the healthcare sector and tended to use primary care more frequently but their confidence and trust in their own general practitioner (GP) was similar to that of the UK population as measured by the annual English GP patient survey. CONCLUSIONS The survey was acceptable to patients and mostly provided data of sufficient quality for review by clinicians and members of the public. It is now ready to use at a population level to estimate the frequency and nature of potentially harmful preventable problems in primary care from a patient's perspective.
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Affiliation(s)
- Susan J Stocks
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Ailsa Donnelly
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Aneez Esmail
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Joanne Beresford
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Carolyn Gamble
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - Sarah Luty
- General Practitioner NHS Greater Glasgow and Clyde, Medical Directorate, NHS Education for Scotland, Glasgow, Scotland
| | | | - Avril Danczak
- Central and South Manchester Specialty Training Programme for General Practice, Health Education England North West (HEENWE) Education and Research Centre, Wythenshawe Hospital, Manchester, UK
| | - Nicola Mann
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | - David Townsend
- Research User Group (RUG) of the NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care,Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
| | | | - Paul Bowie
- Medical Directorate, NHS Education for Scotland, Glasgow, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stephen M Campbell
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester, UK
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9
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Luo Z, Chen Q, Annis AM, Piatt G, Green LA, Tao M, Holtrop JS. A Comparison of Health Plan- and Provider-Delivered Chronic Care Management Models on Patient Clinical Outcomes. J Gen Intern Med 2016; 31:762-70. [PMID: 26951287 PMCID: PMC4907946 DOI: 10.1007/s11606-016-3617-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 08/31/2015] [Accepted: 02/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The real world implementation of chronic care management model varies greatly. One aspect of this variation is the delivery mode. Two contrasting strategies include provider-delivered care management (PDCM) and health plan-delivered care management (HPDCM). OBJECTIVE We aimed to compare the effectiveness of PDCM vs. HPDCM on improving clinical outcomes for patients with chronic diseases. DESIGN We used a quasi-experimental two-group pre-post design using the difference-in-differences method. PATIENTS Commercially insured patients, with any of the five chronic diseases-congestive heart failure, chronic obstructive pulmonary disease, coronary heart disease, diabetes, or asthma, who were outreached to and engaged in either PDCM or HPDCM were included in the study. MAIN MEASURES Outreached patients were those who received an attempted or actual contact for enrollment in care management; and engaged patients were those who had one or more care management sessions/encounters with a care manager. Effectiveness measures included blood pressure, low density lipoprotein (LDL), weight loss, and hemoglobin A1c (for diabetic patients only). Primary endpoints were evaluated in the first year of follow-up. KEY RESULTS A total of 4,000 patients were clustered in 165 practices (31 in PDCM and 134 in HPDCM). The PDCM approach demonstrated a statistically significant improvement in the proportion of outreached patients whose LDL was under control: the proportion of patients with LDL < 100 mg/dL increased by 3 % for the PDCM group (95 % CI: 1 % to 6 %) and 1 % for the HPDCM group (95 % CI: -2 % to 5 %). However, the 2 % difference in these improvements was not statistically significant (95 % CI: -2 % to 6 %). The HPDCM approach showed 3 % [95 % CI: 2 % to 6 %] improvement in overall diabetes care among outreached patients and significant reduction in obesity rates compared to PDCM (4 %, 95 % CI: 0.3 % to 8 %). CONCLUSIONS Both care management delivery modes may be viable options for improving care for patients with chronic diseases. In this commercially insured population, neither PDCM nor HPDCM resulted in substantial improvement in patients' clinical indicators in the first year. Different care management strategies within the provider-delivered programs need further investigation.
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Affiliation(s)
- Zhehui Luo
- Department of Epidemiology and Biostatistics, College of Human Medicine, Michigan State University, East Lansing, MI, USA.
| | - Qiaoling Chen
- Department of Research and Evaluation, Kaiser Permanente Sourthen California, Pasadena, CA, USA
| | - Ann M Annis
- VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Gretchen Piatt
- Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Lee A Green
- Department of Family Medicine, University of Alberta, Edmonton, AB, Canada
| | - Min Tao
- Clinical Epidemiology and Biostatistics, Blue Cross Blue Shield of Michigan, Detroit, MI, USA
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