Automated Telephone Self-management Support:
|
|
- Elmer York
- 8 years ago
- Views:
Transcription
1 Automated Telephone Self-management Support: A Public Hospital Innovation with Great Potential Dean Schillinger, MD Professor of Medicine Chief, CA Diabetes Prevention and Control CA Dept of Public Health UCSF Center for Vulnerable Populations San Francisco General Hospital Margaret Handley, MPH PhD Assistant Professor of Epidemiology
2 Rationale: What is Health Literacy? The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make [informed] health decisions. -Institute of Medicine, 2004
3 1 st National Assessment of Health Literacy n=19,714 Below Basic: Circle date on doctor s appointment slip Basic: Give 2 reasons a person with no symptoms should get tested for cancer based on a clearly written pamphlet Intermediate: Determine what time to take Rx medicine based on label Proficient: Calculate employee share of health insurance costs using table National Center for Educational Statistics, U.S. Department of Education, 2003
4 1 st Health Literacy Assessment 12% n=19,714 U.S. Adults Proficient 53% Intermediate Below Basic 14% Basic Hispanic 22% Average Medicare National Assessment of Adult Literacy (NAAL): National Center for Educational Statistics, U.S. Department of Education, 2003.
5 Patients with Diabetes and Low Literacy Less Likely to Know Correct Management Need to Know: symptoms of low blood sugar (hypoglycemia) Low Moderate e High Need to Do: correct action for hypoglycemic symptoms Low Moderate High Percent *Williams et al., Archive of Internal Medicine, 1998 Williams 1998
6 Literacy is Associated with Glycemic Control, N= Inadequate Marginal % of patien nts Adjusted OR=0.57, p=0.05 Adjusted OR=2.03, p=0.02 Adequate e st Quartile (Tight Control: HbA1c 7.2%) 4th Quartile (Poor Control: HbA1c>9.5%) Schillinger JAMA 2002
7 Adjusted odds of self-reported diabetes complications, for patients with inadequate vs. adequate literacy (N=408) Complication n ** AOR 95% CI Retinopathy ( ) Nephropathy ( ) Lower Extremity Amputation ( ) Cerebrovascular Disease ( ) Ischemic Heart Disease ( ) Schillinger JAMA 2002
8 Schillinger 2004 Diabetes Patients with Limited Literacy Experience Poorer Quality Communication, N= Inadequate FHL Adequate FHL 40 OR=3.2;p< OR=1.9;p= OR=3.3;p=0.02 OR=2.4;p= % 26% 33% 21% 10 20% 13% 13% 13% 0 Doctor Use Words Give You Test Results Confused About Doctor Understand Not Understood w/o Explanation Medical Care Problems Doing Rx (Often/Always) (Often/Always) (Often/Always) (Never/Rarely/ Sometimes)
9 The Impact of Language Barriers on Poor Glycemic Control Among Insured Latino Diabetics: Data from DISTANCE Study Fernandez A, Schillinger D, Warton M, Parker M, Adler N, Schenker Y, Moffet H, Salgado V, Ahmed A, and Karter A.
10 Glycemic Control of Latino Diabetics by English Language Ability and by Physician-patient Language Concordance English Speakers (n=2683) All LEP (n=510) P Value LEP - LC (n=137) LEP- LD (n=115) P Value A1c, mean (SD) 7.65 (1.71) 7.81 (1.85) (1.62) 7.99 (1.92) 0.07 Proportion of group with A1c 9% (%) Abbreviations: PCP: Primary Care Physician; LEP: Limited English Proficient; LEP-LC: LEP with language concordant PCP; LEP-LD: LEP with language discordant PCP
11 80% 70% 60% 50% 40% 30% 20% 10% 0% Self-Management Support and 69% telephone 55% group visit Communication 42% internet Interest in Self-Management Support Research questions 1. Are vulnerable diabetes patients interested in selfmanagement support? 2. Do they perceive a benefit to improved communication? 40% perceived a benefit from better provider communication, higher for racial/ethnic minority and limited it health literacy (70%) Conclusion: Vulnerable diabetes patients t desire self-management support and perceive a benefit to improved communication. Sarkar et al., Patient Education and Counseling 2008
12 IDEALL Project: Improving Diabetes Efforts Across Language and Literacy Community Health Network of SF/DPH AHRQ CMWF, TCE, CHCF Schillinger Diab Care 2009
13 Automated Telephone Diabetes Self- Management (ATSM) Nurse Diabetes Care manager ATSM: Weekly Monitoring and Health Education Primary Care Physician Patient Interactive health technology, touch tone response Weekly surveillance & health education (39 weeks=9 mos) In patients preferred language (English, Spanish or Cantonese) Generates weekly reports of out of range responses Live phone follow-up through a bilingual nurse ->behavioral action plans
14 Components of Intervention Proactive, outgoing automated t calls; interactive ti health technology, touch tone response. 6-8 minutes/call (weekly surveillance & health education [39 weeks=9 mos] ) In patients preferred language (English, Spanish or Cantonese) Rotating/recurring topics of questions and health education narratives re healthy eating, exercise, medication adherence, coping/mood, self-monitoring, etc. Generates weekly reports of out of range responses based on a priori thresholds we set For those who trigger : Live phone follow-up through a bilingual nurse ->behavioral action plans/problemsolving
15 Components of Intervention About 50-60% of ATSM calls get answered and completed About 40-50% of these have triggered a call-back. Care manager able to reach the vast majority for f-u and develop patient-generated action plans. Most patients achieve partial or complete success on AP To date, care manager not empowered to up-titrate medications; does communicate with PCP re safety issues or significant ifi problems. Care manager has database for ease of data entry; currently not integrated into medical EHR
16 Key Findings of IDEALL Program Estimating Public Health Reach of Programs Composite reach product ATSM Group Visits (GMV) Overall English Chinese Spanish Adequate Literacy Limited Literacy Schillinger, et al.health Ed and Behavior 2007
17 Results: Structure and Process Measures * * UC ATSM GMV PACIC 75 * UC ATSM GMV Communication pre post *P<.05. * * UC ATSM GMV Self-Efficacy * UC ATSM GMV * 4.1 Self-Management Behavior Schillinger, in press Diabetes Care
18 Results: Functional Outcomes Rate ratio 0.5 vs UC, 0.35 vs GMV * 1.4 UC ATSM GMV Bed Days 3.6 pre post OR 0.37 vs UC 18 UC ATSM GMV Diabetes Interference * UC ATSM GMV UC ATSM GMV SF12 - Mental Health SF12 - Physical Health *P<.05
19 Results: Physiologic Outcomes UC ATSM GMV SBP pre post UC ATSM GMV DBP UC ATSM GMV UC ATSM GMV HbA1c BMI
20 ATSM as Surveillance Tool? ATSM Data Automated Completed Calls Patient-Nurse Encounters CONSENSUS AE PotAE No event Medical Record Classification - Preventability - Primary Provider Awareness
21 Automated telephony provides safety surveillance function participants, p 54% inadequate 100 health literacy events 60 among participants (86%) AE s and 153 PotAE s 0 Sarkar, Schillinger et al JGIM Number of Events Preventability Incident AE Prevalent AE PotAE Incident Prevalent Preventable Ameliorable PotAE Unable to determine Non-preventable
22 Clinician Survey Findings Responses from 87 of 113 (77%) physicians who cared for 245 of the 330 (74%) patients (mean, 2.8 per physician). Compared to UC, patients exposed to ATSM were perceived as more likely to be activated to create and achieve goals for chronic care (standardized effect size, ATSM vs. UC, +0.41, p=0.05). 05) Over half of physicians reported that ATSM helped overcome 4 of 5 common barriers to diabetes care Physicians rated quality of care as higher among patients exposed to ATSM compared to usual care (OR 3.6, p=0.003), and compared to GMV (OR 2.2, p=0.06) The majority felt ATSM should be expanded to more patients with diabetes (88%) a technology-facilitated SMS model was particularly effective for their patients and practice settings, suggesting that such programs should be disseminated and implemented more widely. Bhandari, Schillinger SGIM 2008
23 Health System Findings: Cost-Effectiveness; Health Plans Based on functional improvements, we estimated that the cost per QALY for ATSM was: >$65,000 for both set-up and ongoing costs >$ 32,000 for ongoing costs only Cost effectiveness could be further improved with (a) scaling up or (b) metabolic outcomes improved A large majority of CA Medicaid health plans reported an interest in employing ATSM-like technology Handley, Schillinger, in press Ann Fam Med 2008 Goldman, Schillinger et al. Am J Man Care 2007
24 Key Findings of IDEALL Program Reach significant, ifi especially for lower literacy, non- English speaking, Medi-Cal, uninsured. Interactive health technology improves patient centered care, health behaviors, functional status and promotes safety, due to proactive nature hierarchical logic communication tailoring For physiologic i effects to be achieved, need medication intensification Health plans and clinicians favorably inclined A challenge for individual clinics to implement
25
26 Current Project Partner with a local Medicaid health plan: San Francisco Health Plan SFHP care managers will make ATSM response calls Test effectiveness when implemented in realworld Compare ATSM-ONLY with ATSM-PLUS (medication activation) ATSM-PLUS involves merging pharmacy claims data with ithatsm data to enable care manager counseling
27 Design and Outcomes Wait List Design, with randomization among exposed participants. i t Total N=500 Outcomes (wait-list vs. ATSM vs. ATSM-Plus): -communication -behavior -functional status -metabolic indicators -patient safety (prevalence and root causes)
28 Suboptimal Refill Non- Self-Reported Goals on Adherence Med Non- Diabetes on Pharmacy Adherence on Registry Claims ATSM SFHP Care Manager Call to Patient: Check understanding and educate regarding diabetes goals Elicit barriers to adherence Inform about current data & goals Assess understanding of discussions with PCP Assess willingness to increase or add new medication to meet goals Develops action plan using motivational interviewing principles
29 SFHP Pre- Enrollment Post Card English
30 Spanish
31 Cantonese
32 SFHP Wallet-Size Card English, Spanish and Cantonese
33 Care manager field
34 Potential Safety Event
35 Safety event assessment
36 Engagement g with Smart Steps Sample: 186 SFHP patients enrolled in Smart Steps in actively receiving calls in March, 2010, who had completed at least 3 weeks of calls. Results: Overall, 132 of 186 (71%) engaged with program This represents: 89% engaged among Cantonese (94/106) 86% engaged among Spanish (12/14) 40% engaged among English speakers (26/66)
37
38 Improvements/Threats Improvements to future dissemination: Care manager health coach Harnessing pharmacy claims data Marketing and outreach Trusted health plan Potentially sustainable Development of detailed training manual/qa processes Threats to implementation: Delays in implementation Staff plan Maintaining fidelity to intervention processes Care mgr processes; claims data/registry data incomplete Coordinating treatment preferences/medication activation with PCP
Health System Strategies to Improve Chronic Disease Management and Prevention: What Works?
Health System Strategies to Improve Chronic Disease Management and Prevention: What Works? Michele Heisler, MD, MPA VA Center for Clinical Practice Management Research University of Michigan Department
More informationRED, BOOST, and You: Improving the Discharge Transition of Care
RED, BOOST, and You: Improving the Discharge Transition of Care Jeffrey L. Greenwald, MD, SFHM Massachusetts General Hospital - Clinician Educator Service Co-Investigator Project RED & Project BOOST The
More informationDiabetes Prevention in Latinos
Diabetes Prevention in Latinos Matthew O Brien, MD, MSc Assistant Professor of Medicine and Public Health Northwestern Feinberg School of Medicine Institute for Public Health and Medicine October 17, 2013
More informationRacial and ethnic disparities in type 2 diabetes
Racial and ethnic disparities in type 2 diabetes Nisa M. Maruthur, MD, MHS Assistant Professor of Medicine & Epidemiology Welch Center for Prevention, Epidemiology, & Clinical Research The Johns Hopkins
More informationDIABETES DISEASE MANAGEMENT PROGRAM DESCRIPTION FY11 FY12
DIABETES DISEASE MANAGEMENT PROGRAM DESCRIPTION FY11 FY12 TABLE OF CONTENTS 1. INTRODUCTION.3 2. SCOPE........3 3. PROGRAM STRUCTURE...4 3.1. General Educational Interventions.....4 3.2. Identification
More informationSafety Events during an Automated Telephone Self-Management Support Intervention
Journal of Diabetes Science and Technology Volume 7, Issue 3, May 2013 Diabetes Technology Society SYMPOSIUM Safety Events during an Automated Telephone Self-Management Support Intervention Courtney R.,
More informationDiabetes Care 2011-2012
Clinical Innovations in the Patient Centered Medical Home to Improve Diabetes Care Robert A. Gabbay, MD, PhD, FACP Chief Medical Officer & Senior Vice President Joslin Diabetes Center Harvard Medical School
More informationMedicaid Health Plans: Adding Value for Beneficiaries and States
Medicaid Health Plans: Adding Value for Beneficiaries and States Medicaid is a program with numerous challenges, both for its beneficiaries and the state and federal government. In comparison to the general
More informationRisk Adjustment: Implications for Community Health Centers
Risk Adjustment: Implications for Community Health Centers Todd Gilmer, PhD Division of Health Policy Department of Family and Preventive Medicine University of California, San Diego Overview Program and
More informationColumbus Regional Health. Diabetes Educators designing programs using Health Coach extenders in the PCMH.
Columbus Regional Health Diabetes Educators designing programs using Health Coach extenders in the PCMH. Objectives: Define what generated the need for the project. Discuss the delivery design model in
More informationThe Economic Impact and Cost-Effectiveness of Glucose Monitoring
The Economic Impact and Cost-Effectiveness of Glucose Monitoring William H. Herman, MD, MPH Stefan S. Fajans/GlaxoSmithKline Professor of Diabetes Professor of Internal Medicine and Epidemiology University
More informationPOPULATION HEALTH MANAGEMENT The Lynchpin of Emerging Healthcare Delivery Improve Patient Outcomes, Engage Physicians, and Manage Risk
POPULATION HEALTH MANAGEMENT The Lynchpin of Emerging Healthcare Delivery Improve Patient Outcomes, Engage Physicians, and Manage Risk Julia Andrieni, MD, FACP Vice President, Population Health and Primary
More informationThe New Complex Patient. of Diabetes Clinical Programming
The New Complex Patient as Seen Through the Lens of Diabetes Clinical Programming 1 Valerie Garrett, M.D. Medical Director, Diabetes Center at Mission Health System Nov 6, 2014 Diabetes Health Burden High
More informationMaximizing Limited Care Management Resources to Improve Clinical Quality and Ensure Safe Transitions
Maximizing Limited Care Management Resources to Improve Clinical Quality and Ensure Safe Transitions Scott Flinn MD Deborah Schutz RN JD Fritz Steen RN Arch Health Partners A medical foundation formed
More informationRacial and Ethnic Health Disparities in Health and Health Care Kansas City Regional Data
Racial and Ethnic Health Disparities in Health and Health Care Kansas City Regional Data By Debbie Chase, MPA Consultant, Center for Health Policy University of Missouri -- Columbia 1 Quantitative Data
More informationApproaches to Asthma Management:
Approaches to Asthma Management: BY CAROL MCPHILLIPS-TANGUM AND CAROLINE M. ERCEG ASTHMA IS A CHRONIC DISEASE that affects millions of people in the United States and disproportionately impacts children,
More informationBreathe With Ease. Asthma Disease Management Program
Breathe With Ease Asthma Disease Management Program MOLINA Breathe With Ease Pediatric and Adult Asthma Disease Management Program Background According to the National Asthma Education and Prevention Program
More informationAmong health plans, Aetna has distinguished itself as a
Aetna s Program in Health Care Disparities: The Diabetes Pilot Program INTRODUCTION Among health plans, Aetna has distinguished itself as a national leader in the area of identifying and addressing racial
More informationHealthy Living with Diabetes. Diabetes Disease Management Program
Healthy Living with Diabetes Diabetes Disease Management Program Healthy Living With Diabetes Diabetes Disease Management Program Background According to recent reports the incidence of diabetes (type
More informationHealthCare Partners of Nevada. Heart Failure
HealthCare Partners of Nevada Heart Failure Disease Management Program 2010 HF DISEASE MANAGEMENT PROGRAM The HealthCare Partners of Nevada (HCPNV) offers a Disease Management program for members with
More informationTHE ROLE OF HEALTH INFORMATION TECHNOLOGY IN PATIENT-CENTERED CARE COLLABORATION. 2012 Louisiana HIPAA & EHR Conference Presenter: Chris Williams
THE ROLE OF HEALTH INFORMATION TECHNOLOGY IN PATIENT-CENTERED CARE COLLABORATION 2012 Louisiana HIPAA & EHR Conference Presenter: Chris Williams Agenda Overview Impact of HIT on Patient-Centered Care (PCC)
More informationImproving Diabetes Care for All New Yorkers
Improving Diabetes Care for All New Yorkers Lynn D. Silver, MD, MPH Assistant Commissioner Bureau of Chronic Disease Prevention and Control Diana K. Berger, MD, MSc Medical Director Diabetes Prevention
More informationEvaluating the Effectiveness of Physician and Clinical Pharmacist Patient Education and Disease Management in Diabetes Mellitus
Evaluating the Effectiveness of Physician and Clinical Pharmacist Patient Education and Disease Management in Diabetes Mellitus Sotheavy Vann Jackson-Hinds Comprehensive Health Center Jackson, MS Introduction
More informationSelf-management for people with chronic health conditions Innovation Community
Self-management for people with chronic health conditions Innovation Community Presenter Kate Lorig, DrPH Stanford Patient Education Research Center 1000 Welch Road, Suite 204 Palo Alto CA 94304 USA 650-723-7935
More informationImproving drug prescription in elderly diabetic patients. FRANCESC FORMIGA Hospital Universitari de Bellvitge
Improving drug prescription in elderly diabetic patients FRANCESC FORMIGA Hospital Universitari de Bellvitge High prevalence, but also increases the incidence. The older the patients, the higher the percentages
More informationGuide to Chronic Disease Management and Prevention
Family Health Teams Advancing Primary Health Care Guide to Chronic Disease Management and Prevention September 27, 2005 Table of Contents 3 Introduction 3 Purpose 4 What is Chronic Disease Management
More informationCalifornia Public Hospitals and the Health Care Coverage Initiatives: A Model for Health Care Reform
California Association of Public Hospitals and Health Systems April 2009 POLICY BRIEF 70 WASHINGTON STREET, SUITE 215 OAKLAND, CALIFORNIA 94607 510.874.7100 WWW.CAPH.ORG California Public Hospitals and
More informationWays to Fix the System
Building the Health Informatics Chunnel: The PHR Meets the EHR Daniel Z. Sands, MD, MPH Cisco Systems and Harvard Medical School Boston, MA Harvard Medical School Copyright D. Z. Sands IBSG - 1 U.S. Healthcare
More informationBACKGROUND. ADA and the European Association recently issued a consensus algorithm for management of type 2 diabetes
BACKGROUND More than 25% of people with diabetes take insulin ADA and the European Association recently issued a consensus algorithm for management of type 2 diabetes Insulin identified as the most effective
More informationClinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D.
Clinical Research on Lifestyle Interventions to Treat Obesity and Asthma in Primary Care Jun Ma, M.D., Ph.D. Associate Investigator Palo Alto Medical Foundation Research Institute Consulting Assistant
More informationLost in Translation: The use of in-person interpretation vs. telephone interpretation services in the clinic setting with Spanish speaking patients
Kellie Hawkins, MD, MPH CRC IRB Proposal November 2011 Lost in Translation: The use of in-person interpretation vs. telephone interpretation services in the clinic setting with Spanish speaking patients
More informationImplementing an Evidence Based Hospital Discharge Process
Implementing an Evidence Based Hospital Discharge Process Learning from the experience of Project Re-Engineered Discharge (RED) Webinar January 14, 2013 Chris Manasseh, MD Director, Boston HealthNet Inpatient
More informationThe Medical Home: A Continuing Renovation Job. Paul Kaye, MD Executive VP, Practice Transformation February 22, 2012
The Medical Home: A Continuing Renovation Job Paul Kaye, MD Executive VP, Practice Transformation February 22, 2012 DISCLAIMER: The views and opinions expressed in this presentation are those of the author
More informationDCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study
DCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study National Diabetes Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What
More informationHarnessing the Power of Data Analytics to Transform Care for Vulnerable Populations
Harnessing the Power of Data Analytics to Transform Care for Vulnerable Populations Fred Cerise, MD, MPH President and CEO, Parkland Health and Hospital System Ruben Amarasingham, MD, MBA, President and
More informationKaiser Permanente: Health Education. Mei Ling Schwartz, MPH Director, Health & Physician Education Kaiser Permanente Panorama City Medical Center
Kaiser Permanente: Health Education Mei Ling Schwartz, MPH Director, Health & Physician Education Kaiser Permanente Panorama City Medical Center Who Is Kaiser Permanente? Founded in 1945, Kaiser Permanente
More informationKaiser Permanente Southern California Depression Care Program
Kaiser Permanente Southern California Depression Care Program Abstract In 2001, Kaiser Permanente of Southern California (KPSC) adopted the IMPACT model of collaborative care for depression, developed
More informationModern care management
The care management challenge Health plans and care providers spend billions of dollars annually on care management with the expectation of better utilization management and cost control. That expectation
More informationEffect of group visits vs. usual care to initiate insulin. Charlotte Kuo, NP San Francisco General Hospital Charlotte.kuo@sfdph.
Effect of group visits vs. usual care to initiate insulin Charlotte Kuo, NP San Francisco General Hospital Charlotte.kuo@sfdph.org ADA 5 th Disparities Partnership Forum October 23, 2012 Disclosure Disclosed
More informationAn Interprofessional Approach to Diabetes Management
Disclosures An Interprofessional Approach to Diabetes Management Principal in DiabetesReframed, LLC. Inventor of U.S. Provisional Patent Application No. 61/585,483 METHODS OF USING A DIABETES CROSS- DISCIPLINARY
More informationHealth Literacy & Medication Safety
Health Literacy & Medication Safety Can We Confuse Patients Less? Michael S. Wolf, MA MPH PhD Assistant Professor and Director Health Literacy and Learning Program (HeLP) Division of General Internal Medicine
More informationCare Planning and Goal setting in Diabetes management
Care Planning and Goal setting in Diabetes management How can we provide self-management support to people with chronic conditions? Professor Malcolm Battersby Flinders University Flinders Human Behaviour
More informationBurden of Obesity, Diabetes and Heart Disease in New Hampshire, 2013 Update
Burden of Obesity, Diabetes and Heart Disease in New Hampshire, 2013 Update Background Overweight and obesity have greatly increased among all age groups and regardless of income and education. Contributing
More informationIMPROVING OUR CLIENTS WHOLE HEALTH THROUGH DATA-INFORMED CARE MANAGEMENT
IMPROVING OUR CLIENTS WHOLE HEALTH THROUGH DATA-INFORMED CARE MANAGEMENT Laurie Alexander, Ph.D., Alexander BH Consulting Melba Mannell Whatcom Counseling & Psychiatric Clinic Laura Sureepisarn Compass
More informationCARE MANAGEMENT FOR LATE LIFE DEPRESSION IN URBAN CHINESE PRIMARY CARE CLINICS
CARE MANAGEMENT FOR LATE LIFE DEPRESSION IN URBAN CHINESE PRIMARY CARE CLINICS Dept of Public Health Sciences February 6, 2015 Yeates Conwell, MD Dept of Psychiatry, University of Rochester Shulin Chen,
More informationNetworked Personal Health Records
Networked Personal Health Records Table of Contents Potential of Personal Health Records (PHRs) What is a PHR? Common functions of a PHR Ideal attributes The PHR environment Consumer perceptions about
More informationCreating teams in primary care Breakout Series 1, Breakout A
Creating teams in primary care Breakout Series 1, Breakout A Tom Bodenheimer MD Center for Excellence in Primary Care UCSF Department of Family and Community Medicine Objectives Discuss some nuts and bolts
More informationManaging Patients with Multiple Chronic Conditions
Best Practices Managing Patients with Multiple Chronic Conditions Advocate Medical Group Case Study Organization Profile Advocate Medical Group is part of Advocate Health Care, a large, integrated, not-for-profit
More informationPay for Performance: Its Influence on the Use of IT in Physician Organizations
Pay for Performance: Its Influence on the Use of IT in Physician Organizations Thomas R. Williams, M.B.A., M.P.H.,* Kristiana Raube, Ph.D., Cheryl L. Damberg, Ph.D., and Russell E. Mardon, Ph.D.** T he
More informationDisease Management Program Description
Denver Health Medical Plan, Inc. Disease Management Program Description Commercial, Exchange, and Medicare Products 2015 Approved by the QMC: Presenting on May 12, 2015 Contents Overview...3 Introduction
More informationUsing Health Information Technology to Improve Quality of Care: Clinical Decision Support
Using Health Information Technology to Improve Quality of Care: Clinical Decision Support Vince Fonseca, MD, MPH Director of Medical Informatics Intellica Corporation Objectives Describe the 5 health priorities
More informationThe Electronic Medical Record (EMR)
Journal of Applied Medical Sciences, vol. 2, no. 2, 2013, 79-85 ISSN: 2241-2328 (print version), 2241-2336 (online) Scienpress Ltd, 2013 The Electronic Medical Record (EMR) PeterChris Okpala 1 Abstract
More informationHow To Analyze Health Data
POPULATION HEALTH ANALYTICS ANALYTICALLY-DRIVEN INSIGHTS FOR POPULATION HEALTH LAURIE ROSE, PRINCIPAL CONSULTANT HEALTH CARE GLOBAL PRACTICE DISCUSSION TOPICS Population Health: What & Why Now? Population
More informationQuality Improvement in Primary Care Settings
Quality Improvement in Primary Care Settings Eboni Price Haywood, MD, MPH Chief Medical Officer, Tulane Community Health Medical Director, Tulane Community Health @ Covenant House Team Approach to Quality
More informationIn the United States, costs associated with chronic illness care account
Cost-Effectiveness of Automated Telephone Self-Management Support With Nurse Care Management Among Patients With Diabetes Margaret A. Handley, PhD, MPH 1,2,4 Martha Shumway, PhD 3 Dean Schillinger, MD
More informationEffectiveness of an iphone application on Diabetes Self-Management
Effectiveness of an iphone application on Diabetes Self-Management Ms Morwenna Kirwan, Dr. Corneel Vandelanotte, Dr. Mitch Duncan, Dr Andrew Fenning, Prof. Kerry Mummery Institute for Health and Social
More informationPhysician Cultural Competency Independent Training Module for Simply Healthcare, Better Health and, Clear Health Alliance Providers
Physician Cultural Competency Independent Training Module for Simply Healthcare, Better Health and, Clear Health Alliance Providers Purpose of Training This Cultural Competency training aims to ensure
More informationUnderstanding Language and Culture Issues Between Patients and Providers
Understanding Language and Culture Issues Between Patients and Providers Over the past four decades, the United States has attracted immigrants from all around the world, with the majority emigrating from
More informationDIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE
DIET AND EXERCISE STRATEGIES FOR WEIGHT LOSS AND WEIGHT MAINTENANCE 40 yo woman, BMI 36. Motivated to begin diet therapy. Which of the following is contraindicated: Robert B. Baron MD MS Professor and
More informationEffectiveness of quality improvement strategies on the management of diabetes: Systematic review
Effectiveness of quality improvement strategies on the management of diabetes: Systematic review Noah Ivers MD, CCFP PhD Candidate, University of Toronto on behalf of the diabetes QI review team CAHSPR
More informationHealth risk assessment: a standardized framework
Health risk assessment: a standardized framework February 1, 2011 Thomas R. Frieden, MD, MPH Director, Centers for Disease Control and Prevention Leading causes of death in the U.S. The 5 leading causes
More informationSupporting Diabetes Self-care in Underserved Populations: A Randomized Pilot Study Using. Medical Assistant Coaches
1 Supporting Diabetes Self-care in Underserved Populations: A Randomized Pilot Study Using Medical Assistant Coaches Laurie Ruggiero, Ph.D., University of Illinois at Chicago, School of Public Health Ada
More informationHealthy Solutions for Life
Healthy Solutions for Life 2015 Presentation Overview About Healthy Solutions for Life Disease Management Health Coaching Model DM Programs TeleCare Monitoring 2013 Nurtur Health, Inc. All Rights Reserved.
More informationRiverside. Program Description
Program Description The Chronic Care Model developed by Ed Wagner, MD, director of Improving Chronic Illness Care (ICIC), a national clinical quality initiative was adopted by Kaiser Permanente (KP) Care
More informationSlide 2: Outline. Slide 3: Introduction
Slide 1: Using Electronic Health Records to Better Coordinate Decision Making for Complex Patients: What Can We Learn From Wiki? Aanand D. Naik, MD and Hardeep Singh, MD, MPH Houston HSR&D CoE, Michael
More informationAn Integrated, Holistic Approach to Care Management Blue Care Connection
An Integrated, Holistic Approach to Care Management Blue Care Connection With health care costs continuing to rise, both employers and health plans need innovative solutions to help employees manage their
More informationTotal population health. One person at a time.
Total population health. One person at a time. Health Dialog is a total population health services provider that has a 20-year track record of helping organizations reduce costs. Through the combination
More informationImplementing Mobile Health Programs
Implementing Mobile Health Programs By William Tella, President and Chief Executive Officer, GenerationOne Over a period of just 10 years, people across the globe have changed the basic nature of their
More informationUsing Public Health Evaluation Models to Assess Health IT Implementations
Using Public Health Evaluation Models to Assess Health IT Implementations September 2011 White Paper Prepared for Healthcare Information and Management Systems Society 33 West Monroe Street Suite 1700
More informationBig Time, Big Deal. Strategies for Creating a Successful Organization-wide EMR. Charles B Wang Community Health Center Laminasti (Ina) Elbaar
Big Time, Big Deal Strategies for Creating a Successful Organization-wide EMR Charles B Wang Community Health Center Laminasti (Ina) Elbaar 5 th Annual Asian & Pacific Islander Community Health Center
More informationSix Communication Best Practices for Transitional Care Management
WHITE PAPER Six Communication Best Practices for Transitional Care Management In the era of chronic illness and historically long lifespans, patient care transitions to home or another facility have become
More informationChronic Disease Management in the Medi-Cal Program
Medi-Cal Summary Chronic Disease Management in the Medi-Cal Program Introduction: Chronic Disease Chronic diseases are conditions of long duration that limit a person s activities and may require ongoing
More informationBipolar Disorder and Substance Abuse Joseph Goldberg, MD
Diabetes and Depression in Older Adults: A Telehealth Intervention Julie E. Malphurs, PhD Asst. Professor of Psychiatry and Behavioral Science Miller School of Medicine, University of Miami Research Coordinator,
More informationThe Use of Psychographic Data for Chronic Condition Self Management:
The Use of Psychographic Data for Chronic Condition Self Management: Claims based study reveals health outcomes and economic returns Ninth Annual Population Health & DM Colloquium March 2 nd, 2010 Dr.
More informationSustaining a High-Quality Breast MRI Practice
Sustaining a High-Quality Breast MRI Practice Christoph Lee, MD, MSHS Associate Professor of Radiology Adjunct Associate Professor, Health Services University of Washington September 11, 2015 Overview
More informationNear-Elderly Adults, Ages 55-64: Health Insurance Coverage, Cost, and Access
Near-Elderly Adults, Ages 55-64: Health Insurance Coverage, Cost, and Access Estimates From the Medical Expenditure Panel Survey, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research
More information4/9/2015. Opportunities for Making Type 2 Diabetes Prevention a Reality. Pat Schumacher, MS, RD. Objectives
Opportunities for Making Type 2 Diabetes Prevention a Reality The findings and conclusions in this presentation are those of the author and do not necessarily represent the official position of the Centers
More informationGlobal Lab for Innovation
Global Lab for Innovation Innovation Profile econsults The large-scale implementation of secure electronic communications allows primary care practitioners (PCPs) to initiate and receive electronic consultations
More informationAssessment of Primary Care Resources and Supports for Chronic Disease Self Management (PCRS)
Assessment of Primary Care Resources and Supports for Chronic Disease Self Management (PCRS) Individuals interested in using the PCRS in quality improvement work or research are free to do so. We request
More informationDiabetes Care in Public Hospitals: Effective Interventions
National Association of Public Hospitals and Health Systems August 2008 1301 Pennsylvania Avenue, NW, Suite 950 Washington, DC 20004 202 585 0100 tel / 202 585 0101 fax www.naph.org Diabetes Care in Public
More informationTelehealth: Today & Tomorrow National Health Policy Forum
Telehealth: Today & Tomorrow National Health Policy Forum April 11, 2014 Karen E. Edison, MD Philip Anderson Prof. & Chair, Dept. of Dermatology Medical Director, Missouri Telehealth Network Director,
More informationNurses at the Forefront: Care Delivery and Transformation through Health IT
Nurses at the Forefront: Care Delivery and Transformation through Health IT Ann OBrien RN MSN CPHIMS National Senior Director of Clinical Informatics Kaiser Permanente Robert Wood Johnson Executive Nurse
More informationOutpatient EMR-Based Clinical Decision Support: Challenges and Opportunities
Outpatient EMR-Based Clinical Decision Support: Challenges and Opportunities Patrick J. O Connor MD MA MPH Senior Clinical Investigator HealthPartners Research Foundation 1 Disclosures Employed full time
More informationOregon Standards for Certified Community Behavioral Health Clinics (CCBHCs)
Oregon Standards for Certified Community Behavioral Health Clinics (CCBHCs) Senate Bill 832 directed the Oregon Health Authority (OHA) to develop standards for achieving integration of behavioral health
More informationCalifornia HIV/AIDS Policy Research Center at the Center for AIDS Prevention Studies at the University of California, San Francisco
California HIV/AIDS Policy Research Center at the Center for AIDS Prevention Studies at the University of California, San Francisco Valerie B. Kirby, MPH, Wayne T. Steward, PhD, and Emily A. Arnold, PhD
More informationCare and EHR Integration Connecting Physical and Behavioral Health in the EHR. Tarzana Treatment Centers Integrated Healthcare
Care and EHR Integration Connecting Physical and Behavioral Health in the EHR Tarzana Treatment Centers Integrated Healthcare Outline of Presentation Why Integrate Care? Integrated Care at Tarzana Treatment
More informationLEADING THE WAY: CALIFORNIA S DELIVERY SYSTEM REFORM INCENTIVE PROGRAM (DSRIP)
September 2014 LEADING THE WAY: CALIFORNIA S DELIVERY SYSTEM REFORM INCENTIVE PROGRAM (DSRIP) 7 0 W A S H I N G T O N S T R E E T, S U I T E 2 1 5 O A K L A N D, CA 9 4 6 0 7 P H O N E : ( 5 1 0 ) 8 7
More informationResults of a Peer Mentoring Intervention in Older Patients with Diabetes: The Care Companion Program
Results of a Peer Mentoring Intervention in Older Patients with Diabetes: The Care Companion Program Deborah Graham, MSPH AAFP National Research Network Cynthia Henderson, RN, CCM WellMed Medical Management
More informationState of New Jersey. Department of Health. Diabetes Prevention and Control 2014. Clinical Decision Support (CDS) System
State of New Jersey Department of Health Diabetes Prevention and Control 2014 Clinical Decision Support (CDS) System May 5, 2014 1.0 INFORMATION FOR APPLICANTS... 3 1.1 Summary Information... 3 1.2 Background...
More informationThe Triple Aim. Two System Changes. PCMH Short Definition. Doctors Employed by Hospitals Exceed 100,000
Doctors Employed by Hospitals Exceed 100,000 You May Be Hiring Physicians Is Your Primary Care Strategy Successful? 2004 64, 392 full time physicians were employed by hospitals In 2011 More than 100,000
More informationThe Teach Back Technique
The Teach Back Technique Communicating Effectively With Patients Table of Contents What Is the Teach Back Technique?...2 Why Use the Teach Back Technique?...2 Teach Back Tips and Cautions...4 Tips...4
More informationCoventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business
Coventry Health Care of Florida, Inc. Coventry Health Plan of Florida, Inc. Coventry Health and Life Insurance Company Commercial Lines of Business Quality Management Program 2012 Overview Quality Improvement
More informationWhite Paper. Medicare Part D Improves the Economic Well-Being of Low Income Seniors
White Paper Medicare Part D Improves the Economic Well-Being of Low Income Seniors Kathleen Foley, PhD Barbara H. Johnson, MA February 2012 Table of Contents Executive Summary....................... 1
More informationChapter 8 - General Discussion
Chapter 8 - General Discussion 101 As stated in the introduction, the goal of type 2 diabetes care is to offer patients an integrated set of interventions in relation to life style, blood pressure regulation,
More informationDoctor s Office Quality Information Technology (DOQ-IT) Practice Performance Improvement Practice Readiness Assessment Form
Doctor s Office Quality Information Technology (DOQ-IT) Practice Performance Improvement Practice Readiness Assessment Form Once you are enrolled in the DOQ-IT project, you will be asked to complete this
More informationQuality Improvement Case Study: Improving Blood Pressure Control in a 3- Provider Primary Care Practice
Quality Improvement Case Study: Improving Blood Pressure Control in a 3- Provider Primary Care Practice EXECUTIVE SUMMARY Organization Ellsworth Medical Clinic 1 is a family medicine practice in Wisconsin
More informationMaking Health Promotion Our Daily Business A Case Study of Health Oriented Healthcare Management
Making Health Promotion Our Daily Business A Case Study of Health Oriented Healthcare Management Keynote presentation - 21st International HPH Conference Gothenburg, May 2013 Dr. Diane Levin-Zamir, PhD,
More informationPopulation Health Management & the Medical Neighborhood. Patient Centered Primary Care Collaborative Monthly National Briefing September 26, 2013
Population Health Management & the Medical Neighborhood Patient Centered Primary Care Collaborative Monthly National Briefing September 26, 2013 Outline What is Population Health Management? Registries
More informationFacts about Diabetes in Massachusetts
Facts about Diabetes in Massachusetts Diabetes is a disease in which the body does not produce or properly use insulin (a hormone used to convert sugar, starches, and other food into the energy needed
More informationDoes referral from an emergency department to an. alcohol treatment center reduce subsequent. emergency room visits in patients with alcohol
Does referral from an emergency department to an alcohol treatment center reduce subsequent emergency room visits in patients with alcohol intoxication? Robert Sapien, MD Department of Emergency Medicine
More information