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Norifumi Kamo, A James Bender, Kavitha Kalmady, C Craig Blackmore
We present a case study of Virginia Mason Medical Center's successful implementation of the online patient portal. The organization exceeded its Meaningful Use 2 View/Download/Transmit targets and national benchmarks, with over 70% of unique patient encounters being provided timely online access to their health information, over 50% viewing, downloading, and transmitting health information electronically, and potential cost savings to the institution. Key lessons learned in our implementation process were.
October 7, 2016: Healthcare
William H Gruber, Adam C Powell, John B Torous
Historically, the process of scientific discovery and the process of clinical delivery have been poorly integrated. As a result of the Decade of Health Information Technology (2004-2014), many of the former barriers to capturing, processing, and retrieving medical information at the point of care have been surmounted. This change has the potential to both transform how new medical discoveries are made and how evidence-based medicine is put into practice. To illustrate the impact of this ongoing change, several examples are provided of institutions which have innovatively used information at the point of care...
October 6, 2016: Healthcare
Jessica L Baldwin, Hardeep Singh, Dean F Sittig, Traber Davis Giardina
Widespread use of health information technology (IT) could potentially increase patients' access to their health information and facilitate future goals of advancing patient-centered care. Despite having increased access to their health data, patients do not always understand this information or its implications, and digital health data can be difficult to navigate when displayed in a small-format, complex interface. In this paper, we discuss two forms of patient-facing health IT tools-patient portals and applications (apps)-and highlight how, despite several limitations of each, combining high-yield features of mobile health (mHealth) apps with portals could increase patient engagement and self-management and be more effective than either of them alone...
October 3, 2016: Healthcare
Scott A Berkowitz, Patricia Brown, Daniel J Brotman, Amy Deutschendorf, Linda Dunbar, Anita Everett, Debra Hickman, Eric Howell, Leon Purnell, Carol Sylvester, Ray Zollinger, Michele Bellantoni, Samuel C Durso, Constantine Lyketsos, Paul Rothman
To address the challenging health care needs of the population served by an urban academic medical center, we developed the Johns Hopkins Community Health Partnership (J-CHiP), a novel care coordination program that provides services in homes, community clinics, acute care hospitals, emergency departments, and skilled nursing facilities. This case study describes a comprehensive program that includes: a community-based intervention using multidisciplinary care teams that work closely with the patient's primary care provider; an acute care intervention bundle with collaborative team-based care; and a skilled nursing facility intervention emphasizing standardized transitions and targeted use of care pathways...
September 29, 2016: Healthcare
Ursula Koch, Somava Stout, Bruce E Landon, Russell S Phillips
Innovations in payment are encouraging clinical-community partnerships that address health determinants. However, little is known about how healthcare systems transform and partner to improve population health. We synthesized views of population health experts from nine organizations and illustrated the resulting model using examples from four health systems. The transformation requires a foundation of primary care, connectors and integrators that span the boundaries, sharing of goals among participants, aligned funding and incentives, and a supporting infrastructure, all leading to a virtuous cycle of collaboration...
September 28, 2016: Healthcare
Mariétou H Ouayogodé, Carrie H Colla, Valerie A Lewis
BACKGROUND: Medicare's Accountable Care Organization (ACO) programs introduced shared savings to traditional Medicare, which allow providers who reduce health care costs for their patients to retain a percentage of the savings they generate. OBJECTIVE: To examine ACO and market factors associated with superior financial performance in Medicare ACO programs. METHODS: We obtained financial performance data from the Centers for Medicare and Medicaid Services (CMS); we derived market-level characteristics from Medicare claims; and we collected ACO characteristics from the National Survey of ACOs for 215 ACOs...
September 27, 2016: Healthcare
Zirui Song
No abstract text is available yet for this article.
September 27, 2016: Healthcare
Ravi B Parikh, Brynn Bowman, Constance Dahlin, Jeanne S Twohig, Diane E Meier
Early, integrated palliative care has been shown to improve quality of life and reduce utilization in both inpatient and outpatient settings. As health systems shift to risk-based payment structures, palliative care will play an increasing role in improving value of care outside of the hospital. Based on successful models of community-based palliative care, we identify six principles - interdisciplinary team-based care; 24/7 access and responsiveness; concurrent palliative care with disease-directed treatment; targeting services to high-risk patients; integrated medical and social supports; and caregiver support - that are widely implemented because of their impact on improving value for seriously ill individuals...
September 27, 2016: Healthcare
Erica Frank, Kate Tairyan, Michelle Everton, Jennifer Chu, Craig Goolsby, Alisa Hayes, Ann Hulton
BACKGROUND: The WHO has called for the use of computer-aided education to train millions of additional health providers. We herein address this appeal with the first globally available, free, accredited, computer-aided, and peer and mentor-guided course. METHODS: The intervention studied was's first course, "Emergency Medicine (EM) for Senior Medical Students", required for the graduating Classes of 2013 at the University of Missouri (UM) and the U...
September 20, 2016: Healthcare
Lawrence P Casalino, Norman Chenven
BACKGROUND: Value-based purchasing (VBP) favors provider organizations large enough to accept financial risk and develop care management infrastructure. Independent Practice Associations (IPAs) are a potential alternative for physicians to becoming employed by a hospital or large medical group. But little is known about IPAs. METHODS: We selected four IPAs that vary in location, structure, and strategy, and conducted interviews with their president and medical director, as well as with a hospital executive and health plan executive familiar with that IPA...
September 8, 2016: Healthcare
Roy A Beveridge, Laura E Happe, Mike Funk
Decades of practice under a system that set the financial interests of physicians and insurers at odds, has resulted in physician distrust of insurers being cited a key obstacle to value-based arrangements. Insurers must work to shift the insurer-provider relationship from one that's transactional to a partnership built on trust. Even when physicians and insurers agree philosophically on quality over quantity, there are practical challenges. Insurers can provide the data, systems and analytical insights that help inform the physician's care strategy...
September 2, 2016: Healthcare
Jessica Greene, Rebecca M Sacks, Judith H Hibbard, Valerie Overton
BACKGROUND: Primary care provider (PCP) support of patient self-management may be important mechanism to improving patient health outcomes. In this paper we develop a PCP-reported measure of clinician strategies for supporting patient self-management, and we psychometrically test and validate the measure. METHODS: We developed survey items based upon effective self-management support strategies identified in a prior mixed methods study. We fielded a survey in the fall of 2014 with 139 Fairview Health Services PCPs, and conducted exploratory factor analysis and Cronbach's Alpha to test for scale reliability...
September 2, 2016: Healthcare
Sarah Gebauer, Timothy Petersen, Elizabeth Steele
Practices, hospitals, and healthcare systems are increasingly able to collect data about individual physician clinical performance. There is a strong temptation to use the data to make decisions about physicians' quality of care without first taking the time to establish a system that ensures valid conclusions. In addition, physicians are not informed that their data are being used, and thus do not have an opportunity to correct any inaccuracies. A HIPAA-equivalent law or regulation for physicians would help patients and physicians more accurately address these and other issues related to complex healthcare data...
August 3, 2016: Healthcare
Elise Russo, Dean F Sittig, Daniel R Murphy, Hardeep Singh
Electronic health record (EHR) data repositories contain large volumes of aggregated, longitudinal clinical data that could allow patient safety researchers to identify important safety issues and conduct comprehensive evaluations of health care delivery outcomes. However, few health systems have successfully converted this abundance of data into useful information or knowledge for safety improvement. In this paper, we use a case study involving a project on missed/delayed follow-up of test results to discuss real-world challenges in using EHR data for patient safety research...
July 26, 2016: Healthcare
Daniel Wolfson, Anthony Suchman
Choosing Wisely began at a time when a polarized national debate on healthcare reform stymied effective conversation on effective and efficient resource use. The ABIM Foundation sought to change attitudes and culture and promote the idea that removing waste is an integral component of providing high quality care by using an approach of constructive engagement to persuade specialty societies to identify five wasteful tests or treatments within their field.
September 2016: Healthcare
James B Haddow, Maria Walshe, Dinesh Aggarwal, Ankur Thapar, John Hardman, Jonathan Wilson, Ayo Oshowo, Chetan Bhan, Hasan Mukhtar
We aimed to improve the lead-time and the patient experience of the diagnostic stage of the suspected colorectal cancer pathway. This project worked within the constraints of limited resources and an austere environment. The core team included a project manager trained in quality improvement methodologies. Senior and Fleming's planned change model was used as the overall framework. Baseline data supported the case for change and highlighted targets for improvement. A stakeholder workshop employed social movement theory, lean thinking, experience-based design and patient stories to engage influential leaders and secure support and commitment...
September 2016: Healthcare
Ankoor Y Shah, Karen LLanos, Denise Dougherty, Stephen Cha, Patrick H Conway
OBJECTIVE: The Children's Health Insurance Program (CHIP) was re-authorized in 2009, ushering in an unprecedented focus on children's health care quality one of which includes identifying a core set of performance measures for voluntary reporting by states' Medicaid/CHIP programs. However, there is a wide variation in the quantity and quality of measures states chose to report to the Center's for Medicare & Medicaid Services (CMS). The objective of this study is to assess reporting barriers and to identify potential opportunities for improvement...
September 2016: Healthcare
Bijan J Borah, Yang Qiu, Nilay D Shah, Patrick P Gleason
BACKGROUND: The Medicare 5-Star Rating System measures and provides incentive for improving Medicare Part D plans through a quality-based payment program. Adherence to medications for chronic conditions is key to the Star ratings. Our objective was to assess the impact of direct-to-provider letters on improving medication adherence. METHODS: Members of a large US pharmacy benefits manager (PBM) who did not adhere to prescription of oral diabetes (antidiabetics), cholesterol-reducing (statins), or hypertension (renin angiotensin system [RAS] antagonists) drug therapy were identified from the prescriptions claims data of>600,000 continuously enrolled Medicare members...
September 2016: Healthcare
Steven Koslov, Elizabeth Trowbridge, Sandra Kamnetz, Sally Kraft, Jeffrey Grossman, Nancy Pandhi
BACKGROUND: Primary care is considered the foundation of an effective health care system. However, primary care departments at academic health centers have numerous challenges to overcome when trying to achieve the Triple Aim. METHODS: As part of an organizational initiative to redesign primary care at a large academic health center, departments of internal medicine, general pediatrics and adolescent medicine, and family medicine worked together to comprehensively redesign primary care...
September 2016: Healthcare
Mark D Neuman, Molly R Passarella, Rachel M Werner
BACKGROUND: While 30-day risk-adjusted mortality is a performance measure for hip fracture care, it has not been shown to predict long-term outcomes. We assessed whether hospital rankings based on historical 30-day mortality predicted subsequent hip fracture outcomes. METHODS: Using national Medicare data, we calculated annual hospital performance rankings based on standardized 30-day hip fracture mortality ratios. We used logistic regression to measure the association of patients' survival at 180 days with their hospital's ranking for the year prior to admission...
September 2016: Healthcare
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