Health Quality Innovation

Comprehensive Program Featuring Registry, Self-Management Education, Action Plans, and Home Visits Reduces Asthma-Related Admissions and Emergency Department Visits

The University of Michigan Health System implemented a comprehensive asthma management program that includes the following elements:

• a registry of all patients with asthma,
• standardized patient education and self-management asthma action plans,
• periodic home visits from nurses, and
• specialized programs for children with asthma who are at high risk for emergency department visits or hospitalizations.

Overseen by a multidisciplinary committee, this program allows the health system to develop innovative interventions tailored to the unique needs of individual patients with asthma. The initiative has led to more patients having self-management plans, fewer asthma-related hospitalizations (both overall and among children), and fewer emergency department visits among children with asthma.

Read the full innovation profile at the AHRQ Health Care Innovations Exchange...

Changing Policy: The Elements for Improving Childhood Asthma Outcomes

Asthma is the single most common chronic condition among children, with one in every seven children diagnosed with the disease that causes attacks of wheezing, shortness of breath, chest tightness and coughing.

The U.S. spends about $8 billion a year treating childhood asthma – more than almost any other childhood condition—in part because more than 1 million children with asthma lack health insurance.

George Washington University School of Public Health and Health Services researchers Sara Rosenbaum and Anne Markus, Ph.D. ’00, spent last year identifying what policy reforms could be made to improve the lives of children with asthma and their families.

Read a full summary of the report at the GWU website...

 

 

Challenges and Barriers to Clinical Decision Support (CDS)

Clinical Decision Support (CDS) has been demonstrated to help safety-net health care clinicians with their efforts to improve efficiency and effectiveness of care for the patients they serve.  But the challenge facing safety-net clinic leaders is how to develop an effective CDS system?

This March 2010 AHRQ report, Challenges and Barriers to Clinical Decision Support (CDS) Design and Implementation Experienced in the AHRQ CDS Demonstration briefly describes the two AHRQ CDS demonstrations, as well as the challenges and barriers that the contractors encountered during the initial periods of their CDS demonstration project, how they addressed these obstacles, and the effectiveness of their strategies. The goal of this report is to share the experiences of the contractors throughout the planning, design, and implementation phases to aid others who are considering funding or undertaking similar efforts.

Lessons learned by health care provider organizations:

• The goals of CDS development and implementation projects should align with organizational priorities to promote buy-in from both management and staff.
• The organizational working environment should foster meaningful EMR usage, including not only software and hardware needs but also the attitudinal changes needed to support adoption.
• Engaging a well-respected clinician “champion” to lead CDS education, training, and implementation efforts will promote clinician adoption.
• Institutions wishing to utilize a knowledge management process will need access to personnel with specialized knowledge in clinical informatics and experience in designing new tools or using existing tools to support CDS development.

Read or download the full report from AHRQ ....

A Powerful Strategy: Patient-Centered Medical Homes with Value-Based Insurance Design

The patient-centered medical home (PCMH) is focused on improving patient outcomes by applying a defined set of health care practice strategies.  Value-based insurance design (VBID) is focused on designing payment strategies to removing barriers for screenings, tests, and treatments that are proven to be effective - especially for high risk patients for whom compliance with care is essential for health. 

In this white paper, authors from the Naional Business Coalition on Health, the Patient-Centered Primary Care Collaborative (PCPCC), and the University of Michigan Center for VBID describe how the PCMH and VBID can be used in concert to improve quality and cost effectiveness.  Ten case studies illustrate this integrated strategy in practice.

Click here to download the white paper (in pdf format) from PCPCC...

 

 

Physician Insights on Barriers to Care for Diabetes Patients

A new study by J.C.Crosson, et.al. and published in the Journal of the American Board of Family Medicine reports on physicians' perspectives of barriers to care for diabetic patients with CVD risks.  The barriers range from health system obstacles to socioeconomic obstacles to lack of patient motivation.  While physicians have a role in addressing some of these barriers, many barriers are beyond the ability of the physician to address.  There is clearly a need for more comprehensive approaches involving a range of professionals collaborating for quality improvement. 

^{Read the full study online here...}

 

 

Motivational Interviewing: Evoking Commitment to Change

Motivational Interviewing is a tool that can assist clinicians in their efforts to provide self-management support to patients with chronic illness.

This video,  produced by the Colorado Clinical Guidelines Collaborative (CCGC) provides a demonstration of motivational interviewing.  The provider in this demonstration does this by asking open-ended questions, providing affirmation, using reflective listening and summarizing for the patients (OARS). He also helps the patient to scale the importance of the issue and the patients confidence level for change behavior.  (CCGC, 5.5 min. [YouTube])

Video Series Describes Evidence-Based Health Coaching and Motivational Interviewing

Produced by Health Sciences Institute (HSI), this series of videos offers an introduction to Motivational Interviewing and evidence-based health coaching. In the videos Susan Butterworth, Ph.D. Associate Professor, Schools of Nursing & Medicine,Oregon Health Sciences University and HSI Advisory Board Member defines and describes Motivational Interviewing techniques and their application in the clinical setting.

This series may be of benefit to organizations considering using  'health coaches' on their PCMH, disease management, or chronic care improvement inter-disciplinary teams.

Video topics include:

• Applying Motivational Interviewing in Health Care (4.5 min)
• What is Motivational Interviewing (4.0 min)
• Patient Centered Care or 'Worst Case Scenario' (7.0 min)
• How can organizations Build  Evidence-Based Health Coaching Teams? (3.5 min)
• What are the Guiding Principle of Motivational Interviewing? (5.0 min)
• What is the 'Best Case Scenario' for Patient Centered Care? (5.0 min)

Click here to go to the HSI website to view these videos

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Improving Chronic Illness Care Website offers 'Evidence for Better Care'

This website continues to serve as a leading resource for those involved in chronic illness care improvement.

One very useful resource from the ICIC website is found in Evidence for Better Care a collection of supporting bibliographies of peer-reviewed literature. 

Evidence for Better Care is divided into two categories:

1.  Chronic Care Model Literature

2.  Condition Specific Literature

• Arthritis
• Asthma
• Depression
• Diabetes
• Geriatric Care
• Heart Failure
• Hypertension

Those groups working to improve chronic illness care will want to check out these resources.

Click hear to view ICIC bibliographies

The Guide to Community Preventive Services Gives Separate Recommendations for Case Management and Disease Management for Diabetes

"Case management" and "disease management" mean different things to different people, and often the two terms are interchanged in conversations related to chronic care improvement strategies.

The Guide to Community Preventive Services offers separate guidelines and definitions for each of these interventions (Diabetes Guidelines) and may serve as a starting point when trying to "define" services for your chronically ill patients.

Click here to view suggested guidelines for diabetes.

Click here to view Disease Management Intervention Recommendations for Diabetes (pdf)

Click here to view Case Management Intervention Recommendations for Diabetes (pdf)

The Guide to Community Preventive Services Helps Identify "What Works" in Chronic Illness Care

The Guide to Community Preventive Services, the community health complement to The Guide to Clinical Preventive Services, identifies which population-oriented prevention interventions work. 

Evidence-based guidelines are presented for a number of health care topics that would be of interest to communities working to improve chronic illness care, including:

• Alcohol

• Cancer

• Diabetes

• Mental Health

• Nutrition

• Obesity

• Oral Health

• Physical Activity

• Social Environment

• Substance Abuse

• Tobacco

• Worksite

Recommendations, made by The Task Force on Community Preventive Services, are based on careful systematic reviews of all available literature on a topic . The findings from the reviews are published in peer-reviewed journals and also made available on "The Guide" Internet website. 

Communities focused on improving chronic illness care will want to learn more about "The Community Guide".

Click here to learn more about how to The Community Guide can be used by health providers to improve health and prevent disease in your community.