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Collaborative care for chronic illness and information technology

Collaborative care for chronic illness and information technology . Introduction AcademyHealth 2005 David A. Dorr, MD MS OHSU. Objectives. State of collaborative and chronic physical and mental illness care Framework for collaborative care and Information Technology (IT) use

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Collaborative care for chronic illness and information technology

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  1. Collaborative care for chronic illness and information technology Introduction AcademyHealth 2005 David A. Dorr, MD MS OHSU

  2. Objectives • State of collaborative and chronic physical and mental illness care • Framework for collaborative care and Information Technology (IT) use • Successes and challenges

  3. Chronic illness care: problems • Underuse • Effective treatments for chronic illness care only given 54% of the time. • Misuse • Preventable, injurious outpatient AEs occur in 1-9% of patients. • Overuse • Up to 30% of treatments provided for some illnesses (low back pain) are inappropriate. Terms from Chassin MR. JAMA. 1998; Sources: EA McGlynn, NEJM; Rothman, Annals; Wennberg; Forster, 2003; Dorr 2004.

  4. Chronic illness care: VA transformation Jha 2003.

  5. Root causes of problems with chronic illness care • Culture / History • “Tyranny of the urgent” • Art and craft of medicine • Complexity • Individual versus population focused • Financial

  6. Root causes: information based • Information/knowledge needed is • Enormous • Challenging to find • Lacking • In the wrong form • Difficult to communicate

  7. Information system: definition • Any system to store / retrieve / display / aggregate / or otherwise touch information • Not just computers or charts in broad sense • Our focus is primarily on computer-supported information systems

  8. Health information / data Results management Order entry Decision support Communication and connectivity Patient support Administrative process Reporting and population health Information System domains (IOM)

  9. More successes Chronic conditions Medications • Results management • Patient worksheet • Order entry • Corollary orders and order sets improve safety, can reduce cost, and improve outcomes. • Savings of up to $44 billion dollars per year. Preventive care summary Pertinent labs Pertinent exams Passive reminders Organized by illness Wilcox 2005; CITL report 2003.

  10. Individual categories: successes • Decision support • 30-66% improvement in adherence to preventive care and acute care guidelines. • But … chronic illness has mixed results. • Patient support • Congestive heart failure

  11. Access Best Practices Communication Health information / data Results management Order entry Decision support Communication and connectivity Patient support Administrative process Reporting and population health IT and domains: hierarchy

  12. Care management packages to Improve Quality of Care: Information System focus • Chronic Care Model • Hartford / Intermountain Health Care generalist care management • Disease management • Veterans’ Administration transformation QUERI (reTIDES, EQUIP, PAS, CHIACC)

  13. Community Health System Resources and Policies ------ Organization of Health Care Self-Management Support Delivery System Design Clinical Information Systems Decision Support Informed, Activated Patients & Caregivers Prepared, Proactive Practice Team Improving Care for Chronic Illness Collaborative Care Functional and Clinical Outcomes From: E.H. Wagner & RWJF Improving Chronic Illness Care Initiative

  14. Generalist care management system • Improvement in diabetes, depression, and congestive heart failure outcomes. Dorr et al, HSR, in press; Dorr et al, Disease management, in press.

  15. Disease management • Companies external to health workers provide • Technology (e.g. monitoring devices) • System (e.g. 24 hour nursing support) • To reduce utilization and cost.

  16. Final thoughts • IS use can help solve chronic illness performance issues. • Advanced information system use only 15-25% in US, and still difficult to know what will work. • Financial, implementation, and workflow barriers significant.

  17. Thanks! • Amy Cohen, PhD • Adam Wilcox, PhD • Laurie Burns • Paul D. Clayton, PhD • Larry Casalino, MD PhD

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