Summary by Stacey Slager
\nThis is an assessment of an early PHR system (2007) looking at patient-centered outcomes based on a framework that includes (1) respect for patient values, preferences, and expressed needs; (2) information and education; (3) access to care; (4) emotional support to relieve fear and anxiety; (5) involvement of family and friends; (6) continuity and secure transition between healthcare providers; (7) physical comfort; (8) coordination of care. Researchers conducted semi-structured interviews of clinicians in larger health care settings where there was early adoption of a PHR integrated with the EHR to find how useful different aspects of that link was. The ability for patients to message providers turned out to be the most useful, as well as for patients to look at labs. Patients were not always very interested in looking at clinical notes.
Summary by Darin Humphreys
\nPatient-centered care means more than simply creating patient-centered medical homes, argue Greene et al. in their Special Report funded by the Group Health Research Institute, it is “comprehensive, integrative, [and] consistent” in approach and builds trust with each patient in the population. The authors define patient-centered care as care that “honors and responds to the individual patient preferences, needs, values, and goals,” and they delineate three dimensions and attributes of a patient-centered health care system: 1) Interpersonal relationships, including communication, knowing the patient, and the influence of teams; 2) Clinical, or provision of care, which includes clinical decision support, coordination and continuity, and support for a range of encounter types (i.e. in person, virtual, telephone, email, etc.); and, 3) Structural or system features, that include the physical environment, ease of access for all encounter types, and HIT that meet the patients’ and providers’ needs across the continuum of care. The authors demonstrate how their employer, Group Health Cooperative, has integrated features of patient-centered care, including the following features that relate to HIT and learning health systems: an online self-management program for chronic disease and support groups; a smartphone “app” that provides patients mobile access to their medical record and connection to their care team; patient preference tracking in the EHR; lab and pharmacy waiting times viewable through the smartphone app; and the intent to adopt Meaningful Use provisions. The authors do not describe efforts for clinical decision support, and they do not state if the patient record available on the smartphone app can be used by the provider as well as the consumer. This paper comes from a presentation made to the Group Health Cooperative leadership forum in 2010.
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\nApproximately 145 million Americans have chronic conditions today; this number is estimated to grow to 171 million by 2030. The current system is ineffective in managing this patient population.
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The chronic care model identifies several improvements to the current model: care coordination, appropriate follow up, engagement of patients in their own self care management, patients with an active role in both psychosocial and physical needs related to their illness.
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The authors discuss evidence illustrating the benefits of collaborative problem solving and its role in chronic disease management in primary care and it’s implications for patient engagement and empowerment. Barriers to better chronic disease management include: time limitations on primary care providers, skills needed by the providers to engage patients effectively, in addition to lack of training, frequent cross coverage and annual resident turnover in a residency setting.
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This article discusses a feasibility study to implement a patient centered care plan (PCCP) in the EHR. This PCCP includes 3 sections: “About Me”, “My Goal”, and “My Progress” used to develop the patients preferences, goals and results respectively. This was piloted using a paper based PCCP with a 4th year resident, a medical assistant and 15 patients. With the success of this pilot phase, the authors moved into a controlled trial.
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The experimental group included 7 physicians and 1 MA; the 28 experimental group patients only saw these providers.. The control group was also composed of 7 physicians and 1 MA and 30 control group patients only saw control physicians.
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The research team ran into a delay in integrating the PCCP into the EHR that required a workaround – having the PCCP placed in the “Social Documentation” section rather than designing a PCCP that would automatically populate a visit and be available when the patient’s chart was opened. This required additional clicks to open the PCCP.
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The experimental group patients were more consistently exposed to problem solving than were the control group patients. The interview results found that use of the PCCP engendered alignment illustrated by feelings of continuity, feeling known, respected and wanting assistance in building a viable self-management plan. The providers in this group were also interviewed and the feedback data suggests that PCCP can be a useful training and clinical tool with proper staffing ratios and time allocations.
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The authors conclude that training provider/support team to use a patient centered care plan like PCCP in the EHR is a simple intervention to change the provider-patient interaction towards more patient engagement. EHRs will need to be improved to include prompted collaborative problems solving fields. Doing so will not only improve patient engagement and empowerment but also promote self-management.
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\nPatient-centered care is care that makes the patient and their loved ones an integral part of the care team who collaborate to make decisions, and places monitoring and self-care in the patients hands.
\nInformatics can promote patient-centered care, though it can potentially serve as a barrier to patient-centered care, as well.
\ninformatics can facilitate the availability of important information, information technology can also increase bureaucracy, contribute to dehumanize and interfere with doctor-patient relationships
\nOne way that information technology can promote patient-centered care is by providing a mechanism for a patient to provide his or her clinician(s) with critical information about him or herself, including the patient’s functioning and well-being (e.g., health-related quality of life) [dark blue arrow]
\nClinicians can use informatics to integrate the information they learn from patients with their medical knowledge and data resources to improve patient care [pink arrow].
\nInformatics can also help patients share information with their family and friends, and with other patients (e.g.,social networking sites) [dotted orange lines], as well as helping multiple members of their care team update and share critical information about them (e.g., electronic medical records) [dotted plum lines].
\nThe key to harnessing the potential of informatics to promote patient-centered care is to use technology to direct both patients and clinicians to high-quality information, and to share this information with one another
\nIn second-generation medicine, referred to by some as “Medicine 2.0,” healthcare systems “… need to move away from hospital-based medicine, focus on promoting health, provide healthcare in people’s own homes, and empower consumers to take responsibility for their own health.
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\nThis 29 page document is a summary of a much larger, 1,531 page report by AHRQ which details findings of 16 projects to enhance patient-centered care. The report discusses four areas of focus for patient centered care. The four areas are:
\nPatient Self-management projects included home-based computer reminder and alert systems and a patient focused drug educational intervention using DVDs.
\nAccess to Medical Information projects included systems for gathering and sharing health information through the web and automated voice recognition software.
\nPatient-Clinician Communication projects include secure messaging systems, templates designed to gather additional information in the PHR, and visual displays in the PHR.
\nShared decision-making projects include a template driven interface for individual patient care planning and query driven health coaching.
\nResults of each of the sixteen projects are summarized in the article. They vary from, non-acceptance of the intervention to improved patient compliance and more complete medical records.
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Because of technologic advances as well as changes in the organization and financing of care delivery, contemporary health care has evolved tremendously since the concept of patient-centeredness was introduced in the late 1980s. Historically, those advocating patient-centered care have focused on the relationship between the patient and the physician or care team. Although that relationship is still integral, changes to the health care system suggest that a broader range of factors may affect the patient-centeredness of health care experiences. A multidimensional conceptualization of patient-centered care and examples from our health care system illustrate how clinical, structural, and interpersonal attributes can collectively influence the patient's experience. The proposed framework is designed to enable any health system to identify ways in which care could be more patient-centered and move toward a goal of making it a “systems property.”", "publicationTitle": "The Permanente Journal", "publisher": "", "place": "", "date": "2012", "volume": "16", "issue": "3", "section": "", "partNumber": "", "partTitle": "", "pages": "49-53", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Perm J", "DOI": "", "citationKey": "", "url": "http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442762/", "accessDate": "2014-12-05T06:51:26Z", "PMID": "", "PMCID": "", "ISSN": "1552-5767", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "PubMed Central", "callNumber": "", "rights": "", "extra": "PMID: 23012599\nPMCID: PMC3442762", "tags": [ { "tag": "patient centered care" } ], "collections": [ "C2XMTZI4" ], "relations": { "owl:sameAs": "http://zotero.org/groups/284130/items/ETCX29US" }, "dateAdded": "2014-12-12T15:58:40Z", "dateModified": "2014-12-12T15:58:40Z" } }, { "key": "VQWG8ER6", "version": 2, "library": { "type": "group", "id": 313787, "name": "Learning Health System Journal Club (public)", "links": { "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/313787/items/VQWG8ER6", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public/items/VQWG8ER6", "type": "text/html" } }, "meta": { "createdByUser": { "id": 665508, "username": "brokenjade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/brokenjade", "type": "text/html" } } }, "creatorSummary": "Moore et al.", "parsedDate": "2008", "numChildren": 3 }, "data": { "key": "VQWG8ER6", "version": 2, "itemType": "journalArticle", "title": "Architectural choices and challenges of integrating electronic patient questionnaires into the electronic medical record to support patient-centered care", "creators": [ { "creatorType": "author", "firstName": "Barbara J.", "lastName": "Moore" }, { "creatorType": "author", "firstName": "Stephan", "lastName": "Gaehde" }, { "creatorType": "author", "firstName": "Clayton", "lastName": "Curtis" } ], "abstractNote": "Strategies to deliver guideline-concordant, patient-centered care during office visits sometimes impose conflicting demands on clinicians. One way to help relieve time-constrained visits and to improve the patient-centeredness of care may be through patients electronically self-reporting data that flow automatically into an EMR note for clinician confirmation or editing, relieving physicians of some data entry and rote history-gathering tasks, thus freeing up time to allow clinicians to focus on significant issues and patient concerns while also increasing the likelihood that necessary data are gathered and available for decision-making. We developed a prototype to enable such data gathering and integration into the EMR. The lack of consistent provision of interfaces by vendors for sending data into EMRs and the idiosyncrasies of any particular EMR in the context of a particular organizations IT infrastructure and policies pose architectural choices and challenges that healthcare organizations embarking on such IT projects may need to consider.", "publicationTitle": "AMIA ... Annual Symposium proceedings / AMIA Symposium. AMIA Symposium", "publisher": "", "place": "", "date": "2008", "volume": "", "issue": "", "section": "", "partNumber": "", "partTitle": "", "pages": "490-494", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "AMIA Annu Symp Proc", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1942-597X", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 18999024 \nPMCID: PMC2655980", "tags": [ { "tag": "Artificial Intelligence", "type": 1 }, { "tag": "Forms and Records Control", "type": 1 }, { "tag": "Information Storage and Retrieval", "type": 1 }, { "tag": "Medical Records Systems, Computerized", "type": 1 }, { "tag": "Natural language processing", "type": 1 }, { "tag": "Patient-Centered Care", "type": 1 }, { "tag": "Pattern Recognition, Automated", "type": 1 }, { "tag": "Questionnaires", "type": 1 }, { "tag": "Systems Integration", "type": 1 }, { "tag": "United States", "type": 1 }, { "tag": "User-Computer Interface", "type": 1 }, { "tag": "patient centered care" } ], "collections": [ "C2XMTZI4" ], "relations": { "owl:sameAs": "http://zotero.org/groups/284130/items/C5Z8BAKG" }, "dateAdded": "2014-12-12T15:58:40Z", "dateModified": "2014-12-12T15:58:40Z" } }, { "key": "KGQBKRWF", "version": 2, "library": { "type": "group", "id": 313787, "name": "Learning Health System Journal Club (public)", "links": { "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/313787/items/KGQBKRWF", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public/items/KGQBKRWF", "type": "text/html" } }, "meta": { "createdByUser": { "id": 665508, "username": "brokenjade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/brokenjade", "type": "text/html" } } }, "creatorSummary": "Snyder et al.", "parsedDate": "2011-08", "numChildren": 2 }, "data": { "key": "KGQBKRWF", "version": 2, "itemType": "journalArticle", "title": "The role of informatics in promoting patient-centered care", "creators": [ { "creatorType": "author", "firstName": "Claire F.", "lastName": "Snyder" }, { "creatorType": "author", "firstName": "Albert W.", "lastName": "Wu" }, { "creatorType": "author", "firstName": "Robert S.", "lastName": "Miller" }, { "creatorType": "author", "firstName": "Roxanne E.", "lastName": "Jensen" }, { "creatorType": "author", "firstName": "Elissa T.", "lastName": "Bantug" }, { "creatorType": "author", "firstName": "Antonio C.", "lastName": "Wolff" } ], "abstractNote": "Patient-centered care is an important aspect of high-quality care. Health informatics, particularly advances in technology, has the potential to facilitate, or detract from, patient-centered cancer care. Informatics can provide a mechanism for patients to provide their clinician(s) with critical information and to share information with family, friends, and other patients. This information may enable patients to exert greater control over their own care. Clinicians may use information systems (e.g., electronic medical records) to coordinate care and share information with other clinicians. Patients and clinicians may use communication tools and information resources to interact with one another in new ways. Caution in using new information resources is warranted to avoid reliance on biased or inappropriate data, and clinicians may need to direct patients to appropriate information resources. Perhaps the greatest challenge for both patients and providers is identifying information that is high quality and that enhances (and does not impede) their interactions.", "publicationTitle": "Cancer Journal (Sudbury, Mass.)", "publisher": "", "place": "", "date": "2011 Jul-Aug", "volume": "17", "issue": "4", "section": "", "partNumber": "", "partTitle": "", "pages": "211-218", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Cancer J", "DOI": "10.1097/PPO.0b013e318225ff89", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1540-336X", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 21799327 \nPMCID: PMC3146983", "tags": [ { "tag": "Electronic Health Records", "type": 1 }, { "tag": "Health Personnel", "type": 1 }, { "tag": "Internet", "type": 1 }, { "tag": "Medical Informatics", "type": 1 }, { "tag": "Medical Records 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"alternate": { "href": "https://www.zotero.org/brokenjade", "type": "text/html" } } }, "creatorSummary": "Care and Initiative", "parsedDate": "2013", "numChildren": 1 }, "data": { "key": "8J8HS49G", "version": 2, "itemType": "journalArticle", "title": "AHRQ Health Information Technology Ambulatory Safety and Quality", "creators": [ { "creatorType": "author", "firstName": "Patient-Centered", "lastName": "Care" }, { "creatorType": "author", "firstName": "Grant", "lastName": "Initiative" } ], "abstractNote": "", "publicationTitle": "", "publisher": "", "place": "", "date": "2013", "volume": "", "issue": "", "section": "", "partNumber": "", "partTitle": "", "pages": "", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "", "DOI": "", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "Google Scholar", "callNumber": "", "rights": "", "extra": 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"https://www.zotero.org/groups/learning_health_system_journal_club_public/items/7BU2BS3J", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/313787/items/B9XDW5W7", "type": "application/json" } }, "meta": { "createdByUser": { "id": 665508, "username": "brokenjade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/brokenjade", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "7BU2BS3J", "version": 2, "parentItem": "B9XDW5W7", "itemType": "note", "note": "Summary by Casey Rommel
\nThis article was meant to show the state of patient-centered care in cardiovascular medicine in 2009. The authors note a few features that are essential to Patient-Centered Care. They include but are not limited to enhanced clinician-patient communication, health literacy, clinician-directed patient education, assessment of patient-centered outcomes, shared decision-making, collaborative care planning, collaborative goal setting, and patient empowerment and self-management. In this statement they note the importance of sharing information, creating medical homes, and compensating clinicians correctly.
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\nThis paper introduces a prototype system that enables patients’ entry for some of clinical data, such as 5-item asthma survey. The authors provide a detailed discussion about how they made the choices to set up the technical architecture. Main considerations includes: simplicity, standard compatibility, accessibility, technical limitation. Nearly half the issues are related to their local technical limitations. Thus their final choices might not be generalizable to other similar system design / development.
\nThe high light of this paper is that they implemented the connection between the prototype system and the VA EMR system. With new data entered, notification message will be shown on EMR interface. They proposed some future work such as evaluation, patient authentication. If there are some user feedback, the study could be a very good reference paper for future research. I am particularly interested in how the doctors think about the prototype: does it work? does it helps? do they like it in their real work? However, I didn’t find any following up study.
", "tags": [], "relations": { "owl:sameAs": "http://zotero.org/groups/284130/items/5XC5ZTCM" }, "dateAdded": "2014-12-12T15:58:40Z", "dateModified": "2014-12-12T15:58:40Z" } }, { "key": "Z7ZBSXJH", "version": 2, "library": { "type": "group", "id": 313787, "name": "Learning Health System Journal Club (public)", "links": { "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/313787/items/Z7ZBSXJH", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public/items/Z7ZBSXJH", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/313787/items/HQUZZGJS", "type": "application/json" } }, "meta": { "createdByUser": { "id": 665508, "username": "brokenjade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/brokenjade", "type": "text/html" } } } }, "data": { "key": "Z7ZBSXJH", "version": 2, "parentItem": "HQUZZGJS", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2014-12-05T06:50:01Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/22866953", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": { "owl:sameAs": "http://zotero.org/groups/284130/items/NMPWGB8B" }, "dateAdded": "2014-12-12T15:58:40Z", "dateModified": "2014-12-12T15:58:40Z" } }, { "key": "RZHPER5B", "version": 2, "library": { "type": "group", "id": 313787, "name": "Learning Health System Journal Club (public)", "links": { "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/313787/items/RZHPER5B", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public/items/RZHPER5B", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/313787/items/KGQBKRWF", "type": "application/json" } }, "meta": { "createdByUser": { "id": 665508, "username": "brokenjade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/brokenjade", "type": "text/html" } } } }, "data": { "key": "RZHPER5B", "version": 2, "parentItem": "KGQBKRWF", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2014-12-05T06:49:25Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/21799327", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": { "owl:sameAs": "http://zotero.org/groups/284130/items/CR4UTNCV" }, "dateAdded": "2014-12-12T15:58:40Z", "dateModified": "2014-12-12T15:58:40Z" } }, { "key": "VZCJAZA6", "version": 2, "library": { "type": "group", "id": 313787, "name": "Learning Health System Journal Club (public)", "links": { "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/313787/items/VZCJAZA6", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public/items/VZCJAZA6", "type": "text/html" } }, "meta": { "createdByUser": { "id": 665508, "username": "brokenjade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/brokenjade", "type": "text/html" } } }, "creatorSummary": "Reti et al.", "parsedDate": "2010-04", "numChildren": 2 }, "data": { "key": "VZCJAZA6", "version": 2, "itemType": "journalArticle", "title": "Improving personal health records for patient-centered care", "creators": [ { "creatorType": "author", "firstName": "Shane R.", "lastName": "Reti" }, { "creatorType": "author", "firstName": "Henry J.", "lastName": "Feldman" }, { "creatorType": "author", "firstName": "Stephen E.", "lastName": "Ross" }, { "creatorType": "author", "firstName": "Charles", "lastName": "Safran" } ], "abstractNote": "OBJECTIVE: To assess the patient-centeredness of personal health records (PHR) and offer recommendations for best practice guidelines.\nDESIGN: Semi-structured interviews were conducted in seven large early PHR adopter organizations in 2007. Organizations were purposively selected to represent a variety of US settings, including medium and large hospitals, ambulatory care facilities, insurers and health plans, government departments, and commercial sectors.\nMEASUREMENTS: Patient-centeredness was assessed against a framework of care that includes: (1) respect for patient values, preferences, and expressed needs; (2) information and education; (3) access to care; (4) emotional support to relieve fear and anxiety; (5) involvement of family and friends; (6) continuity and secure transition between healthcare providers; (7) physical comfort; (8) coordination of care. Within this framework we used evidence for patient preferences (where it exists) to compare existing PHR policies, and propose a best practice model.\nRESULTS: Most organizations enable many patient-centered functions such as data access for proxies and minors. No organization allows patient views of clinical progress notes, and turnaround times for PHR reporting of normal laboratory results can be up to 7 days.\nCONCLUSION: Findings suggest patient-centeredness for personal health records can be improved, and recommendations are made for best practice guidelines.", "publicationTitle": "Journal of the American Medical Informatics Association: JAMIA", "publisher": "", "place": "", "date": "2010 Mar-Apr", "volume": "17", "issue": "2", "section": "", "partNumber": "", "partTitle": "", "pages": "192-195", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "J Am Med Inform Assoc", "DOI": "10.1136/jamia.2009.000927", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1527-974X", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 20190063 \nPMCID: PMC3000780", "tags": [ { "tag": "Benchmarking", "type": 1 }, { "tag": "Continuity of Patient Care", "type": 1 }, { "tag": "Health Care Surveys", "type": 1 }, { "tag": "Health Records, Personal", "type": 1 }, { "tag": "Patient Preference", "type": 1 }, { "tag": "Patient-Centered Care", "type": 1 }, { "tag": "United States", "type": 1 }, { "tag": "patient centered care" } ], "collections": [ "C2XMTZI4" ], "relations": { "owl:sameAs": "http://zotero.org/groups/284130/items/MZGZFIEQ" }, "dateAdded": "2014-12-12T15:58:40Z", "dateModified": "2014-12-12T15:58:40Z" } }, { "key": "B9XDW5W7", "version": 2, "library": { "type": "group", "id": 313787, "name": "Learning Health System Journal Club (public)", "links": { "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/313787/items/B9XDW5W7", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public/items/B9XDW5W7", "type": "text/html" } }, "meta": { "createdByUser": { "id": 665508, "username": "brokenjade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/brokenjade", "type": "text/html" } } }, "creatorSummary": "Norine Walsh et al.", "parsedDate": "2012-06-05", "numChildren": 1 }, "data": { "key": "B9XDW5W7", "version": 2, "itemType": "journalArticle", "title": "ACCF 2012 Health Policy Statement on Patient-Centered Care in Cardiovascular MedicineA Report of the American College of Cardiology Foundation Clinical Quality Committee", "creators": [ { "creatorType": "author", "firstName": "Mary", "lastName": "Norine Walsh" }, { "creatorType": "author", "firstName": "Alfred A.", "lastName": "Bove" }, { "creatorType": "author", "firstName": "Russell R.", "lastName": "Cross" }, { "creatorType": "author", "firstName": "Keith C.", "lastName": "Ferdinand" }, { "creatorType": "author", "firstName": "Daniel E.", "lastName": "Forman" }, { "creatorType": "author", "firstName": "Andrew M.", "lastName": "Freeman" }, { "creatorType": "author", "firstName": "Suzanne", "lastName": "Hughes" }, { "creatorType": "author", "firstName": "Elizabeth", "lastName": "Klodas" }, { "creatorType": "author", "firstName": "Michelle", "lastName": "Koplan" }, { "creatorType": "author", "firstName": "William R.", "lastName": "Lewis" }, { "creatorType": "author", "firstName": "Brian", "lastName": "MacDonnell" }, { "creatorType": "author", "firstName": "David C.", "lastName": "May" }, { "creatorType": "author", "firstName": "Joseph V.", "lastName": "Messer" }, { "creatorType": "author", "firstName": "Susan J.", "lastName": "Pressler" }, { "creatorType": "author", "firstName": "Mark L.", "lastName": "Sanz" }, { "creatorType": "author", "firstName": "John A.", "lastName": "Spertus" }, { "creatorType": "author", "firstName": "Sarah A.", "lastName": "Spinler" }, { "creatorType": "author", "firstName": "Louis", "lastName": "Evan Teichholz" }, { "creatorType": "author", "firstName": "John B.", "lastName": "Wong" }, { "creatorType": "author", "firstName": "Katherine", "lastName": "Doermann Byrd" } ], "abstractNote": "", "publicationTitle": "Journal of the American College of Cardiology", "publisher": "", "place": "", "date": "June 5, 2012", "volume": "59", "issue": "23", "section": "", "partNumber": "", "partTitle": "", "pages": "2125-2143", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Journal of the American College of Cardiology", "DOI": "10.1016/j.jacc.2012.03.016", "citationKey": "", "url": "http://dx.doi.org/10.1016/j.jacc.2012.03.016", "accessDate": "2014-12-05T07:02:10Z", "PMID": "", "PMCID": "", "ISSN": "0735-1097", "archive": "", "archiveLocation": "", "shortTitle": "", "language": "", "libraryCatalog": "Silverchair", "callNumber": "", "rights": "", "extra": "", "tags": [ { "tag": "Health Policy", "type": 1 }, { "tag": "Patient-Centered Care", "type": 1 }, { "tag": "american college of cardiology", "type": 1 }, { "tag": "cardiovascular diseases", "type": 1 }, { "tag": "patient centered care" }, { "tag": "self-management", "type": 1 } ], "collections": [ "C2XMTZI4" ], "relations": { "owl:sameAs": "http://zotero.org/groups/284130/items/RM6UFHN5" }, "dateAdded": "2014-12-12T15:58:40Z", "dateModified": "2014-12-12T15:58:40Z" } }, { "key": "HQUZZGJS", "version": 2, "library": { "type": "group", "id": 313787, "name": "Learning Health System Journal Club (public)", "links": { "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/313787/items/HQUZZGJS", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public/items/HQUZZGJS", "type": "text/html" } }, "meta": { "createdByUser": { "id": 665508, "username": "brokenjade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/brokenjade", "type": "text/html" } } }, "creatorSummary": "Chunchu et al.", "parsedDate": "2012-09", "numChildren": 2 }, "data": { "key": "HQUZZGJS", "version": 2, "itemType": "journalArticle", "title": "A patient centered care plan in the EHR: improving collaboration and engagement", "creators": [ { "creatorType": "author", "firstName": "Kavitha", "lastName": "Chunchu" }, { "creatorType": "author", "firstName": "Larry", "lastName": "Mauksch" }, { "creatorType": "author", "firstName": "Carol", "lastName": "Charles" }, { "creatorType": "author", "firstName": "Valerie", "lastName": "Ross" }, { "creatorType": "author", "firstName": "Judith", "lastName": "Pauwels" } ], "abstractNote": "Patients attempting to manage their chronic conditions require ongoing support in changing and adopting self-management behaviors. However, patient values, health goals, and action plans are not well represented in the electronic health record (EHR) impeding the ability of the team (MA and providers) to provide respectful, ongoing self-management support. We evaluated whether a team approach to using an EHR based patient centered care plan (PCCP) improved collaborative self-management planning. An experimental, prospective cohort study was conducted in a family medicine residency clinic. The experimental group included 7 physicians and a medical assistant who received 2 hr of PCCP training. The control group consisted of 7 physicians and a medical assistant. EHR charts were analyzed for evidence of 8 behavior change elements. Follow-up interviews with experimental group patients and physicians and the medical assistant assessed their experiences. We found that PCCP charts had more documented behavior change elements than control charts in all 8 domains (p < .001). Experimental group physicians valued the PCCP model and suggested ways to improve its use. Patient feedback demonstrated support for the model. A PCCP can help team members to engage patients with chronic illnesses in goal setting and action planning to support self-management. An EHR design that stores patient values, health goals, and action plans may strengthen continuity and quality of care between patients and primary care team members. (PsycINFO Database Record (c) 2012 APA, all rights reserved).", "publicationTitle": "Families, Systems & Health: The Journal of Collaborative Family Healthcare", "publisher": "", "place": "", "date": "Sep 2012", "volume": "30", "issue": "3", "section": "", "partNumber": "", "partTitle": "", "pages": "199-209", "series": "", "seriesTitle": "", "seriesText": "", "journalAbbreviation": "Fam Syst Health", "DOI": "10.1037/a0029100", "citationKey": "", "url": "", "accessDate": "", "PMID": "", "PMCID": "", "ISSN": "1939-0602", "archive": "", "archiveLocation": "", "shortTitle": "A patient centered care plan in the EHR", "language": "eng", "libraryCatalog": "NCBI PubMed", "callNumber": "", "rights": "", "extra": "PMID: 22866953", "tags": [ { "tag": "Chi-Square Distribution", "type": 1 }, { "tag": "Cooperative Behavior", "type": 1 }, { "tag": "Electronic Health Records", "type": 1 }, { "tag": "Patient Care Planning", "type": 1 }, { "tag": "Patient-Centered Care", "type": 1 }, { "tag": "Physician-Patient Relations", "type": 1 }, { "tag": "Physicians, Primary Care", "type": 1 }, { "tag": "Pilot Projects", "type": 1 }, { "tag": "Problem Solving", "type": 1 }, { "tag": "Prospective Studies", "type": 1 }, { "tag": "Self Care", "type": 1 }, { "tag": "Young Adult", "type": 1 }, { "tag": "patient centered care" } ], "collections": [ "C2XMTZI4" ], "relations": { "owl:sameAs": "http://zotero.org/groups/284130/items/XJAV3RD6" }, "dateAdded": "2014-12-12T15:58:40Z", "dateModified": "2014-12-12T15:58:40Z" } }, { "key": "7CPT9ZKC", "version": 2, "library": { "type": "group", "id": 313787, "name": "Learning Health System Journal Club (public)", "links": { "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/313787/items/7CPT9ZKC", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public/items/7CPT9ZKC", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/313787/items/239R2JT2", "type": "application/json" } }, "meta": { "createdByUser": { "id": 665508, "username": "brokenjade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/brokenjade", "type": "text/html" } } } }, "data": { "key": "7CPT9ZKC", "version": 2, "parentItem": "239R2JT2", "itemType": "attachment", "linkMode": "linked_url", "title": "PubMed entry", "accessDate": "2014-12-05T06:40:33Z", "url": "http://www.ncbi.nlm.nih.gov/pubmed/20132341", "note": "", "contentType": "text/html", "charset": "", "tags": [], "relations": { "owl:sameAs": "http://zotero.org/groups/284130/items/DFRPXWV8" }, "dateAdded": "2014-12-12T15:58:36Z", "dateModified": "2014-12-12T15:58:36Z" } }, { "key": "ZJ4H782J", "version": 2, "library": { "type": "group", "id": 313787, "name": "Learning Health System Journal Club (public)", "links": { "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/313787/items/ZJ4H782J", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public/items/ZJ4H782J", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/313787/items/239R2JT2", "type": "application/json" } }, "meta": { "createdByUser": { "id": 665508, "username": "brokenjade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/brokenjade", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "ZJ4H782J", "version": 2, "parentItem": "239R2JT2", "itemType": "note", "note": "Summary by Teresa Taft
\nThis article reports on a logistic regression model developed to predict future healthcare expenditures. A patient's having a higher number of chronic conditions was the most significant factor associated with higher healthcare costs. Patient reported incidence of chronic conditions is almost as good an indicator of future health costs as administrative data. Once identified, these patients may receive additional health management support and the effectiveness of these interventions, in reducing health care costs and improving outcomes, may be evaluated.
\nThe study only looked at the self reported incidence of six conditions, therefore, the generalizability of this study to other conditions needs further investigation.
", "tags": [], "relations": { "owl:sameAs": "http://zotero.org/groups/284130/items/NBHX5J5T" }, "dateAdded": "2014-12-12T15:58:36Z", "dateModified": "2014-12-12T15:58:36Z" } }, { "key": "EBGJTUQX", "version": 2, "library": { "type": "group", "id": 313787, "name": "Learning Health System Journal Club (public)", "links": { "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public", "type": "text/html" } } }, "links": { "self": { "href": "https://api.zotero.org/groups/313787/items/EBGJTUQX", "type": "application/json" }, "alternate": { "href": "https://www.zotero.org/groups/learning_health_system_journal_club_public/items/EBGJTUQX", "type": "text/html" }, "up": { "href": "https://api.zotero.org/groups/313787/items/TTVH2Q63", "type": "application/json" } }, "meta": { "createdByUser": { "id": 665508, "username": "brokenjade", "name": "", "links": { "alternate": { "href": "https://www.zotero.org/brokenjade", "type": "text/html" } } }, "numChildren": 0 }, "data": { "key": "EBGJTUQX", "version": 2, "parentItem": "TTVH2Q63", "itemType": "note", "note": "Summary by Casey Rommel
\nThis study uses a quasi-experimental design to review the financial impact over two years of the implementation of an electronic health record (EHR) system. The study took baseline measurements of the 30 practices being studied in the year prior to implementation of an EHR system. The implementation of the EHR had a significant negative impact on the productivity of the practices. The physicians saw less patients than they had prior to the implementation of the EHR. On the other side, the practices had significantly higher reimbursement rates after implementing the electronic medical record system. Physicians had a limited amount of time to devote to learning the new system and there were outside factors that potentially created some bias and limitations. The article’s generalizability is limited by only being completed in a single academic institution and being quasi-experimental there was no random assignment.
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\nIn Dranove’s paper for the National Bureau of Economic Research, the professor and his colleagues at the Kellogg School of Management investigate the effects of HITECH subsidization funds on national EHR adoption rates, and argue that without the stimulus, it would have taken hospitals two years longer for the percentage of EHR adoption to move from 48% in 2008 to the 77% found in 2011. The authors question whether the subsidies encouraged adoption by hospitals that would not have otherwise purchased EHR systems, or if the subsidies simply shifted the rate of adoption by hospitals that would have done so regardless of government financial incentives. The authors do not conclude that the incentive encouraged hospitals that would not have otherwise adopted, but state that the incentive simply increased the adoption rate. The authors point out that adoption of EHR systems after HITECH includes hospitals that already had EHR systems, and therefore they estimate the incremental cost of adoption by marginal adopters at $48 million per hospital. The authors of the article do not investigate advancements in EHR technology spurred by Meaningful Use or the HITECH act incentives, but it is reasonable to think that the mandate had an effect on EHR products, and that such advancements were additional incentives for adopters. The authors also do not investigate the spillover effect of an increased adoption rate of EHRs that meet Meaningful Use. Such spillover might include the lowering of regional costs to hospitals by increasing HIE facility.
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