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Kaiser Permanente’s Joint Replacement Registry Improves Patient Outcomes While Reducing Costs

Within the US, over 600,000 total hip and total knee replacements are performed each year. By the year 2030, that number is projected to exceed 4 million. Annual hospital costs associated with these procedures are projected to exceed $65 billion by 2015. The projected increases in the demand for total joint replacements and the costs associated with these procedures will challenge our already overburdened US health care system. Kaiser Permanante’s Total Joint Replacement Registry helps its surgeons and patients make informed decisions about which implant to use or in which patients the risks and potential costs of failure make surgery unwise.


Excerpted from The Permanente Journal article:

“Within the US, over 600,000 total hip and total knee replacements are performed each year. By the year 2030, that number is projected to exceed 4 million. Annual hospital costs associated with these procedures are projected to exceed $65 billion by 2015. Although patients who undergo total joint arthroplasty (TJA) are often of retirement age, recent studies have shown that patients below age 65 represent 35-45% of all TJA recipients in the US. As TJA is marketed more as a lifestyle operation than as a final option to retain mobility for end-stage arthritis, the proportion of patients below age 65 may increase.

The projected increases in TJA demand and the costs associated with these procedures will challenge our already overburdened US health care system. One potential method to address this pending crisis is through comparative safety and clinical effectiveness research aimed at reducing the need for TJA revision surgery. Registries are one example of clinical effectiveness studies that can help surgeons and patients make informed decisions about which implant to use or in which patients the risks and potential costs of failure make surgery unwise. These studies can also identify the relative value of TJA over alternative treatments or the effectiveness of one implant brand or design over another. Although implants vary widely in cost, there is little evidence to support the use of new, more expensive designs instead of more established, traditional designs.

The goals of the Kaiser Permanente (KP) Total Joint Replacement Registry (TJRR) are: 1) to monitor revision, failure, and rates of key complications (e.g., infection, venous thromboembolic disease such as blood clots and embolism, and mortality); 2) to identify patients at risk for poor clinical outcomes following TJA; 3) to identify the most effective techniques and implant devices (best practices and implant constructs); 4) to track implant usage and costs; and 5) to monitor and to support implant recalls and advisories in cooperation with the US Food and Drug Administration.”

Link to full journal article: http://xnet.kp.org/permanentejournal/sum08/joint-replacement.html

Keywords: clinical effectiveness, total hip replacements, total knee replacements, joint replacement, total joint replacement registry, total joint arthroplasty, TJA, Kaiser Permanente, KP, Southern California, registries

For More Information:

Jean Sud
Senior Manager, Public Policy & Communications
Kaiser Permanente, The Permanente Federation
1 Kaiser Plaza
Oakland, CA 94612
tel. 510.271.6317
Jean.L.Sud@kp.org
www.kaiserpermanente.org

Information Technology Supported Care Teams Significantly Improve Care for Patients with Heart Disease

Kaiser Permanente Colorado has significantly reduced the mortality rate for patients with heart disease, which is the nation’s number one killer for both women and men. Using team-based medical best practices and computer-supported care registries, doctors and clinical care teams reduced overall mortality by 76 percent and cardiac mortality by 73 percent. Coronary Artery Disease is the dangerous buildup of plaque inside the coronary arteries. Cardiac mortality refers to all deaths related to heart events.


Excerpt from Kaiser Permanente case study:
http://xnet.kp.org/future/ahrstudy/032709cardiac.html

“Kaiser Permanente Colorado has significantly reduced the mortality rate for patients with heart disease, which is the nation’s number one killer for both women and men. Using team-based medical best practices and computer-supported care registries, doctors and clinical care teams reduced overall mortality by 76 percent and cardiac mortality by 73 percent. Coronary Artery Disease is the dangerous buildup of plaque inside the coronary arteries. Cardiac mortality refers to all deaths related to heart events.

The ability of clinical care teams to coordinate their efforts in cardiac care is greatly enhanced by the availability of electronic health information—which provides instant access to patient information—and evidence-based clinical care guidelines and protocols.”

Keywords: CAD, care coordination, care teams, cardiac care program, chronic care, collaborative care, colorado, communication, coronary artery disease, electronic medical record, evidence-based medicine, health information technology, integrated care, Kaiser Permanente, KP Healthconnect, patient support, population health, preventive care, safety, treatment, value

FOR MORE INFORMATION:

Jean Sud
Senior Manager, Public Policy & Communications
Kaiser Permanente, The Permanente Federation
1 Kaiser Plaza
Oakland, CA 94612
tel. 510.271.6317
Jean.L.Sud@kp.org
www.kaiserpermanente.org

Depression Care Curbs Rate of Suicides at Henry Ford

A quality improvement initiative for the Health Alliance Plan members who receive care at Henry Ford Medical Group resulted in dramatically bringing down the rate of suicide in its 200,000 patient population. Over 9 consecutive quarters, there were no suicides among the patients of the Perfect Depression Care Program of the Behavioral Health Services division of Henry Ford, in stark contrast to the 230 suicides expected in an average population of 100,000. The goal of the initiative was to completely redesign care delivery around the six aims outlined in the Institute of Medicine’s Crossing the Quality Chasm report–safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity—in order to reduce the number of suicides to zero. The belief held by the program is that perfect depression care would result in no suicides—not just a reduced risk of suicide.


Excerpted from:
Depression Care Effort Brings Dramatic Drop in Large HMO Population’s Suicide Rate
Tracy Hampton, PhD
JAMA. 2010;303(19):1903-1905.
http://jama.ama-assn.org/content/303/19/1903.extract

“While physicians and other health care workers may not be ableto predict which of their patients will attempt suicide, theycan implement preventive strategies that markedly lower therisk of such tragedies. Now, one pioneering program has demonstratedthe importance of pursuing 2 key approaches at once: carefullyassessing patients for risk of suicide and adopting measuresto reduce the likelihood that a patient will attempt suicide.

The example comes from a quality-improvement initiative that succeeded in substantially bringing down the rate of suicide in a population of about 200 000 members of a large health maintenance organization (HMO). Through the second quarter of last year, the Perfect Depression Care program of the Behavioral Health Services (BHS) division of the Henry Ford Health System resulted in 9 consecutive quarters without any suicides, a dramatic contrast to the annual rate of 89 suicides per 100,000 members at baseline and approximately 230 suicides per 100,000 individuals expected in a patient population . . .”

Keywords: care team; depression; Henry Ford Health System; Michigan; Perfect Depression Care Program; prevention; quality improvement; rate of suicide;

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel.313-876-8709
Dangell1@hfhs.org
www.henryfordhealth.org

Diabetic Care Management at Intermountain Healthcare

Diabetes is the sixth leading cause of death by disease in the US. But caring for diabetic patients is remarkably simple. Most health care providers understand what needs to be done to keep diabetics well, but it is difficult and time-intensive to get the patient to participate in the process — and it’s easy for things to fall through the cracks. To care effectively for diabetic patients, a care management model must be put in place and followed consistently in order to keep diabetic patients healthy. Intermountain Healthcare’s system makes it easier for the health provider and the patient to do the right thing.


Diabetic Care Management at Intermountain Healthcare Diabetes is the sixth leading cause of death by disease in the US. But caring for diabetic patients is remarkably simple. Most health providers understand what needs to be done to keep diabetics well, but it is difficult and time-intensive to get the patient to participate in the process — and it’s easy for things to fall through the cracks. To care effectively for diabetic patients, a care management model must be put in place and followed consistently in order to keep diabetic patients healthy. Here’s how Intermountain Healthcare does it:

  1. When a diabetic patient is identified (in one of its 140 clinics, 21 hospitals, or among its 400,000 health plan members), this is noted in Intermountain’s advanced computerized electronic patient record.
  2. This electronic record then follows the patient wherever they go in the Intermountain system and identifies them to caregivers as diabetic.
  3. Patient education is provided in the physician office as well as in regular, consistent mailings. Care managers (typically nurses) are assigned to help individual diabetic patients and make outreach phone calls.
  4. Most of Intermountain’s hospitals and large clinics offer diabetic education classes as well as diabetic educators who visit the patients in their hospital room. There are multiple Diabetes Education Centers that have more than 20,000 patient visits each year.
  5. Patients are strongly encouraged and frequently reminded to get tests and screenings related to their diabetes. This helps them keep their blood sugar in control and avoid other complications.
  6. Intermountain’s health plan sends quarterly diabetes reports to physician offices listing the names, screening statuses, and lab results of diabetic patients. If patients have not been filling their diabetic medication prescriptions, the physician is notified so he can follow up with the patient. This report also allows physicians to see how his/her diabetes patient management compares to other physicians.
  7. Clinical teams of physicians, nurses, pharmacists, diabetes educators, and computer specialists meet monthly to measure and refine the process.

How does diabetic care at Intermountain compare to the U.S.? Two examples:

  • Intermountain ranks above the national average in getting patients to do annual extensive HbA1c (blood sugar) testing, with 90 percent participating appropriately.
  • Only 22 percent of Intermountain patients have poor HbA1c control compared to the national average of 29 percent. Poor control can contribute to a variety of other health problems.

It’s important to note that it’s unlikely any health care organization will achieve perfection. Much of this process depends on personal involvement by the patient, and some patients are more motivated than others.

Keywords:care teams, care management, care coordination, communication, diabetes, electronic medical record, EMR, evidence-based medicine, health information technology, Intermountain Healthcare, Salt Lake City, Utah, safety, treatment, value

FOR MORE INFORMATION:

Dave Green
Communications Manager
Intermountain Healthcare
36 South State Street
Salt Lake City, UT 8411
tel. 801.442.2844
dave.green@ihc.com
www.ihc.com

TeleStroke: Using Technology to Facilitate Care

Approximately 60 percent of stroke patients access their initial medical care within three hours of the onset of symptoms. The TeleStroke program of Cleveland Clinic is a distance health application that will address the issues surrounding time-critical therapeutic intervention.

TeleStroke uses videoconferencing and image transfer to connect Cleveland Clinic stroke specialists with stroke patients located within a 200-mile radius of Cleveland. The TeleStroke program provides 24/7 professional consults to bedside physicians at outlying hospitals for diagnosis and recommendation for treatment and/or transfer. When necessary, these consults — in coordination with existing staff and critical care transport — may result in transfers to Cleveland Clinic for a range of stroke interventions not available at most regional hospitals.

The well-coordinated operations between specialists at Cleveland Clinic and the frontline physicians at regional hospitals are key to the program’s success.Stroke is a significant medical burden, ranking as the third leading cause of death in the U.S. and the leading cause of long-term disability, with more than 700,000 strokes in the U.S. per year. However, significant barriers slow treatment to a large number of patients with non-hemorrhagic stroke: emergency room physicians and non-stroke neurologists are reluctant to administer the proper medicine due to potential complications; and a shortage of neurologists delays acute and consultative care. Therefore, TeleStroke provides an urgent and compelling alternative to having a stroke neurologist always present at the bedside for treatment of acute strokes.

Keywords: access,coordinated care, Cleveland Clinic, Ohio, stroke, telemedicine

FOR MORE INFORMATION:

Megan Pruce
Senior Manager, Communications & Public Affairs
Cleveland Clinic
tel. 216- 445-7452
prucem@ccf.org
www.clevelandclinic.org @ccf.org

Controlling Elective Inductions at Intermountain Brings Benefits to Mothers and Newborns

A few years ago, Intermountain noticed a striking trend that was part of a larger national phenomenon. Women and their doctors were more frequently choosing to induce labor and increasingly, those inductions were happening at 37 or 38 weeks gestational age. Intermountain’s medical research team was concerned that early inductions might have negative health consequences for babies and moms. Armed with statistical information from their own hospitals and using standards from the American College of Obstetrics and Gynecologists, Intermountain instituted a new guideline to limit labor inductions before 39 weeks unless a consulting physician agreed that an earlier induction was medically necessary. Today, there is strong support for the best practice protocol throughout all of Intermountain’s labor and delivery units.


Elective Inductions

Utah has the highest birthrate in the nation, so it may not be surprising that close to 33,000 babies are delivered every year at Intermountain Healthcare, a Salt Lake City-based system of nonprofit hospitals and clinics. In fact, labor and delivery is the most common admission for Intermountain’s 18 hospitals that offer the service. But beyond delivering lots of babies, Intermountain Healthcare also has a national reputation for quality improvement efforts, which are supported by a sophisticated electronic medical record system.

A few years ago, Intermountain noticed a striking trend that was part of a larger national phenomenon. Women and their doctors were more frequently choosing to induce labor and increasingly, those inductions were happening at 37 or 38 weeks gestational age. Intermountain’s medical research team was concerned that early inductions might have negative health consequences for babies and moms. When they analyzed the data from births at Intermountain’s hospitals, they found that women who deliver before babies reach 39 weeks gestational age tend to have longer and more complicated deliveries. Researchers also found a statistically significant increase in the number of newborns with medical complications.

Specifically, the data showed that of babies delivered at 37 weeks gestational age, 8.85 percent were admitted to the neonatal intensive care unit. The number dropped to 4.51 percent of babies delivered at 38 weeks and then bottomed out to 3.34 percent at 39 weeks. The percentage of NICU admissions climbs slowly for babies born at 40 weeks gestational age and beyond. So according to Intermountain’s statistics, hitting the magic 39-week mark seemed to significantly cut the chances of a baby being sent to the NICU.

But that wasn’t all the research found. Babies also were more likely to struggle with respiratory distress syndrome if physicians electively induced labor before 39 weeks. The data showed that if delivery occurs at 37 weeks, 1.92 percent of babies were affected. At 38 weeks the percentage drops to .68 percent and bottoms out at .42 percent at 39 weeks, before slightly climbing again at 40 weeks. The need for newborns to be on a ventilator was also significantly reduced if delivery occurred at 39 weeks gestational age.

Armed with statistical information from their own hospitals and using standards from the American College of Obstetrics and Gynecologists, Intermountain instituted a new guideline to limit labor inductions before 39 weeks unless a consulting physician agreed that an earlier induction was medically necessary. Today, there is strong support for the best practice protocol throughout all of Intermountain’s labor and delivery units.

In 1999, approximately 28 percent of all inductions at Intermountain’s hospitals occurred before 39 weeks. Today, that percentage is near two percent. And with the significant drop in early elective inductions, Intermountain has also seen a 90-minute drop in the average length of labor in electively induced patients, with fewer cesarean sections (about 21 percent compared to the national average of 31 percent) and other medical complications associated with deliveries. The guidelines benefit new babies and their moms. And as icing on the cake, the protocol has also saved patients millions each year.

Keywords: early elective inductions, evidence-based medicine, labor and delivery, labor induction, Intermountain Healthcare, neonatal, NICU, quality improvement, Salt Lake City, Utah, safety, treatment, value

FOR MORE INFORMATION:

Dave Green
Communications Manager
Intermountain Healthcare
36 South State Street
Salt Lake City, UT 84111
tel. 801.442.2844
dave.green@ihc.com
www.ihc.com

HomeCare Program Delivers Coordinated Care to High Risk Patients at Home

HealthCare Partners believed that high risk patients could have better medical outcomes if cared for in a home setting using an interdisciplinary team approach that focuses on both the patient and his/her family and caregivers. To better care for its highest risk patients, HealthCare Partners Medical Group implemented a HomeCare Program in 2008. The program uses an interdisciplinary team approach to provide coordinated care to patients, with a focus on including the patient’s family and caregivers. The goal of the program is to improve the quality of life and clinical outcomes for homebound and other high risk patients.

Patients are referred into the HomeCare Program by our primary care physicians, hospitalists, and specialists. To identify the initial group of patients to be seen as part of the HomeCare Program, HealthCare Partners also used a health plan stratification tool. The target population may not always be physically homebound, but may have complex psycho-social needs that require in-home management.

Services and goals of the HomeCare Program may include acute medical management after a hospitalization or skilled nursing facility stay, management of chronic medical conditions, assistance with complex social situations, advanced care planning, and a change in living arrangements for some patients.

The program’s current staffing model includes two physicians, two nurse practitioners, one social worker, and two medical assistants to manage a panel of approximately 360-400 patients. A clinician initially sees each patient for a 90-minute consultation, and then the patient is seen monthly on a routine basis, and urgently as needed. Patients, families, and referring physicians are given 24/7 direct telephone access to the HomeCare team.

Clinicians are able to complete medical record documentation in the patient’s home using a laptop with a wireless connection to our Electronic Medical Record system. The HomeCare team holds weekly meetings to review patient status, treatment, and progress, and to determine follow-up needs. Pharmacists, geriatricians, and behavioral health providers participate in the team meetings as needed.

To maximize the effectiveness of the HomeCare Program, the HomeCare team continues to work closely with the patients’ primary care physicians, specialists, and hospitalist teams. The HomeCare team has access to a rich database of claims, pharmacy, and electronic medical record data, which provides point-of-care evidence-based reminders for preventive and chronic care needs to enhance the clinical outcome for these high risk patients.

The program’s success is measured on such dimensions as patient satisfaction, chronic disease measures (e.g., LDL, HbA1C, blood pressure, acute hospital admits, acute hospital days, ER visits, Urgent Care visits, and PCP visits), and overall cost of care compared to a control population.

Keywords: HealthCare Partners Medical Group, HCP, coordinated care, homecare, home care, homebound, high risk patient, care team, electronic medical record, electronic health record, EMR, EHR, evidence-based medicine, health information technology, hospital readmission, integrated care, medical management, treatment

FOR MORE INFORMATION:

Robert Klein
HealthCare Partners Medical Group
19191 S. Vermont Avenue
Torrance, CA 90502
tel. 310.630.4126
rjklein@healthcarepartners.com
www.healthcarepartners.com

Integrating Depression Screening and Treatment in Primary Care Clinics

Depression often remains undetected despite its high prevalence. From 2005-2008 Henry Ford developed, tested, and refined a model for integrating depression screening and treatment into primary care clinics. Pilot study outcomes resulted in a 23% detection rate for depression (220/974 patients). Clinical action to positive screenings (treatment or referral) was 90%, and patient refusal for screening was only 1%. The practice model utilized a nurse practitioner experienced in Behavioral Health to serve as coach to the primary care clinic team for implementing depression screening processes and tools. Medical assistants determined patients’ screening eligibility and administered screening tests, and physicians used test results to drive discussion with patients for diagnosis and treatment plans. The Behavioral Health nurse served to reinforce clinical screening and treatment guidelines and also provide psychiatric treatment. Henry Ford integrated two depression screening tools, as well as evidence-based treatment guidelines, into the electronic medical record system for availability to all Henry Ford clinicians.


Integrating Depression Screening and Treatment in Primary Care Clinics
http://www.henryford.com/body.cfm?id=52274

Aim
To improve the detection and appropriate treatment of clinical depression in Primary Care using an integrated, collaborative depression care model.

Measures
In the first month we tracked weekly the number of eligible patients screened (chart audit of all filled appointments).

  • Number of patients screening positive for depression (DST > 10).
  • Disposition of those screening positive (#/% receiving antidepressant treatment versus referred to Behavioral Health Services versus patient refusal, etc.)
  • Clinical outcomes of antidepressant treatment (mean DST change score, % with 50% reduction in DST score, % with DST < 5).
  • Impact on comorbid chronic disease clinical parameters (e.g., pre-post change in LDL and HgA1C).

Changes
Embedded a nurse practitioner experienced in Behavioral Health in the Primary Care clinic to serve as a depression coach/mentor in a team approach.

Trained the team how to use a standardized screening tool for depression (e.g., DST adapted from the PHQ-9) and evidenced-based treatment guidelines. Convened a team that included representation from all clinic roles (e.g., clinic service representative, medical assistant, RN, MD) to help develop a clinic process for depression care that would be sustainable.

Developed screening criteria for high-risk patients.
Moved from a paper process to the DST embedded within the electronic medical record (EMR) system.

Moved to a two-step screening process, using the PHQ-2 followed by the full DST when the PHQ-2 was positive.
Collaborated with Information Technology to build two new note types in the EMR to document the PHQ-2 screening, and worked to build electronic reports to track monthly depression screening rates.

Results
Pilot results indicated that approximately 50% of eligible patients were screened although initial screening criteria were too broad, resulting in over 300 patients being screened in the first month with a 21% detection rate. This led to the process being amended in two ways: 1) screening criteria were streamlined to patients with either CAD, HF, DM, or complaints of depression; and 2) the PHQ-2 was added, with only those positive on the two-question survey going on to complete the full DST. After adding the PHQ-2, detection with the DST rose dramatically to approximately 60% while significantly reducing the time burden on clinical staff. The integrated model led to Primary Care physicians addressing detected depression > 90% of the time, with initiation of an antidepressant in about 70% of the cases.

Clinical outcomes were impressive, with a group mean change in DST score from 15 at baseline to 7 at 24-week follow-up (50% reduction indicates treatment response and a DST score of < 5 indicates remission).

Further subanalysis of patients with comorbid DM showed that for patients whose depression was successfully treated (DST reduction by at least 50%), 65% showed improvement in HgA1C with a group mean pre-post drop in HgA1c of 1.01 (a 1 point drop in HgA1c has been shown in the literature to significantly reduce diabetes complications).

Next Steps/Lessons Learned

  • Produce electronic monthly reports to track PHQ-2 frequency by site and provider; can assess usage trends over time; email these reports to administrators at the pilot sites monthly.
  • Booster (training) sessions at the initial pilot sites at set time intervals to re-review the process.
  • Periodic case conference at sites that have implemented this process to promote continuous learning and collaboration with Behavioral Health Services.
  • Use of the DICE tool with the design team at the beginning was critical to assess the perceived importance of the initiative and likelihood of project success.
  • Involving the clinical staff (end users) was critical to help build the process.
  • Use of multiple PDCA cycles to test the processes developed, and to revise what was not working well, helped the team to make changes quickly as needed.
  • Giving clinical staff frequent data reports helped each to know how they were performing and what positive impact the new process (and their actions) had on patients.
  • Plan to roll out the program across the Henry Ford Medical Group over time.

Contact Information: Terri Robertson, PhD, Project Manager, Center for Clinical Care Design, Henry Ford Health System, 313-874-2495.

Keywords: access, behavioral health, care team, chronic care, Detroit, depression, evidence-based medicine, Henry Ford Medical Center, health information technology, health screening, Michigan, MyHealth web portal, patient support, patient web portal, safety, treatment, value

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel.313.876.8709
Dangell1@hfhs.org
www.henryfordhealth.org

The Henry Ford MyHealth Patient Portal with eVisits

Henry Ford Health System continually works to integrate web technologies into health care delivery. More than 80,000 patient appointments are scheduled by patients online annually. For personalized management of health services, Henry Ford offers patients the MyHealth web portal, a secured site to access test results, to renew and refill prescriptions, and to perform other tasks including eVisits. More than 65,000 requests for test results and prescription renewals are received each year, and more than 3,000 eVisits have occurred since the pilot study in 2006. An eVisit offers patients easy access to health care by providing virtual clinical consultations for non-emergent conditions. Patients with chronic disease especially benefit from eVisits through increased interaction with their physicians for better management of their conditions between office visits.


The Henry Ford MyHealth Patient Portal with eVisits

Henry Ford Health System has long worked to integrate web technologies into the delivery of health care to continually improve the quality, accessibility, and cost-effectiveness of care. In 2008, more than 80,000 patient appointments were scheduled by consumers on the System’s website. For personalized management of health services, Henry Ford offers patients the MyHealth web portal, which has grown to become the largest eHealth portal in the Midwest with 237,000 patients enrolled.

MyHealth provides a private, secure site allowing patients to view customized health information, obtain laboratory and other test results, renew and refill prescriptions, manage billing issues, and participate in eVisits. More than 65,000 requests for test results and prescription renewals are received annually on MyHealth, and 3,000 eVisits have occurred since the pilot of this new service in 2006.

The eVisit offers convenient, cost-effective access to health care by providing virtual clinic consultations. eVisits may be used for non-emergent acute conditions such as stomach pain, and chronic conditions such as diabetes and hypertension. The eVisit begins when an enrolled patient logs into the MyHealth account and selects a non-urgent problem to report to the physician. A series of targeted questions survey the essential information, much as a physician would during a live office visit, and the patient’s responses are sent securely to the physician’s message center. The physician responds with a course of action or schedules an office appointment. eVisits are free of charge for Henry Ford Medical Group HAP members and $20 for other patients.

The eVisit improves patient access and allows physicians to make more frequent adjustments in a patient’s treatment regimen to achieve clinical goals. Patients with chronic disease especially benefit from eVisits through increased interaction with their physicians for better management of their conditions between office visits.

eVisit patients surveyed had among the highest patient satisfaction scores of those using Henry Ford services:

  • 97% strongly agreed that their physician responded to them in a reasonable timeframe and were satisfied with the quality of the response.
  • 100% agreed they would use eVisit again and would recommend the service to others.
  • In a focus group conducted with insured patients aged 40 to 60 years, patients indicated they wanted even more online interaction with physicians in the future.

Physicians surveyed found the eVisit system easy to use, with 100% of respondents agreeing that:

  • The summation of the clinical patient interview provided adequate information to make clinical judgment.
  • They were satisfied with the quality of their interaction with their patient.
  • They would recommend the eVisit to their patients.

Chart reviews done to determine the clinical quality of eVisits showed that:

  • Patients were using the eVisit system appropriately, software worked appropriately, and physicians were answering appropriately.
  • Of 75 eVisit records reviewed, 86% qualified for a HEDIS measure, with these patients showing improved HEDIS measures compared to patients not using eVisits.

Through continually improving MyHealth services, Henry Ford remains at the forefront of transforming the quality of health care for all patients.

Keywords: access, care team, chronic care, Detroit, e-visits, Henry Ford Medical Center, health information technology, Michigan, MyHealth web portal, patient support, patient web portal, safety, treatment, value

For more information on this project, contact Pam Landis, IT Services, Henry Ford Health System, plandis1@hfhs.org.

FOR MORE INFORMATION:

Dwight Angell
Director of Public Affairs
Henry Ford Health System
One Ford Place
Detroit, Michigan
tel. 313-876-8709
Dangell1@hfhs.org
www.henryfordhealth.org

Tracking, Measuring, Studying and Searching Patient Care Data Over Time

The Cleveland Clinic Knowledge Program allows physicians and researchers to electronically follow, measure, study and search patient health data over time. The program can be used to track individual patient medical histories, as well as broader patient populations, using electronic medical records, a database of anonymous health information, and an innovative search engine. This ability–called the Knowledge Program–creates a complete health biography of each patient, compiling information across specialties and locations (in-patient, outpatient, rehab, etc.), medications, self-assessments, and follow-up.


Tracking, Measuring, Studying and Searching Patient Care Data Over Time
http://my.clevelandclinic.org/neurological_institute/research/knowledgeprogram.aspx

The Cleveland Clinic Knowledge Program allows physicians and researchers to electronically follow, measure, study and search patient health data over time. The program can be used to track individual patient medical histories, as well as broader patient populations, using electronic medical records, a database of anonymous health information, and an innovative search engine. For individual patients, the Knowledge Program creates a complete health biography of each patient, compiling information across specialties and locations (in-patient, outpatient, rehab, etc.), medications, self-assessments, and follow-up. Health status measures are embedded into every patient encounter, fostering customized patient care.

For broader research, the program can access segments of anonymous patient data that can be searched, studied and analyzed to better understand patient outcomes, taking into account the continuum of care — patient health awareness, delivery of care, treatment effectiveness, patient response and quality of life., As a validated approach to care using evidence-based medicine, the program allows physicians to see how patients respond to treatments, both individually and as a larger population.

The Knowledge Program was developed in Cleveland Clinic’s Neurological Institute, which treats more than 14,000 patients annually, making it one of the busiest centers for neurological diagnosis and treatment in the country. Cleveland Clinic is currently rolling out the Knowledge Program across its entire health system. Patients record self assessments in one of three ways: through MyChart (a Cleveland Clinic web-based personal health record), a hand-held electronic tablet or by a caregiver. The Program is a powerful tool when demonstrating improved efficiency and outcomes to payors, government agencies, and the public, while possibly leading to incremental improvements to standard-of-care guidelines.

Keywords: Cleveland Clinic, health information technology, evidence-based medicine, integrated delivery system, multispecialty group practice, Ohio, patient support, treatment, safety, value

FOR MORE INFORMATION:

Megan Pruce
Senior Manager, Communications & Public Affairs
Cleveland Clinic
tel. 216- 445-7452
prucem@ccf.org
www.clevelandclinic.org @ccf.org