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Breast Cancer Screening Outreach Program Uses Coordinated Teams and Health Information Technology

Kaiser Permanente has become a national leader in breast cancer screening, demonstrating the improved quality of care that results from coordinated health teams and electronic information sharing. Information technology is helping caregivers coordinate activities throughout the organization. Clinicians and staff are using these new and constantly improving IT tools to communicate and coordinate with each other between departments and with patients. These strategies made Kaiser Permanente’s Southern California region the national leader in breast cancer screening rates in 2008.


Excerpted from Kaiser Permanente case study:

“Kaiser Permanente has become a national leader in breast cancer screening, demonstrating the improved quality of care that results from coordinated health teams and electronic information sharing. Information technology is helping caregivers coordinate activities throughout the organization. Clinicians and staff are using these new and constantly improving IT tools to communicate and coordinate with each other between departments and with patients. These strategies made Kaiser Permanente’s Southern California region the national leader in breast cancer screening rates in 2008.

The Importance of Early Screening and Detection

Women have a 13.2 percent lifetime risk of being diagnosed with breast cancer. That risk increases to a 1-in-7 chance as women reach their 60s. Unfortunately, too many women delay mammography or are not screened at recommended intervals. Reasons for delay include making the time, avoidance of discomfort, lack of understanding, fear of diagnosis, body image/self-consciousness issues, mobility, and geographic issues. Because 96 percent of all early-stage breast cancers are curable, actions such as early screening, detection, and treatment can reduce the death rate by 20 – 50 percent.

Engaging the Patient: A Coordinated Approach with an Informed Personal Touch

Addressing these many challenges required identifying new ways to engage women in breast health. Using an electronic database, we sent out routine notification letters to women who were due or overdue for their mammography screening. Even with simultaneous educational and awareness campaigns, the multidisciplinary care teams found that more direct and personalized interventions were required to increase the number of women receiving mammograms.”

Link to full case study: http://xnet.kp.org/future/ahrstudy/032709bcancer.html

Keywords: breast cancer, care teams, care coordination, communication, electronic medical record, health information technology, integrated care, Kaiser Permanente, kp healthconnect, mammography, mammogram, patient support, population health, preventive care, treatment, radiology ,safety, Southern California, 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

Kaiser Permanente’s Computerized Pharmacy Alert System Increases Medication Safety for Elderly Patients

When an elderly patient is prescribed a potentially inappropriate medication, Kaiser Permanente Colorado’s computerized alert system notifies the pharmacist who contacts the prescribing physician to review the order. This system reduced the risk of dispensing potentially inappropriate medication by 16 percent among their elderly patients.


Excerpted from Commonwealth Fund case study:

Kaiser Permanente: Bridging the Quality Divide with Integrated Practice, Group Accountability, and Health Information Technology
http://www.commonwealthfund.org/Content/Publications/Case-Studies/2009/Jun/Kaiser-Permanente.aspx

“The Colorado region developed a computerized pharmacy alert system that reduced the relative risk of dispensing potentially inappropriate medication by 16 percent among elderly patients. When an elderly patient is prescribed a potentially inappropriate medication, the system notifies a pharmacist, who contacts the physician by phone or e-mail to review the order using a standard questionnaire and to recommend changes when warranted. For patients taking anticoagulation medication, a telephonic, clinical pharmacist–managed anticoagulation service reduced the risk of therapy-related complications by 39 percent compared with usual care.”

Keywords: care coordination, care team, communication, Colorado, computerized pharmacy alert system, electronic medical record, health information technology, health care quality, KP Healthconnect, Kaiser Permanente, medication management, integrated care, safety, treatment

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

Primary Care Teams that Include Behavioral Health Specialists Manage Both the Mental and Physical Conditions of Patients

Kaiser Permanente’s Northern California region has integrated behavioral health care within its primary care offices, which improves their patients’ access to mental health services and provides a wider perspective on the patient’s health.

Excerpt from Commonwealth Fund case study:

Kaiser Permanente: Bridging the Quality Divide with Integrated Practice, Group Accountability, and Health Information Technology

” Each primary care team in Northern California includes a behavioral medicine specialist, who is a licensed clinical psychologist or clinical social worker trained to work in primary care. The behavioral medicine specialist co-manages patients with identified mental health conditions such as depression or anxiety disorders, providing counseling (using proven modalities such as cognitive behavioral therapy or behavioral activation) and problem-solving support individually or in group sessions. The patient’s primary care physician is responsible for medication management. Patients with severe mental health conditions or substance use disorders are referred to psychiatric specialty care or chemical dependency treatment.

Since many patients have co-occurring mental and physical conditions, colocation of behavioral medicine specialists in primary care allows a broad perspective that is superior to disease-specific approaches. It also improves access to mental health care, since many patients prefer to receive such services from their primary care team and may not visit mental health specialists even when referred.

Through its participation in a study of a collaborative care model called IMPACT, the organization learned that outcomes could be enhanced by adopting a more systematic approach to caring for patients with depression. As a result, the region recently began using a population database and a patient-completed questionnaire called the PHQ-9 to track patients’ progress and provide feedback so that the physician and behavioral medicine specialist can tailor treatment to achieve symptom-improvement goals. The region ranks second among health plans nationally on a measure of antidepressant medication management–acute phase treatment, according to the NCQA.”

Link to full case study: http://www.commonwealthfund.org/Content/Publications/Case-Studies/2009/Jun/Kaiser-Permanente.aspx

Keywords: access, behavioral health, care coordination, care teams, chronic care, collaborative care, communication, Kaiser Permanente, behavioral health, mental health, depression, electronic medical record, health information technology, integrated care, Northern California, kp healthconnect, patient support, population health, preventive care, treatment

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

High-Tech Resources Plus Personal Attention Creates a Comprehensive Diabetes Program

The comprehensive Diabetes Program at the Palo Alto Medical Foundation uses screenings, classes, nurse educators, wellness programs, and online medical records to provide diabetic patients with the individualized lifestyle support that they need.


Diabetes Program Emphasizes Individual Care
http://www.pamf.org/news/services/0508diabetesprogram.html

New drugs and treatments make it easier than ever for individuals with diabetes to avoid many of the serious health consequences of the disorder. However, patients still need to make lifestyle changes and work closely with their health care team to control the disease.

This is why PAMF’s Diabetes Program combines high-tech resources with personal attention to provide patients with the comprehensive tools and support they need to be their healthiest.

“As many resources as we now have for high-tech disease management, setting lifestyle goals is a process that must take place one-on-one with the patient playing an active role,” says Linda Klieman, R.N., MSN, ANP, a nurse care manager for PAMF’s Online Disease Management. “If the patient doesn’t have buy-in to the changes he or she will need to make, it will not work.”

Diabetes is an increasingly common disorder where the body loses the ability to regulate how much sugar is in the blood. According to the U.S. Centers for Disease Control and Prevention, one in three Americans will now develop diabetes in his or her lifetime.

Diabetes cannot be cured, but it can be controlled with medical treatments such as injections of the sugar-processing hormone insulin, and lifestyle changes such as eating a diet lower in sugar and fat, exercising more and losing weight.

However, making these lifestyle changes is easier said than done. For patients with type 2 diabetes, which is the most common and fastest growing form of the disorder, the diagnosis typically comes after age 40, when the diet and exercise habits that put them at risk for diabetes in the first place have become ingrained over the years, and thus are more difficult to change.

The symptoms of type 2 diabetes are often outwardly mild and may include feeling fatigued and irritable, being very thirsty, having blurred vision, and urinating more frequently. Because few people see their doctors for such symptoms, as many as a third of people with diabetes may not even know they have it. However, inside the body, diabetes can begin to damage organs and the circulatory and nervous systems long before the disease is detected. To increase the chance that diabetes is caught early, PAMF doctors typically recommend that all pregnant women and anyone who has one or more diabetes risk factors — including being overweight, having high blood pressure, being over age 45, having a close relative with diabetes or being a member of an ethnic group that has a high incidence of the disease — have their blood glucose level tested.

To keep diabetes patients committed to controlling their disease — not just for a few months or years, but for the rest of their lives — PAMF’s Diabetes Program offers a broad array of resources that can be combined in numerous ways to meet individual needs:

  • For those who feel most comfortable in group situations, PAMF offers classes on diabetes-related health topics, and a monthly support group for patients and their families.
  • Patients who prefer to research their disease on their own can visit PAMF’s Community Health Resource Centers and receive assistance from a registered nurse health educator.
  • Individuals who are having a hard time controlling and managing their diabetes may receive individual phone and in-person consultations with a PAMF diabetes educator. In addition, if depression is making it hard for patients to take charge of their lives and their disease, PAMF offers a weekly “Diabetes and Depression” drop-in support group.
  • For patients with special needs, like diabetes during pregnancy (gestational diabetes), or individual cultural concerns and risks factors, there are resources tailored just for them. These include a special Gestational Diabetes class and the PRANA (Prevention and Awareness for South Asians) Wellness Program.
  • Finally, for patients who have their disease under control and need little added support, viewing their electronic health record online via PAMFOnline, PAMF’s e-health service, can help them keep track of medications, test results and health care appointments, anywhere there is access to the Internet. One diabetes patient, for example, uses PAMFOnline to manage his disease as he travels around the country by RV for months at a time.

“In the future, even more patients may choose to take advantage of these high-tech disease management capabilities, but the human element will always be at the heart of any diabetes program,” said PAMFOnline Manager Barbara Love.

Keywords: California, care coordination, care team, chronic care, diabetes management, disease management, electronic medical record, evidence-based medicine, health information technology, health education, Palo Alto Medical Foundation, patient support, preventive care, treatment

FOR MORE INFORMATION:

Jill Antonides
Director, Communications and Public Affairs
Palo Alto Medical Foundation
795 El Camino Real
Palo Alto, CA 94301
tel. 650.691.6240
antonij1@pamf.org
www.pamf.org

Proactive Office Visit Program Significantly Improves Quality of Care

Kaiser Permanente’s Southern California region has increased the use of preventive cancer screenings and effectively encouraged improved maintenance of cholesterol by coordinating care across all who touch patient’s lives and integrating incentives and information technology.


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

“Kaiser Permanente’s Southern California region has increased the use of preventive cancer screenings and effectively encouraged improved maintenance of cholesterol by coordinating care across all who touch patient’s lives and integrating incentives and information technology. The proactive office encounter program fosters cooperation among providers: Clinical care teams composed of doctors, nurses, medical assistants and other staff work together to identify opportunities to engage patients and provide support and encouragement for positive action across the continuum of health care services. In addition, front-line union employees are financially rewarded through a performance sharing program when quality care goals, many affected by these types of screenings and preventative measures, are achieved.

The Challenge: Increasing Use of Preventive Care

Individuals in the U.S., regardless of insurance status, receive only about 55 percent of recommended health care, according to a 2004 RAND Corporation study. From preventive health screenings to routine monitoring and maintenance of treatable chronic health conditions, U.S. citizens under-utilize available basic care services.

Recognizing the need to improve delivery of health prevention services, Kaiser Permanente’s Southern California region created the proactive office encounter program to identify and target patients with chronic medical conditions and encourage them to be active participants in their own care. The program uses all members of the clinical care team in a coordinated and collaborative effort to engage, encourage and support patient health. The information and tools provided have helped increase preventive screenings and improve treatment adherence.”

Keywords: breast cancer screening, care teams, communication, cervical cancer screening, cholesterol control, chronic care, collaborative care, colon cancer screening, disease management, electronic medical record, evidence-based medicine, health information technology, integrated care, Kaiser Permanente, kp healthconnect, preventive care, safety, Southern California, 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

 

Patients with Chronic Diseases Benefit from Support Targeted to the Level of Care They Need

Patients who have chronic diseases or who are at risk of developing one require different levels of support and care. Kaiser Permanente’s Northern California region developed a strategy to improve the care and outcomes for these patients by dividing their care into three well-defined levels of specialty care. Kaiser Permanente’s Colorado region later adopted the strategy to include a telephonic cardiac medication management service.


Excerpt from Commonwealth Fund case study:

Kaiser Permanente: Bridging the Quality Divide with Integrated Practice, Group Accountability, and Health Information Technology

http://www.commonwealthfund.org/Content/Publications/Case-Studies/2009/Jun/Kaiser-Permanente.aspx

“The Northern California region uses a population and patient-panel management strategy to improve care and outcomes for patients who have–or who are at risk for developing–chronic diseases. This approach is built on the philosophy that a strong primary care system offers the most efficient way to interact with most patients most of the time, while recognizing that some patients need additional support and specialty care to achieve the best possible outcomes. Patients are stratified into three levels of care:

  1. Primary care with self-care support for the 65 percent to 80 percent of patients whose conditions are generally responsive to lifestyle changes and medications.
  2. Assistive care management to address adherence problems, complex medication regimens, and comorbidities for the 20 percent to 30 percent of patients whose diseases are not under control through care at level one.
  3. Intensive case management and specialty care for the 1 percent to 5 percent of patients with advanced disease and complex comorbidities or frailty.

Level one emphasizes a proactive team approach that conserves physician time for face-to-face encounters by enhancing the contributions of ancillary staff (medical assistants and also nurses and pharmacists in some locations) to conducting outreach to patients between visits. . .

At level two, care managers (specially trained nurses, clinical social workers, or pharmacists) support the primary care team to help patients gain control of a chronic condition. . . .

An example of intensive case management (level three) is a cardiac rehabilitation program called Multifit for patients with advanced heart disease, such as those recovering from a heart attack or heart surgery. Nurse case managers provide telephonic education and support for up to six months to help patients make lifestyle changes and reduce their risk of future cardiac events. Aided by the EHR and a patient registry, the Colorado region enhanced the program by adding a telephonic cardiac medication management service provided by clinical pharmacy specialists, with ongoing follow-up until patients achieve treatment goals and can be transferred to primary care for maintenance. Results for patients participating in the Colorado program included the following:

  • Cholesterol screening increased from 55 percent to 97 percent of patients, while cholesterol control has almost tripled from 26 percent to 73 percent of patients. The Colorado plan ranked first among health plans nationally in 2007 on a measure of cholesterol screening for patients with cardiovascular conditions.
  • Relative risk of death declined by 89 percent among those enrolled in the program within 90 days of a cardiac event, and by 76 percent for those with any contact with the program. An estimated 260 major cardiac events and 135 deaths have been avoided per year because of these improvements.”

Keywords: assistive care management, care coordination, care teams, chronic care, chronic disease management, communication, specialty care, case management, electronic medical record, evidence-based medicine, health information technology, Kaiser Permanente, kp healthconnect, clinical collaboration, integrated care, Northern California, patient support, population health, preventive care, 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