We performed two cycles of laboratory-based usability testing of three food registration prototyp... more We performed two cycles of laboratory-based usability testing of three food registration prototypes for people with diabetes. The design concepts were a commercial web application, various smartphones and a mobile phone photo blogging approach. Six adults with Type 1 diabetes and three adults with Type 2 diabetes participated in the usability tests. The results provided five distinct implications for devices for the future dietary management support of people with diabetes. Study participants valued many of the features offered by the three systems that were tested, although the usability tests also revealed several opportunities to enhance their design. Our findings suggest that further development is justified of mobile dietary and nutritional support for individuals living with diabetes. Applications that support healthy eating habits should be integrated with applications for managing blood glucose data and physical activity data, and potentially medication data as well.
This paper describes one organization's interpretation of the Patient-Centered Medical Home c... more This paper describes one organization's interpretation of the Patient-Centered Medical Home concept and the healthcare delivery system that has emerged from their participatory redesign initiative. Group Health, a large integrated healthcare system based in Seattle, Washington, USA initiated a Patient-Centered Medical Home care delivery system transformation in January 2007. Current theories and evidence about the Patient-Centered Medical Home (PCMH), the Chronic Care Model, and effective primary care were interpreted via a facilitated group process and translated into a core set of 5 system design principles. These design principles guided all subsequent system transformation activities. The central organizing principle is supporting and sustaining the patient-primary care physician relationship. The emergent PCMH healthcare delivery system comprises both opportunistic point-of-care and outreach components, many of which leverage and enhance the organization's health inform...
Strong evidence suggests that patient-reported outcomes (PROs) aid in managing chronic conditions... more Strong evidence suggests that patient-reported outcomes (PROs) aid in managing chronic conditions, reduce omissions in care, and improve patient-provider communication. However, provider acceptability of PROs and their use in clinical HIV care is not well known. We interviewed providers (n=27) from four geographically diverse HIV and community care clinics in the U.S. that have integrated PROs into routine HIV care, querying perceived value, challenges, and use of PRO data. Perceived benefits included the ability of PROs to identify less-observable behaviors and conditions, particularly suicidal ideation, depression, and substance use; usefulness in agenda-setting prior to a visit; and reduction of social desirability bias in patient-provider communication. Challenges included initial flow integration issues and ease of interpretation of PRO feedback. Providers value same-day, electronic patient-reported measures for use in clinical HIV care with the condition that PROs are 1) tailored to be the most clinically relevant to their population; 2) well-integrated into clinic flow; 3) easy to interpret, highlighting chief patient concerns and changes over time.
We compared same-day provider medical record documentation and interventions addressing depressio... more We compared same-day provider medical record documentation and interventions addressing depression and risk behaviors before and after delivering point-of-care patient-reported outcomes (PROs) feedback for patients who self-reported clinically relevant levels of depression or risk behaviors. During the study period (1 January 2006-15 October 2010), 2289 PRO assessments were completed by HIV-infected patients. Comparing the 8 months before versus after feedback implementation, providers were more likely to document depression (74% before vs. 87% after feedback, p = 0.02) in patients with moderate-to-severe depression (n = 317 assessments), at-risk alcohol use (41 vs. 64%, p = 0.04, n = 155) and substance use (60 vs. 80%, p = 0.004, n = 212). Providers were less likely to incorrectly document good adherence among patients with inadequate adherence after feedback (42 vs. 24%, p = 0.02, n = 205). While PRO feedback of depression and adherence were followed by increased provider interven...
Medical groups are challenged to adopt a systematic, evidence-based approach to selecting a physi... more Medical groups are challenged to adopt a systematic, evidence-based approach to selecting a physician compensation method that supports the group's overall financial and organizational strategies, including managed care contracting strategies; is consistent with the philosophies, beliefs, and attitudes of the group's membership as they pertain to individual productivity; and can be supported by the organization's information technology, decision support, and management infrastructures. This article explains how research in physician profiling, benchmarking, general compensation theory, and physician productivity provides evidence that can serve as the foundation for a pragmatic approach to evaluating physician compensation method alternatives. It also presents a unique production-based compensation model for illustrative purposes.
Background: This study examines the impact of same-day PRO reports to providers on chart document... more Background: This study examines the impact of same-day PRO reports to providers on chart documentation of provider awareness and behavior. Methods: In an HIV clinic, patients complete electronic PRO assessments immediately before their visit, reporting recent sexual intercourse without condoms, missing antiretroviral doses in the last 4 days, AUDIT-C scores, and PHQ-9 scores >10, identified patients with at-risk sexual behavior, inadequate adherence, at-risk alcohol use, and moderate-to-severe depression respectively. Providers receive the report before entering the patient's examination room. Chart reviewers, blinded to whether providers received PRO reports, reviewed same-day provider documentation regarding awareness and actions of these 4 domains occurring within 8 months before and after initiation of provider reports. Results: Among 166 patients reporting at-risk sexual behavior, no differences were present in provider documentation of at-risk sex before vs. after PRO r...
Obesity is often cited as the most prevalent chronic health condition and highest priority public... more Obesity is often cited as the most prevalent chronic health condition and highest priority public health problem in the United States. There is a limited but growing body of evidence suggesting that mobile eHealth behavioral interventions, if properly designed, may be effective in promoting and sustaining successful weight loss and weight maintenance behavior changes. This paper reviews the current literature on the successes and failures of public health, provider-administered, and self-managed behavioral health interventions for weight loss. The prevailing theories of health behavior change are discussed from the perspective of how this knowledge can serve as an evidence base to inform the design of mobile eHealth weight loss interventions. Tailored informational interventions, which, in recent years, have proven to be the most effective form of conventional health behavior intervention for weight loss, are discussed. Lessons learned from the success of conventional tailored informational interventions and the early successes of desktop computer-assisted self-help weight management interventions are presented, as are design principles suggested by Social Cognitive Theory and the Social Marketing Model. Relevant computing and communications technology convergence trends are also discussed. The recent trends in rapid advancement, convergence, and public adoption of Web-enabled cellular telephone and wireless personal digital assistant (PDA) devices provide timely opportunities to deliver the mass customization capabilities, reach, and interactivity required for the development, administration, and adoption of effective population-level eHealth tailored informational interventions for obesity.
BACKGROUND: Patient-centered access is a philosophy and a method that supports efforts to redesig... more BACKGROUND: Patient-centered access is a philosophy and a method that supports efforts to redesign healthcare delivery systems to deliver higher quality care and to better meet the needs and preferences of patients. Since mid-2000, Group Health Cooperative has pursued an ensemble of strategic initiatives aimed at promoting patient-centered access, referred to as the Access Initiative. In support of this strategy, Group Health has also engaged in enterprise implementation of an electronic medical record and clinical information system that is integrated with their patient Web site, MyGroupHealth. OBJECTIVE: To elicit, describe, and characterize providers' perceptions of the effects of the Access Initiative, an information technology-enabled organizational redesign initiative intended to promote patient-centered access. DESIGN: Thematic analysis of semi-structured indepth interviews. PARTICIPANTS: Twenty-two care providers representing 14 primary care, medical, and surgical specialties at Group Health Cooperative, an integrated health-care system based in Seattle, Washington. FINDINGS: Analyses of the interview transcripts revealed nine emergent themes, five of which have particular relevance for health-care organizations pursuing patient-centered access: the Access Initiative improved patient satisfaction, improved the quality of encounter-based care, compromised providers' focus on population health, created additional work for providers, and decreased job satisfaction for primary care providers and some medical specialists. CONCLUSIONS: Providers like that the Access Initiative is mostly good for their patients, but dislike the negative effects on their own quality of lifeespecially in primary care. These reforms may not be sustainable under current models of organization and financing.
Abbreviations: (app) application, (BG) blood glucose, (FTA) Few Touch Application, (HC) health ca... more Abbreviations: (app) application, (BG) blood glucose, (FTA) Few Touch Application, (HC) health care, (ICT) information and communication technology, (mHealth) mobile health, (PHA) personal health application, (SMS) short message service, (T1DM) type 1 diabetes mellitus, (T2DM) type 2 diabetes mellitus
This paper describes the development process of an evaluation framework for describing and compar... more This paper describes the development process of an evaluation framework for describing and comparing web survey tools. We believe that this approach will help shape the design, development, deployment, and evaluation of population-based health interventions. A conceptual framework for describing and evaluating web survey systems will enable the developers of health interventions to identify, select, and use the most appropriate and relevant survey tools. The primary contributors included survey methodologists, computer scientists, informaticians, technical communications specialists, educators, evaluators, clinical practitioners, and health services researchers, who together developed a comprehensive ontology to describe the electronic survey domain. This paper will describe the survey ontology development process and detail lessons learned in the creation of the web survey system evaluation framework.
A patient-centered medical home (PCMH) demonstration was undertaken at 1 healthcare system, with ... more A patient-centered medical home (PCMH) demonstration was undertaken at 1 healthcare system, with the goals of improving patient experience, lessening staff burnout, improving quality, and reducing downstream costs. Five design principles guided development of the PCMH changes to staffing, scheduling, point-of-care, outreach, and management. To report differences in patient experience, staff burnout, quality, utilization, and costs in the first year of the PCMH demonstration. Prospective before and after evaluation. Baseline (2006) and 12-month (2007) measures were compared. Patient and staff experiences were measured using surveys from a random sample of patients and all staff at the PCMH and 2 control clinics. Automated data were used to measure and compare change components, quality, utilization, and costs for PCMH enrollees versus enrollees at 19 other clinics. Analyses included multivariate regressions for the different outcomes to account for baseline case mix. After adjusting ...
department screening and transition bundle performance and the reliability of implementing this c... more department screening and transition bundle performance and the reliability of implementing this complex model is improving each month. Approximately 2,000 patients have been discharged from units where the pilots were in operation. Conclusions: The TOCI approach is interdisciplinary at all level's governance, coordination, and patient care. We believe the methods that are developed and utilized, including specialized screening tools, nursing and care management protocols, interdisciplinary team rounds, discharge protocols and post acute care management strategies, will be essential components of the national strategy to reduce readmissions.
Background and Objective: We evaluated patient acceptance of an electronic questionnaire to colle... more Background and Objective: We evaluated patient acceptance of an electronic questionnaire to collect breast cancer risk-factor data in a mammography setting. Methods: We developed an electronic questionnaire on a tablet computer incorporating prefilled answers and skip patterns. Using a randomized controlled study design, we tested the survey in a mammography clinic that administers a paper risk-factor questionnaire to every woman at her screening mammogram. We randomized 160 women to use the electronic survey (experimental group, n 5 86) or paper survey (control group, n 5 74). We evaluated patient acceptance and data completeness. Results: Overall, 70.4% of the experimental group women thought the survey was very easy to use, compared to 55.6% of women in the control group. Ninety percent of experimental group women preferred using the tablet, compared to the paper questionnaire. Preference for the tablet did not differ by age; however, women > 60 years did not find the tablet as easy to use as did women !60 years. The proportion of missing data was significantly lower on the tablet compared to the paper questionnaire (4.6% vs. 6.2%, P 5 .04). Conclusion: Electronic questionnaires are feasible to use in a mammography setting, can improve data quality, and are preferred by women regardless of age.
Electronic consultation (e-consultation) is an emerging tool that primary care clinicians can use... more Electronic consultation (e-consultation) is an emerging tool that primary care clinicians can use to communicate with specialists about patients asynchronously--that is, at different times that are convenient for each physician. To conduct an e-consultation, clinicians use either a Web-based program or a shared electronic medical record. Early adopters of e-consultation describe positive experiences for patients, clinicians, and health systems, including improved continuity of care, access to specialists, convenience, and information transfer. E-consultation presents opportunities to improve health care quality and reduce specialty care costs, but dissemination will be limited unless incentives are created and clinicians are encouraged to use e-consultation through financial reimbursement.
Electronic consultation (e-consultation) is an emerging tool that primary care clinicians can use... more Electronic consultation (e-consultation) is an emerging tool that primary care clinicians can use to communicate with specialists about patients asynchronously--that is, at different times that are convenient for each physician. To conduct an e-consultation, clinicians use either a Web-based program or a shared electronic medical record. Early adopters of e-consultation describe positive experiences for patients, clinicians, and health systems, including improved continuity of care, access to specialists, convenience, and information transfer. E-consultation presents opportunities to improve health care quality and reduce specialty care costs, but dissemination will be limited unless incentives are created and clinicians are encouraged to use e-consultation through financial reimbursement.
Providers routinely under diagnose at risk behaviors and outcomes, including depression, suicidal... more Providers routinely under diagnose at risk behaviors and outcomes, including depression, suicidal ideation, substance abuse, and poor medication adherence. To address this, we developed a webbased, self-administered patient-reported assessment tool and integrated it into routine primary care for HIV-infected adults. Printed results were delivered to providers and social workers immediately prior to patient appointments. The assessment included brief, validated instruments measuring clinically relevant domains including depression, substance use, medication adherence, and HIV transmission risk behaviors. Utilizing the Institute for Healthcare Improvement's Plan-Do-Study-Act (PDSA) approach to quality improvement, we addressed issues with clinic flow, technology, scheduling, and delivery of assessment results with the support of all levels of clinic staff. We found web-based patient-reported assessments to be a feasible tool that can be integrated into a busy multi-provider HIV primary care clinic. These assessments may improve provider recognition of key patient behaviors and outcomes. Critical factors for successful integration of such assessments into clinical care include: strong toplevel support from clinic management, provider understanding of patient-reported assessments as a valuable clinical tool, tailoring the assessment to meet provider needs, communication among clinic staff to address flow issues, timeliness of delivery, and sound technological resources.
We performed two cycles of laboratory-based usability testing of three food registration prototyp... more We performed two cycles of laboratory-based usability testing of three food registration prototypes for people with diabetes. The design concepts were a commercial web application, various smartphones and a mobile phone photo blogging approach. Six adults with Type 1 diabetes and three adults with Type 2 diabetes participated in the usability tests. The results provided five distinct implications for devices for the future dietary management support of people with diabetes. Study participants valued many of the features offered by the three systems that were tested, although the usability tests also revealed several opportunities to enhance their design. Our findings suggest that further development is justified of mobile dietary and nutritional support for individuals living with diabetes. Applications that support healthy eating habits should be integrated with applications for managing blood glucose data and physical activity data, and potentially medication data as well.
This paper describes one organization's interpretation of the Patient-Centered Medical Home c... more This paper describes one organization's interpretation of the Patient-Centered Medical Home concept and the healthcare delivery system that has emerged from their participatory redesign initiative. Group Health, a large integrated healthcare system based in Seattle, Washington, USA initiated a Patient-Centered Medical Home care delivery system transformation in January 2007. Current theories and evidence about the Patient-Centered Medical Home (PCMH), the Chronic Care Model, and effective primary care were interpreted via a facilitated group process and translated into a core set of 5 system design principles. These design principles guided all subsequent system transformation activities. The central organizing principle is supporting and sustaining the patient-primary care physician relationship. The emergent PCMH healthcare delivery system comprises both opportunistic point-of-care and outreach components, many of which leverage and enhance the organization's health inform...
Strong evidence suggests that patient-reported outcomes (PROs) aid in managing chronic conditions... more Strong evidence suggests that patient-reported outcomes (PROs) aid in managing chronic conditions, reduce omissions in care, and improve patient-provider communication. However, provider acceptability of PROs and their use in clinical HIV care is not well known. We interviewed providers (n=27) from four geographically diverse HIV and community care clinics in the U.S. that have integrated PROs into routine HIV care, querying perceived value, challenges, and use of PRO data. Perceived benefits included the ability of PROs to identify less-observable behaviors and conditions, particularly suicidal ideation, depression, and substance use; usefulness in agenda-setting prior to a visit; and reduction of social desirability bias in patient-provider communication. Challenges included initial flow integration issues and ease of interpretation of PRO feedback. Providers value same-day, electronic patient-reported measures for use in clinical HIV care with the condition that PROs are 1) tailored to be the most clinically relevant to their population; 2) well-integrated into clinic flow; 3) easy to interpret, highlighting chief patient concerns and changes over time.
We compared same-day provider medical record documentation and interventions addressing depressio... more We compared same-day provider medical record documentation and interventions addressing depression and risk behaviors before and after delivering point-of-care patient-reported outcomes (PROs) feedback for patients who self-reported clinically relevant levels of depression or risk behaviors. During the study period (1 January 2006-15 October 2010), 2289 PRO assessments were completed by HIV-infected patients. Comparing the 8 months before versus after feedback implementation, providers were more likely to document depression (74% before vs. 87% after feedback, p = 0.02) in patients with moderate-to-severe depression (n = 317 assessments), at-risk alcohol use (41 vs. 64%, p = 0.04, n = 155) and substance use (60 vs. 80%, p = 0.004, n = 212). Providers were less likely to incorrectly document good adherence among patients with inadequate adherence after feedback (42 vs. 24%, p = 0.02, n = 205). While PRO feedback of depression and adherence were followed by increased provider interven...
Medical groups are challenged to adopt a systematic, evidence-based approach to selecting a physi... more Medical groups are challenged to adopt a systematic, evidence-based approach to selecting a physician compensation method that supports the group's overall financial and organizational strategies, including managed care contracting strategies; is consistent with the philosophies, beliefs, and attitudes of the group's membership as they pertain to individual productivity; and can be supported by the organization's information technology, decision support, and management infrastructures. This article explains how research in physician profiling, benchmarking, general compensation theory, and physician productivity provides evidence that can serve as the foundation for a pragmatic approach to evaluating physician compensation method alternatives. It also presents a unique production-based compensation model for illustrative purposes.
Background: This study examines the impact of same-day PRO reports to providers on chart document... more Background: This study examines the impact of same-day PRO reports to providers on chart documentation of provider awareness and behavior. Methods: In an HIV clinic, patients complete electronic PRO assessments immediately before their visit, reporting recent sexual intercourse without condoms, missing antiretroviral doses in the last 4 days, AUDIT-C scores, and PHQ-9 scores >10, identified patients with at-risk sexual behavior, inadequate adherence, at-risk alcohol use, and moderate-to-severe depression respectively. Providers receive the report before entering the patient's examination room. Chart reviewers, blinded to whether providers received PRO reports, reviewed same-day provider documentation regarding awareness and actions of these 4 domains occurring within 8 months before and after initiation of provider reports. Results: Among 166 patients reporting at-risk sexual behavior, no differences were present in provider documentation of at-risk sex before vs. after PRO r...
Obesity is often cited as the most prevalent chronic health condition and highest priority public... more Obesity is often cited as the most prevalent chronic health condition and highest priority public health problem in the United States. There is a limited but growing body of evidence suggesting that mobile eHealth behavioral interventions, if properly designed, may be effective in promoting and sustaining successful weight loss and weight maintenance behavior changes. This paper reviews the current literature on the successes and failures of public health, provider-administered, and self-managed behavioral health interventions for weight loss. The prevailing theories of health behavior change are discussed from the perspective of how this knowledge can serve as an evidence base to inform the design of mobile eHealth weight loss interventions. Tailored informational interventions, which, in recent years, have proven to be the most effective form of conventional health behavior intervention for weight loss, are discussed. Lessons learned from the success of conventional tailored informational interventions and the early successes of desktop computer-assisted self-help weight management interventions are presented, as are design principles suggested by Social Cognitive Theory and the Social Marketing Model. Relevant computing and communications technology convergence trends are also discussed. The recent trends in rapid advancement, convergence, and public adoption of Web-enabled cellular telephone and wireless personal digital assistant (PDA) devices provide timely opportunities to deliver the mass customization capabilities, reach, and interactivity required for the development, administration, and adoption of effective population-level eHealth tailored informational interventions for obesity.
BACKGROUND: Patient-centered access is a philosophy and a method that supports efforts to redesig... more BACKGROUND: Patient-centered access is a philosophy and a method that supports efforts to redesign healthcare delivery systems to deliver higher quality care and to better meet the needs and preferences of patients. Since mid-2000, Group Health Cooperative has pursued an ensemble of strategic initiatives aimed at promoting patient-centered access, referred to as the Access Initiative. In support of this strategy, Group Health has also engaged in enterprise implementation of an electronic medical record and clinical information system that is integrated with their patient Web site, MyGroupHealth. OBJECTIVE: To elicit, describe, and characterize providers' perceptions of the effects of the Access Initiative, an information technology-enabled organizational redesign initiative intended to promote patient-centered access. DESIGN: Thematic analysis of semi-structured indepth interviews. PARTICIPANTS: Twenty-two care providers representing 14 primary care, medical, and surgical specialties at Group Health Cooperative, an integrated health-care system based in Seattle, Washington. FINDINGS: Analyses of the interview transcripts revealed nine emergent themes, five of which have particular relevance for health-care organizations pursuing patient-centered access: the Access Initiative improved patient satisfaction, improved the quality of encounter-based care, compromised providers' focus on population health, created additional work for providers, and decreased job satisfaction for primary care providers and some medical specialists. CONCLUSIONS: Providers like that the Access Initiative is mostly good for their patients, but dislike the negative effects on their own quality of lifeespecially in primary care. These reforms may not be sustainable under current models of organization and financing.
Abbreviations: (app) application, (BG) blood glucose, (FTA) Few Touch Application, (HC) health ca... more Abbreviations: (app) application, (BG) blood glucose, (FTA) Few Touch Application, (HC) health care, (ICT) information and communication technology, (mHealth) mobile health, (PHA) personal health application, (SMS) short message service, (T1DM) type 1 diabetes mellitus, (T2DM) type 2 diabetes mellitus
This paper describes the development process of an evaluation framework for describing and compar... more This paper describes the development process of an evaluation framework for describing and comparing web survey tools. We believe that this approach will help shape the design, development, deployment, and evaluation of population-based health interventions. A conceptual framework for describing and evaluating web survey systems will enable the developers of health interventions to identify, select, and use the most appropriate and relevant survey tools. The primary contributors included survey methodologists, computer scientists, informaticians, technical communications specialists, educators, evaluators, clinical practitioners, and health services researchers, who together developed a comprehensive ontology to describe the electronic survey domain. This paper will describe the survey ontology development process and detail lessons learned in the creation of the web survey system evaluation framework.
A patient-centered medical home (PCMH) demonstration was undertaken at 1 healthcare system, with ... more A patient-centered medical home (PCMH) demonstration was undertaken at 1 healthcare system, with the goals of improving patient experience, lessening staff burnout, improving quality, and reducing downstream costs. Five design principles guided development of the PCMH changes to staffing, scheduling, point-of-care, outreach, and management. To report differences in patient experience, staff burnout, quality, utilization, and costs in the first year of the PCMH demonstration. Prospective before and after evaluation. Baseline (2006) and 12-month (2007) measures were compared. Patient and staff experiences were measured using surveys from a random sample of patients and all staff at the PCMH and 2 control clinics. Automated data were used to measure and compare change components, quality, utilization, and costs for PCMH enrollees versus enrollees at 19 other clinics. Analyses included multivariate regressions for the different outcomes to account for baseline case mix. After adjusting ...
department screening and transition bundle performance and the reliability of implementing this c... more department screening and transition bundle performance and the reliability of implementing this complex model is improving each month. Approximately 2,000 patients have been discharged from units where the pilots were in operation. Conclusions: The TOCI approach is interdisciplinary at all level's governance, coordination, and patient care. We believe the methods that are developed and utilized, including specialized screening tools, nursing and care management protocols, interdisciplinary team rounds, discharge protocols and post acute care management strategies, will be essential components of the national strategy to reduce readmissions.
Background and Objective: We evaluated patient acceptance of an electronic questionnaire to colle... more Background and Objective: We evaluated patient acceptance of an electronic questionnaire to collect breast cancer risk-factor data in a mammography setting. Methods: We developed an electronic questionnaire on a tablet computer incorporating prefilled answers and skip patterns. Using a randomized controlled study design, we tested the survey in a mammography clinic that administers a paper risk-factor questionnaire to every woman at her screening mammogram. We randomized 160 women to use the electronic survey (experimental group, n 5 86) or paper survey (control group, n 5 74). We evaluated patient acceptance and data completeness. Results: Overall, 70.4% of the experimental group women thought the survey was very easy to use, compared to 55.6% of women in the control group. Ninety percent of experimental group women preferred using the tablet, compared to the paper questionnaire. Preference for the tablet did not differ by age; however, women > 60 years did not find the tablet as easy to use as did women !60 years. The proportion of missing data was significantly lower on the tablet compared to the paper questionnaire (4.6% vs. 6.2%, P 5 .04). Conclusion: Electronic questionnaires are feasible to use in a mammography setting, can improve data quality, and are preferred by women regardless of age.
Electronic consultation (e-consultation) is an emerging tool that primary care clinicians can use... more Electronic consultation (e-consultation) is an emerging tool that primary care clinicians can use to communicate with specialists about patients asynchronously--that is, at different times that are convenient for each physician. To conduct an e-consultation, clinicians use either a Web-based program or a shared electronic medical record. Early adopters of e-consultation describe positive experiences for patients, clinicians, and health systems, including improved continuity of care, access to specialists, convenience, and information transfer. E-consultation presents opportunities to improve health care quality and reduce specialty care costs, but dissemination will be limited unless incentives are created and clinicians are encouraged to use e-consultation through financial reimbursement.
Electronic consultation (e-consultation) is an emerging tool that primary care clinicians can use... more Electronic consultation (e-consultation) is an emerging tool that primary care clinicians can use to communicate with specialists about patients asynchronously--that is, at different times that are convenient for each physician. To conduct an e-consultation, clinicians use either a Web-based program or a shared electronic medical record. Early adopters of e-consultation describe positive experiences for patients, clinicians, and health systems, including improved continuity of care, access to specialists, convenience, and information transfer. E-consultation presents opportunities to improve health care quality and reduce specialty care costs, but dissemination will be limited unless incentives are created and clinicians are encouraged to use e-consultation through financial reimbursement.
Providers routinely under diagnose at risk behaviors and outcomes, including depression, suicidal... more Providers routinely under diagnose at risk behaviors and outcomes, including depression, suicidal ideation, substance abuse, and poor medication adherence. To address this, we developed a webbased, self-administered patient-reported assessment tool and integrated it into routine primary care for HIV-infected adults. Printed results were delivered to providers and social workers immediately prior to patient appointments. The assessment included brief, validated instruments measuring clinically relevant domains including depression, substance use, medication adherence, and HIV transmission risk behaviors. Utilizing the Institute for Healthcare Improvement's Plan-Do-Study-Act (PDSA) approach to quality improvement, we addressed issues with clinic flow, technology, scheduling, and delivery of assessment results with the support of all levels of clinic staff. We found web-based patient-reported assessments to be a feasible tool that can be integrated into a busy multi-provider HIV primary care clinic. These assessments may improve provider recognition of key patient behaviors and outcomes. Critical factors for successful integration of such assessments into clinical care include: strong toplevel support from clinic management, provider understanding of patient-reported assessments as a valuable clinical tool, tailoring the assessment to meet provider needs, communication among clinic staff to address flow issues, timeliness of delivery, and sound technological resources.
Uploads
Papers by Jim Tufano