Doctor breaking cigarette

Patient Perspectives on Smoking Cessation and Interventions in Rheumatology Clinics.

Patient Perspectives on Smoking Cessation and Interventions in Rheumatology Clinics.

Although smoking is a risk factor for cardiovascular and rheumatic disease severity, only 10% of rheumatology visits document cessation counseling. HIP Investigator, Dr. Christie Bartels et al. identified themes and categories of patient and health system-level facilitators/barriers to smoking cessation. Participant-reported barriers and facilitators to cessation involved psychological, health, and social and economic factors, and healthcare messaging, and resources.

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The importance of health insurance claims data in creating learning health systems: evaluating care for high-need high-cost patients using the National Patient-Centered Clinical Research Network (PCORNet)

The importance of health insurance claims data in creating learning health systems: evaluating care for high-need high-cost patients using the National Patient-Centered Clinical Research Network (PCORNet)

Case management programs for high-need high-cost patients are spreading rapidly among health systems. PCORNet has substantial potential to support learning health systems in rapidly evaluating these programs, but access to complete patient data on health care utilization is limited as PCORNet is based on electronic health records not health insurance claims data. Because matching cases to comparison patients on baseline utilization is often a critical component of high-quality observational comparative effectiveness research for high-need high-cost patients, limited access to claims may negatively affect the quality of the matching process. HIP Investigator, Dr. Maureen Smith and team (including HIP Investigator, Dr. Menggang Yu) sought to determine whether the evaluation of programs for high-need high-cost patients required claims data to match cases to comparison patients.

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Yao Liu with camera

Scaling Up Teleophthalmology for Diabetic Eye Screening: Opportunities for Widespread Implementation in the USA

Scaling Up Teleophthalmology for Diabetic Eye Screening: Opportunities for Widespread Implementation in the USA

Teleophthalmology is an evidence-based form of diabetic eye screening. This technology has been proven to substantially increase diabetic eye screening rates and decrease blindness. However, teleophthalmology implementation remains limited among U.S. health systems. In this paper, HIP Investigator Dr. Yao Liu et al. discuss opportunities to address key barriers to widespread implementation of teleophthalmology programs for diabetic eye screening in the United States (U.S.).

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Medical students in front of laptop

Broadening Medical Students' Exposure to the Range of Illness Experiences: A Pilot Curriculum Focused on Depression Education

Broadening Medical Students' Exposure to the Range of Illness Experiences: A Pilot Curriculum Focused on Depression Education

Exposing medical students to a broad range of illness experiences is crucial for teaching them to practice patient-centered care, but students often have limited interaction with patients with diverse illness presentations. In this pilot, Dr. Rachel Grob et. al developed, implemented, and evaluated a self-directed online curriculum followed by a small group discussion focused on depression education. The curriculum was based on a module created using the Database of Individual Patients’ Experiences methodology.

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Content validity of the PROMIS® family relationships measure for children with chronic illness

Content validity of the PROMIS® family relationships measure for children with chronic illness

Elizabeth D. Cox, MD, PhD and colleagues recently published new findings about the content validity of the Patient-Reported Outcomes Measurement Information System® (PROMIS®) Family Relationships measure in the journal, Health and Quality of Life Outcomes.  This NIH-funded study used qualitative methods to assess whether this new patient-reported outcome measure reflects the experiences of children with chronic conditions.  The authors found that the Family Relationships measure, which had been developed and validated in a general pediatric population, does capture the experience of family relationships for chronically ill children.  For the study, over 30 children with asthma, sickle cell disease, or type 1 diabetes and their parents were interviewed about their family experiences and the impact of chronic illness on those relationships. Interviewees described their family relationships in a manner consistent with the facets of the PROMIS® metric.  Findings suggest potential utility for this metric in research and clinical practice with chronically ill children and their families. 

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Sociodemographics and hypertension control among young adults

Sociodemographics and hypertension control among young adults

Young adults ages 18-39 have low hypertension control rates compared to young adults. Using electronic health record data, Dr. Heather Johnson et al. evaluated the role of sociodemographic factors in hypertension control among young adults with primary care access and incident hypertension. They found that young men had a 39% lower rate of hypertension control compared to young women, and that people for whom English was not their primary language and unmarried people also had lower control rates.

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Variability in care management programs in Medicare ACOs

Variability in care management programs in Medicare ACOs

In this study co-authored by Dr. Maureen Smith and Peter Nordby, investigators surveyed medical directors and clinical leaders in 15 care management programs across the country with the goal of classifying models of care management in Medicare ACOs. They found high variability in multiple domains across programs, and that most programs use cost & utilization measures to determine outcomes with relatively few patient and stakeholder experience measures. Due to the wide variation in structures and processes, classification proved challenging, and a wider range of outcomes is needed to better understand the best processes to achieve those outcomes and the value of the case management programs.

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Checking blood pressure

Connecting rheumatology patients to primary care for high blood pressure

Connecting rheumatology patients to primary care for high blood pressure

High blood pressure is the most prevalent cardiovascular risk factor for rheumatology patients, yet blood pressures are not frequently addressed in specialty visits. Dr. Christie Bartels et al. developed the BP Connect Health protocol to address this issue by training medical assistants and nurses to (1) re-check high blood pressures, (2) advise patients about the link betweeen rheumatic and cardiovascular diseases, and (3) connect patients with timely primary care follow-up using electronic health record orders. In an analysis of the intervention, investigators found that the odds of timely primary care follow-up doubled and the media time to follow-up declined by nearly half, from 71 to 38 days. Additionally, the number of rheumatology visits with high blood pressure declined from 17% to 8% in the 2 years after the protocol was implemented, which suggests that the protocol resulted in population-level declines in high blood pressure. A free toolkit with the BP Connect Health protocol and tools to successfully implement it is available on HIPxChange here.

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Nurse checking senior woman's blood pressure

Frequency and predictors of communication about high blood pressure in RA visits

Frequency and predictors of communication about high blood pressure in RA visits

Patients with rheumatoid arthritis (RA) have a heightened risk of cardiovascular disease. Dr. Christie Bartels et al. conducted a retrospective cohort study to determine whether having high blood pressure increased the likelihood of communication about blood pressure in rheumatology visits. The investigators identified patients in the electronic health record who had both RA and uncontrolled hypertension and who received both primary and rheumatology care, and then trained abstractors reviewed the RA visit notes to determine whether blood pressure communication occurred. They found that only 22% of RA clinic visits contained documented communication about blood pressure, and that patients with stage II elevation of blood pressure were not singificantly more likely to have documented communication. Action steps recommending follow-up for high blood pressure were documented in less than 10% of eligible visits. 

Press about the article was featured in Rheumatology News and Healio.

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Assessing unwanted variations in rheumatology clinic previsit rooming

Assessing unwanted variations in rheumatology clinic previsit rooming

Edmond Ramly et al. conducted a cross-sectional time-study and work-system analysis to measure rooming workflows in three rheumatology clinics to assess the current capacity for population management in the clinics. They found that total room duration varied by clinic, with a median of 6.75-8.25 minutes, and vital sign measurement and medication reconciliation took up more than half of the rooming time. Additionally, two of 15 tasks varied significantly in duration across clinics, and 9 tasks varied in frequency. Due to these variations, clinic leaders modified their policies and procedures regarding 6 high-variation tasks, which streamlined the assessment of weight, height, pain scores, tobacco use, disease activity, and refill needs.

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