A new toolkit developed by Dr. Elizabeth Magnan is available on HIPxChange. The Algorithm for Identifying Patients with Multiple Chronic Conditions (Multimorbidity) contains over 4,000 ICD-9 codes that are mapped to AHRQ Clinical Classification Software (CCS) codes, which are then bundled into 69 clinically relevant chronic condition categories. Researchers can use these categories to examine the effect of multiple chronic conditions or specific comorbidities on health and outcomes, or in quality improvement or public reporting work.
The Coordinated Transitional Care (C-TraC) program led by HIP investigator Dr. Amy Kind was recently identified by the Veterans Engineering Resource Center as one of 4 best practices to improve care coordination in Veterans Affairs hospitals nationwide. The C-TraC program is a low-resource, registered nurse telephone-based initiative that aims to improve transitional care and post-discharge outcomes. You can learn more about C-TraC and download the protocol on HIPxChange.
A new effort led by Dr. Nancy Pandhi to integrate mental health care into the primary health care system is being undertaken by several Dane county healthcare organizations and UW-Madison programs. The project, Dane 1 in 4, kicked off Monday, September 20 with a forum at the United Way that involved attendees from more than 15 health delivery systems, advocacy organizations, school mental health programs, and other agencies. Starting in October, Dane 1 in 4 will be seeking patient feedback through an anonymous survey that will be available on their website (dane1in4.org) and in various Dane county clinics and health centers.
Dr. Elizabeth Cox's project funded by the Patient Centered Outcomes Research Institute (PCORI) is featured in a recent article on patient engagement in clinical trials in the Wall Street Journal. In the project, Dr. Cox and colleagues are working with children and their families to determine the optimal way to tailor a family-centered diabetes management program to pediatric patients' specific needs.
The Children's Hospital Safety Climate Questionnaire and Access Integrated Primary Care Consulting Psychiatry toolkit were recently posted as resources in the iCollaborative section of the AAMC MedEdPORTAL, a website that aims to equip healthcare professionals across the continuum of care with tools to improve patient care.
Several HIP investigators were recently awarded pilot grants from the UW Institute for Clinical and Translational Research (UW-ICTR). Drs. Christie Bartels, Michelle Chui, Korey Kennelty, Nancy Pandhi, and Gretchen Schwarze will be conducting projects on a variety of topics in inpatient, outpatient, and pharmacy settings that engage patients and community health care organizations as collaborators.
Dr. Christie Bartels was recently awarded a 2.5 year Pfizer Independent Grant for Learning and Change for her project, "Systems-based CVD prevention protocols for rheumatology teams: A low-cost multidisciplinary approach." The goal of the project is to improve management of modifiable cardiovascular disease risk factors as a path to improve the cardiovascular health and survival of patients with rheumatic diseases. The project will apply evidence-based staff-driven protocols in RA clinic visits to improve management of hypertension and tobacco use. This QI project responds to the aim of the Pfizer program to support "screening for and modification of modifiable CVD risk factors in RA patients."
Dr. Jane Mahoney and Betsy Abramson from The Wisconsin Institute for Healthy Aging (WIHA) recently spoke on Wisconsin Public Radio about the types of programs that WIHA offers to support older adults and people living with chronic illnesses, as well as the many benefits of the programs. In collaboration with WIHA, the Health Innovation Program helped support the development of Healthy Living with Diabetes, one of the programs that they discuss in the interview.
The NIH-National Institute on Aging has just funded a 5 year Project (Project PI: Dr. Amy Kind) for a prospective, single-blind randomized controlled trial of the Coordinated-Transitional Care (C-TraC) program. The primary goal of this study is to determine C-TraC's impact on 30-day rehospitalizations, caregiver stress, and the patient-centered post-hospital outcomes of delirium prevention/resolution, functional maintenance/recovery, and falls prevention in patients with dementia discharged from the hospital to the community.
Dr. Nancy Pandhi and Dr. Gretchen Schwarze have been selected to receive New Investigator awards from the Wisconsin Partnership Program for their projects, "Aligning Preferences in Older Adults with Decision for High Risk Surgery" and "The Effectiveness of an Integrated Mental Health and Primary Care Model for Wisconsin Patients with Severe Mental Illness," respectively.