Achieving a High Response Rate With a Health Care Provider Survey, Washington State, 2006 (original) (raw)
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2000
Objective: To describe adherence to a number of quality indicators and clinical outcomes for asthma, diabetes mellitus, hypertension, coronary heart dis- ease, atrial fibrillation, and cerebrovascular disease in the primary care practices of the Practice Partner Research Network (PPRNet). Study Design: Cross-sectional epidemiologic design. Patients and Methods: PPRNet is a national research network of ambulatory, mostly primary care practices that
Population Health Management, 2011
The objective of this cross-sectional, retrospective study was to utilize claims data to establish a quality-of-care benchmark in a large multistate Medicaid population overall and by race. Quality of care and medication adherence (persistence and compliance) per national treatment guidelines, and health care costs/utilization were assessed across common chronic conditions in a large, 9-state Medicaid population. Overall, quality of care was suboptimal across conditions. Over 15% of asthma patients had 1 asthma-related emergency room/hospital event and 12% of chronic obstructive pulmonary disease patients had a Level II or III exacerbation. Only 36% of depression patients filled any antidepressant medication within 90 days of new episode. Only 45% of diabetes patients received 2 A1c tests. Patients who filled a prescription for any acceptable pharmacotherapy ranged from 35% (depression) to 83% (heart failure [HF]). Persistence for those filling any acceptable medication ranged from 16% (asthma) to 68% (HF). Compliance for patients filling 2 prescriptions ranged from 27% (asthma) to 75% (HF). Blacks had the lowest medication compliance and persistence for all conditions except hyperlipidemia. The results highlight the need to assess and improve quality across the spectrum of care, both overall and by race.
Improving the quality of health care for chronic conditions
Quality and Safety in Health Care, 2004
Chronic conditions are increasingly the primary concern of healthcare systems throughout the world. In response to this challenge, the World Health Organization has joined with the MacColl Institute for Healthcare Innovation to adapt the Chronic Care Model (CCM) from a global perspective. The resultant effort is the Innovative Care for Chronic Conditions (ICCC) framework which expands community and policy aspects of improving health care for chronic conditions and includes components at the micro (patient and family), meso (healthcare organisation and community), and macro (policy) levels. The framework provides a flexible but comprehensive base on which to build or redesign health systems in accordance with local resources and demands.
Improving the Management of Chronic Disease at Community Health Centers
New England Journal of Medicine, 2007
BACKGROUND The Health Disparities Collaboratives of the Health Resources and Services Administration (HRSA) were designed to improve care in community health centers, where many patients from ethnic and racial minority groups and uninsured patients receive treatment. METHODS We performed a controlled preintervention and postintervention study of community health centers participating in quality-improvement collaboratives (the Health Disparities Collaboratives sponsored by the HRSA) for the care of patients with diabetes, asthma, or hypertension. We enrolled 9658 patients at 44 intervention centers that had participated in the collaboratives and 20 centers that had not participated (external control centers). Each intervention center also served as an internal control for another condition. Quality measures were abstracted from medical records at each health center. We created overall quality scores by standardizing and averaging the scores from all of the applicable measures. Changes in quality were evaluated with the use of hierarchical regression models that controlled for patient characteristics. RESULTS Overall, the intervention centers had considerably greater improvement than the external and internal control centers in the composite measures of quality for the care of patients with asthma and diabetes, but not for those with hypertension. As compared with the external control centers, the intervention centers had significant improvements in the measures of prevention and screening, including a 21% increase in foot examinations for patients with diabetes, and in disease treatment and monitoring, including a 14% increase in the use of antiinflammatory medication for asthma and a 16% increase in the assessment of glycated hemoglobin. There was no improvement, however, in any of the intermediate outcomes assessed (urgent care or hospitalization for asthma, control of glycated hemoglobin levels for diabetes, and control of blood pressure for hypertension). CONCLUSIONS The Health Disparities Collaboratives significantly improved the processes of care for two of the three conditions studied. There was no improvement in the clinical outcomes studied.
Health Services Research, 2007
Objective. The validity of quality of care measurement has important implications for practicing clinicians, their patients, and all involved with health care delivery. We used empirical data from managed care patients enrolled in west coast physician organizations to test the hypothesis that observed changes in health-related quality of life across a 2.5-year window reflecting process of care. Data Sources/Study Setting. Patient self-report data as well as clinically detailed medical record review regarding 963 patients with chronic disease associated with managed care from three west coast states. Study Design. Prospective cohort study of change in health-related quality of life scores across 30 months as measured by change in SF-12 physical component scores. Data Collection/Extraction Methods. Patient self-report and medical record abstraction. Principal Findings. We found a positive relationship between better process scores and higher burden of illness ( po.05). After adjustment for burden of illness, using an instrumental variables approach revealed better process is associated with smaller declines in SF-12 scores across a 30-month observation window ( p 5 .014). The application of the best quartile of process of care to patients currently receiving poor process is associated with a 4.24 increment in d SF-12-physical component summary scores.
The Chronic Care Model and Relationships to Patient Health Status and Health-Related Quality of Life
American Journal of Preventive Medicine, 2008
Background: The chronic care model (CCM) is a system-level framework used to guide quality improvement efforts in health care. However, little is known about its relationship to patient-level health measures. This study describes the implementation of the CCM as adapted for prevention and health behavior counseling in primary care practices, and examines relationships between the CCM and patient health measures, including general health status and health-related quality of life (HRQOL).