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Medical
Informatics Care Management |
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New OHSU Senior Care
Program Gets $2.5M Boost
Other Topics: Medical
Informatics Consulting,
Radiotherapy On-Board Imager
Oregon Health & Science University
April 10, 2007
John A. Hartford Foundation grant supports expansion of Care
Management Plus: Information Technology Tools for the Care of
Seniors
Portland, OR -- A $2.5 million grant to Oregon Health & Science
University will expand Care Management Plus, a
technology-intensive, innovative primary care model that reduces
hospitalizations, lowers costs, and improves health outcomes for
older adults with chronic illnesses.
The four-year grant from The John A. Hartford Foundation will
make Care Management Plus available to dozens of rural and urban
clinics across the country. |
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"By marrying
clinically supported technology and personalized, one-to-one
care, Care Management Plus has helped primary care teams enhance
care for patients with complex illnesses," said David Dorr,
M.D., assistant professor of medical informatics and clinical
epidemiology, OHSU School of Medicine, and the project's
principal investigator.
In initial studies of Care Management Plus, seniors with
diabetes in the program had better control of their blood sugars
and were more likely to be regularly tested. They also had 15 to
25 percent fewer long-term complications, a 20 percent reduction
in mortality, and a 24 percent reduction in hospitalizations,
compared to a control group.
"We are optimistic that the program could also improve treatment
and lower costs for the care of other chronic diseases, such as
depression, cardiovascular and end-of-life care," Dorr said.
This would represent an important step forward, as patients with
chronic illness account for 75 percent of health care
expenditures in the United States. Sixty-five percent of the
Medicare-funded population have two or more chronic conditions
and represent 95 percent of Medicare costs, and this group has
up to 98 times the rate of preventable hospitalizations than the
rest of the population.
Cherie P. Brunker, M.D., co-principal investigator,
Intermountain Healthcare and the University of Utah Division of
Geriatric Medicine, describes Care Management Plus as "giving
providers the tools they need to improve care and meet the
increasing needs of older adults - all with a focus on the goals
of the individual."
At the heart of Care Management Plus is a robust tracking and
reminding system that takes advantage of medical informatics
innovations developed at Intermountain Healthcare and OHSU, and
well-trained, "technology-enhanced" care managers. Together,
they help patients and caregivers self-manage their conditions,
prioritize health care needs, prevent complications through
structured health care protocols, and navigate an increasingly
complex health care system.
For example, an elderly woman with diabetes, high blood
pressure, mild congestive heart failure, arthritis and memory
problems would have a care manager, such as a specially trained
nurse or social worker, assigned to her. The care manager would
work with her to create a care plan, act as a catalyst to ensure
the plan is followed, and remain a point of contact for the care
team, including specialists and the primary care physician.
Information technology is used to store and update the care
plan, remind the care manager and others about protocols and
best practices, and facilitate and document communication among
the care team.
"The frail elderly are at high risk of avoidable complications,
and the system - information technology with a trained care
manager - has been an effective solution for them," said Linda
Leckman, M.D., CEO of Intermountain Healthcare Medical Group,
and an early proponent of the system.
The care manager also collaborates with the patient, the family
and physicians to adjust the plan as needed. The goal is to
prevent problems rather than treating them after they occur. The
care manager is most frequently a nurse, and the grant will
foster collaboration with the OHSU School of Nursing and its
John A. Hartford Center of Geriatric Nursing Excellence, led by
Heather Young, Ph.D.
Building Patient Relations, Improving Clinician Productivity
Care Management Plus is a "proven model" that emphasizes
face-to-face time with patients, rather than the common model of
telephonic care. As a result, care managers "develop really
strong relationships with the patient. Sometimes patients just
need education, but a lot of times they need this ongoing care,"
Dorr said.
Care Management Plus also can help physicians be more productive
by making the care of patients with complex illnesses more
efficient, and it pays for itself after the first year. In the
pilot study, productivity increased by 8 percent to 12 percent
among 50 physicians who used the program compared with 72
control physicians who did not use the program, which meant a
savings of $99,000 per clinic in additional revenue that paid
for the cost of the care manager.
"If a patient is in crisis, the ability to refer them
immediately to the care manager who can sit with them and talk
with them about issues, do some formal assessment and get them
to a specialist the next day really saves me as a physician time
to do more complex things with the patient that ultimately
affects my bottom line," Dorr said. "By helping patients help
themselves through self-management, they're better prepared and
they don't go to the hospital as much."
Overall health care costs decrease, Dorr said. At the end of the
grant period, his team estimates a $9 million savings for
Medicare. Based on these results, dissemination has already
begun at 26 clinics through this grant and through a Geriatrics
Teams in Practice Dissemination grant, also funded by the John
A. Hartford Foundation, and led by Eric Coleman, M.D. He adds,
"These outcomes speak volumes to both chief clinical officers
and chief financial officers alike."
Looking Ahead Dorr hopes Care Management Plus reshapes health
care practice in the care for elders and those with multiple
chronic diseases, which has been described as mediocre,
fragmented and inefficient in the United States.
Care Management Plus "establishes a medical home by overcoming
the problem of complexity of follow-up," Dorr said. "Patients
don't get forgotten."
Persons interested in benefiting from the training and
technology supported by the program can visit the project's Web
site at www.caremanagementplus.org.
About OHSU
Oregon Health & Science University is the state's only health
and research university, and only academic health center. OHSU
is Portland's largest employer and the fourth largest in Oregon
(excluding government), with nearly 12,000 employees. It serves
189,000 patients, and is a conduit for learning for more than
3,400 students and trainees. OHSU is the source of more than 200
community outreach programs that bring health and education
services to each county in the state. As part of its
multifaceted public mission, OHSU strives for excellence in
education, research and scholarship, clinical practice and
community service. Through its dynamic interdisciplinary
environment, OHSU stimulates the spirit of inquiry, initiative,
and cooperation among students, faculty and staff. OHSU is made
up of the schools of Medicine, Dentistry, Nursing, and School of
Science & Engineering. For more information about OHSU, call
(503) 494-8311 or visit www.ohsu.edu.
About The John A. Hartford Foundation
Founded in 1929, the John A. Hartford Foundation is a committed
champion of training, research and service system innovations
that promote the health and independence of America's older
adults. Through its grant making, the Foundation seeks to
strengthen the nation's capacity to provide effective,
affordable care to this rapidly increasing older population by
educating "aging prepared" health professionals (physicians,
nurses, social workers), and developing innovations that improve
and better integrate health and supportive services. The
Foundation was established by John A. Hartford. Mr. Hartford and
his brother, George L. Hartford, both former chief executives of
the Great Atlantic & Pacific Tea Company, left the bulk of their
estates to the Foundation upon their deaths in the 1950s.
Additional information about the Foundation and it programs is
available at www.jhartfound.org.
Oregon Health & Science University is the state's only health
and research university, and only academic health center. OHSU
is Portland's largest employer and the fourth largest in Oregon
(excluding government), with nearly 12,000 employees. It serves
189,000 patients, and is a conduit for learning for more than
3,400 students and trainees. OHSU is the source of more than 200
community outreach programs that bring health and education
services to each county in the state. As part of its
multifaceted public mission, OHSU strives for excellence in
education, research and scholarship, clinical practice and
community service. Through its dynamic interdisciplinary
environment, OHSU stimulates the spirit of inquiry, initiative,
and cooperation among students, faculty and staff. OHSU is made
up of the schools of Medicine, Dentistry, Nursing, and School of
Science & Engineering. For more information about OHSU, call
(503) 494-8311 or visit www.ohsu.edu. |
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