Care coordination: pragmatic measurement

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Care coordination pragmatic measurement

• David A. Dorr
• OHSU, Medical Informatics
• Funding support by The John A. Hartford
  Foundation, AHRQ, NLM

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Care coordination through Care Management
Disseminated to gt 75 primary care clinics
www.caremanagementplus.org References Dorr et
al, JAGS, 2008 Wilcox, Proc AMIA, 2005 Dorr et
al., HSR, 2005
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Guideline Adherence Results
plt0.01
Dorr, HSR, 2005
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Odds of dying were reduced significantly.
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Odds of admission (any cause) were reduced by
27-40 in a subset.
OR0.56 p0.013
OR0.65 p0.036
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Measurement to assure fidelity to key successes
in studies
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Techniques for selection of population

• Organic
• (Semi)Automated

Benefits Relatively good selection Productivity Tr
ust-building Simple Cons Clinician Differences
Provider recognizes patient at risk refers
Care coordination
Feedback over time
Benefits Higher likelihood of utilization
change Target conditions Better population
planning Cons Unclear productivity and
trust Complex
Population selected by algorithm
Provider / CM gets list contacts patient
Care Management Plus
Feedback over time?
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Algorithm Development
Dorr et al, JAGS 2007
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Further stratification
Hibbard, IOM (PAM, Health Literacy) Dorr, JAGS,
2007 (Quality of life)
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Components as dosage
Different drugs breadth
Different services breadth
Amount
Amoxicillin 500mg One pill po q6hrs x 7
days Dispense 28
Duration
Amount
Education 1 hr Every 3 weeks x 6 mos Dispense CM
Frequency
Duration
Frequency
Dorr, JGIM, 2007 Adapted from work by Huber et al
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Dosage components what works?
N768
N1223
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Pillars can help define implementation success.
Caretransitions.org
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Coordination Across Sites of CareCare
Transition Measure Scores, Emergency Department
Use, and Hospital Readmissions
Emergency Department Use
Hospital Readmissions
p0.01
p0.04

• When I left the hospital, I had a good
  understanding of the things I was responsible for
  in managing my health when I left the hospital,
  I clearly understood the purpose for taking each
  of my medications The hospital staff took my
  preferences and those of my family or caregiver
  into account in deciding what my health care
  needs would be when I left the hospital.
• Source E.A. Coleman, Windows of Opportunity for
  Improving Transitional Care, Presentation to The
  Commonwealth Fund Commission on a High
  Performance Health System, March 30, 2006.

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RE-AIM key measurement
www.re-aim.org
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Best practices Patient Worksheet
Chronic conditions
Medications
Allergies
Functional status
Preventive care summary
Pertinent labs
Pertinent exams
Wilcox, Proc of AMIA Symp, 2005
Passive reminders Organized by illness
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Population TicklerWorkflow for coordination in
HITOther issuesworkforceinterleaved protocols
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Thank you!

• Contact dorrd_at_ohsu.edu

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Algorithmic approaches needs vary
lt 1 of population Caseload 15-45
Care Management Plus Caseload 250-350
3-5 of population Caseload 90-350
50 of pop. Case load 1000
Pop. of primary care clinic
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Odds of being admitted for a ambulatory care
sensitive condition were reduced by 60.
OR0.33 p0.004
OR0.73 p0.425
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What services does Care Management Plus
provide?In all, 4,735 patients (1,582 seniors)
were seen in 2004-05, receiving 22,899 services
(9,434 for seniors).
Dorr et al, JGIM 2007
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Patterns of care
Average 70.2
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Clusters

• 5 clusters found.