A Web-based tool that extracts information from the electronic medical record helps primary care physicians improve care and manage their entire panel of patients. Those are the findings of two new Kaiser Permanente studies – the first to examine the effectiveness of a population care tool in a large, diverse patient population.
The first study, published in The American Journal of Managed Care, found that the proprietary Panel Support Tool helped doctors improve care for patients with diabetes and/or heart disease. The other study, whose findings appeared in Population Health Management, found that the PST also helped doctors provide better preventive care for healthy patients.
The Panel Support Tool, devised and implemented by doctors at Kaiser Permanente, is a Web-based tool that helps primary care physicians manage care for individual patients, groups of patients or their entire panel. It does this by comparing the care the patient is receiving to the care that is recommended by national guidelines. For example, doctors can query the PST in advance of a patient visit to find out if that patient needs a screening test or vaccine. They can ask the PST to display a list of all of their patients who are overdue for a mammogram or colon cancer screening test, or a list of their diabetic patients whose blood sugar levels are too high, or those who need a foot or eye exam.
“Patients in the U.S. receive only about half of the preventive and follow-up care now recommended by national guidelines. Our study shows that, by using the innovative Panel Support Tool, in conjunction with the electronic medical record, we can provide patients with more of the care they are supposed to receive,” said Adrianne Feldstein, MD, MS, lead author of the American Journal of Managed Care study and senior investigator at the Kaiser Permanente Center for Health Research in Portland, Ore.
“Doctors and staff love the Panel Support Tool because it makes primary care practice more efficient by addressing the needs of all of their patients,” said Yvonne Zhou, PhD, senior manager of Analytics & Evaluation at Kaiser Permanente. Zhou was lead author of the Population Health Management study. “Harnessing the power of immediately available and complete patient information, the PST allows primary care providers to rapidly examine what is recommended for an individual patient, a group of patients with a specific condition, or their entire panel of patients.”
The retrospective, longitudinal study in the October issue of The American Journal of Managed Care followed 204 primary care teams who were using the Panel Support Tool to manage care for 48,344 patients with diabetes and/or heart disease. After three years, for patients with diabetes, the percentage of care recommendations met every month increased from 67.9 percent to 72.6 percent; for heart disease patients, the percentage rose from 63.5 percent to 70.6 percent.
The AJMC study used 2005 as the pre-intervention, 2006 as the implementation, and 2007 as the post-intervention periods. Care recommendations measured included blood sugar levels, blood pressure screening and control, retinopathy, nephropathy, foot screening, use of aspirin, statins, angiotensin converting enzyme inhibitors and beta blockers, and influenza and pneumococcal vaccination.
The second study, published online in Population Health Management, involved 207 primary-care teams that were using the PST to manage the care of 263,509 adult patients, some whom were relatively healthy and others who have chronic diseases. The study looked at 13 different care recommendations and found that after 20 months, the PST improved performance from 72.9 percent to an average of 80 percent. Researchers found that during the first year of tool use, performance in delivering the care recommendations improved to a statistically significant degree every four months.
The PST is a Web-based application that is tightly integrated with Kaiser Permanente HealthConnect®, the world’s largest private-sector electronic health record. Providers can toggle between the PST and KP HealthConnect, which includes comprehensive documentation of patient care in all settings including the lab, pharmacy, radiology and other ancillary systems.
The PST monitors recommendations pertaining to medication management and screening for comorbidities in six chronic conditions: asthma, diabetes, coronary artery disease, heart failure, hypertension and chronic kidney disease. The tool also monitors preventive care measures, such as administering adult immunizations and screening for breast, cervical and colorectal cancer, hyperlipidemia and osteoporosis. For each care recommendation, the Panel Support Tool indicates what actions need to be taken, if any.
Most recommendations monitored by the tool are derived from the Healthcare Effectiveness Data and Information Set, a tool developed by the National Committee for Quality Assurance and used by more than 90 percent of America’s health plans to measure performance on important dimensions of care and service. Other recommendations reflect organizational priorities based on peer-reviewed literature and/or internal research at Kaiser Permanente.
Once a day the PST extracts data from KP HealthConnect and other data repositories and automatically updates all patient-level and panel views. When patients obtain needed screening or lab tests or fill prescriptions, the panel support tool reflects that activity the following day.
The Population Health Management study found that the best ways to improve care using PST include querying the system for care gaps for the entire panel every two to four weeks; sending standardized letters or secure email messages around the time of members’ birthdays that identify all needed care; having medical assistants or nurses call patients to schedule screening tests; and having pharmacists review patients’ records for needed care when refilling medications. While the PST is a great tool to help physicians take better care of their patients, it does not override shared decision making between doctor and patient.
More research is necessary to optimize results and determine if patient outcomes improve with improved care delivery.
Authors on The American Journal of Managed Care study included: Adrianne Feldstein, MD, MS, Nancy A. Perrin, PhD, A. Gabriela Rosales, MS, Gregory A. Nichols, PhD, David H. Smith, RPh, MHA, PhD, and Jennifer Schneider, MPH of the Kaiser Permanente Center for Health Research; Robert Unitan, MD, of Northwest Permanente; Carrie M. Davino, MD and Nancy Louie Lee, RPh of Kaiser Permanente Northwest; and Yvonne Zhou, PhD of Kaiser Permanente.
Authors on the Population Health Management study included: Yvonne Zhou, PhD , Jian J. Wang, MS and Marianne Turley, PhD from Analytics & Evaluation, HIT Transformation/Analytics, Kaiser Permanente; Robert Unitan, MD and Homer Chin, MD of Northwest Permanente; and Terhilda Garrido, MPH and Linda Radler, MBA, of HIT Transformation/Analytics, Kaiser Permanente.
About the Kaiser Permanente Center for Health Research
Kaiser Permanente’s Center for Health Research, founded in 1964, is a nonprofit research institution dedicated to advancing knowledge to improve health. It has research sites in Portland, Ore., Honolulu and Atlanta. For more information, visit http://www.kpchr.org.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: http://www.kp.org/newscenter.
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- In the United States, patients receive roughly half of recommended preventive, acute and chronic illness care. By using the new tool, doctors at Kaiser Permanente were able to improve quality scores and provide more of this recommended care.
- These are the first studies to examine the effectiveness of a population care tool in a large, diverse patient population.
- While primary care physicians may see 20 or 30 patients a day, there are hundreds of patients they don’t see who often need preventive tests, medications and screenings. By using this population care tool, physicians at Kaiser Permanente have improved care for healthy patients as well as those with chronic disease.