1.  Information Technology to Support Improved Care For Chronic Illness

Author(s): Young AS, Chaney E, Shoai R, Bonner L, Cohen AN, Doebbeling B, Dorr D, Goldstein MK, Kerr E, Nichol P, Perrin R

Source: J Gen Intern Med 2007 Dec;22(Suppl 3):425-30.

Summary: BACKGROUND: In populations with chronic illness, outcomes improve with the use of care models that integrate clinical information, evidence-based treatments, and proactive management of care. Health information technology is believed to be critical for efficient implementation of these chronic care models. Health care organizations have implemented information technologies, such as electronic medical records, to varying degrees. However, considerable uncertainty remains regarding the relative impact of specific informatics technologies on chronic illness care. OBJECTIVE: To summarize knowledge and increase expert consensus regarding informatics components that support improvement in chronic illness care. DESIGN: A systematic review of the literature was performed. "Use case" models were then developed, based on the literature review, and guidance from clinicians and national quality improvement projects. A national expert panel process was conducted to increase consensus regarding information system components that can be used to improve chronic illness care. RESULTS: The expert panel agreed that informatics should be patient-centered, focused on improving outcomes, and provide support for illness self-management. They concurred that outcomes should be routinely assessed, provided to clinicians during the clinical encounter, and used for population-based care management. It was recommended that interactive, sequential, disorder-specific treatment pathways be implemented to quickly provide clinicians with patient clinical status, treatment history, and decision support. CONCLUSIONS: Specific informatics strategies have the potential to improve care for chronic illness. Software to implement these strategies should be developed, and rigorously evaluated within the context of organizational efforts to improve care.

2.  Creating and Validating a Pneumococcal Vaccination Registry

Author(s): Dexheimer JW, Gregg W, Talbot TR, Aronsky D

Source: AMIA Annu Symp Proc 2005 (NULL);(NULL)((NULL)):201-5.

Summary: Healthy People 2010 set a goal of 90% vaccination rate for pneumococcal vaccine in elderly patients. We developed a keyword search, using pharmacy orders for Pneumovax as a gold standard, to determine patient eligibility for a computerized pneumococcal vaccination registry. The keyword search captured 98% of vaccinations in the validation dataset. A total of 4,768 patients matched at least one keyword in the search and were added to the immunization registry. Through our search, we found a 63% vaccination rate in the primary care patient population older than 65, leaving 37% of the high risk population still needing vaccinations.

3.  BRIEF REPORT: The Prevalence and Use of Chronic Disease Registries in Physician Organizations: A National Survey

Author(s): Julie Schmittdiel, Thomas Bodenheimer, Neil A Solomon, Robin R Gillies, and Stephen M Shortell

Source: J Gen Intern Med 2005 September;20(9):855–858.

Summary: 

4.  A randomized trial of three diabetes registry implementation strategies in a community internal medicine practice

Author(s): Stroebel RJ, Scheitel SM, Fitz JS, Herman RA, Naessens JM, Scott CG, Zill DA, Muller L

Source: Jt Comm J Qual Improv 2002 (NULL);28((NULL)):441–50.

Summary: BACKGROUND: Disease registries are powerful tools with the potential to transform the way chronic diseases are managed. To date, however, little work has been done to determine how to optimize the implementation of a chronic disease registry in practice. METHODS: Twenty-nine physicians and their nurse teams in a large community internal medicine practice participated in this 6-month prospective randomized trial in 2000. Teams were assigned to one of three implementation strategies using information from a diabetes registry. Process and outcome measures for diabetes management were analyzed. Process measures included the percentage of patients completing glycosylated hemoglobin (Hgb) testing within 6 months and low-density lipoprotein (LDL) testing within 12 months. Outcome measures included the percentage of patients with a glycosylated Hgb > 9.3% (equivalent to a HgbA1c > 8.0%), the percentage of patients with an LDL cholesterol > 130 mg/dl, and the percentage of patients with controlled blood pressure, defined as < 130/85 millimeters of mercury. Mean change in LDL and glycosylated Hgb values was also measured. RESULTS: Teams randomized to an intervention strategy that included direct letters to patients showed significant improvement across a number of measures. The improvement was most apparent among patients without recent testing or with poorly controlled disease. The two interventions that did not include direct patient letters resulted in limited improvement. DISCUSSION: Disease registries can be used to improve outcomes in the management of diabetes and other chronic diseases. Better outcomes were seen in patients who received letters based on registry-generated data. This strategy should be included as part of a comprehensive chronic disease management plan. Further refinements in the use of registries should result in further incremental improvement.

5.  Building a Computerized Disease Registry for Chronic Illness Management of Diabetes

Author(s): Jeffrey Hummel, MD, MPH

Source: CLINICAL DIABETES 2000 (NULL);18(3):(NULL).

Summary: Changes in lifestyle and food consumption are fueling a dramatic increase in type 2 diabetes in children and adolescents.  To combat the increasing prevalence of obesity that underlies this trend, health care providers must recognize risk factores in their pediatric patients so that aggressive intervention can be offered.  Development of strategies to curb obesity and prevent type 2 diabetes require a team effort by parents, health providers, school personnel, and motivated patients.