Decision support systems
A physician-led practice offers integrated, coordinated care under capitated contracts to high-risk, moderate- and low-income seniors enrolled in Medicare Advantage plans, leading to high levels of adherence to recommended screening services, good blood glucose control among patients with diabetes, below-average use of inpatient services, high patient satisfaction, and improvements in patient access to medications.
Primary care practices leverage information technologies to identify patients at risk of undiagnosed hypertension and schedule them for automated office blood pressure measurement, reducing the likelihood of remaining undiagnosed by more than 70 percent.
Supported by mobile technology, trained health coaches and nurse care coordinators use home visits and telephone-based monitoring to identify and address declines in health status in recently discharged Medicare patients, leading to a significant reduction in readmissions and associated cost savings.
An emergency department uses an eight-variable risk assessment tool to determine which patients should be tested for undiagnosed HIV, leading to the identification of the same number of HIV-positive patients as through universal screening, thus suggesting greater cost-effectiveness.
A safety net hospital employs a software application that uses electronic health record data and predictive modeling to identify and allocate scarce resources to high-risk patients, leading to fewer readmissions and lower costs.
An online clinic enhances access to and reduces the costs of care for 40 minor health problems that can safely be handled without a face-to-face visit, generating significant time savings and positive feedback from patients, physicians, and payers.
Multiple pieces of legislation in Washington state are starting to have an impact on use of shared decisionmaking in clinical practice, including a mandated demonstration project, recognition of use of decision aids as informed consent in malpractice cases, and formation of a learning collaborative.
A health plan supports providers in orthopedic clinics in distributing decision aids to patients and using shared decisionmaking, contributing to reductions in joint replacement surgeries and overall health care costs.
The health department in New York City uses subsidies, upfront and ongoing technical support, and quality of care feedback to promote implementation and use of electronic health records by primary care practices in medically underserved areas, leading to better care for patients in these practices.
Before seeing their provider, patients with diabetes complete an easy-to-use assessment tool that helps identify and address their biggest quality-of-life concerns, generating overwhelmingly positive feedback from patients and clinicians.