Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? Issue Brief – The Commonwealth Fund – 7 August 2014

Posted on August 8, 2014. Filed under: Chronic Disease Mgmt | Tags: , , |

Caring for High-Need, High-Cost Patients: What Makes for a Successful Care Management Program? Issue Brief – The Commonwealth Fund – 7 August 2014

“Provider groups taking on risk for the overall costs of care in accountable care organizations are developing care management programs to improve care and thereby control costs. Many such programs target “high-need, high-cost” patients: those with multiple or complex conditions, often combined with behavioral health problems or socioeconomic challenges. In this study we compared the operational approaches of 18 successful complex care management programs in order to offer guidance to providers, payers, and policymakers on best practices for complex care management. We found that effective programs customize their approach to their local contexts and caseloads; use a combination of qualitative and quantitative methods to identify patients; consider care coordination one of their key roles; focus on building trusting relationships with patients as well as their primary care providers; match team composition and interventions to patient needs; offer specialized training for team members; and use technology to bolster their efforts.”

Toward Increased Adoption of Complex Care Management – NEJM – 7 August 2014

Instant Replay – A Quarterback’s View of Care Coordination – NEJM – 7 August 2014

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Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally – The Commonwealth Fund – 16 June 2014

Posted on June 16, 2014. Filed under: Comparative Effectiveness Research, Health Mgmt Policy Planning | Tags: |

Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally – The Commonwealth Fund – 16 June 2014

“Executive Summary

The United States health care system is the most expensive in the world, but this report and prior editions consistently show the U.S. underperforms relative to other countries on most dimensions of performance. Among the 11 nations studied in this report—Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States—the U.S. ranks last, as it did in the 2010, 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last or near last on dimensions of access, efficiency, and equity. In this edition of Mirror, Mirror, the United Kingdom ranks first, followed closely by Switzerland (Exhibit ES-1).

Expanding from the seven countries included in 2010, the 2014 edition includes data from 11 countries. It incorporates patients’ and physicians’ survey results on care experiences and ratings on various dimensions of care. It includes information from the most recent three Commonwealth Fund international surveys of patients and primary care physicians about medical practices and views of their countries’ health systems (2011–2013). It also includes information on health care outcomes featured in The Commonwealth Fund’s most recent (2011) national health system scorecard, and from the World Health Organization (WHO) and the Organization for Economic Cooperation and Development (OECD).”

… continues on the site

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International Profiles of Health Care Systems, 2013 – The Commonwealth Fund – 14 November 2013

Posted on November 27, 2013. Filed under: Evidence Based Practice, Health Economics, Health Informatics, Health Mgmt Policy Planning, Health Policy | Tags: |

International Profiles of Health Care Systems, 2013 – The Commonwealth Fund – 14 November 2013

S. Thomson, R. Osborn, D. Squires, and M. Jun, International Profiles of Health Care Systems, 2013, The Commonwealth Fund, November 2013.

“This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization and governance, health care quality and coordination, disparities, efficiency and integration, use of information technology and evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views.”

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Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System – Commonwealth Fund – 10 January 2013

Posted on January 10, 2013. Filed under: Clin Governance / Risk Mgmt / Quality, Health Economics, Patient Participation | Tags: |

Confronting Costs: Stabilizing U.S. Health Spending While Moving Toward a High Performance Health Care System – Commonwealth Fund – 10 January 2013 

Media release. Commission of Leading Health Care Experts Offers New Strategy to Slow Spending Growth by $2 Trillion Over 10 Years While Improving Health System Performance – Commonwealth Fund – 10 January 2013

“Changing How Care Is Paid For, Giving Consumers Better Information and Incentives to Choose Wisely, and Improving How Health Care Markets Function Could Result in Substantial Savings for Federal and Local Governments, Employers, and Families”

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International Profiles of Health Care Systems – Commonwealth Fund – 19 November 2012

Posted on November 20, 2012. Filed under: Health Mgmt Policy Planning, Health Policy | Tags: |

International Profiles of Health Care Systems – Commonwealth Fund – 19 November 2012

“Overview
This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Iceland, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, care coordination, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views.”

S. Thomson, R. Osborn, D. Squires, and M. Jun, International Profiles of Health Care Systems, 2012, The Commonwealth Fund, November 2012.

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Using Electronic Health Records to Improve Quality and Efficiency: The Experiences of Leading Hospitals – The Commonwealth Fund – 2 July 2012

Posted on July 3, 2012. Filed under: Health Informatics, Medical Records | Tags: , , |

Using Electronic Health Records to Improve Quality and Efficiency: The Experiences of Leading Hospitals – The Commonwealth Fund – 2 July 2012

Authors: Sharon Silow-Carroll et al

“Overview

An examination of nine hospitals that recently implemented a comprehensive electronic health record (EHR) system finds that clinical and administrative leaders built EHR adoption into their strategic plans to integrate inpatient and outpatient care and provide a continuum of coordinated services. Successful implementation depended on: strong leadership, full involvement of clinical staff in design and implementation, mandatory staff training, and strict adherence to timeline and budget. The EHR systems facilitate patient safety and quality improvement through: use of checklists, alerts, and predictive tools; embedded clinical guidelines that promote standardized, evidence-based practices; electronic prescribing and test-ordering that reduces errors and redundancy; and discrete data fields that foster use of performance dashboards and compliance reports. Faster, more accurate communication and streamlined processes have led to improved patient flow, fewer duplicative tests, faster responses to patient inquiries, redeployment of transcription and claims staff, more complete capture of charges, and federal incentive payments.”

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Measuring the Success of Medical Homes: Recommendations from the PCMH Evaluators’ Collaborative – Commonwealth Fund – 18 May 2012

Posted on May 21, 2012. Filed under: Health Mgmt Policy Planning | Tags: , |

Measuring the Success of Medical Homes: Recommendations from the PCMH Evaluators’ Collaborative – Commonwealth Fund – 18 May 2012

“There are currently more than 90 commercial health plans, 42 states, and three federal initiatives testing the patient-centered medical home (PCMH) model. Yet, while elements of the medical home have been shown to be associated with better quality and lower cost, there are only a few high-quality, published evaluations of the impact of the PCMH model as a whole. There is an urgent need for rigorous data to strengthen the evidence base of the medical home as well as to improve implementation. In an effort to harness and share lessons from the many disparate medical home pilots and evaluations under way, The Commonwealth Fund established the Patient-Centered Medical Home Evaluators’ Collaborative in 2009.

The objectives of the Evaluators’ Collaborative are to:”

… continues on the site

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Recommended Core Measures for Evaluating the Patient-Centered Medical Home: Cost, Utilization, and Clinical Quality – The Commonwealth Fund – 16 May 2012

Posted on May 17, 2012. Filed under: Aged Care / Geriatrics, Chronic Disease Mgmt, Clin Governance / Risk Mgmt / Quality | Tags: , |

Recommended Core Measures for Evaluating the Patient-Centered Medical Home: Cost, Utilization, and Clinical Quality – The Commonwealth Fund – 16 May 2012

M. B. Rosenthal, M. K. Abrams, A. Bitton, and the Patient-Centered Medical Home Evaluators’ Collaborative, Recommended Core Measures for Evaluating the Patient-Centered Medical Home: Cost, Utilization, and Clinical Quality, The Commonwealth Fund, May 2012.

“Overview
The patient-centered medical home has emerged as a promising solution to address the significant fragmentation, poor quality, and high costs that afflict the U.S. health care system. The medical home model includes core components of primary and patient-centered care, recent innovations in practice redesign and health information technology, and changes to the way practices and providers are paid. There are initiatives across the country testing the promise of the medical home model. However, to properly evaluate and compare results that will aid in the implementation of these and other initiatives, researchers need a standard set of core measures. This brief describes the process and recommendations of more than 75 researchers who came together to identify a core set of standardized measures to evaluate the patient-centered medical home. It focuses on two domains of medical home outcomes: cost/utilization and clinical quality.”

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The Performance Improvement Imperative: Utilizing a Coordinated, Community-Based Approach to Enhance Care and Lower Costs for Chronically Ill Patients – The Commonwealth Fund – 26 April 2012

Posted on April 27, 2012. Filed under: Chronic Disease Mgmt, Clin Governance / Risk Mgmt / Quality | Tags: |

The Performance Improvement Imperative: Utilizing a Coordinated, Community-Based Approach to Enhance Care and Lower Costs for Chronically Ill Patients – The Commonwealth Fund – 26 April 2012

The Commonwealth Fund Commission on a High Performance Health System

“Overview

The Commonwealth Fund Commission on a High Performance Health System believes the federal government needs a comprehensive implementation plan to take full advantage of the opportunities in recent health reform legislation. Such a plan requires a vision and clear goals for performance improvement, collaboratively determined priorities, simplified administrative requirements, and rapid data-driven feedback. By 2016, the nation should seek to double annual improvement in quality-of-care metrics and to hold the per capita increase in health expenditures to the annual growth in per capita GDP, plus 0.5 percentage points—reducing national expenditures by $893 billion over 10 years. To help achieve these goals, the Commission proposes the U.S. create 50 to 100 voluntary “Health Improvement Communities” focused on patients with multiple, high-cost chronic conditions. Through payment reform, enhanced primary care, and health information technology, this effort could yield $184 billion in savings, or 21 percent of the overall target.”

News release: Commission of Leading Experts Unveils Plan to Improve Care for Chronically Ill Patients and Reduce Health Spending By $184 Billion Over the Next Decade

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Incentivizing Quality Care Through Pay-for-Performance – Commonwealth Fund – April 2012

Posted on April 24, 2012. Filed under: Clin Governance / Risk Mgmt / Quality, Health Economics | Tags: , |

Incentivizing Quality Care Through Pay-for-Performance – Commonwealth Fund – April 2012

by David Squires

“One target of reforms to reduce health care spending and improve quality has been the fee-for-service payment model, long criticized for creating incentives for providers to increase the volume of services, rather than improve the quality and efficiency of care. Alternative payment models have gained momentum in the U.S. and abroad to align providers’ incentives with value rather than volume.

One such alternative is pay-for-performance reimbursement, which rewards providers for meeting designated targets. Rather than replacing traditional payment methods, pay-for-performance approaches can be combined with them to provide incentives to improve. For example, a primary care doctor may receive an extra payment if a certain percentage of his or her patients receive all of their recommended screening tests. Accountable care organizations are another, far more sophisticated, example; in such organizations the target is to provide high-quality care while reducing costs and the reward is a portion of the cost savings.

Many countries have experimented with pay-for-performance models in recent years. These experiences offer examples and lessons for using incentive payments to encourage improvements.”

… continues on the site

Looks at:
England: The Quality and Outcomes Framework
Australia: Practice Incentives Program
Germany: Disease Management Programs

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Ensuring Access to After-Hours Care – Commonwealth Fund – 4 April 2012

Posted on April 24, 2012. Filed under: Emergency Medicine, Health Mgmt Policy Planning, Health Systems Improvement | Tags: |

Ensuring Access to After-Hours Care – Commonwealth Fund – 4 April 2012

by David Squires

“Urgent care needs are not confined to weekdays and work hours. Nonetheless, patients often have difficulty accessing care after hours without going to the emergency department, which in many circumstances can be an inappropriate and inefficient use of health care resources. Ensuring that patients have timely access to the appropriate level of care on nights and weekends has the potential to reduce unnecessary emergency department use; it can also ensure that patients receive patient-centered, efficient care.

According to past Commonwealth Fund International Surveys, after-hours care is particularly difficult to obtain in the U.S. without going to the emergency department. In recent years, several countries, including the Netherlands, Denmark, and Germany, have sought to expand access to after-hours care—often by transitioning from the traditional approach, in which practices designate someone to be “on-call,” to group-based or regional approaches. As the U.S. seeks to strengthen primary care, particularly through the development of patient-centered medical homes, it has a great deal to learn from these international models.”

… continues on the site

Looks at:
The Netherlands
Denmark
Germany

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Bundling Payments to Promote Integration and Efficiency – Commonwealth Fund – 4 April 2012

Posted on April 24, 2012. Filed under: Chronic Disease Mgmt, Health Economics | Tags: , |

Bundling Payments to Promote Integration and Efficiency – Commonwealth Fund – 4 April 2012

by David Squires

“High-quality care for patients with chronic and complex conditions often involves coordinating between multiple providers and sources of care. Fee-for-service payment, which reimburses providers for a particular service, fails to provide incentives to coordinate care and can encourage providers to work in silos. Bundled payments—also known as episode-based payment or case rates—have been proposed as a way to encourage coordination across providers and to promote more efficient care. Under a bundled payment, a single fee is paid for an entire episode of care; for example, a single fee for hip replacement would cover both the procedure itself and the rehabilitation and follow-up treatments. This fee would be divided among the providers along the care pathway, either prospectively or retroactively.

Bundled payments already exist in the U.S. in a number of systems, such as the Geisinger Health System. The Affordable Care Act contains provisions advancing bundled payments in Medicare, including a large-scale pilot scheduled to be rolled out by January 1, 2013. Other countries have also experimented with bundled payments, most notably the Netherlands and Germany. Their experiences can inform U.S. efforts to reform health system payment and drive improvement.”

… continues on the site

Looks at:
Bundling Payments for Chronic Conditions in the Netherlands
Integrated Care Contracts in Germany

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Using Comparative Effectiveness Research to Inform Policymaking – Commonwealth Fund – 4 April 2012

Posted on April 24, 2012. Filed under: Evidence Based Practice | Tags: , |

Using Comparative Effectiveness Research to Inform Policymaking – Commonwealth Fund – 4 April 2012

by David Squires

“Comparative effectiveness research (CER) assesses alternative treatments or diagnostic options for the same condition. Such research can prove useful for clinicians and patients as a tool to inform decisions about treatment and care. It also has potential to inform policymaking, such as decisions over which treatments to cover and at what price. In the United States, the 2009 Recovery Act for the first time provided significant funding for CER, and the 2010 Affordable Care Act went further, establishing an independent institute to commission such research—the Patient-Centered Outcomes Research Institute—with dedicated long-term funding.

Several industrialized countries have operated organizations conducting and commissioning CER for many years. In some countries these bodies are government agencies, while in others they are freestanding organizations with more independence. Policymakers often use the research these organizations generate to determine the content of publicly provided health benefits—for example, to decide whether a new drug should be covered under regional or national formularies. Other uses include negotiating pricing arrangements with drug companies or designing “value-based” cost-sharing arrangements, wherein patients pay more out-of-pocket for drugs deemed less effective than their alternative. As the Patient-Centered Outcomes Research Institute develops and CER becomes more widely available, U.S. decision-makers can learn from international experiences using CER to drive health care toward improved quality and value.”

… continues on the site

Looks at:
England’s National Institute for Health and Clinical Excellence
France’s National Authority for Health (HAS)
Germany’s Institute for Quality and Efficiency in Health Care
Australia’s Pharmaceutical Benefits Advisory Committee

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Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical Homes – Commonwealth Fund – 27 February 2012

Posted on February 29, 2012. Filed under: Primary Hlth Care | Tags: , |

Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical Homes – Commonwealth Fund – 27 February 2012

“Executive Summary

A robust primary care sector is the foundation of a more effective and efficient health care system. However, achieving a robust primary care sector will require widespread practice transformation. A growing consensus supports the patient-centered medical home (PCMH) model, proposed as joint principles by the major primary care professional associations, as the blueprint for practice transformation. Under these principles, a PCMH would provide each person with a personal physician who leads a team that takes responsibility for ongoing care for all health issues and coordinates care with other service providers. Medical homes would also ensure the quality and safety of their care through performance measurement and continuous quality improvement and provide their patients with enhanced access. Finally, payment systems would reward the added value provided by medical homes. While these joint principles describe the general expectations of a PCMH, they do not make concrete suggestions for how primary care organizations can change their practices to become one.

As part of The Commonwealth Fund’s Safety Net Medical Home Initiative (SNMHI), this report sought to develop a more detailed and concrete definition that describes the changes that most practices would need to make to become PCMHs. After reviewing the literature, the study team proposed eight characteristics of medical homes—called change concepts—which provide general directions for transforming a practice. We further identified more specific practice modifications called key changes for each change concept. A technical expert panel assembled for the SNMHI reviewed the change concepts and key changes and suggested alterations. A second panel, convened for another PCMH transformation project, also provided feedback.

Many, but not all, of the change concepts and key changes are supported by evidence of positive effects on important outcomes. Therefore, the following eight change concepts should be viewed as general guidance for transforming the practice as well as opportunities for innovation and adaptation.”

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Eliminating Central Line Infections and Spreading Success at High-Performing Hospitals – The Commonwealth Fund – 1 December 2011

Posted on December 6, 2011. Filed under: Infection Control | Tags: , |

Eliminating Central Line Infections and Spreading Success at High-Performing Hospitals – The Commonwealth Fund – 1 December 2011

“Overview
One of the most common types of health care–associated infections is the central line–associated bloodstream infection (CLABSI), which can result when a central venous catheter is not inserted or maintained properly. About 43,000 CLABSIs occurred in hospitals in 2009; nearly one of five infected patients died as a result. This report synthesizes lessons from four hospitals that reported they did not experience any CLABSIs in their intensive care units in 2009. Lessons include: the importance of following evidencebased protocols to prevent infection; the need for dedicated teams to oversee all central line insertions; the value of participation in statewide, national, or regional CLABSI collaboratives or initiatives; and the necessity for close monitoring of infection rates, giving feedback to staff, and applying internal and external goals. The report also presents ways these hospitals are spreading prevention techniques to non-ICU units, and strategies for preventing other health care–associated infections.”

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Building Medical Homes: Lessons From Eight States with Emerging Programs – The Commonwealth Fund – 2 December 2011

Posted on December 6, 2011. Filed under: Community Services | Tags: , |

Building Medical Homes: Lessons From Eight States with Emerging Programs – The Commonwealth Fund – 2 December 2011

“Overview
Many states are strategically engaging public and private payers in the design of medical home programs as a means of achieving better health outcomes, increasing patient satisfaction, and lowering per capita health care costs. The eight states profiled in this report—Alabama, Iowa, Kansas, Maryland, Montana, Nebraska, Texas, and Virginia—are at different stages in the development and implementation of a medical home program and have relied on different strategies to encourage primary care providers to adopt the model, including developing state medical home qualification standards instead of adopting national standards. As a whole, their experiences demonstrate that states can play a critical role in convening stakeholders, helping practices improve performance, and addressing antitrust concerns that arise when multiple payers come together to create a medical home program.”

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EHR-Based Care Coordination Performance Measures in Ambulatory Care – The Commonwealth Fund – November 2011

Posted on November 21, 2011. Filed under: Chronic Disease Mgmt, Health Informatics, Primary Hlth Care | Tags: |

EHR-Based Care Coordination Performance Measures in Ambulatory Care – The Commonwealth Fund – November 2011
K. S. Chan, J. P. Weiner, S. H. Scholle et al

“Overview
Good coordination of care in the ambulatory setting has the potential to reduce unnecessary or duplicative use of health services, prevent hospitalizations for ambulatory care–sensitive conditions, improve patient safety, and potentially reduce costs. Unfortunately, coordination failures are common across the health care system. Using performance measures can drive practice improvement, particularly if reimbursement aligns with measurement. However, there are few well-developed, standardized measures of care coordination. This study sought to develop electronic health record–based measures to assess the quality of coordination during the primary care physician-to-specialist referral process, one of the most common transitions across providers in health care. Using input from interviews with primary care physicians and experts, the authors developed a core set of five electronic measures for use in primary care and specialist settings. Through a preliminary evaluation, they determined that the measures are valid with practicing physicians and two are ready for implementation.”

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Electronic Health Records: An International Perspective on “Meaningful Use” – The Commonwealth Fund – November 2011

Posted on November 18, 2011. Filed under: Health Informatics | Tags: |

Electronic Health Records: An International Perspective on “Meaningful Use” – The Commonwealth Fund – November 2011

“Overview
Research has shown that the United States lags many other countries in the adoption of electronic health records (EHRs). The U.S. has now embarked on a major effort to achieve “meaningful use” of health information technology by clinicians and hospitals. This issue brief describes the extent of meaningful use in three countries with very high levels of health information technology adoption—Denmark, New Zealand, and Sweden. While all three have achieved high levels of meaningful use, none has reached 100 percent in all categories. The brief find high levels of meaningful use for EHR items and substantial information-sharing with other organizations or health authorities, although less information is shared with patients. Insights that may prove useful to the United States include providing economic incentives to encourage adoption and designating an organization to take responsibility for standardization and interoperability.”

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Strengthening Primary Care: Recent Reforms and Achievements in Australia, England, and the Netherlands – The Commonwealth Fund – 15 November 2011

Posted on November 17, 2011. Filed under: Primary Hlth Care | Tags: |

Strengthening Primary Care: Recent Reforms and Achievements in Australia, England, and the Netherlands – The Commonwealth Fund – 15 November 2011

S. Willcox, G. Lewis, and J. Burgers, Strengthening Primary Care: Recent Reforms and Achievements in Australia, England, and the Netherlands, The Commonwealth Fund, November 2011.

“Overview
Recent reforms in Australia, England, and the Netherlands have sought to enhance the quality and accessibility of primary care. Quality improvement strategies include postgraduate training programs for family physicians, accreditation of general practitioner (GP) practices, and efforts to modify professional behaviors—for example, through clinical guideline development. Strategies for improving access include national performance targets, greater use of practice nurses, assured after-hours care, and medical advice telephone lines. All three countries have established midlevel primary care organizations both to coordinate primary care health services and to serve other functions, such as purchasing and population health planning. Better coordination of primary health care services is also the objective driving the use of patient enrollment in a single general practice. Payment reform is also a key element of English and Australian reforms, with both countries having introduced payment-for-quality initiatives. Dutch payment reform has stressed financial incentives for better management of chronic disease.”

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International Profiles of Health Care Systems: Australia, Canada, Denmark, England, France, Germany, Italy, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States – The Commonwealth Fund – 9 November 2011

Posted on November 11, 2011. Filed under: Health Mgmt Policy Planning | Tags: |

International Profiles of Health Care Systems: Australia, Canada, Denmark, England, France, Germany, Italy, Japan, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States – The Commonwealth Fund – 9 November 2011
S. Thomson, R. Osborn, D. Squires, and S. J. Reed, International Profiles of Health Care Systems, 2011, The Commonwealth Fund, November 2011.

“Overview
This publication presents overviews of the health care systems of Australia, Canada, Denmark, England, France, Germany, Japan, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. Each overview covers health insurance, public and private financing, health system organization, quality of care, health disparities, efficiency and integration, use of health information technology, use of evidence-based practice, cost containment, and recent reforms and innovations. In addition, summary tables provide data on a number of key health system characteristics and performance indicators, including overall health care spending, hospital spending and utilization, health care access, patient safety, care coordination, chronic care management, disease prevention, capacity for quality improvement, and public views.”

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Disease-Management Programs Can Improve Quality of Care for the Chronically Ill, Even in a Weak Primary Care System: A Case Study from Germany – Commonwealth Fund – 3 November 2011

Posted on November 4, 2011. Filed under: Chronic Disease Mgmt | Tags: |

Disease-Management Programs Can Improve Quality of Care for the Chronically Ill, Even in a Weak Primary Care System: A Case Study from Germany – Commonwealth Fund – 3 November 2011

Authors: S. Stock, D. Starke, L. Altenhofen, and L. Hansen

“Overview

Enhancing the coordination and quality of care for chronically ill patients is a challenge across health care systems. In Germany, following a 2002 reform, physician-based and patient-centered disease-management programs (DMPs) were implemented in a nationwide rollout. These programs are characterized by information technology support, the central role of a designated doctor in ambulatory care, a patient-centered approach that encourages patient self-management, quality assurance (including reminders and benchmarking), and financial incentives for physicians, patients, and sickness funds. Results of a four-year follow-up show that despite the programs’ implementation in a weak primary care system, quality of care and patient satisfaction have improved while hospitalization rates, duration of hospital stay, patient mortality, and drug costs have been significantly lowered. In some areas up to 90 percent of all eligible patients are enrolled, thereby giving the programs a broadly representative base.”

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National Scorecard on U.S. Health System Performance, 2011 – The Commonwealth Fund – 18 October 2011

Posted on October 25, 2011. Filed under: Health Mgmt Policy Planning | Tags: , , |

National Scorecard on U.S. Health System Performance, 2011 – The Commonwealth Fund – 18 October 2011

“Overview
The National Scorecard on U.S. Health System Performance, 2011, updates a series of comprehensive assessments of U.S. population health and health care quality, access, efficiency, and equity. It finds substantial improvement on quality-of-care indicators that have been the focus of public reporting and collaborative initiatives. However, U.S. health system performance continues to fall far short of what is attainable, especially given the enormity of public and private resources devoted nationally to health. Across 42 performance indicators, the U.S. achieves a total score of 64 out of a possible 100, when comparing national rates with domestic and international benchmarks. Overall, the U.S. failed to improve relative to these benchmarks, which in many cases rose. Costs were up sharply, access to care deteriorated, health system efficiency remained low, disparities persisted, and health outcomes failed to keep pace with benchmarks. The Affordable Care Act targets many of the gaps identified by the Scorecard.”

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Electronic Consultations Between Primary and Specialty Care Clinicians: Early Insights – The Commonwealth Fund – October 2011

Posted on October 20, 2011. Filed under: Health Informatics, Primary Hlth Care | Tags: |

K. Horner, E. Wagner, and J. Tufano, Electronic Consultations Between Primary and Specialty Care Clinicians: Early Insights, The Commonwealth Fund, October 2011.
Overview

“Electronic consultation (e-consultation) is an emerging tool that primary care clinicians can use to communicate with specialists about patients asynchronously—that is, at different times that are convenient for each physician. To conduct an e-consultation, clinicians use either a Web-based program or a shared electronic medical record. Early adopters of e-consultation describe positive experiences for patients, clinicians, and health systems, including improved continuity of care, access to specialists, convenience, and information transfer. E-consultation presents opportunities to improve health care quality and reduce specialty care costs, but dissemination will be limited unless incentives are created and clinicians are encouraged to use e-consultation through financial reimbursement.”

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Delivery System Reform Tracking: A Framework for Understanding Change – Commonwealth Fund – 2 June 2011

Posted on June 29, 2011. Filed under: Health Mgmt Policy Planning, Health Systems Improvement | Tags: , , , |

L. Tollen, A. Enthoven, F. J. Crosson et al., Delivery System Reform Tracking: A Framework for Understanding Change, The Commonwealth Fund, June 2011.

“Overview
The health care delivery system is changing rapidly, with providers forming patient-centered medical homes and exploring the creation of accountable care organizations. Enactment of the Affordable Care Act will likely accelerate these changes. Significant delivery system reforms will simultaneously affect the structures, capabilities, incentives, and outcomes of the delivery system. With so many changes taking place at once, there is a need for a new tool to track progress at the community level. Many of the necessary data elements for a delivery system reform tracking tool are already being collected in various places and by different stakeholders. The authors propose that all elements be brought together in a unified whole to create a detailed picture of delivery system change. This brief provides a rationale for creating such a tool and presents a framework for doing so.”

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Keeping the Commitment: A Progress Report on Four Early Leaders in Patient Safety Improvement – Synthesis Report – March 2011

Posted on April 29, 2011. Filed under: Patient Safety | Tags: |

Keeping the Commitment: A Progress Report on Four Early Leaders in Patient Safety Improvement – Synthesis Report – March 2011
The Commonwealth Fund.
“ABSTRACT: Four case studies document the progress achieved in the past five years by health care organizations that were early leaders in patient safety improvement. Their experience reflects an expansion of interventions from individual hospital units to whole facilities and delivery systems, including new settings such as home health care. Approaches include developing practical methods for training, coaching, and motivating staff to engage in patient safety work; designing effective tools and systems to minimize error and maximize learning; and leading change by setting ambitious goals, measuring and holding units accountable for performance, and sharing stories to convey values. Results include advancements in safety practices, reductions in serious events of patient harm, improved organizational safety climate and morale, and declines in malpractice claims. Keeping the commitment to patient safety has required sustained focus on making safety a core organizational value, a willingness to innovate and adapt, and perseverance in pursuing goals. “

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WhyNottheBest.org Readmission Case Study Series – Commonwealth Fund – 16 February 2011

Posted on February 17, 2011. Filed under: Aged Care / Geriatrics, Chronic Disease Mgmt, Clin Governance / Risk Mgmt / Quality, Health Systems Improvement | Tags: , |

WhyNottheBest.org Readmission Case Study Series

“Overview
Nearly one of five elderly patients who are discharged from the hospital in the United States is rehospitalized within 30 days. Evidence suggests that many of these readmissions are avoidable, caused by complications or infections from the initial hospital stay, poorly managed transitions to post-acute care, or recurrence or exacerbation of symptoms of their chronic diseases. In addition to taking a physical and emotional toll on patients and their families, avoidable readmissions are extremely costly.

Reducing readmissions has become a priority among health care providers, health plans, government, and other stakeholders. Readmission rates for three clinical areas—heart failure, heart attack, and pneumonia—are collected and publicly reported by the Centers for Medicare and Medicaid Services and other organizations. The risk-adjusted readmission rates show significant variation across hospitals, indicating that some hospitals are more successful than others at addressing the causes of readmissions. This case study is part of a series that highlights best practices among hospitals.

This case studies series was created for  WhyNotTheBest.org . The goal of WhyNotTheBest.org is to foster health care quality improvement by promoting transparency and public reporting, and by providing tools and case studies of top performers to aid organizations in their own improvement efforts.”

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Systems of Care Coordination for Children: Lessons Learned Across State Models – Commonwealth Fund – 3 September 2010

Posted on September 7, 2010. Filed under: Child Health / Paediatrics, Health Systems Improvement | Tags: |

Systems of Care Coordination for Children: Lessons Learned Across State Models – Commonwealth Fund – 3 September 2010

S. Silow-Carroll and G. Hagelow, Systems of Care Coordination for Children: Lessons Learned Across State Models, The Commonwealth Fund, Sept. 2010.

“Overview
There are few organized systems of referral and care coordination for children and families identified with early developmental delays, complex medical conditions, and difficulties negotiating the medical and related support systems, but some promising models are emerging. This report summarizes lessons from programs in five states that refer families to appropriate community or state programs, help coordinate their care, provide support and follow-up to ensure they receive needed services, and provide a feedback loop to primary care providers. Common features of successful programs include: maximizing efficiencies through shared resources, leveraging and partnering with other organizations, in-depth involvement with pediatric practice staff, appropriate training and tools, flexible program design, measurement and evaluation, and a holistic approach to care. The findings point to a need for greater identification and dissemination of best practices and technical assistance, stable funding sources, and integration of care coordination into new models of health care financing and delivery.”

Downloads Issue Brief (703K PDF)

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The Triple Aim Journey: Improving Population Health and Patients’ Experience of Care, While Reducing Costs – The Commonwealth Fund – 22 July 2010

Posted on July 26, 2010. Filed under: Health Systems Improvement | Tags: |

D. McCarthy and S. Klein, The Triple Aim Journey: Improving Population Health and Patients’ Experience of Care, While Reducing Costs, The Commonwealth Fund, 22 July 2010.

“Overview
Case studies of three organizations participating in the Institute for Healthcare Improvement’s Triple Aim initiative shed light on how they are partnering with providers and organizing care to improve the health of a population and patients’ experience of care while lowering—or at least reducing the rate of increase in—the per capita cost of care. The organizations—CareOregon, a nonprofit managed health care plan serving low-income Medicaid enrollees; Genesys Health System, a nonprofit integrated delivery system in Flint, Mich.; and QuadMed, a Wisconsin-based subsidiary of printer Quad/Graphics that develops and manages worksite health clinics and wellness programs—were selected to illustrate diverse approaches. Lessons from these organizations can guide others who wish to undertake or promote transformation in health care delivery.”

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State Case Studies of Infant and Early Childhood Mental Health Systems: Strategies for Change – July 16, 2010

Posted on July 21, 2010. Filed under: Child Health / Paediatrics, Mental Health Psychi Psychol | Tags: |

State Case Studies of Infant and Early Childhood Mental Health Systems: Strategies for Change – July 16, 2010

Fund Report (518K PDF)

D. R. Lyman, W. Holt, and R. H. Dougherty, State Case Studies of Infant and Early Childhood Mental Health Systems: Strategies for Change, The Commonwealth Fund, July 2010.

“Overview
This report examines the efforts made in Colorado, Indiana, Massachusetts, and Rhode Island to develop mental health systems of early identification and intervention for children from birth to age 5. While each state is in a different stage of development, together they provide a picture of progress and opportunities for national change in this evolving area of health care. The study focuses on the process of change and identifies common strategies for achieving innovation. State profiles, examples of major initiatives, and descriptions of exemplary practices illustrate ways that states can improve services and policies. Conclusions underscore the value of articulating a national vision of comprehensive infant and early childhood developmental and mental health systems of care, in which child and family well-being are promoted and needs are identified and treated as early as possible in life.”

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National Progress Report on eHealth [US] – Commonwealth Fund – 13 July 2010

Posted on July 14, 2010. Filed under: Health Informatics | Tags: |

National Progress Report on eHealth [US] – Commonwealth Fund – 13 July 2010

eHealth Initiative, National Progress Report on eHealth (Washington, D.C.: eHealth Initiative, July 2010).

“A new report from eHealth Initiative—an organization that seeks to help health care industry stakeholders better understand and use health information technology (IT)—tracks developments over the past three years in promoting the adoption and use of health IT. Supported by The Commonwealth Fund, the National Progress Report on eHealth finds that:

  • Significant advances have been made as a result of public and private sector initiatives. The 2009 American Recovery and Reinvestment Act, which allocated $30 billion to promote health IT, has been a key driver of progress.
  • Many providers are concerned about the lack of coordination across government health and health information technology initiatives.
  • More education and outreach to consumers about health IT and health information exchange are needed.
  • Knowledge and transparency of privacy and security policies will be key to building consumer trust.

More than a hundred experts helped assess progress in the following five areas: aligning incentives, engaging consumers, improving population health, managing privacy, security and confidentiality, and transforming care delivery. Stakeholders’ perceptions of progress were also gauged. Sixty-one percent agreed or strongly agreed that significant progress has been made in the successful adoption and use of health IT since 2007, but most (67%) felt that outreach to educate consumers about the value of electronic health records and health information exchanges is not effective.

To realize the goal of using health IT adoption to improve quality in care delivery, the report recommends implementing policies and programs that take into consideration all sectors of the health care community, including consumers, and promoting further education on the new privacy and security laws and regulations.”

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Public Hospital Case Study Series: Introduction – 7 July 2010 – The Commonwealth Fund

Posted on July 8, 2010. Filed under: Clin Governance / Risk Mgmt / Quality, Health Mgmt Policy Planning, Health Systems Improvement | Tags: |

Public Hospital Case Study Series: Introduction – 7 July 2010  – The Commonwealth Fund

“Compared with other hospitals, public hospitals are generally assumed to face multiple barriers to providing high-quality care: lower revenues; sicker patients who may have infrequent contact with the health care system; and an older infrastructure, particularly related to health information technology.

This case study series set out to find how some public hospitals have succeeded in achieving excellence in quality of care, in spite of such challenges. We sought to understand the strategies and factors that contribute to high performance, as well as the barriers and challenges public hospitals face. To do so, researchers examined aggregate quality scores on 23 process-of-care measures reported by CMS, for all hospitals submitting data from July 2007 through June 2008. They selected for case study analysis eight public hospitals from among 14 that performed among the top 10 percent of more than 2,000 public and private hospitals reporting during this period.

For the purposes of this series, we defined “public hospital” as any government-owned hospital or member of the National Association of Public Hospitals.”   …continues

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Mirror Mirror On The Wall: How the Performance of the U.S. Health Care System Compares Internationally 2010 Update – 23 June 2010

Posted on June 23, 2010. Filed under: Health Mgmt Policy Planning | Tags: , |

Mirror Mirror On The Wall: How the Performance of the U.S. Health Care System Compares Internationally 2010 Update, by Commonwealth Fund researchers Karen Davis, Cathy Schoen, and Kristof Stremikis

U.S. Ranks Last Among Seven Countries on Health System Preformance Based on Measures of Quality, Efficiency, Access, Equity, and Healthy Lives –  Press release
Affordable Care Act Holds Promise for U.S. Performance; Focus on Information Technology and Primary Care Vital To Achieving High Performance    June 23, 2010

“Overview
Despite having the most costly health system in the world, the United States consistently underperforms on most dimensions of performance, relative to other countries. This report—an update to three earlier editions—includes data from seven countries and incorporates patients’ and physicians’ survey results on care experiences and ratings on dimensions of care. Compared with six other nations—Australia, Canada, Germany, the Netherlands, New Zealand, and the United Kingdom—the U.S. health care system ranks last or next-to-last on five dimensions of a high performance health system: quality, access, efficiency, equity, and healthy lives. Newly enacted health reform legislation in the U.S. will start to address these problems by extending coverage to those without and helping to close gaps in coverage—leading to improved disease management, care coordination, and better outcomes over time.”

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International Profiles of Health Care Systems – 23 June 2010

Posted on June 23, 2010. Filed under: Health Mgmt Policy Planning | Tags: , |

International Profiles of Health Care Systems: Australia, Canada, Denmark, England, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States
June 23, 2010

D. Squires, The Commonwealth Fund, and others, International Profiles of Health Care Systems, The Commonwealth Fund, June 2010.

Fund Report (1086K PDF)

“This publication presents overviews of the health care systems of 13 countries—Australia, Canada, Denmark, England, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States. A summary table presents information on population, health care spending, number of physicians, hospital spending and utilization, use of health information technology, and number of potentially avoidable deaths. Each country summary provides information on insurance coverage and benefits, health system financing, delivery system organization, quality assurance mechanisms, efforts to improve efficiency and control costs, and recent innovations and reforms.”

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Evidence-Based Health Care for Children: What Are We Missing? The Commonwealth Fund – April 2010

Posted on May 19, 2010. Filed under: Child Health / Paediatrics, Evidence Based Practice | Tags: |

R. D. Sege and E. De Vos, Evidence-Based Health Care for Children: What Are We Missing?, The Commonwealth Fund, April 2010.

Issue Brief (748K PDF)

“Overview
With the enactment of comprehensive health reform, reimbursement for a variety of health care services will likely depend on evidence to support that provision. Understanding what constitutes “evidence” will have a profound effect on the range of clinical care provided. A too-narrow definition may have a considerable impact on pediatric care in particular: much of current child health care requires consideration of a broader body of evidence than is usually relied upon when developing clinical guidelines. This is especially true for care that addresses behavioral and developmental problems. The current standard for evaluating evidence uses study design as a proxy for the quality of evidence; it may therefore inadvertently exclude many important findings and fail to support further relevant research. The project described here yielded a new, broader framework for evaluating clinical practice, one that should be of value to both clinicians and policymakers.”

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Blueprint for the Dissemination of Evidence-Based Practices in Health Care – The Commonwealth Fund – May 2010

Posted on May 19, 2010. Filed under: Evidence Based Practice | Tags: , |

C. T. Yuan, I. M. Nembhard, A. F. Stern et al., Blueprint for the Dissemination of Evidence-Based Practices in Health Care, The Commonwealth Fund, May 2010.

Issue Brief (618K PDF)

“Overview
Aimed at fostering the broad adoption of effective health care interventions, this report proposes a blueprint for improving the dissemination of best practices by national quality improvement campaigns. The blueprint’s eight key strategies are to: 1) highlight the evidence base and relative simplicity of recommended practices; 2) align campaigns with strategic goals of adopting organizations; 3) increase recruitment by integrating opinion leaders into the enrollment process; 4) form a coalition of credible campaign sponsors; 5) generate a threshold of participating organizations that maximizes network exchanges; 6) develop practical implementation tools and guides for key stakeholder groups; 7) create networks to foster learning opportunities; and 8) incorporate monitoring and evaluation of milestones and goals. The impact of quality campaigns also depends on contextual factors, including the nature of the innovation itself, external environmental incentives, and features of adopting organizations.”

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The Vermont Accountable Care Organization Pilot: A Community Health System to Control Total Medical Costs and Improve Population Health – 14 May 2010

Posted on May 19, 2010. Filed under: Health Economics, Health Mgmt Policy Planning | Tags: |

The Vermont Accountable Care Organization Pilot: A Community Health System to Control Total Medical Costs and Improve Population Health – 14 May 2010

Fund Report (572K PDF)

“Overview
An accountable care organization—a model of care being promoted through the new health reform law—is a provider organization that takes on responsibility for meeting the health needs of a defined population, including the total cost of care and the quality and effectiveness of services. This report describes the efforts of three health care provider organizations in Vermont that are planning pilot tests of accountable care organizations, to be launched next year as part of a national learning network.”

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Widespread Adoption of Information Technology in Primary Care Physician Offices in Denmark: A Case Study – 11 March 2010

Posted on March 16, 2010. Filed under: General Practice, Health Informatics | Tags: |

Widespread Adoption of Information Technology in Primary Care Physician Offices in Denmark: A Case Study
March 11, 2010

D. Protti and I. Johansen, Widespread Adoption of Information Technology in Primary Care Physician Offices in Denmark: A Case Study, The Commonwealth Fund, March 2010.
 
Issue Brief (529K PDF) 
 
“Overview
 
Denmark is one of the world’s leading countries in the use of health care technology. Virtually all primary care physicians have electronic medical records with full clinical functionality. Their systems are also connected to a national network, which allows them to electronically send and receive clinical data to and from consultant specialists, hospitals, pharmacies, and other health care providers. Under the auspices of a nonprofit organization called MedCom, over 5 million clinical messages are transferred monthly. One of the most important innovations has been the “one-letter solution,” which allows one electronic form to be used for all types of letters to and from primary care physicians; it is used in over 5,000 health institutions with 50 different technology vendor systems.”

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Health Care Leader Action Guide to Reduce Avoidable Readmissions – the Commonwealth Fund – 25 January 2010

Posted on January 28, 2010. Filed under: Clin Governance / Risk Mgmt / Quality, Patient Safety | Tags: |

A. Osei-Anto, M. Joshi, A.-M. Audet et al., Health Care Leader Action Guide to Reduce Avoidable Readmissions, Health Research & Educational Trust, The Commonwealth Fund, and the John A. Hartford Foundation, January 2010.

“Executive Summary

Reducing avoidable hospital readmissions is an opportunity to improve quality and reduce costs in the health care system. This guide is designed to serve as a starting point for hospital leaders to assess, prioritize, implement, and monitor strategies to reduce avoidable readmissions.”

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Henry Ford Health System: A Framework for System Integration, Coordination, Collaboration, and Innovation – 13 August 2009

Posted on August 14, 2009. Filed under: Health Mgmt Policy Planning, Health Systems Improvement | Tags: , |

Henry Ford Health System: A Framework for System Integration, Coordination, Collaboration, and Innovation

August 13, 2009
D. McCarthy, K. Mueller, S. Klein, Henry Ford Health System: A Framework for System Integration, Coordination, Collaboration, and Innovation, The Commonwealth Fund, August 2009.

Overview

“Henry Ford Health System is a vertically integrated health care system in southeastern Michigan whose leadership is committed to systemic integration, clinical excellence, and customer value through the core competencies of collaboration, care coordination, and innovation and learning. Henry Ford’s care innovation initiatives are multidisciplinary, team-led projects that target improvements in quality measures and evidence-based standards through problem-solving and the identification of common metrics to build consensus. The collaborative approach, fostered by shared vision and values, facilitates transformation throughout the system. Moreover, Henry Ford’s integration of care delivery and coverage facilitates quality monitoring, measurement, and improvement activities.”

Full text of the Case Study (1167K PDF )

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Mayo Clinic: Multidisciplinary Teamwork, Physician-Led Governance, and Patient-Centered Culture Drive World-Class Health Care – 13 August 2009

Posted on August 14, 2009. Filed under: Health Mgmt Policy Planning, Health Systems Improvement | Tags: , |

D. McCarthy, K. Mueller, S. Klein, Mayo Clinic: Multidisciplinary Teamwork, Physician-Led Governance, and Patient-Centered Culture Drive World-Class Health Care, The Commonwealth Fund, August 2009.   18p.
August 13, 2009

Overview

“The Mayo Clinic is the world’s oldest and largest integrated multispecialty group medical practice, combining clinical practice, education, and research at the regional, national, and international levels for the benefit of individuals with routine as well as complex health care needs. Mayo’s model of integrated care is one of multidisciplinary practice with salary-based compensation that fosters team-oriented patient care and peer accountability, a supportive infrastructure allowing physicians and other caregivers to excel at clinical work, and a physician-led governance structure promoting a patient-centered culture. Full integration of the hospital and clinic and the use of a shared electronic medical record across inpatient and outpatient settings also have been critical to realizing efficiencies and promoting clinical excellence. Mayo fosters a learning environment in which teams of medical professionals use information technology and systems engineering to learn from each other and improve care in tandem with clinical practice.”

Full text of the Case Study (1033K PDF )

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Emergency Department Operations in Top-Performing Safety-Net Hospitals [US] – Commonwealth Fund report – July 31, 2009

Posted on July 31, 2009. Filed under: Emergency Medicine | Tags: |

Emergency Department Operations in Top-Performing Safety-Net Hospitals – July 31, 2009
Full Text of the Commonwealth Fund Report (275K PDF )

L. Nolan, M. Regenstein et al., Emergency Department Operations in Top-Performing Safety-Net Hospitals, The Commonwealth Fund, 2009.

Overview

“This report profiles five safety-net hospitals—Boston Medical Center, Denver Health, Memorial Regional Hospital, Memorial Hospital West, and Virginia Commonwealth University Health System—that made improvements to curb emergency department (ED) crowding, reduce long waits, and lower the number of hours spent on ambulance diversion. Hospitals used a combination of interventions, including: reconfiguring the ED to maximize efficiency; devising a pre-diversion system to alert staff of ED crowding; installing an electronic tracking system; designating staff members to be responsible for tracking patients; and developing meaningful performance metrics. To be successful, such interventions need to take place within a broader improvement strategy that entails: recognition that ED crowding is a hospital-wide issue; leadership provided by the CEO and other senior staff; vigilance in pursuing change, reviewing outcomes, and working to improve; transparency; and a commitment to quality for safety-net populations.”

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National Authority for Health: France – The Commonwealth Fund – 22 July 2009

Posted on July 23, 2009. Filed under: Health Economics, Health Mgmt Policy Planning, Health Systems Improvement, Health Technology Assessment | Tags: , |

L. Rochaix and B. Xerri, National Authority for Health: France, The Commonwealth Fund, July 2009.

Overview

“The French National Authority for Health (Haute Autorité de Santé, or HAS) was established to assist France’s public institutions in optimizing the basket of reimbursable goods and services and to help health care professionals continuously improve their clinical practice by defining best-care standards and identifying relevant tools and methods. HAS carries out single technology assessment (STA) and multiple technology assessment (MTA), assessing both the intrinsic benefit of the new technology and its effectiveness compared with that of existing technologies. A new treatment may not be covered unless it provides either improved benefit or lower cost, and STA is mandatory before a new drug, device, or medical procedure can be added to the benefit list for sickness funds. While HAS recommendations are advisory, the decision-making bodies (the Ministry of Health or the union of sickness funds) accept its findings in most cases.”

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Evidence-Based Decision-Making Within Australia’s Pharmaceutical Benefits Scheme – The Commonwealth Fund – 22 July 2009

Posted on July 23, 2009. Filed under: Pharmacy | Tags: , |

R. Lopert, Evidence-Based Decision-Making Within Australia’s Pharmaceutical Benefits Scheme, The Commonwealth Fund, July 2009.

Overview

“In Australia, most prescription drugs are subsidized through the Pharmaceutical Benefits Scheme (PBS), one of several government programs in which evidence-based decision-making is applied to the funding of health technologies. PBS processes are intended to ensure “value for money” for the Australian taxpayer and to support affordable, equitable access to prescription medicines; they are not intended as a mechanism for cost containment. The inclusion of a drug on the national formulary depends on the recommendation of the Pharmaceutical Benefits Advisory Committee (PBAC), which considers not only the comparative effectiveness but also the comparative cost-effectiveness of drugs proposed for listing. While some decisions have been controversial, the PBS retains strong public support. Moreover, evidence does not suggest that the consideration of cost-effectiveness has created a negative environment for the drug industry: Australia has a high penetration of patented medicines, with prices for some recently approved drugs at U.S. levels.”

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Comparative Effectiveness Review Within the U.K.’s National Institute for Health and Clinical Excellence – The Commonwealth Fund – 22 July 2009

Posted on July 23, 2009. Filed under: Clin Governance / Risk Mgmt / Quality | Tags: , , |

K. Chalkidou, Comparative Effectiveness Review Within the U.K.’s National Institute for Health and Clinical Excellence, The Commonwealth Fund, 22 July 2009.

Overview

“The U.K.’s National Institute for Health and Clinical Excellence (NICE) was established to perform three core functions: 1) reduce unwarranted variation in practice across the United Kingdom through the development and dissemination of best practice evidence-based standards; 2) encourage fast diffusion and uniform uptake of high-value medical innovations; and 3) ensure the taxpayers’ money is invested in the National Health Service so that health benefit is maximized. NICE decisions are made by independent committees of health professionals, academics, and industry and lay representatives. More than 2,000 experts engage with NICE processes throughout the year. NICE committees consider comparative clinical and cost effectiveness, social values (including impact on equity), and U.K. and European Union legislation when making their decisions.”

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United Hospital Center: Improving Surgical Care Through Evidence-Based Education and Standardization, The Commonwealth Fund, July 2009

Posted on July 6, 2009. Filed under: Health Systems Improvement, Surgery | Tags: |

S. Silow-Carroll, A. Lashbrook, United Hospital Center: Improving Surgical Care Through Evidence-Based Education and Standardization, The Commonwealth Fund, July 2009

“In just a few years, the United Hospital Center (UHC) rose from being one of the lower-performing U.S. hospitals on process-of-care measures to being one of the top performers. This case study focuses on UHC’s achievement in providing recommended treatment related to surgical care. UHC’s improvement can be attributed to hospital-wide strategies as well as policies and practices focused on the surgery department. Hospital-wide strategies include the creation of a subcommittee that reviews performance data and works across departments and disciplines to address performance gaps; careful data recording, assessment, and validation to gain the trust of physicians; engagement of the CEO, medical staff chairman, and medical staff; and communication of progress and challenges. Surgical care strategies include: emphasizing best-practice literature to bring surgeons on board; providing consistent data feedback, including to individual surgeons; using peer pressure when needed; and standardizing operating room procedures through standing orders, practice sets, and checklists.”

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Group Health Cooperative: Reinventing Primary Care by Connecting Patients with a Medical Home, The Commonwealth Fund, July 2009

Posted on July 6, 2009. Filed under: Health Mgmt Policy Planning, Primary Hlth Care | Tags: |

D. McCarthy, K. Mueller, and I. Tillmann, Group Health Cooperative: Reinventing Primary Care by Connecting Patients with a Medical Home, The Commonwealth Fund, July 2009

Overview

“Group Health Cooperative (GHC) is a nonprofit, consumer-governed health care organization serving 580,000 members in Washington State and Idaho through an integrated multispecialty group practice and a network of community providers. Integrated financing and delivery—supported by a partnership between health plan administrators and medical group physicians—enable GHC to launch innovations and organize services in ways that make the most sense operationally and clinically. Exemplifying this approach is GHC’s implementation of a patient-centered medical home model of primary care that enhances the roles of a multidisciplinary care team and uses electronic health records to deliver proactive, coordinated care. Information technology is a key to improving patients’ communication with their care team, engaging them in evidence-based care, and reducing fragmentation of services. GHC is using “lean” techniques to involve care teams and other frontline staff in standardizing their work, an approach that can likely be expanded to include other organizations.”

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Organizing for Higher Performance: Case Studies of Organized Delivery Systems, The Commonwealth Fund, July 2009

Posted on July 6, 2009. Filed under: Health Systems Improvement | Tags: |

D. McCarthy, K. Mueller, Organizing for Higher Performance: Case Studies of Organized Delivery Systems, The Commonwealth Fund, July 2009

Overview

“Fifteen case studies illustrate how diverse types of organized health care delivery systems promote higher performance through information continuity, patient engagement, care coordination, team-oriented care delivery, continuous innovation and learning, and convenient access to care. Those attributes are supported by values-driven leadership, interdisciplinary teamwork, integration and aligned incentives (both at the organizational and provider level), accountability, and transparency. Commonly reported results include improved clinical quality of care and control of chronic diseases, increased patient satisfaction, shorter waiting times, and reduced hospitalizations, emergency visits, and prescription drug expenses. The experience of these organizations supports recent recommendations by The Commonwealth Fund Commission on a High Performance Health System to stimulate greater organization of health care in the United States.”

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