Chronic diseases such as diabetes and heart disease account for 75% of all healthcare spending but at the same time managing chronic illnesses can be fragmented and ineffective. Patients are increasingly being treated for multiple chronic diseases by many different providers resulting in decreases in the quality of their care and patients are facing more safety concerns.
Treating chronic care patients can be helped through care coordination, active follow-up, good self management, clinician decision support, and the use of information systems. Despite the potential for HIT to help treat chronic care patients, research to date has often failed to show clear benefits.
The Department of Family Medicine and Community Medicine at the University of Missouri-Columbia received funding from AHRQ to study how using several strategies to implement HIT would help patients with chronic diseases. The researchers are devising methods that providers can use to compare and improve their clinical performance against standardized performance targets.
In the study, researchers will provide patients with access to a web-based interactive software system to help with in-home reconciliation of all medications. Also, patients will use in-home smart diagnostic devices to send their data directly to their care team.
A multi-method evaluation of the HIT innovations will be used in the study including qualitative interviews and surveys. The HIT system involving chronic disease care at the University of Missouri will not only be studied but will be implemented differently in various practices and with several associated care systems.
AHRQ is also supporting chronic care research at the Department of Psychiatry, University of Texas Southwest Medical Center in Dallas to specifically help psychiatric settings provide effective care. Depression is the most common mental health cause for disability and treatments therefore the treatment needs to take into account the chronic nature of the disorder.
Despite the development of effective treatments, evidence from practice settings continues to show that inadequate antidepressant medication treatment is used in terms of doses and duration. The goal is to develop a computerized decision support system integrated with an electronic health record to disseminate evidence-based treatment for chronic depression in large systems of care. This project will be implementing Measurement-Based Care (MBC) in an ambulatory care setting using an integrated Clinical Decision Support System (CDSS) and an electronic health record.
The University is collaborating with the Centerstone Community Mental Health Center a behavioral health services provider located in Tennessee. The proposed EHR-CDSS facilitating MBC will be instituted in 24 clinics by 50 clinicians to treat approximately 8000 patients with major depressive disorders.