Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3108 — The CHIACC Project: Characterizing Information Technology that Supports Improvement of Chronic Illness Care

Young AS (VISN-22 MIRECC) , Chaney E (Seattle VA), Bonner L (Seattle VA), Cohen AN (VISN-22 MIRECC), Shoai R (Los Angeles VA), Dorr DA (Oregon Health & Science University), Goldstein M (Palo Alto VA), Kerr E (Ann Arbor VA), Perrin R (VIReC)

Objectives:
Chronic illnesses are common, disabling, and costly. Comorbidity, incomplete treatment response, and poor quality care are common. Outcomes have been shown to improve, however, with the use of chronic care models that integrate clinical patient information, care coordination, and evidence-based treatments. Health information technology is believed to be a critical component of these care models. There is uncertainty regarding the impact of specific informatics components, and development and implementation of these technologies has been difficult. The objective of this project ("CHIACC") was to summarize knowledge and inform development and implementation of clinical information systems that support improvement in chronic illness care.

Methods:
First, a systematic review of the literature identified research regarding information systems used in chronic illness care. An evaluation was performed of the relationship between system design, study quality, and setting; and process, quality outcomes, and costs. Second, "use case" models were developed based on the literature, guidance from expert clinicians, and active VA quality improvement projects. Finally, a national expert panel was conducted to review these use cases and increase consensus regarding required informatics components.

Results:
Much of the literature in this area is non-experimental. In research, components related to positive outcomes are: connection to an electronic medical record, population management, prompts and decision support, electronic scheduling, and patient health records. Providing access to guidelines is not associated with positive outcomes. The expert panel agreed that informatics should be patient-centered and focused on improving patient outcomes. Clinically detailed processes and outcomes of care should be routinely assessed, provided to clinicians during the clinical encounter, and used for population-based care management. It was recommended that an interactive, longitudinal treatment planning system be developed to quickly provide clinicians with the patient’s treatment history, current clinical status, and decision support.

Implications:
Specific informatics strategies can support interventions to improve chronic illness care. These strategies allow management of patient recovery and health through the continuum of care.

Impacts:
Software should be developed that implements effective informatics strategies. This software should be used within organizational interventions to improve the quality of chronic illness care. These interventions will need to be rigorously evaluated.