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CDA 09-212 – HSR&D Study

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CDA 09-212
Integrating Telemanagement of Complex Patients in Primary Care
Benjamin Jared Powers MD BA MHS
Durham VA Medical Center, Durham, NC
Durham, NC
Funding Period: July 2010 - December 2011

BACKGROUND/RATIONALE:
In spite of VA's long history of high quality care, veterans consistently rate the VA lower on convenience and accessibility. This is particularly a problem for rural veterans who comprise nearly 40% VHA enrollees. Remote patient encounters over the telephone or internet have the potential to improve quality and access to healthcare, but are not routinely delivered as a part of planned and comprehensive primary care.

OBJECTIVE(S):
For this four year career development award, I had three specific aims. Specific Aim 1: Evaluate stakeholder perspectives on integrating remote patient encounters in primary care. Specific Aim 2: Develop and pilot test structured telephone visits in primary care. Specific Aim 3: Evaluate the effectiveness of structured telephone visits in primary care

METHODS:
For the first specific aim used qualitative methods and focus groups to obtain input from the three key stakeholder groups: primary care providers, nurses and staff, and patients. For the second aim we will conduct a pilot intervention study with comparison to concurrent controls. Data was independently coded by 2 investigators for the important themes from these discussions using Atlas.ti.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
The VA has committed to remote patient encounters as a means to improve the quality and access of care and as a principle of the Patient Aligned Care Teams. Understanding the perspectives of all stakeholders involved is an important step in designing and implementing new models of remote patient encounters. While not all patients will be appropriate for structured remote patient encounters, developing this method of delivering care will create more flexibility for patients to interact with the health care system and may contribute to a more patient-centered experience.

PUBLICATIONS:

Journal Articles

  1. Williams JW, Jackson GL, Powers BJ, Chatterjee R, Bettger JP, Kemper AR, Hasselblad V, Dolor RJ, Irvine RJ, Heidenfelder BL, Kendrick AS, Gray R. Closing the quality gap: revisiting the state of the science (vol. 2: the patient-centered medical home). Evidence Report/Technology Assessment. 2012 Jul 1;(208.2):1-210.
  2. Powers BJ, Coeytaux RR, Dolor RJ, Hasselblad V, Patel UD, Yancy WS, Gray RN, Irvine RJ, Kendrick AS, Sanders GD. Updated report on comparative effectiveness of ACE inhibitors, ARBs, and direct renin inhibitors for patients with essential hypertension: much more data, little new information. Journal of general internal medicine. 2012 Jun 1; 27(6):716-29.
  3. Wang V, Smith VA, Bosworth HB, Oddone EZ, Olsen MK, McCant F, Powers BJ, Van Houtven CH. Economic evaluation of telephone self-management interventions for blood pressure control. American heart journal. 2012 Jun 1; 163(6):980-6.
  4. Crowley MJ, Powers BJ, Myers ER, McBroom AJ, Sanders GD. Angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers for treatment of ischemic heart disease: Future research needs prioritization. American heart journal. 2012 May 1; 163(5):777-782.e8.
  5. Crowley MJ, Smith VA, Olsen MK, Danus S, Oddone EZ, Bosworth HB, Powers BJ. Treatment intensification in a hypertension telemanagement trial: clinical inertia or good clinical judgment? Hypertension. 2011 Oct 1; 58(4):552-8.
  6. Powers B, Greene L, Balfe LM. Updates on the treatment of essential hypertension: a summary of AHRQ's comparative effectiveness review of angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, and direct renin inhibitors. Journal of managed care pharmacy : JMCP. 2011 Oct 1; 17(8 Suppl):S1-14.
  7. Bosworth HB, Powers BJ, Olsen MK, McCant F, Grubber J, Smith V, Gentry PW, Rose C, Van Houtven C, Wang V, Goldstein MK, Oddone EZ. Home blood pressure management and improved blood pressure control: results from a randomized controlled trial. Archives of internal medicine. 2011 Jul 11; 171(13):1173-80.
  8. Powers BJ, Olsen MK, Smith VA, Woolson RF, Bosworth HB, Oddone EZ. Measuring blood pressure for decision making and quality reporting: where and how many measures? Annals of internal medicine. 2011 Jun 21; 154(12):781-8, W-289-90.
  9. Bosworth HB, Olsen MK, Grubber JM, Powers BJ, Oddone EZ. Racial differences in two self-management hypertension interventions. The American journal of medicine. 2011 May 1; 124(5):468.e1-8.
  10. Powers BJ, Danus S, Grubber JM, Olsen MK, Oddone EZ, Bosworth HB. The effectiveness of personalized coronary heart disease and stroke risk communication. American heart journal. 2011 Apr 1; 161(4):673-80.
  11. Shah BR, Adams M, Peterson ED, Powers B, Oddone EZ, Royal K, McCant F, Grambow SC, Lindquist J, Bosworth HB. Secondary prevention risk interventions via telemedicine and tailored patient education (SPRITE): a randomized trial to improve postmyocardial infarction management. Circulation. Cardiovascular quality and outcomes. 2011 Mar 1; 4(2):235-42.
  12. Bosworth HB, Powers BJ, Oddone EZ. Patient self-management support: novel strategies in hypertension and heart disease. Cardiology Clinics. 2010 Nov 1; 28(4):655-63.
  13. Powers BJ, Trinh JV, Bosworth HB. Can this patient read and understand written health information? JAMA : the journal of the American Medical Association. 2010 Jul 7; 304(1):76-84.
Reports

  1. Williams JW, Jackson GL, Powers BJ, Chatterjee R, Prvu Bettger J, Kemper AR, Hasselblad V, Dolor RJ, Irvine RJ, Heidenfelder BL, Kendrick AS, Gray R. Closing the Quality Gap Series: The Patient-Centered Medical Home. Rockville, MD: Agency for Healthcare Research and Quality; 2012 Jul 3. 20 p. Report No.: 208.
  2. Powers BJ, Crowley MJ, McCrory DC, Pendergast K, Posey R, Hadley C, Gray R, Sanders GD. Future Research Needs for Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), or Direct Renin Inhibitors (DRIs) for Treating Hypertension: Identification of Future Research Needs From Comparative Effectiveness Review No. 34. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Mar 1. 58 p. Report No.: 12-EHC046-EF.
  3. Williams JW, Jackson GL, Powers BJ. Closing the Quality Gap: Revisiting the State of the Science Series: "The Patient-Centered Medical Home". Rockville, MD: AHRQ; 2011 Jun 9. 10 p. Report No.: 1.
  4. Sanders GD, Coeytaux R, Dolor RJ, Hasselblad V, Patel UD, Powers B, Yancy WS, Gray RN, Irvine RJ, Kendrick A. Angiotensin-Converting Enzyme Inhibitors (ACEIs), Angiotensin II Receptor Antagonists (ARBs), and Direct Renin Inhibitors for Treating Essential Hypertension: An Update. Rockville, MD: Agency for Healthcare Research and Quality (US); 2011 Jun 1. 1-8 p. Report No.: 11-EC063-EF.
  5. Sanders GD, Powers BJ, Powers BJ, Crowley M. Future Research Needs for Angiotensin Converting Enzyme (ACE) Inhibitors or Angiotensin II Recepton Blockers (ARBs) added to Standard Medical Therapy for Treating Stable Ischemic Heart Disease. Rockville, MD: Agency for Healthcare Research and Quality; 2010 Sep 1. 1-10 p. Report No.: 18.
Conference Presentations

  1. Allen KD, Sanders L, Olsen MK, Bowlby L, Katz JN, Mather RC, Powers BJ, Sperber N, Voils CI, Williams JW. Effectiveness of Internet and DVD decision aids for patients with hip and knee osteoarthritis. Poster session presented at: Osteoarthritis Research Society International World Congress on Osteoarthritis; 2014 Apr 24; Paris, France.
  2. Chatterjee R, Williams JW, Jackson GL, Powers BJ, Bettger J, Dolor RJ, Hasselblad V. The Patient-Centered Medical Home, A Systematic Review. Poster session presented at: Agency for Healthcare Research and Quality Annual Conference; 2012 Sep 1; Bethesda, MD.
  3. Maciejewski ML, Bosworth HB, Olsen MK, Smith V, Edelman D, Powers BJ, Kaufman M, Oddone EZ, Jackson GL. The Persistent Clinical Benefits of Participating in a Hypertension Self-Management Trial. Paper presented at: VA HSR&D / QUERI National Meeting; 2012 Jul 18; National Harbor, MD.
  4. Maciejewski ML, Bosworth HB, Olsen MK, Smith V, Edelman D, Powers BJ, Oddone EZ, Jackson GL. The Persistent Clinical Benefits of Participating in a Hypertension Self-Management Trial. Poster session presented at: AcademyHealth Annual Research Meeting; 2012 Jun 24; Orlando, FL.
  5. Chatterjee R, Jackson GL, Bettger J, Powers BJ, Kemper A, Dolor R, Williams JW. The Patient Centered Medical Home: A systematic review. Paper presented at: Society of General Internal Medicine Annual Meeting; 2012 May 9; Orlando, FL.
  6. Powers BJ, Grubber J, Olsen MK, Crowley M, Bosworth HB. The Cholesterol, Hypertension, and Glucose Education (CHANGE) study: results from a randomized controlled trial in African Americans with diabetes. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2012 May 9; Orlando, FL.
  7. Powers BJ, Coeytaux RR, Dolor RJ, Hasselblad V, Patel UD, Yancy WS, Gray RN, Irvine J, Kendrick A, Sanders GD. An update of the 2007 report on the comparative effectiveness of ACE-I and ARBs for patients with essential hypertension: Much more data, but no new information. Paper presented at: AcademyHealth Annual Research Meeting; 2011 Jun 14; Seattle, WA.
  8. Jackson GL, Bosworth HB, Powers BJ, Maciejewski ML, Edelman D. Do the Economic Benefits of Participation in Disease Management Trials Persist After Trial Completion? Paper presented at: AcademyHealth Annual Research Meeting; 2011 Jun 12; Seattle, WA.
  9. Powers BJ, Olsen MK, Smith V, Woolson RF, Bosworth HB, Oddone EZ. Measuring Blood Pressure for Decision Making and Quality Reporting: Where and How Many Measures? Paper presented at: Society of General Internal Medicine Annual Meeting; 2011 May 6; Phoenix, AZ.
  10. Jackson GL, Olsen MK, Smith V, Edelman D, Bosworth HB, Powers BJ, Kaufman M, Maciejewski ML. Do the Economic Benefits of Participation in a Diabetes Group Visits Trial Persist After Trial Completion? Paper presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD.
  11. Powers BJ, Danus SM, Grubber J, Olsen MK, Oddone EZ, Bosworth HB. The Effectiveness of Personalized Coronary Heart Disease and Stroke Risk Communication. Poster session presented at: VA HSR&D National Meeting; 2011 Feb 17; National Harbor, MD.
  12. Crowley M, Smith V, Danus SM, Oddone EZ, Bosworth HB, Powers BJ. Lack of Treatment Intensification in a Trial of Home Telemonitoring and Medication Management: Clinical Inertia or Good Clinical Judgment? Paper presented at: VA HSR&D National Meeting; 2011 Feb 16; National Harbor, MD.


DRA: Health Systems
DRE: Prevention, Treatment - Efficacy/Effectiveness Clinical Trial
Keywords: Complex care, Primary care, Telemedicine
MeSH Terms: none

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