Online tool boosts chronic disease and preventive care

By Bernie Monegain
04:27 PM
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A web-based tool that extracts information from the electronic medical record is helping physicians provide better care for patients with diabetes and heart disease, according to a new Kaiser study. A separate study showed the technology, called Panel Support Tool, also helped doctors provide better preventive care.

The Kaiser Permanente studies are the first to examine the effectiveness of a population care tool in a large, diverse patient population.

The first study was published Monday in The American Journal of Managed Care.

The Panel Support Tool (PST), devised and implemented by doctors at Kaiser Permanente, is a Web-based tool that helps primary care physicians to manage care for individual patients, groups of patients or their entire panel. It does this by comparing the care the patient is receiving to the care that is recommended by national guidelines. For example, doctors can query the PST in advance of a patient visit to find out if that patient needs a screening test or vaccine. They can ask the PST to display a list of all of their patients who are overdue for a mammogram or colon cancer screening test, or a list of their diabetic patients whose blood sugar levels are too high, or those who need a foot or eye exam.

Key findings showed:

  • In the United States, patients receive roughly half of recommended preventive, acute and chronic illness care. By using the new tool, doctors at Kaiser Permanente were able to improve quality scores and provide more of this recommended care.
  • While primary care physicians may see 20 or 30 patients a day, there are hundreds of patients they don't see who often need preventive tests, medications and screenings. By using this population care tool, physicians at Kaiser Permanente have improved care for healthy patients as well as those with chronic disease.

"Patients in the U.S. receive only about half of the preventive and follow-up care now recommended by national guidelines," said Adrianne Feldstein, MD, lead author of the American Journal of Managed Care study and senior investigator at the Kaiser Permanente Center for Health Research in Portland, Ore. "Our study shows that, by using the innovative Panel Support Tool, in conjunction with the electronic medical record, we can provide patients with more of the care they are supposed to receive."

"Doctors and staff love the Panel Support Tool because it makes primary care practice more efficient by addressing the needs of all of their patients," said Yvonne Zhou, senior manager of analytics and evaluation at Kaiser Permanente. Zhou was lead author of the Population Health Management study.

"Harnessing the power of immediately available and complete patient information, the PST allows primary care providers to rapidly examine what is recommended for an individual patient, a group of patients with a specific condition, or their entire panel of patients."

Methodology

The retrospective, longitudinal study in the October issue of The American Journal of Managed Care followed 204 primary care teams who were using the Panel Support Tool to manage care for 48,344 patients with diabetes and/or heart disease. After three years, for patients with diabetes, the percentage of care recommendations met every month increased from 67.9 percent to 72.6 percent; for heart disease patients, the percentage rose from 63.5 percent to 70.6 percent.

The AJMC study used 2005 as the pre-intervention, 2006 as the implementation, and 2007 as the post-intervention periods. Care recommendations measured included blood sugar levels, blood pressure screening and control, retinopathy, nephropathy, foot screening, use of aspirin, statins, angiotensin converting enzyme inhibitors and beta blockers, and influenza and pneumococcal vaccination.

The second study, published online in Population Health Management, involved 207 primary-care teams that were using the PST to manage the care of 263,509 adult patients. Some were relatively healthy and others had chronic diseases. The study looked at 13 different care recommendations and found that after 20 months, the PST improved performance from 72.9 percent to an average of 80 percent. Researchers found that during the first year of tool use, performance in delivering the care recommendations improved to a statistically significant degree every four months.

The PST is a Web-based application that is tightly integrated with Kaiser Permanente HealthConnect, the world's largest private-sector electronic health record. Providers can toggle between the PST and KP HealthConnect, which includes comprehensive documentation of patient care in all settings including the lab, pharmacy, radiology and other ancillary systems.