A patient-centered longitudinal care plan: vision versus reality

Dykes, Patricia C.; Samal, Lipika; Donahue, Moreen; Greenberg, Jack J.; Hurley, Ann C.; Hasan, Omar; O'Malley, Terrance A; Venkatesh, Arjun K.; Volk, Lynn A.; Bates, David W.

doi:10.1136/amiajnl-2013-002454

Cited by 55 publications

(48 citation statements)

References 29 publications

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“…Limitations include: inability to generate population-based reports easily; problems in presenting usable alerts and reminders; inability to capture data on preventive care; and non-interoperability between different EHR systems [ 2 ]. In addition, longitudinal care plans are not used [ 12 ] and while systems may be able to alert providers about gaps in care, they do not link to relevant clinical patient data [ 29 ].…”

Section: Medical Home Technologies and Phmmentioning

confidence: 99%

Health IT’s Essential Role in the Patient-Centered Medical Home and Practice-Based Population Health Management

Grundy

Hodach²

2016

Health Informatics

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This chapter focuses on the IT capabilities required by patient-centered medical homes, including electronic registries and associated applications that enable care teams to automate processes and provide continuous care to their patient populations. In addition, the chapter explores new technology options, including patient portals, remote monitoring, mobile health apps, and cognitive computing. Our goal is to show how patient-centered medical homes can use automation tools, analytics, and big data to improve population health.

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Section: Medical Home Technologies and Phmmentioning

confidence: 99%

Health IT’s Essential Role in the Patient-Centered Medical Home and Practice-Based Population Health Management

Grundy

Hodach²

2016

Health Informatics

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“…Additionally, although small studies have demonstrated the benefit of EMR-based ECP tools,4 in practice, ECPs are not typically used in the ambulatory setting and significant ambiguity exists regarding what constitutes care planning 3. Where longitudinal ECPs exist, they are often not standardized or interdisciplinary in nature and are variably found in electronic format 5. And while care planning and coordination are of significant interest to commercial vendors, commercial tools are more commonly used for data aggregation and identification of high-risk populations and overdue interventions rather than for workflow coordination or communication enhancement capabilities 6…”

Section: Introductionmentioning

confidence: 99%

The critical components of an electronic care plan tool for primary care: an exploratory qualitative study

Rotenstein

Tucker

Kakoza

et al. 2016

jhi

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Background A critical need exists for effective electronic tools that facilitate multidisciplinary care for complex patients in patient-centered medical homes. Objective To identify the essential components of a primary care (PC) based electronic care plan (ECP) tool that facilitates coordination of care for complex patients. Methods Three focus groups and nine semi-structured interviews were conducted at an academic PC practice in order to identify the ideal components of an ECP. Results Critical components of an ECP identified included: 1) patient background information, including patient demographics, care team member designation and key patient contacts, 2) user-and patient-centric task management functionalities, 3) a summary of a patient's care needs linked to the responsible member of the care team and 4) integration with the electronic medical record. We then designed an ECP mockup incorporating these components. Conclusion Our investigation identified key principles that healthcare software developers can integrate into PC and patient-centered ECP tools.

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“…10 In regard to professional behavior, studies also stress that failures in communication when delivering care and problems with the content and reliability of information transferred through different settings have been identified as threats to patient safety. 11 The services provided within the field of nursing play an important role in the search for quality in healthcare organizations, given the number of professionals working in these institutions and their responsibility in providing 24-hour care. 12 The combination of nursing competencies and training can be linked to the evolution of patients' conditions.…”

Section: Introductionmentioning

confidence: 99%

Brazilian Network for Nursing and Patient Safety: Challenges and Perspectives

Caldana

Guirardello

Urbanetto

et al. 2015

Texto contexto - enferm.

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This study's aim was to describe the experience of implementing the Brazilian Network for Nursing and Patient Safety, as well activities intended to disseminate a culture of patient safety in health and educational institutions. This is an experiment report. The Brazilian Network was completed six years ago and, since its establishment, has promoted actions always in consonance with the objectives of the International Network for Nursing and Patient Safety and the World Alliance for Patient Safety. Networks proposed by the Pan American Health Organization corroborated the actions taken by the Brazilian Network. These actions have been successful, as every year new members are added and new Centers are established, while the Network has participated in academic, scientific and government activities. The challenge lies in increasing the impact of these actions to implement safe practices effectively in healthcare facilities. DESCRIPTORS: Patient safety. Nursing. Quality assurance health care. Quality of health care. REDE BRASILEIRA DE ENFERMAGEM E SEGURANÇA DO PACIENTE: DESAFIOS E PERSPECTIVAS RESUMO: O estudo objetivou descrever a experiência da implementação da Rede Brasileira de Enfermagem e Segurança do Paciente, bem como as atividades desenvolvidas a fim de disseminar a cultura de segurança do paciente em instituições de saúde e de ensino. Trata-se de um relato de experiência. A Rede completou seis anos e, desde a sua criação, vem realizando ações em consonância com os objetivos da Rede Internacional de Enfermagem e Segurança do Paciente e a Aliança Mundial para Segurança do Paciente. Entendese que o trabalho em Redes, proposto pela Organização Pan-Americana da Saúde, corroborou com as ações realizadas pela Rede no Brasil, que podem ser consideradas exitosas, tendo em vista que a cada ano há inserção de novos membros, abertura de novos Polos e Núcleos, e a participação da Rede em atividades acadêmicas, científicas e governamentais. O desafio está no aumento do impacto dessas ações com vistas à efetivação da prática segura nas instituições de saúde. DESCRITORES: Segurança do paciente. Enfermagem. Garantia da qualidade dos cuidados de saúde. Qualidade da assistência à saúde. LA RED BRASILERA DE ENFERMERÍA Y SEGURIDAD DEL PACIENTE: DESAFÍOS Y PERSPECTIVASRESUMEN: Este estudio tiene como objetivo describir la experiencia de la implementación de la Red Brasileña de Enfermería y Seguridad del Paciente, así como las actividades realizadas para difundir la cultura de seguridad del paciente en las instituciones de salud y de enseñanza. Se trata de un relato de experiencia. La Red tiene seis años. Desde sus inicios viene desarrollando acciones siempre en consonancia con los objetivos de la Red Internacional de Enfermería y Seguridad del Paciente y la Alianza Mundial para la Seguridad del Paciente. Se entiende que el trabajo en redes propuestas por la Organización Panamericana de la Salud corroboró las medidas adoptadas por la Red Brasileña que pueden considerarse un éxito, teniendo en cuenta que, cada año se da la inclu...

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A patient-centered longitudinal care plan: vision versus reality

Abstract: The use of LCPs to support care transitions is suboptimal. Strategies are needed to transform the LCP from vision to reality.

Cited by 55 publications

References 29 publications

Health IT’s Essential Role in the Patient-Centered Medical Home and Practice-Based Population Health Management

Health IT’s Essential Role in the Patient-Centered Medical Home and Practice-Based Population Health Management

The critical components of an electronic care plan tool for primary care: an exploratory qualitative study

Brazilian Network for Nursing and Patient Safety: Challenges and Perspectives

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