A Randomized Trial of a Telephone Care-Management Strategy

Wennberg, David E.; Marr, Amy; Lang, Lance; O'Malley, Stephen; Bennett, George

doi:10.1056/nejmsa0902321

Cited by 183 publications

(178 citation statements)

References 23 publications

(18 reference statements)

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“…In the meantime, however, as millions of baby-boomers are reaching retirement age each year, near-term improvements may be achievable by developing and adopting clinical models that improve outcomes for high-risk people with multiple chronic conditions. Some such models have shown promise, [7][8][9][10][11][12] while others have either failed 13 or have not yet been tested rigorously. 14 Guided Care is a new model of comprehensive, interdisciplinary care that comprises primary care-based care management, transitional care, and support for self-management and family caregiving.…”

Section: Introductionmentioning

confidence: 99%

A Matched-Pair Cluster-Randomized Trial of Guided Care for High-Risk Older Patients

et al. 2013

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BACKGROUND: Patients at risk for generating high health care expenditures often receive fragmented, lowquality, inefficient health care. Guided Care is designed to provide proactive, coordinated, comprehensive care for such patients. OBJECTIVE: We hypothesized that Guided Care, compared to usual care, produces better functional health and quality of care, while reducing the use of expensive health services. DESIGN: 32-month, single-blind, matched-pair, cluster-randomized controlled trial of Guided Care, conducted in eight community-based primary care practices. PATIENTS: The "Hierarchical Condition Category" (HCC) predictive model was used to identify high-risk older patients who were insured by fee-for-service Medicare, a Medicare Advantage plan or Tricare. Patients with HCC scores in the highest quartile (at risk for generating high health care expenditures during the coming year) were eligible to participate. INTERVENTION: A registered nurse collaborated with two to five primary care physicians in providing eight services to participants: comprehensive assessment, evidence-based care planning, proactive monitoring, care coordination, transitional care, coaching for selfmanagement, caregiver support, and access to community-based services. MAIN MEASURES: Functional health was measured using the Short Form-36. Quality of care and health services utilization were measured using the Patient Assessment of Chronic Illness Care and health insurance claims, respectively. KEY RESULTS: Of the eligible patients, 904 (37.8 %) gave written consent to participate; of these, 477 (52.8 %) completed the final interview, and 848 (93.8 %) provided complete claims data. In intention-to-treat analyses, Guided Care did not significantly improve participants' functional health, but it was associated with significantly higher participant ratings of the quality of care (difference=0.27, 95 % CI=0.08-0.45) and 29 % lower use of home care (95 % CI=3-48 %). CONCLUSIONS: Guided Care improves high-risk older patients' ratings of the quality of their care, and it reduces their use of home care, but it does not appear to improve their functional health.

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Section: Introductionmentioning

confidence: 99%

A Matched-Pair Cluster-Randomized Trial of Guided Care for High-Risk Older Patients

et al. 2013

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“…[1][2][3][4][5][6][7][8][9][10][11] A critical component of population management requires proactive, regular interaction between patients and the clinician or clinical team-engagement and communication that will take place outside the traditional face-to-face encounter. [12][13][14][15][16][17][18] Outreach outside of physician visits, for example, has been shown to improve colorectal cancer screening, 19 increase influenza vaccination, 20,21 reduce medical costs and hospitalizations, 22 and improve care and health outcomes for patients with chronic care conditions. 23 Consumer e-health tools-electronic tools and services, including secure messaging between patients and providers, mobile health (mHealth) apps, and existing technologies used in novel ways-offer unique opportunities to improve patient-provider communication and facilitate patient engagement.…”

Section: Introductionmentioning

confidence: 99%

Using Digital Technology to Engage and Communicate with Patients: A Survey of Patient Attitudes

et al. 2015

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BACKGROUND: As primary care moves toward a system of population health management, providers will need to engage patients outside traditional office-based interactions. OBJECTIVE: We assessed patient attitudes regarding technology use to communicate with their primary care team or to engage with other patients outside typical office settings. Design/Participants/Main Measures We c o n d u c t e d a n a t i o n a l s u r v e y u s i n g G f K KnowledgePanel ® to examine attitudes on the use of digital technology (email, text messaging, and social media such as Facebook and Twitter) to communicate with primary care teams about health behavior goals and test results. We also assessed attitudes toward the use of digital technologies to engage with other patients in activities such as peer coaching. KEY RESULTS: Of the 5119 panel members invited to participate, 3336 completed the survey (response rate, 65.2 %). Among respondents, more than half (58 %) reported using Facebook, and nearly two-thirds (64.1 %) used text messaging. Overall, few participants were willing to communicate about health goals via social media (3.1 %) or text messaging (13.3 %), compared to email (48.8 %) or phone (75.5 %) (results were similar for communication about test results). Among those that used text messaging, race/ethnicity was the only factor independently associated with greater support for text messaging [African American (OR 1.44; 95 % CI, 1.01-2.06) and Hispanic (OR 1.8; 95 % CI, 1.25-2.59)] in multivariate models. Participants interested in engaging in peer coaching through Facebook (11.7 %) were more likely to be younger (p<0.0001), female (p<0.001), and a racial/ ethnic minority (African American, non-Hispanic or Hispanic, p<0.0004). CONCLUSIONS: Despite regular use of new digital technology such as text messaging and social media, few participants supported using these tools for communicating with their physicians' practice. Participants were most supportive of using email for communication. Contrary to previous studies, among users of technology, low socioeconomic status and racial/ethnic minorities were equally or more likely to support use.

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“…The principal components [4] (Table 1) are fundamental to professional and regulatory standards of conduct for clinicians. It may be applied to any setting where equipoise or multiple treatment options exist and where the 'right' decision depends upon balancing the benefits, risks and likely outcomes of treatment options against the preferences, needs and values of the individual [5]. Both patient and clinician must take an active role in decision-making (including deferral or doing nothing, where appropriate), by remaining informed, motivated and engaged in the process [6].…”

Section: Introductionmentioning

confidence: 99%

Shared decision-making in back pain consultations: an illusion or reality?

Jones

Roberts

Little³

et al. 2014

Eur Spine J

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Purpose Amid a political agenda for patient-centred healthcare, shared decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. However, observational studies have shown that shared decision-making is rarely implemented in practice. The purpose of this study was to measure the prevalence of shared decision-making in clinical encounters involving physiotherapists and patients with back pain.Method Eighty outpatient encounters (comprising 40 h of data) were observed audio-recorded, transcribed verbatim and analysed using the 12-item OPTION scale. The higher the score, the greater is the shared decision-making competency of the clinicians. Results The mean OPTION score was 24.0 % (range 10.4-43.8 %). Conclusion Shared decision-making was under-developed in the observed back pain consultations. Clinicians' strong desire to treat acted as a barrier to shared decisionmaking and further work should focus on when and how it can be implemented.

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A Randomized Trial of a Telephone Care-Management Strategy

Abstract: A targeted telephone care-management program was successful in reducing medical costs and hospitalizations in this population-based study. (Funded by Health Dialog Services; ClinicalTrials.gov number, NCT00793260.)

Cited by 183 publications

References 23 publications

A Matched-Pair Cluster-Randomized Trial of Guided Care for High-Risk Older Patients

A Matched-Pair Cluster-Randomized Trial of Guided Care for High-Risk Older Patients

Using Digital Technology to Engage and Communicate with Patients: A Survey of Patient Attitudes

Shared decision-making in back pain consultations: an illusion or reality?

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