Care planning and adherence to diabetes process guidelines: Medicare data analysis

2013 ◽  
Vol 37 (1) ◽  
pp. 83 ◽  
Author(s):  
Akuh Adaji ◽  
Peter Schattner ◽  
Kay Margaret Jones ◽  
Bronwyn Beovich ◽  
Leon Piterman
Keyword(s):  
General Practice ◽  
Strong Association ◽  
Hdl Cholesterol ◽  
Practice Management ◽  
Care Plan ◽  
Care Planning ◽  
Process Measures ◽  
Care Plans ◽  
Management Plans ◽  
Chi Square Analysis

Objective. To test the association, in patients with a diagnosis of diabetes I and II, between having or not having a care plan, (i.e. General Practice Management Plans (GPMPs),Team Care Arrangements (TCAs)), and having the recommended number of biochemical checks according to the diabetes Annual Cycle of Care guideline. The checks comprised HbA1c, HDL cholesterol and urinary microalbumin. Methods. Chi-square analysis of retrospective group data obtained from the Medicare database (from ‘billing’ patterns only). Results. The creation of GPMPs was associated with general practitioners (GPs) requesting checks for HbA1c (59.7%), HDL cholesterol (36.9%) and microalbumin (50.8%) for diabetes patients in accordance with guideline recommendations. Although the introduction of multidisciplinary care via a TCA was associated with an increase in the frequency of HbA1c checks (61.3%) in accordance with the guidelines, there was a reduction in the number of HDL cholesterol (23.7%) and microalbumin (36.8%) checks. The group with no care plans had the lowest association with HbA1c (47.8%), HDL cholesterol (19.7%) and microalbumin (29.3%) checks that met guideline requirements for diabetes. Conclusions. The use of GPMPs showed strong association with increased testing of process measures that met guideline requirements for diabetes. Further research is needed to understand the value and benefits of TCAs in promoting adherence to diabetes guidelines. What is known about the topic? Research suggests that care planning is associated with increased adherence by GPs to some of the processes of care stipulated in diabetes guidelines. What does the paper add? This study examines Australia-wide data obtained from Medicare. The findings demonstrated strong association between care planning and the process measures examined in this study. In contrast to previous studies, multidisciplinary team involvement via a TCA appeared to be less important than a GPMP in promoting adherence to process measures. What are the implications for practitioners? GPs should continue to provide structure care to patients via General Practice Management Plans.

scholarly journals Care plan use among older people with functional impairment: analysis of the English General Practice Patient Survey

2018 ◽  
Vol 6 (4) ◽  
pp. 571
Author(s):  
Alice Shiner ◽  
John A Ford ◽  
Nicholas Steel
Keyword(s):  
General Practice ◽  
Older People ◽  
Functional Impairment ◽  
Planning Process ◽  
Interpersonal Relationship ◽  
Patient Survey ◽  
Care Plan ◽  
Care Planning ◽  
Care Plans ◽  
Practice Patient

Objectives: Care plans may improve health when patients are involved in the care planning process. They are recommended for primary care.  This study aimed to identify characteristics of older patients with functional impairment (age ≥75 years with problems completing daily activities) who report having a care plan and who are involved in care planning.Methods: The General Practice Patient Survey (individual-level dataset) 2015-16 in England was analysed. Logistic regression was used to estimate associations between having a care plan and being involved with care planning and age, gender, ethnicity, deprivation, multimorbidity, interpersonal relationship with general practitioner (GP) and other variables, clustered at practice level.Results: Three point five percent of GPPS respondents and 14.4% of older people with functional impairment reported having a care plan; however, only a quarter of the latter were involved with the care planning process. Involvement with care planning was associated with seeing own GP (odds ratio (OR) 1.88, 95% confidence interval (CI)1.48 to 2.38) and factors reflecting a positive interpersonal relationship with the GP, including having confidence in the GP (OR 5.92, CI 2.38 to 14.77). Respondents involved with care planning reported greater confidence in managing their own health.Conclusions: Few older people with functional impairment report having a care plan and fewer report involvement in the care planning process. This may reduce the ability of care plans to deliver health benefits and person-centered care.

Prevalence and Benefits of Care Plans and Care Planning for People with Long-Term Conditions in England

2012 ◽  
Vol 17 (1_suppl) ◽  
pp. 64-71 ◽  
Author(s):  
Jenni Burt ◽  
Martin Roland ◽  
Charlotte Paddison ◽  
David Reeves ◽  
John Campbell ◽  
...  
Keyword(s):  
Patient Survey ◽  
Care Plan ◽  
Care Planning ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Long Term Conditions ◽  
Patient Reports ◽  
Care Plans ◽  
Interpersonal Care

Objectives Among patients with long-term conditions, to determine the prevalence and benefits of care planning discussions and of care plans. Methods Data from the 2009/10 General Practice Patient Survey, a cross sectional survey of 5.5 million patients in England. Outcomes were patient reports of: care planning discussions; perceived benefit from care planning discussions and resultant care plans. Patient and practice variables were included in multilevel logistic regression to investigate predictors of each outcome. Results Half the respondents (49%) reported a long-term condition and were eligible to answer the care planning questions. Of these, 84% reported having a care planning discussion during the last 12 months and most reported some benefit. Only 12% who reported a care planning discussion also reported being told they had a care plan. Patients who reported having a care plan were more likely to report benefits from care planning discussions. Several factors predicted the reporting of care planning and care plans of which the most important was patients' reports of the quality of interpersonal care. Conclusions There is a gap between policy and current practice which might reflect uncertainty as to the benefits of care plans. There is, therefore, a need for rigorous evaluation of care plans.

scholarly journals How do patients with malignant brain tumors experience general practice care and support? Qualitative analysis of English Cancer Patient Experience Survey (CPES) data

2019 ◽  
Vol 7 (3) ◽  
pp. 313-319
Author(s):  
Isabell Fraulob ◽  
Elizabeth A Davies
Keyword(s):  
General Practice ◽  
Cancer Patient ◽  
Patient Experience ◽  
Brain Cancer ◽  
Care Plan ◽  
Care Plans ◽  
Care And Support ◽  
Experience Survey ◽  
General Practice Care ◽  
Practice Care

Abstract Background English Cancer Patient Experience Survey (CPES) data show patients with brain cancer report the least-positive experiences of general practice support. We aimed to understand these findings by identifying the issues described in qualitative survey feedback and suggest how care may be improved. Methods We reviewed 2699 qualitative comments made to open questions about what was good or might be improved about National Health Service care between 2010 and 2014. We identified 84 (3%) specific comments about general practice care and used open coding and framework analysis to develop a thematic framework. Results We identified 3 key themes and 12 subthemes: first, the experience of initial diagnosis by a general practitioner (GP), including apparent complexity of making the diagnosis, apparent slowness in referral for investigation, referral made by patient or family, delay in receiving scan results, and whether the GP quickly identified the problem and referred to a specialist; second, the experience of care and support from the general practice, including lack of supportive response from the GP, lack of follow-up care from the GP, lack of family involvement by the GP, lack of GP knowledge about management, and whether the GP responded in a supportive way to the diagnosis; and third, the experience of overall coordination in care, including lack of communication between the hospital and general practice and good communication about the care plan. Conclusion Qualitative responses from patients with brain cancer reveal their needs for better emotional and practical support within primary care. Suggestions include increasing the speed of initial referral for investigation, the depth of discussion about diagnostic difficulties, and developing coordinated care plans with cancer centers.

Promoting patient health maintenance with cancer care planning at diagnosis and during treatment: baseline data of the Coleman Supportive Oncology Collaborative (CSOC).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24051-e24051
Author(s):  
Christine B. Weldon ◽  
Julia Rachel Trosman ◽  
Rosa Berardi ◽  
Al Bowen Benson ◽  
Betty Roggenkamp ◽  
...  
Keyword(s):  
Patient Care ◽  
Cancer Care ◽  
Online Survey ◽  
Care Plan ◽  
Care Planning ◽  
Health Maintenance ◽  
Supportive Cancer Care ◽  
Personalized Care ◽  
Care Plans ◽  
The Impact

e24051 Background: CSOC conducts quality improvements (QI) for cancer patients that facilitate delivery of appropriate health maintenance and supportive cancer care at diagnosis and during treatment. CSOC is implementing a care planning QI starting at diagnosis using the 4R oncology model (Right Info / Care / Patient / Time), which provides patients a formal personalized care plan called Patient Care Sequence. Each Care Sequence includes health maintenance, cancer treatments and supportive care. As part of CSOC, we conducted provider surveys as a pre-intervention baseline to inform QI opportunities. Methods: Online survey of cancer providers from 8 cancer centers (4 academic, 4 community) conducted July 2018 - October 2019, prior to 4R implementation. The survey focused on current care planning practices and inclusion of guideline recommended health maintenance in care plans. Results: Survey response rate: 80% (180/225); respondents were 53% physicians, 20% advanced practice, 27% nurses. Only 59% (107/180) of respondents give patients care plans at diagnosis: 61% (65/107) verbally, 22% (24/107) written, 17% (18/107) using a printed form. Providers reported considerable gaps in including guideline-based health maintenance and promotion activities in care plans given to patients (Table). Additionally, 61% of providers reported concerns that it is challenging for their patients to manage their own health maintenance activities. Providers who are concerned about patients’ challenges in managing their own health maintenance are significantly more likely to give their patients a written or printed plan (76%, 32/42) compared to those providing care plans to patients verbally or not at all (56%, 77/138), p = .02. Conclusions: Guideline based health promotion activities are not consistently included in care plans, and care planning is not sufficiently conducted at cancer diagnosis. The CSOC 4R Oncology Model, which implements Patient Care Sequences at diagnosis, will address these gaps and examine the impact of formal care planning on improving utilization of health maintenance and promotion activities. [Table: see text]

scholarly journals Initial Pain Management Plans in Response to Severe Pain Indicators on Oncology Clinic Previsit Questionnaires

2014 ◽  
Vol 19 (6) ◽  
pp. 309-312
Author(s):  
Michael S Sanatani ◽  
Maan Kattan ◽  
Dwight E Moulin
Keyword(s):  
Pain Management ◽  
Cancer Treatment ◽  
Severe Pain ◽  
Clinical Care ◽  
Symptom Assessment ◽  
Assessment System ◽  
Care Plan ◽  
Care Plans ◽  
Patient Reported ◽  
Management Plans

BACKGROUND: The issue of how to address patient pain in the outpatient setting remains challenging. At the London Regional Cancer Program (London, Ontario), patients complete the Edmonton Symptom Assessment System (ESAS) before most visits.OBJECTIVES:To perform a chart review assessing the frequency and, if applicable, the type of a clinical care plan that was developed if a patient indicated pain ≥7 on a 10-point scaleMETHODS: The charts of 100 eligible sequential outpatient visits were reviewed and the initial pain management approaches were documented.RESULTS: Between December 2011 and May 2012, visits by 7265 unique patients included 100 eligible visits (pain ≥7 of 10). In 83 cases, active pain management plans, ranging from counselling to hospital admission, were proposed. Active pain management plans were more likely if the cause was believed to be cancer/treatment related: 63 of 65 (96.9%) versus 20 of 35 (57.1%, noncancer/unknown pain cause); P<0.001. There were no differences depending on cancer treatment intent or medical service.CONCLUSIONS: Active pain management plans were documented in 83% of visits. However, patients who reported severe pain that was assessed as benign or unknown in etiology received intervention less frequently, perhaps indicating that oncologists either consider themselves less responsible for noncancer pain, or believe that pain chronicity may lead to a higher ESAS pain score without indicating a need for acute intervention. Further study is needed to determine the subsequent effect of the care plans on patient-reported ESAS pain scores at future clinic visits.

The Contribution of Child and Adolescent Mental Health Specialists to Care Planning in Child Care Proceedings

1998 ◽  
Vol 3 (3) ◽  
pp. 135-138
Author(s):  
Claire Sturge
Keyword(s):  
Mental Health ◽  
Social Services ◽  
Adolescent Mental Health ◽  
Child And Adolescent ◽  
Care Plan ◽  
Mutual Understanding ◽  
Care Planning ◽  
Care Plans ◽  
Department Of Health

In September 1997 the President's Interdisciplinary Committee organised a conference to look at issues around Care Planning. As important as the content of the conference was the aim of fostering mutual understanding and the cross-fertilisation of ideas across disciplines. Papers were given by judges, social services directors, guardians, Department of Health representatives, researchers, and child and adolescent mental health specialists. Interdisciplinary workshop discussions followed each paper generating group views and papers. All the papers have just been published as a book (Clarke, 1998).Dominating themes were the question of what, if any, influence the judge can exert over the Care Plan, the possibility of refusing to make a Care Order because of an unsatisfactory Care Plan, the value of the Care Plan and the accuracy of its details as a way of furthering and protecting a child's needs, the uncertainty about the proportion of cases where the Care Plan is altered or abandoned for good or bad reasons or major drift occurs, and ways of improving the quality of Care Plans through interdisciplinary co-operation. Various ways of dealing with these issues were suggested.

Do our current approaches to care planning and the CPA enhance the experience and outcomes of a person's recovery?

2014 ◽  
Vol 9 (1) ◽  
pp. 26-34 ◽  
Author(s):  
Miles Rinaldi ◽  
Flippa Watkeys
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Planning Process ◽  
Action Plan ◽  
Care Plan ◽  
Care Planning ◽  
Care Programme ◽  
Content Type ◽  
Care Plans

Purpose – Increasingly mental health services are attempting to become recovery focused which demands changing the nature of day-to-day interactions and the quality of the experience in services. Care planning is the daily work of mental health services and within this context, care planning that enhances both the experience and the outcomes of a person's recovery is a key element for effective services. However, care plans, the care planning process and the Care Programme Approach (CPA) continue to pose a challenge for services. The purpose of this paper is to discuss these issues. Design/methodology/approach – Conceptual paper. Findings – Within recovery focused services a care plan becomes the driving force, or action plan, behind a person's recovery journey and is focused on their individual needs, strengths, aspirations and personal goals. If involving people directly in the development of their care plan is critical to creating better outcomes then supporting self-management, shared decision making and coproduction all underpin the care planning process. Based on the evidence of people's experience of care plans and the care planning process it is time to seriously debate our current conceptualisation and approach to care planning and the future of the CPA. Originality/value – The paper describes aspects of the current situation with regard to the effectiveness of care planning in supporting a person's recovery. The paper raises some important questions.

Supportive care plans: Harnessing technology and patient-reported outcomes to drive quality care across the cancer continuum.

2014 ◽  
Vol 32 (30_suppl) ◽  
pp. 167-167
Author(s):  
Jeannine Brant ◽  
Carrie Tompkins Stricker ◽  
Paul B. Jacobsen
Keyword(s):  
Supportive Care ◽  
Quality Care ◽  
Planning System ◽  
Care Plan ◽  
Current Evidence ◽  
Comprehensive Cancer Center ◽  
Care Planning ◽  
Care Plans ◽  
Patient Reported ◽  
Post Test

167 Background: Cancer care is increasingly complex. Clinicians lack time to stay current on evolving evidence and resources to implement quality standards. Health information technology solutions have proliferated, including electronic patient-reported outcome (ePRO) and care pathway technologies, but adoption has been slow. The goal of this study is to explore feasibility, usability, and acceptability of incorporating a novel supportive care planning technology into clinic workflow. The On Q Care Planning System (CPS) collects ePRO and clinical data to generate a personalized supportive care plan aligned with quality care standards and current evidence. Plans promote self-management and patient-provider communication. Methods: Prospective, multi-center pilot study at 2 NCI-affiliated centers (a comprehensive community cancer program [NCCCP] in the Western U.S., and a NCI-designated comprehensive cancer center [NCCC] in the Southeastern U.S.). 100 patients and their providers will participate; 50 women with gynecological cancers on chemotherapy; 50 women post-active treatment for breast cancer. Patients complete an ePRO assessment and are given an electronically generated, personalized supportive care plan by their providers during office visit(s) over a 3-month period. Study outcomes evaluated at baseline and 6 weeks include feasibility/usability of the platform (patient/provider, post-test only; surveys/platform statistics), patient satisfaction with care (pre/post-test; CG-CAHPS), and adherence to care plan recommendations (post-test survey). Results: To date, 10 patients have enrolled at the NCCCP and 7 completed baseline and 6 week measures; 5 at the NCCC have completed baseline measures. Four providers each at the NCCCP and the NCCC are scheduled for post-test assessments. Updated enrollment and results will be presented at the meeting. Conclusions: The On Q CPS is a novel supportive care planning technology developed to improve care processes and patient outcomes through the delivery of personalized electronic care plans. Feasibility, usability, acceptability, satisfaction and exploratory outcome data will be presented.

Implementing the Survivorship Care Plan

2021 ◽  
pp. 760-766
Author(s):  
Erin E. Hahn ◽  
Patricia A. Ganz
Keyword(s):  
Cancer Treatment ◽  
Cancer Patients ◽  
Cancer Survivorship ◽  
Care Plan ◽  
Care Planning ◽  
Survivorship Care ◽  
Treatment Summaries ◽  
Care Plans ◽  
American Society ◽  
Survivorship Care Planning

There are many challenges associated with ensuring quality care for cancer survivors. Cancer patients often require treatment by multiple specialists (surgeons, radiation oncologists, medical oncologists) due to the use of multimodal therapies. After treatment has ended, cancer patients may be at risk for serious long-term and late effects of their disease and treatment. Unfortunately, the oncology care system often fails to provide education and guidance to patients at the end of active cancer treatment, in contrast to the more standardized communication at the time of diagnosis and initial treatment planning. Delivering high-quality, coordinated care during the posttreatment phase is critical to ensure the best possible patient outcomes. One of the proposed first steps in accomplishing this is the widespread implementation of cancer treatment summaries and survivorship care planning, a key recommendation of the 2006 Institute of Medicine report, From Cancer Patient to Cancer Survivor: Lost in Transition. This has been embraced by a number of leading organizations, including the American Society of Clinical Oncology (ASCO) and the Commission on Cancer. Survivorship care has also become an international priority, with organizations such as the U.K. National Cancer Survivorship Initiative and Organization of European Cancer Institutes championing the importance of survivorship care. This chapter provides an overview of the development and use of treatment summaries and survivorship care planning and briefly reviews research on care plans and the health policy impact of survivorship care plans as they relate to quality improvement activities that are underway.

scholarly journals 52 A Community Cure for Frequent Reattenders: Developing An Interface Geriatrics Service

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i14-i17
Author(s):  
O Davies ◽  
S James
Keyword(s):  
Social Services ◽  
Advance Care Planning ◽  
Care Plan ◽  
Care Planning ◽  
Care Plans ◽  
Frequent Attenders ◽  
Frequent Attender ◽  
Frail Patients ◽  
Complex Patients ◽  
Advance Care

Abstract Topic Setting up an interface geriatrics service in a seaside area with a large elderly population. Many elderly patients are readmitted due to the challenge of managing their chronic health conditions in the community. These patients are frail, with frequently exacerbated chronic conditions causing regular readmissions. We noted that treatment was rarely changed during these admissions and patients were not uniformly managed. Aims Aims for this project were to improve care for older people, reduce readmissions and produce clear patient care plans. Interventions Our first PDSA cycle involved implementing geriatrician presence at community MDTs (involving social services, GPs, intermediate care teams, and various others). This generated home visits to several patients, with a mix of acute and chronic issues. We offered Advance Care planning where appropriate to these patients. We noted several patients were repeatedly discussed at MDT. This brought into focus frequent attenders who were usually well-known to the community. In the next cycle we introduced ‘frequent attender’ plans for these patients, ensuring a unified approach to their management. Subsequent cycles involved geriatrician presence at the ‘frequent attenders’ steering group, and further links with community teams. Our primary intervention has been Advance care & frequent attender plans offering tailored management for complex patients. These are completed by a geriatrician discussing patients wishes for treatment and future care. Improvements Readmission rates show up to 90% reduction in admissions/ED attendances for patients following care plan implementation. Feedback from families and patients is positive – the service is ‘pragmatic and supportive’, delivering ‘empathetic care’. Discussion Implementing an interface geriatrics service highlights the importance of caring for frail patients in their preferred place of care, reducing unnecessary/inappropriate hospitalisations. Geriatrician presence at community MDTs has improved care by offering prompt access to medical advice and review of complex patients. It highlights patients presenting frequently to services, allowing us to work with patients and families to improve management. A frequent attender list generated by the hospital helps target patients for whom intervention will give significant benefit. We plan to extend this further by working with nursing homes that have high conveyancing rates. The service is being extended to more areas within our region, and we are working with GPs and care homes to further offer advance care planning to vulnerable and frail patients.

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