Implementing Home Blood Glucose and Blood Pressure Telemonitoring in Primary Care Practices for Patients with Diabetes: Lessons Learned

Aims The purpose of this qualitative evaluation was to explore the experience of implementing routine telemonitoring (TM) in real-world primary care settings from the perspective of those delivering the intervention; namely the TM staff, and report on lessons learned that could inform future projects of this type. Background Routine TM for high-risk patients within primary care practices may help improve chronic disease control and reduce complications, including unnecessary hospital admissions. However, little is known about how to integrate routine TM in busy primary care practices. A TM pilot for diabetic patients was attempted in six primary care practices as part of the Beacon Community in Western New York. Methods Semi-structured interviews were conducted with representatives of three TM agencies (n=8) participating in the pilot. Interviews were conducted over the phone or in person and lasted ~30 min. Interviews were audio-taped and transcribed. Analysis was conducted using immersion-crystallization to identify themes. Findings TM staff revealed several themes related to the experience of delivering TM in real-world primary care: (1) the nurse–patient relationship is central to a successful TM experience, (2) TM is a useful tool for understanding socio-economic context and its impact on patients’ health, (3) TM staff anecdotally report important potential impacts on patient health, and (4) integrating TM into primary care practices needs to be planned carefully. Conclusions This qualitative study identified challenges and unexpected benefits that might inform future efforts. Communication and integration between the TM agency and the practice, including the designation of a point person within the office to coordinate TM and help address the broader contextual needs of patients, are important considerations for future implementation. The role of the TM nurse in developing trust with patients and uncovering the social and economic context within which patients manage their diabetes was an unexpected benefit.

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Assessing Quality Improvement Capacity in Primary Care Practices

10.21203/rs.2.10354/v2 ◽

2019 ◽

Author(s):

Michael Parchman ◽

Melissa L. Anderson ◽

Katie F Coleman ◽

LeAnn Michaels ◽

Linnaea Schuttner ◽

...

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Primary Care ◽

Quality Improvement ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Prior Experience ◽

Pressure Control ◽

Care Practices ◽

Primary Care Practices

Abstract Background: Healthy Hearts Northwest (H2N) is a study of external support strategies to build quality improvement (QI) capacity in primary care with a focus on cardiovascular risk factors: appropriate aspirin use, blood pressure control, and tobacco screening/cessation. Methods: To guide practice facilitator support, experts in practice transformation identified seven domains of QI capacity and mapped items from a previously validated medical home assessment tool to them. A practice facilitator (PF) met with clinicians and staff in each practice to discuss each item on the Quality Improvement Capacity Assessment (QICA) resulting in a practice-level response to each item. We examined the association between the QICA total and sub-scale scores, practice characteristics, a measure of prior experience with managing practice change, and performance on clinical quality measures (CQMs) for the three cardiovascular risk factors. Results: The QICA score was associated with prior experience managing change and moderately associated with two of the three CQMs: aspirin use (r=0.16, p=0.049) and blood pressure control (r=0.18, p=0.013). Rural practices and those with 2-5 clinicians had lower QICA scores. PFs notes provide examples of high scoring practices devoting time and attention to quality improvement whereas low scoring practices did not. Conclusions: The QICA is useful for assessing QI capacity within a practice and may serve as a guide for both facilitators and primary care practices in efforts to build this capacity and improve measures of clinical quality.

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PCV14 A COMPARISON OF BLOOD PRESSURE OUTCOMES ASSOCIATED WITH THE USE OF ANGIOTENSIN-RECEPTOR BLOCKERS (ARBS) IN PATIENTS SEEN PREDOMINANTLY IN PRIMARY CARE PRACTICES

Value in Health ◽

10.1016/s1098-3015(10)74541-1 ◽

2009 ◽

Vol 12 (7) ◽

pp. A314

Author(s):

J Biskupiak ◽

J Kim

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Angiotensin Receptor Blockers ◽

Angiotensin Receptor ◽

Receptor Blockers ◽

Care Practices ◽

Primary Care Practices

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A multicomponent quality improvement intervention to improve blood pressure and reduce racial disparities in rural primary care practices

Journal of Clinical Hypertension ◽

10.1111/jch.12944 ◽

2016 ◽

Vol 19 (4) ◽

pp. 351-360 ◽

Cited By ~ 9

Author(s):

Crystal W. Cené ◽

Jacqueline R. Halladay ◽

Ziya Gizlice ◽

Katrina E. Donahue ◽

Doyle M. Cummings ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Quality Improvement ◽

Racial Disparities ◽

Quality Improvement Intervention ◽

Rural Primary Care ◽

Care Practices ◽

Primary Care Practices ◽

Improvement Intervention

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Lessons learned from the conduct of a multisite cluster randomized practical trial of decision aids in rural and suburban primary care practices

Trials ◽

10.1186/1745-6215-14-267 ◽

2013 ◽

Vol 14 (1) ◽

pp. 267 ◽

Cited By ~ 9

Author(s):

Kari L Ruud ◽

Annie LeBlanc ◽

Rebecca J Mullan ◽

Laurie J Pencille ◽

Kristina Tiedje ◽

...

Keyword(s):

Primary Care ◽

Decision Aids ◽

Lessons Learned ◽

Care Practices ◽

Practical Trial ◽

Cluster Randomized ◽

Primary Care Practices

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Aggregating Claims Data Across Payers: Approaches, Challenges, and Lessons Learned From the Comprehensive Primary Care Initiative

American Journal of Medical Quality ◽

10.1177/1062860619843350 ◽

2019 ◽

Vol 35 (1) ◽

pp. 29-36

Author(s):

Anne Mutti ◽

Erin Fries Taylor ◽

Deborah Peikes ◽

Janel Jin ◽

Kristie Liao ◽

...

Keyword(s):

Primary Care ◽

Performance Feedback ◽

Claims Data ◽

Lessons Learned ◽

Potential Game ◽

Practice Performance ◽

Care Practices ◽

Primary Care Practices ◽

Incomplete Picture ◽

Game Changer

The Comprehensive Primary Care (CPC) initiative fueled the emergence of new organizational alliances and financial commitments among payers and primary care practices to use data for performance improvement. In most regions of the country, practices received separate confidential feedback reports of claims-based measures from multiple payers, which varied in content and provided an incomplete picture of a practice’s patient panel. Over CPC’s last few years, participating payers in several regions resisted the tendency to guard data as a proprietary asset, instead working collaboratively to produce aggregated performance feedback for practices. Aggregating claims data across payers is a potential game changer in improving practice performance because doing so potentially makes the data more accessible, comprehensive, and useful. Understanding lessons learned and key challenges can help other initiatives that are aggregating claims or clinical data across payers for primary care practices or other types of providers.

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Primary care provider adherence to an alert for intensification of diabetes blood pressure medications before and after the addition of a “chart closure” hard stop

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocy073 ◽

2018 ◽

Vol 25 (9) ◽

pp. 1167-1174 ◽

Cited By ~ 6

Author(s):

Magaly Ramirez ◽

Richard Maranon ◽

Jeffery Fu ◽

Janet S Chon ◽

Kimberly Chen ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Best Practice ◽

High Specificity ◽

Pressure Control ◽

Treatment Providers ◽

Before And After ◽

Practice Advisory ◽

Patients With Diabetes ◽

Primary Care Practices

Abstract Objective To evaluate provider responses to a narrowly targeted “Best Practice Advisory” (BPA) alert for the intensification of blood pressure medications for persons with diabetes before and after implementation of a “chart closure” hard stop, which is non-interruptive but demands an action or dismissal before the chart can be closed. Materials and Methods We designed a BPA that fired alerts within an electronic health record (EHR) system during outpatient encounters for patients with diabetes when they had elevated blood pressures and were not on angiotensin receptor blocking medications. The BPA alerts were implemented in eight primary care practices within UCLA Health. We compared data on provider responses to the alerts before and after implementing a “chart closure” hard stop, and we conducted chart reviews to adjudicate each alert’s appropriateness. Results Providers responded to alerts more often after the “chart closure” hard stop was implemented (P < .001). Among 284 alert firings over 16 months, we judged 107 (37.7%) to be clinically unnecessary or inappropriate based on chart review. Among the remainder, which represent clear opportunities for treatment, providers ordered the indicated medication more often (41% vs 75%) after the “chart closure” hard stop was implemented (P = .001). Discussion The BPA alerts for diabetes and blood pressure control achieved relatively high specificity. The “chart closure” hard stop improved provider attention to the alerts and was effective at getting patients treated when they needed it. Conclusion Targeting specific omitted medication classes can produce relatively specific alerts that may reduce alert fatigue, and using a “chart closure” hard stop may prompt providers to take action without excessively disrupting their workflow.

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