1168-P: Effectiveness of a Comprehensive Diabetes Program for Patients with Poorly Controlled Diabetes in an Academic Health Care System: The Emory Diabetes Management Program

Recently we at Partners Health Care had a series of articles in the Journal of Personalized Medicine describing how we are going about implementing Personalized Medicine in an academic health care system [1–10].[...]

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The Academic Health Care System

JAMA ◽

10.1001/jama.1995.03520430085053 ◽

1995 ◽

Vol 273 (19) ◽

pp. 1549 ◽

Cited By ~ 14

Author(s):

Lee Goldman

Keyword(s):

Health Care ◽

Health Care System ◽

Academic Health ◽

Care System

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Identifying barriers to influenza vaccination recommendation adherence in an academic outpatient primary care clinic setting

INNOVATIONS in pharmacy ◽

10.24926/iip.v5i3.358 ◽

2014 ◽

Vol 5 (3) ◽

Author(s):

Jenni Buu ◽

Shantel Mullin ◽

Carrie McAdam-Marx ◽

Margaret Solomon ◽

Brandon T. Jennings

Keyword(s):

Primary Care ◽

Health Care ◽

Influenza Vaccination ◽

Health Care System ◽

Health Centers ◽

Academic Health ◽

Vaccination Rates ◽

Vaccination Recommendation ◽

New Guidelines ◽

Care System

Objective: The objectives of this study were to identify barriers to influenza vaccination recommendation adherence and determine potential methods to improve influenza vaccination rates at the outpatient primary care health centers within an academic health care system. Methods: This descriptive study consisted of a questionnaire distributed to primary care providers at outpatient health centers within an academic health care system. The questionnaire assessed provider opinions regarding knowledge of influenza vaccination recommendations, barriers to following clinical guidelines, and methods to decrease delay of guideline use. Influenza vaccination rates at each of the health centers were also determined through documentation of vaccination for adults who visited a primary care provider during the 2011-2012 influenza season. Vaccination rates were used as a potential model for vaccination recommendation adherence. Results: When providers were asked about barriers to guideline implementation, 75.0% stated lack of awareness that guidelines have been released and 62.5% identified insufficient time to learn new guidelines as barriers. When asked which would be useful to more quickly implement clinical guidelines, respondents selected education for providers of new guidelines (79.2%), reminders in the electronic medical record (62.5%), and involvement of other health care professionals including pharmacists (54.2%) as potential strategies. Most questionnaire respondents (70.8%) strongly agreed that well-developed guidelines would improve quality of care at their practice site. During the 2011-2012 influenza season, 26.0% of 67,827 adults with an office visit at all outpatient health centers had documentation of administration of an influenza vaccine. Conclusion: Influenza vaccination rates at the outpatient primary care health centers at this academic health care system represent an area for improvement. Provider perceived barriers to clinical practice guideline implementation and adherence at the health centers include lack of awareness of new guidelines and lack of resources such as time and personnel to follow all recommendations. A health care system-wide process needs to be created to better identify strategies to improve adherence to influenza vaccination recommendations and vaccination documentation. Type: Original Research

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Implementation of oral chemotherapy management program in the large integrated health care system and its impact on patient safety.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.30_suppl.279 ◽

2018 ◽

Vol 36 (30_suppl) ◽

pp. 279-279

Author(s):

Jessica Yoo ◽

Salin Nhean ◽

Prabha Vogel ◽

Igor I. Rybkin ◽

Diana Kostoff

Keyword(s):

Health Care ◽

Health Care System ◽

Monitoring Program ◽

Management Program ◽

Oral Chemotherapy ◽

Integrated Monitoring ◽

Clinical Interventions ◽

Ed Visits ◽

Grade 3 ◽

Care System

279 Background: Oral chemotherapy is a progressively growing portion of antineoplastic agents. Although convenient for the patient, it creates a unique challenges for the drug complacency and safety. To address these issues variety of programs and solutions were proposed, ranging from the smart pill bottles and mobile phone applications to telemedicine monitoring programs. This presentation describes development and implementation of the integrated monitoring program within a large health care system and assess impact of this program on patients safety and compliance. Methods: This is a retrospective, quasi-experimental study that compared outcomes of the patients treated with capecitabine, before and after implementation of OCMP (Oral Chemotherapy Management Program) in the Henry Ford Health System. The primary outcome was incidence of all grade and specifically grade 3-4 toxicities commonly associated with capecitabine. Secondary outcomes included emergency department (ED) visits and hospitalizations due to toxicity, adherence rates, and number of clinical interventions. Results: The incidence of adverse effects of Any Grade was significantly lower in the post-OCMP group compared to pre-OCMP group (70.3% vs 58.9%; 95% CI, 0.39-0.94; P = 0.03). All grade and grade 3-4 nausea, vomiting and diarrhea along with grade 3-4 hand-foot syndrome were significantly lower in the post-OCMP group, as well as decreased ED visits (18.9% vs. 8.6%; P = 0.005) and hospitalizations due to toxicities (17.1% vs. 6.3%; P = 0.002). The study also found higher adherence rates in the post-OCMP group. In the post-OCMP period, more than 50% of the patients required clinical interventions by OCMP nurse, mostly for side effect management. Conclusions: Administration of capecitabine on OCMP reduced rate of higher grade adverse events, most likely due to early intervention. OCMP implementation was associated with decreased rate of ED visits and hospitalizations due to the side effects. Patients who were managed by OCMP had higher adherence rates to the prescribed oral chemotherapy.

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