Implementing effective care management in the patient-centered medical home.

Background: There is growing evidence that practice-based care management can improve clinical quality and reduce costly healthcare utilization.

Objectives: To explore how a disparate group of patient-centered medical homes (PCMHs) embedded care management in their team care environment to identify best practices.

Study Design: A positive deviance approach was used to contrast care management implementation in practices having the greatest and least improvement on clinical measures of diabetes, the initial target disease for a multipayer-supported statewide initiative involving 25 National Committee on Quality Assurance-recognized PCMH practices participating in a regional learning collaborative.

Effects of a web-based patient activation intervention to overcome clinical inertia on blood pressure control: cluster randomized controlled trial.

Background: Only approximately half of patients with hypertension have their blood pressure controlled, due in large part to the tendency of primary care providers (PCPs) not to intensify treatment when blood pressure values are elevated.

Objective: This study tested the effect of an intervention designed to help patients ask questions at the point of care to encourage PCPs to appropriately intensify blood pressure treatment.

Methods: PCPs and their patients with hypertension (N=500) were recruited by letter and randomized into 2 study groups: (1) intervention condition in which patients used a fully automated website each month to receive tailored messages suggesting questions to ask their PCP to improve blood pressure control, and (2) control condition in which a similar tool suggested questions to ask about preventive services (eg, cancer screening).

Nurse case management improves blood pressure, emotional distress and diabetes complication screening.

We studied the impact of nurse case management (NCM) on blood pressure (BP), hemoglobin A1C, lipids, and diabetes complication screening. A 1-year randomized-controlled trial was conducted in two primary care clinics of the Penn State Hershey Medical Center. Diabetes patients were randomized to control group (CG) (n=182) who received usual care by their primary care provider and intervention group (IG) (n=150) who received additional NCM care, including self-management education, and implementation of diabetes guidelines.

Initial evaluation of the patient with suspected dementia.

Dementia is a common disorder among older persons, and projections indicate that the number of patients with dementia in the United States will continue to grow. Alzheimer's disease and vascular dementia account for the majority of cases of dementia. After a thorough history and physical examination, including a discussion with other family members, a baseline measurement of cognitive function should be obtained.

Appropriateness of quality indicators for older patients with advanced dementia and poor prognosis.

Objectives: To evaluate the applicability of process-of-care quality indicators (QIs) to vulnerable elders and to measure the effect of excluding indicators based on patients' preferences and for advanced dementia and poor prognosis.

Design: The Assessing Care of Vulnerable Elders (ACOVE) project employed 203 QIs for care of 22 conditions (including six geriatric syndromes and 11 age-associated diseases) for community-based persons aged 65 and older at increased risk of functional decline or death. Relevant QIs were excluded for persons deciding against hospitalization or surgery.

Integrating Web-based computer cases into a required clerkship: development and evaluation.

Purpose: To evaluate a five-year experience (1995-2000) developing and integrating computer cases into a required clerkship.

Method: In Study 1, 54 volunteer students were randomly assigned to study articles, a paper case, or a computer case on low back pain/kidney stones. Students were given an exam immediately after the exercise and one week later.