Growth of Remote Therapeutic Monitoring Lands New Opportunities for Case Management.

Purpose/objectives: An increase in the use of remote therapeutic monitoring (RTM) has been spurred by nationwide factors including the COVID-19 pandemic, authorized reimbursement of RTM by the Centers for Medicare & Medicaid Services, and more frequent use of big data analytics in health care delivery. This article discusses the use of RTM by care teams at the point of care and explores the role of the case manager in RTM to address patients' unmet needs.

Primary Practice Settings: Although RTM may be utilized across inpatient and outpatient levels of care, this article focuses on outpatient care such as community clinics, provider groups, and home health care.

Generating Team-Based Strategies to Reduce Health Inequity in Cancer Care.

Purpose/objectives: Despite increased emphases on reducing racial disparities in the U.S. health care system, interprofessional care teams may inadvertently perpetuate health disparities through lack of awareness or experience in supporting individualized, patient-centered goals of care.

A regional analysis of payer and provider views on cholesterol management: PCSK9 inhibitors as an illustrative alignment model.

Multiple barriers exist for appropriate use of the proprotein convertase subtilisin/kexin type 9 enzyme inhibitors (PCSK9i) in patients with atherosclerotic cardiovascular disease (ASCVD) or familial hypercholesterolemia (FH) with inadequately controlled hypercholesterolemia despite standard therapies. Among these barriers, high payer rejection rates and inadequate prior authorization (PA) documentation by providers hinder optimal use of PCSK9i. To (a) identify and discuss provider and payer discordances on barriers to authorization and use of PCSK9i based on clinical and real-world evidence and (b) align understanding and application of clinical, cost, safety, and efficacy data of PCSK9i.

Community and Case Management Interventions to Address Social Determinants of Health in Infectious Disease.

Purpose/objectives: Professional case managers are responsible to conduct education, counseling, and other interventions that address the unique needs and gaps of the patients and families they serve. Social determinants of health (SDH) can impact barriers to patient care and outcomes that may go undetected among underserved populations without reliable data. This article describes an implementation science study using patient and provider-informed data and designed interventions to mitigate barriers in SDH related to hepatitis B virus (HBV).

Integrated Transitions of Care for Patients With Rare Pulmonary Diseases.

Purpose/objectives: Many continuing education (CE) resources are available to support case management professionals in developing competencies in transitions of care (TOC) that apply generally across disease areas. However, CE programs and tools are lacking for advanced TOC competencies in specific disease areas. This article describes 2 projects in which leading TOC, case management, and CE organizations collaborated to develop CE-accredited interdisciplinary pathways for promoting safe and effective TOC for patients with rare pulmonary diseases, including pulmonary arterial hypertension (PAH) and idiopathic pulmonary fibrosis (IPF).

Assessing Patient and Provider Perceptions of Factors Associated with Patient Engagement in Asthma Care.

Rationale: National quality improvement initiatives emphasize building partnerships between patients and providers by promoting patient engagement through communication, shared decision-making, and self-care skills. Efforts to promote patient engagement are especially important for people with asthma. To cultivate effective partnerships in asthma care, patients and providers may benefit from understanding each other's values and perceptions regarding treatment goals, shared decision-making, as well as barriers to optimal care and outcomes.

Influence of Continuing Medical Education on Rheumatologists' Performance on National Quality Measures for Rheumatoid Arthritis.

Introduction: In recent years researchers have reported deficits in the quality of care provided to patients with rheumatoid arthritis (RA), including low rates of performance on quality measures. We sought to determine the influence of a quality improvement (QI) continuing education program on rheumatologists' performance on national quality measures for RA, along with other measures aligned with National Quality Strategy priorities. Performance was assessed through baseline and post-education chart audits.

Self-Reported Training Adequacy, Experience, and Comfort Level in Performing Schizophrenia-Related Clinical Skills among Psychiatry Residents and Fellows.

Objective: In the context of an educational program on schizophrenia for psychiatry trainees, this survey study analyzed associations between self-reported training adequacy, experience in providing patient care, and comfort level in performing schizophrenia-related clinical skills. The influence of the education on comfort level was also assessed for each skill.

Methods: Survey respondents were psychiatry residents and fellows who participated in a schizophrenia education program at an in-person workshop or through online videos recorded at the workshop.

Improving Interprofessional and Coproductive Outcomes of Care for Patients with Chronic Obstructive Pulmonary Disease.

In the U.S., suboptimal care quality for patients with chronic obstructive pulmonary disease (COPD) is reflected by high rates of emergency department visits and hospital readmissions, as well as excessive costs.

Continuing Medical Education Improves Gastroenterologists' Compliance with Inflammatory Bowel Disease Quality Measures.

Background: Low rates of compliance with quality measures for inflammatory bowel disease (IBD) have been reported for US gastroenterologists.

Aims: We assessed the influence of quality improvement (QI) education on compliance with physician quality reporting system (PQRS) measures for IBD and measures related to National Quality Strategy (NQS) priorities.

Methods: Forty community-based gastroenterologists participated in the QI study; 20 were assigned to educational intervention and control groups, respectively.

Applying Quality Improvement into Systems-based Learning to Improve Diabetes Outcomes in Primary Care.

In the U.S., where the prevalence of type 2 diabetes has reached epidemic proportions, many patients with this disease are treated by primary care physicians in community-based systems, including accountable care organisations (ACOs).

Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities.

Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities.

New Therapies, Evidence, and Guidance in Hepatitis C Management: Expert Practices and Insights from an Educational Symposium at the AMCP 27th Annual Meeting Expo.

Background: The 2013-2014 approvals of new direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection have engendered a paradigm shift in HCV treatment and management, offering the potential for a cure at a population level. The availability of the highly effective and relatively safe DAAs prompted revisions to guidance recommendations based on new clinical trial evidence. In the context of this paradigm shift and considerations of the costs associated with the new DAAs, managed care professionals face new questions and challenges regarding HCV treatment and management approaches.

Impact of Quality Improvement Educational Interventions on Documented Adherence to Quality Measures for Adults with Crohn's Disease.

Background: In recent years, leading organizations in inflammatory bowel disease (IBD) have developed quality measures for the care of adults with Crohn's disease or ulcerative colitis. We used chart audits to assess the impact of quality improvement educational activities on documented adherence to Physician Quality Reporting System measures for IBD.

Methods: Twenty community-based gastroenterologists were recruited to participate in baseline chart audits (n = 200), a series of 4 accredited educational activities with feedback, and follow-up chart audits (n = 200).

Are we prepared for Affordable Care Act provisions of care coordination? Case managers' self-assessments and views on physicians' roles.

Purpose Of Study: Care coordination, traditionally the purview of the case management field, is recognized as a national priority for improving health care delivery and patient outcomes. With reforms of the Affordable Care Act (ACA) of 2010, case managers face new challenges and opportunities in providing care coordination services. The evolving roles of case managers as members of interprofessional care teams will be influenced by new policies that enable physicians to be reimbursed for care coordination.

Applications of comparative effectiveness research to case management.

Purpose/objectives: This article is intended to update case managers on recent advances in comparative effectiveness research (CER) led by the Agency for Healthcare Research and Quality. The article explores potential implications and applications of CER findings to case management practice.

Primary Practice Settings: All case management settings.

Managed approaches to multiple sclerosis in special populations.

Background: Multiple sclerosis (MS) is a chronic demyelinating disorder of the central nervous system that is classified as an immune-mediated inflammatory disease. In managed care, patients with MS can be managed through care coordination that engages an interprofessional approach to a comprehensive spectrum of preventive, medical, rehabilitative, cognitive, and long-term health care services. In addition, the management paradigm for MS is currently in a stage of rapid evolution, with a number of new agents, including more oral drugs, expected to become available in the near future.