Patient-centered outcomes of a value-based insurance design program for patients with diabetes.

Value-based insurance design (VBID) initiatives have been associated with modest improvements in adherence based on evaluations of administrative claims data. The objective of this prospective cohort study was to report the patient-centered outcomes of a VBID program that eliminated co-payments for diabetes-related medications and supplies for employees and dependents with diabetes at a large health system. The authors compared self-reported values of medication adherence, cost-related nonadherence, health status, and out-of-pocket health care costs for patients before and 1 year after program implementation.

Identification of overweight, obesity, and elevated blood pressure: a school-based health center performance improvement initiative.

A growing public health concern over the increasing prevalence of adolescent overweight and obesity and 2007 Expert Committee recommendations on child and adolescent overweight and obesity prompted a performance improvement project at 9 school-based health centers (SBHCs) in Delaware. Body mass index (BMI) and blood pressure measurements were assessed for 1548 students during the 2008-2009 school year. Students identified as having BMI or blood pressure readings out of the normal range were offered nutritional and/or medical services at the center and referred to their primary care physicians, when necessary, for further medical follow-up.

The impact of percutaneous coronary interventions on outcomes for acute myocardial infarction in Pennsylvania.

This research estimates the benefits associated with percutaneous coronary interventions (PCIs) for patients with acute myocardial infarction (AMI) treated at hospitals in Pennsylvania. We studied 31 351 patients with AMI in Pennsylvania during the year 2000, including 10 170 who received PCI. Univariate comparisons between groups were made using chi2 tests for categorical outcomes and Student's t tests for continuous outcomes.

Appropriate admissions to the appropriate unit: a decision tree approach.

An intermediate care decision tree tool was developed to meet the demand for intermediate care beds. Concurrently, a charging process was developed to support the acuity adaptable model of care, allowing the patient to remain in the same bed from admission to discharge, regardless of level of care required, adjusting nurse-to-patient ratios as acuity changes. Since beginning this pilot, 96% to 100% of the patients admitted to intermediate care from the emergency department met the criteria.

You've led the horse to water, now how do you get him to drink: managing change and increasing utilization of computerized provider order entry.

Community hospitals served by predominately private-practice physicians face difficult challenges in implementing computerized provider order entry (CPOE), but there are techniques and incentives that can be employed to change physician behavior Various techniques were used to increase CPOE utilization at Lehigh Valley Hospital, a three-campus, 750-bed tertiary community hospital in eastern Pennsylvania. Those techniques included presenting studies supporting CPOE as a way to improve patient care, recognizing support with small trinkets, providing individual access to computers, adding clinical decision support, and bringing peer pressure to bear Ultimately, financial compensation for the educational time required to learn to use and become proficient with the system was employed and had the greatest impact on behavior Measuring utilization of the CPOE system with data extracted from the hospital's clinical information system, CPOE utilization by physicians increased to 57 percent from 35 percent after a financial compensation program was initiated. Utilization declined to 42 percent several months after completing the first phase of the program and increased to 54 percent after a second phase was initiated.

First do no harm: integrating patient safety and quality improvement.

Background: Lehigh Valley Hospital's (LVH's; Allentown, Penn) interdisciplinary quality improvement program Primum Non Nocere (PNN), or First Do No Harm, is composed of 12 quality improvement (QI) projects that are a combination of ongoing operations improvement projects and new projects in patient safety. The projects stress delivery of cost-effective medical care while reducing preventable adverse events through improved communication, process redesign, and evidence-based protocol use.

Example: WRONG-SITE SURGERY: In response to an initial alert warning in 1998, LVH developed a policy of marking "yes" on the surgical site and "no" on the other side.