Improving colonoscopy referral rates through computer-supported, primary care practice redesign.

This quality improvement project was designed to improve rates of referral for colonoscopy screening in the Utah Health Research Network, University of Utah Community Clinics. This study was conducted between October 2004 and June 2007 with the main intervention being a clinic workflow modification using computerized screening reminders embedded in the electronic medical record (EMR). The intervention led to sustained improvement, largely driven by the performance of two network clinics.

The effect of technology-supported, multidisease care management on the mortality and hospitalization of seniors.

Objectives: To explore changes in mortality and hospital usage for chronically ill seniors enrolled in a multidisease care management program, Care Management Plus (CMP).

Design: Controlled clinical trial with seven intervention and six control clinics with additional patient-level matching.

Setting: Intermountain Health Care, a large health system in Utah; seven intervention and six control clinics.

Care management dosage.

Background: The care of patients with complex illnesses requires careful management, but systems of care management (CM) vary in their structure and effectiveness.

Objective: To create a framework identifying components of broad-based CM interventions and validate the framework, including using this framework to evaluate the contribution of varying components on outcomes of patients with chronic illness.

Design: We create the framework using retrospective information about CM activities and services over 12 months and categorize it using cluster and factor analysis.

Improved clinical outcomes with utilization of a community-acquired pneumonia guideline.

Background: We previously reported decreased mortality following implementation of a community-acquired pneumonia guideline derived from specialty society recommendations. However, patients with respiratory failure and sepsis from pneumonia were not included, adjustment for comorbidities was limited, and no guideline compliance data were available. We also questioned whether decreased mortality continued after 1997.

Use of health-related, quality-of-life metrics to predict mortality and hospitalizations in community-dwelling seniors.

Objectives: To investigate whether health-related quality-of-life (HRQoL) scores in a primary care population can be used as a predictor of future hospital utilization and mortality.

Design: Prospective cohort study measuring Short Form 12 (SF-12) scores obtained using a mailed survey. SF-12 scores, age, and a comorbidity score were used to predict hospitalization and mortality rate using multivariable logistic regression and Cox proportional hazards during the ensuing 28-month period for elderly patients.

Impact of generalist care managers on patients with diabetes.

Objective: To determine how the addition of generalist care managers and collaborative information technology to an ambulatory team affects the care of patients with diabetes.

Study Setting: Multiple ambulatory clinics within Intermountain Health Care (IHC), a large integrated delivery network.

Study Design: A retrospective cohort study comparing diabetic patients treated by generalist care managers with matched controls was completed.