Analysis of Healthcare Interventions that Change Patient Trajectories

Analysis of Healthcare Interventions that Change Patient Trajectories

James H. Bigelow
Kateryna Fonkych
Constance Fung
Jason Wang
Copyright Date: 2005
Edition: 1
Published by: RAND Corporation
Pages: 208
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  • Book Info
    Analysis of Healthcare Interventions that Change Patient Trajectories
    Book Description:

    Examines interventions in the healthcare system that use Electronic Medical Record Systems (EMR-S) to affect patient trajectories--i.e., the sequence of encounters a patient has with the healthcare system--by improving health and thereby reducing healthcare utilization, or by reducing a costly form of utilization (e.g., inpatient stays) and increasing a more economical form (e.g., office visits to physicians, or prescription medications).

    eISBN: 978-0-8330-4097-8
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Preface
    (pp. iii-iv)
  3. Table of Contents
    (pp. v-x)
  4. Figures
    (pp. xi-xii)
  5. Tables
    (pp. xiii-xvi)
  6. Summary
    (pp. xvii-xxxii)
  7. Acknowledgments
    (pp. xxxiii-xxxiv)
  8. Acronyms
    (pp. xxxv-xxxviii)
  9. CHAPTER ONE Introduction
    (pp. 1-4)
    James H. Bigelow

    Apatient trajectoryis the sequence of events that involves the patient with the healthcare system. As part of a larger study, “Using Information Technology to Create a New Future in Healthcare: The RAND Health Information Technology (HIT) Project,” we examined selected interventions in the healthcare system that affect patient trajectories and that should be facilitated by HIT.¹ We have identified four classes of trajectory-changing interventions and we have selected some important interventions in each class:

    Implement Computerized Physician Order Entry (CPOE) as a means to reduce adverse drug events (ADEs).

    Increase the provision of the following preventive services: influenza...

  10. CHAPTER TWO Building the Trajectory Database from the MEPS
    (pp. 5-16)
    James H. Bigelow, Kateryna Fonkych and Constance Fung

    Apatient trajectoryis the sequence of events that involves the patient with the healthcare system. For our analysis of the interventions listed in Chapter One, we have created a database of patient trajectories from several years of the Medical Expenditure Panel Survey (MEPS) (AHRQ, multiple years). The MEPS distinguishes the eight types of events listed in Table 2.1.

    Our database also includes data from the MEPS files that describe the patient, such as age, sex, ethnicity, health insurance status, measures of health status, and medical conditions. Two of each year’s MEPS files, theFull Year Consolidated Data Fileand...

  11. CHAPTER THREE Interpreting MEPS-Based Estimates
    (pp. 17-46)
    James H. Bigelow and Kateryna Fonkych

    Those effects of interventions in the healthcare system that change patient trajectories, which we estimated in Chapter One, are changes in healthcare utilization (e.g., hospital stays, office visits, prescription drug use), changes in healthcare expenditures, and changes in population health outcomes (e.g., workdays or schooldays missed, days spent sick in bed). We have based our estimates largely on data from the Medical Expenditure Panel Survey (MEPS) (AHRQ MEPS, multiple years).

    In this chapter, we discuss how these estimates ought to be interpreted. We considered four reasons for questioning what our estimates mean. The first is the precision of the estimates,...

  12. CHAPTER FOUR Avoiding Adverse Drug Events Through Computerized Physician Order Entry
    (pp. 47-60)
    James H. Bigelow and Constance Fung

    Evidence suggests that Computerized Physician Order Entry (CPOE) can improve patient safety in both hospital and ambulatory environments (Bates, Leape et al., 1998; Bates, Teich et al., 1999; Johnston et al., 2003, 2004; Leape et al., 1995, 2000; Overhage, Tierney, and Zhou, 1997). Unsurprisingly, then, interest in CPOE increased greatly when the Institute of Medicine (IOM) (Corrigan and Donaldson, eds., 1999) reported that between 44,000 and 98,000 people die from medical errors in U.S. hospitals each year. The Leapfrog Group¹ has made installing CPOE in hospitals one of its recommendations (Birkmeyer et al., 2000, 2001).

    One measure of patient safety...

  13. CHAPTER FIVE Short-Term Effects of Preventive Services
    (pp. 61-86)
    James H. Bigelow and Constance Fung

    Here, we discuss our estimates of the short-term costs and benefits of influenza and pneumococcal vaccination, and of screening for cancers of the breast, cervix, and colon. These preventive services are among those recommended by the United States Preventive Services Task Force (USPSTF), a body that “provides evidence-based scientific reviews of preventive health services for use in primary care clinical settings, including screening, counseling, and chemoprevention” (Berg and Allen, 2001).Screeningcovers tests for early detection of many conditions, including breast, cervix, and colon cancers, hypertension, and hyperlipidemia. Counseling is recommended for appropriate persons on topics such as tobacco use,...

  14. CHAPTER SIX Management of Chronic Diseases
    (pp. 87-120)
    James H. Bigelow, Kateryna Fonkych and Constance Fung

    According to the Disease Management Association of America (DMAA),¹disease managementis

    a system of coordinated healthcare interventions and communications for populations with conditions in which patient self-care efforts are significant. Disease management:

    supports the physician or practitioner/patient relationship and plan of care,

    emphasizes prevention of exacerbations and complications utilizing evidence-based practice guidelines and patient empowerment strategies, and

    evaluates clinical, humanistic, and economic outcomes on an ongoing basis with the goal of improving overall health.

    Disease ManagementComponentsinclude:

    Population Identification processes

    Evidence-based practice guidelines

    Collaborative practice models to include physician and support-service providers

    Patient self-management education (may include primary...

  15. CHAPTER SEVEN Estimating Long-Term Effects of Healthy Behavior on Population Health Status and Healthcare
    (pp. 121-140)
    James H. Bigelow, Constance Fung and Jason Wang

    Here, we estimate the maximum effects that might flow from a four-step program of lifestyle change and long-term management of silent conditions, such as hypertension and high cholesterol. The steps are as follows:

    1. Everybody adopts the combination of lifestyle changes and (as necessary) medication use that best promotes good health.

    2. These changes reduce the incidence of a number of chronic medical conditions.

    3. Over time, the reduction in the incidence of each condition results in a reduction in the prevalence of each condition.

    4. Because these conditions are less prevalent, utilization of and expenditures on healthcare decline, and measures of health status...

  16. CHAPTER EIGHT The Patient’s Role in Disease Management and Lifestyle Changes
    (pp. 141-152)
    James H. Bigelow

    Chapter Six assumed that, with the appropriate education and support, chronically ill patients could manage their own chronic conditions effectively. Chapter Seven assumed that everybody could be persuaded to adopt the combination of lifestyle changes and (as necessary) medication use that best promotes good health. That is, everybody refrained from smoking, watched their weight, ate a healthy diet, and exercised. In this chapter, we consider whether most people could be persuaded to adopt healthy habits, and what role Health Information Technology (HIT) could play in making it happen.

    In our view, making it happen requires that patients (or consumers, since...

  17. CHAPTER NINE Realizing the Potential
    (pp. 153-156)
    James H. Bigelow

    In the preceding chapters, we have estimated the potential benefits of several interventions. Bypotentialwe mean the maximum effect that could be achieved, assuming that everything goes as well as it possibly could. But, of course the realization will fall short of this ideal. Not all hospitals or physicians will learn to use Health Information Technology (HIT) as effectively as the best. Not all of the chronically ill will learn to manage their conditions at peak effectiveness. Not all consumers will adopt healthy lifestyles. The benefits actually realized will be less than the potential benefits we have estimated, and...

  18. Bibliography
    (pp. 157-171)