Most of America’s health plans follow care recommendations established by the Healthcare Effectiveness Data and Information Set, a tool created by the private, nonprofit National Committee for Quality Assurance.
Dr. Terry Williams has 1,940 patients.
Some haven’t checked in for years. Others require consistent medical oversight for things like chronic disease, constant pain or medication management.
Now the Vancouver physician is part of an innovative Web-based system designed to improve care for all his patients.
Called the panel support tool, it can keep tabs on high-maintenance patients and reach out to people who go to the doctor only when they see blood spurting.
“It’s all about better and appropriate care for the patients,” said Williams, a family medicine physician at the Kaiser Permanente medical center in Orchards.
And there is a big gap in care, according to a study published recently by Kaiser researchers.
“Patients in the U.S. receive only about half of the preventive and follow-up care now recommended by national guidelines,” said Dr. Adrianne Feldstein, senior investigator at Kaiser’s Center for Health Research in Portland and lead author of a study published in The American Journal of Managed Care.
The panel support tool addresses that shortfall by comparing the care the patient is receiving to what’s recommended by national guidelines.
With the world’s largest nongovernmental set of electronic medical records, Kaiser can sift information for an individual patient, or sort out groups of people with a specific condition.
Clark County residents are about 15 percent of the membership of Kaiser Permanente Northwest.
Williams can use the panel support tool to see which diabetic patients need foot or eye exams. He can then send reminder letters to those patients or have his medical assistant call and remind them to come in for a screening.
You’d think that closing the care gap would just increase Williams’ workload. However, “I don’t see it that way,” he said recently in his Orchards office. “I don’t look at this as extra work. It’s appropriate care we didn’t know about.”
It also would boost prevention, because many serious diseases develop in patients who haven’t been screened for five or 10 years, Williams said.
About 1,500 of his nearly 2,000 patients are part of Kaiser’s e-mail system, which is not part of the panel support tool but still helps Williams’ outreach effort.
“We keep in contact a lot better now,” said Lola Crawford, who had just finished an office visit with Williams.
The Ariel resident likes another aspect of using Kaiser’s e-mail system to receive information generated by the panel support tool: The messages can include everything she needs to know about the recommended screening or procedure.
“I can print out the e-mail and take it into the lab,” she said. “When I’m not feeling good, I have a hard time remembering details.”
Williams has a typical patient panel, according to the study, which reported that the average primary care physician cares for about 2,000 patients.
The system monitors 45 different care gaps in six chronic conditions: asthma, diabetes, coronary artery disease, heart failure, hypertension and chronic kidney disease. The tool also monitors preventive care, including adult immunizations and screening for breast cancer, cervical cancer, colorectal cancer, cholesterol levels and osteoporosis.
And some recommendations are easier to implement than others, said Dr. Robert Unitan, one of the inventors of the panel screening tool. Scheduling a flu shot is usually easier than having a patient adopt a healthier diet.
Percentages matter
Two recently published Kaiser studies were the first to examine the effectiveness of a patient support system in a large, diverse population.
The study in the October issue of The American Journal of Managed Care followed 204 primary care teams that used the system to manage care for 48,344 patients with diabetes or heart disease. After three years, for patients with diabetes, the percentage of care recommendations met every month increased from 67.9 percent to 72.6 percent. For heart disease patients, the percentage rose from 63.5 percent to 70.6 percent.
The second study, published online in Population Health Management, involved 207 primary-care teams with 263,509 adult patients, some relatively healthy and others with chronic diseases. After 20 months, performance in 13 different care recommendations improved from 72.9 percent to 80 percent.
With the number of patients involved, an increase of a few percentage points can improve the care of thousands of people, said Unitan.
“Clinicians didn’t even know who was in their panel,” said Unitan, a specialist in pulmonary critical care. “The thought of making meaningful contact with more than 2,000 people is daunting.”
