While chronic disease care consumes an increasing share of healthcare resources, management of chronic illnesses is often fragmented and ineffective. Patients are increasingly being treated for multiple chronic diseases by many different providers. The resulting fragmented system both decreases the quality of care and increases patient safety concerns, such as interactions between medications prescribed by multiple providers. Wagner's chronic care model provides a framework for improving chronic disease care through care coordination, active follow-up, support for self-management, clinician decision support, and information systems. Despite the potential for health information technology (HIT) to facilitate these processes, research to date has often failed to show clear benefit. To improve patient care quality and safety outcomes, the Family Medicine and General Internal Medicine practices at the University of Missouri-Columbia plan a phased implementation of selected ambulatory care HIT systems and functions. The HIT implementations will use specific strategies to (1) improve providers' access to information, allowing individual providers to compare and improve their clinical performance against standardized performance targets and peers' performance; and (2) enhance patient-provider connectivity and communication to improve clinical decision-making, patient participation in the care process, and ultimately, patient care outcomes. Specific strategies include providing physicians with comparative performance reports in one of three formats, providing patients with access to a web-based, interactive software system that includes secure messaging and in-home reconciliation of all medications, and using in-home """"""""smart"""""""" diagnostic devices that send patient data directly to the care team. We propose a multi-method evaluation of HIT innovations designed to enhance the quality of primary care for chronic diseases. We will include qualitative interviews, surveys, and analysis of outcome data in the evaluation. The planned HIT systems for improving chronic disease care at MU will be implemented differently in various practices and with different associated care systems. This variation in care processes provides an extraordinary opportunity to evaluate factors that influence whether HIT innovations will aid in performance- based quality improvement, assist with care coordination, and facilitate patient self-management. Care for chronic diseases such as diabetes and heart disease accounts for 75% of all health care spending, but management of chronic illnesses is often fragmented and ineffective. Because HIT investment is both needed and is very costly, there is a need for greater understanding of how targeted uses benefit patients and health care providers. To improve the quality of care for patients with chronic illnesses, the proposed project will use new health information technology that includes specific strategies for managing chronic diseases. ? ? ?
