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Moreo K, Sapir T. Growth of Remote Therapeutic Monitoring Lands New Opportunities for Case Management. Prof Case Manag 2024; 29:63-69. [PMID: 38015812 DOI: 10.1097/ncm.0000000000000688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
PURPOSE/OBJECTIVES An increase in the use of remote therapeutic monitoring (RTM) has been spurred by nationwide factors including the COVID-19 pandemic, authorized reimbursement of RTM by the Centers for Medicare & Medicaid Services, and more frequent use of big data analytics in health care delivery. This article discusses the use of RTM by care teams at the point of care and explores the role of the case manager in RTM to address patients' unmet needs. PRIMARY PRACTICE SETTINGS Although RTM may be utilized across inpatient and outpatient levels of care, this article focuses on outpatient care such as community clinics, provider groups, and home health care. FINDINGS/CONCLUSIONS When implemented along with care management interventions, RTM applications have the potential to improve patient adherence, enhance communication between patients and their providers, streamline resource allocation, and address social determinants of health impacting patient care and outcomes. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE RTM reimbursement models are rapidly evolving, utilizing real-world and patient-reported data to identify and initiate timely, individualized solutions that meet the holistic needs of each patient. Use of an RTM system allows the case manager to build rapport with the patient while quickly identifying care gaps and delivering appropriate interventions that can maximize patient outcomes. RTM can drive savings and bring revenue to the system or practice while providing salient documentation of social determinants of health that can be addressed with validation of proven care coordination interventions.
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Affiliation(s)
- Kathleen Moreo
- Kathleen Moreo, BSN, BHSA, RN, CCM, CMGT-BC, CDMS, FCM, was recently inducted into the Class of 2023 Fellows of Case Management by the Case Management Society of America (CMSA) and is a past recipient of the CMSA Case Manager of the Year Award, as well as a CMSA Past President. A researcher and educator, Moreo has published extensively in peer-reviewed medical journals and has authored two books on nursing case management for the American Nurses Association. She currently serves in advisory capacities and volunteers in both health care and environmental causes
- Tamar Sapir, PhD, is the CEO and Founder of Synchronyx, a health tech company addressing gaps in medication adherence and care connectivity. She holds an MSc and a PhD degree from Bar-Ilan University and postdoctoral and business degrees from the University of Miami, FL. She is the author of more than 80 peer-reviewed publications, of which many focus on quality improvement, patient-provider connected tools, and health inequities
| | - Tamar Sapir
- Kathleen Moreo, BSN, BHSA, RN, CCM, CMGT-BC, CDMS, FCM, was recently inducted into the Class of 2023 Fellows of Case Management by the Case Management Society of America (CMSA) and is a past recipient of the CMSA Case Manager of the Year Award, as well as a CMSA Past President. A researcher and educator, Moreo has published extensively in peer-reviewed medical journals and has authored two books on nursing case management for the American Nurses Association. She currently serves in advisory capacities and volunteers in both health care and environmental causes
- Tamar Sapir, PhD, is the CEO and Founder of Synchronyx, a health tech company addressing gaps in medication adherence and care connectivity. She holds an MSc and a PhD degree from Bar-Ilan University and postdoctoral and business degrees from the University of Miami, FL. She is the author of more than 80 peer-reviewed publications, of which many focus on quality improvement, patient-provider connected tools, and health inequities
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Moreo K, Sullivan S, Carter J, Heggen C. Generating Team-Based Strategies to Reduce Health Inequity in Cancer Care. Prof Case Manag 2023; 28:215-223. [PMID: 37487154 DOI: 10.1097/ncm.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
PURPOSE/OBJECTIVES Despite increased emphases on reducing racial disparities in the U.S. health care system, interprofessional care teams may inadvertently perpetuate health disparities through lack of awareness or experience in supporting individualized, patient-centered goals of care. Racial disparities can lead to health inequity. Persistent health disparity gaps exist among Black patients with multiple myeloma (MM) when compared with non-Black patients. Black patients experience a two-fold increase in MM risk and earlier age of onset compared with non-Black patients. Black patients are also less likely to receive timely access to some therapies, undergo autologous stem cell transplant, or enroll in clinical trials. This article describes a large-scale, equity-focused implementation science initiative aimed at identifying and overcoming racial disparities and health inequity among patients with MM through quality improvement goals identified by each of the interprofessional cancer care teams. PRIMARY PRACTICE SETTINGS Interprofessional cancer care teams in two large oncology systems as well as four community clinics were engaged in this study along with their patients with MM. Geographic areas included the following: Chicago, IL; Washington, DC; Charlotte, NC; Columbus, OH; Denver, CO; and Indianapolis, IN. Interprofessional teams included hematologists/oncologists, primary care physicians, nurse practitioners/physician assistants, and case managers/nurse navigators. Teams collectively examined and compared their own beliefs and attitudes about their patients' goals for MM treatment and management versus those of their patients to uncover and address discordances. Medical records from the clinics were audited to evaluate disparities in treatment and practice at the point of care. Live, team-based audit-feedback sessions were implemented among teams to examine data sets, as well as utilize the data to address interprofessional factors that could enhance more equitable care. FINDINGS/CONCLUSIONS Data from comparative surveys between patients and interprofessional team members revealed significant discordances that enabled health care teams to recognize gaps and identify ways to improve patient-centered care, such as shared decision-making. Through audit-feedback sessions, interprofessional teams were able to collaboratively meet and discuss methods to improve access to care coordination services and other strategies aimed at alleviating disparities. Baseline chart audits revealed and confirmed disparities of care including patient/disease characteristics, treatment history, clinical practice metrics, and patient-centered measures. Follow-up chart audits conducted 6 months later measured changes in documented practice behavior. Action plans developed by the interprofessional teams as a result of this study intend to address sustainable reductions in health disparities among patients with MM to improve health equity and overall care. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE This implementation science initiative and data results have several implications for case managers caring for diverse patients with MM in both large health systems and smaller community practices. Results punctuate the importance of identifying and supporting diverse patients' individualized goals and preferences in their care journey to mitigate health inequity and maximize health outcomes. The value of working collaboratively as an interprofessional team is evident in the study results, as is the role of the case manager in appropriate resource allocation to mitigate health disparities. Lessons learned from this initiative may also be applied to other case management settings where complex care delivery and interprofessional teams are at work.
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Affiliation(s)
- Kathleen Moreo
- Kathleen Moreo, BSN, BHSA, RN, CCM, CMGT-BC, CDMS, is the founder of Prime Education, LLC (PRIME), an accredited medical education company advancing the science of learning and behavior change for the interprofessional health care team. She is a past president of the Case Management Society of America, past commissioner of the Commission for Case Manager Certification, and a recipient of the CMSA Case Manager of the Year Award. She has published extensively in peer-reviewed medical journals and has authored two books on nursing case management for the American Nurses Association
- Shelby Sullivan, PharmD, is Director, Scientific Affairs, PRIME Education, LLC, Ft. Lauderdale, FL
- Jeffrey Carter, PhD, is Vice President, Research and Population Heath, PRIME Education, LLC, Ft. Lauderdale, FL
- Cherilyn Heggen, PhD, is Vice President, Scientific Affairs, PRIME Education, LLC, Ft. Lauderdale, FL
| | - Shelby Sullivan
- Kathleen Moreo, BSN, BHSA, RN, CCM, CMGT-BC, CDMS, is the founder of Prime Education, LLC (PRIME), an accredited medical education company advancing the science of learning and behavior change for the interprofessional health care team. She is a past president of the Case Management Society of America, past commissioner of the Commission for Case Manager Certification, and a recipient of the CMSA Case Manager of the Year Award. She has published extensively in peer-reviewed medical journals and has authored two books on nursing case management for the American Nurses Association
- Shelby Sullivan, PharmD, is Director, Scientific Affairs, PRIME Education, LLC, Ft. Lauderdale, FL
- Jeffrey Carter, PhD, is Vice President, Research and Population Heath, PRIME Education, LLC, Ft. Lauderdale, FL
- Cherilyn Heggen, PhD, is Vice President, Scientific Affairs, PRIME Education, LLC, Ft. Lauderdale, FL
| | - Jeffrey Carter
- Kathleen Moreo, BSN, BHSA, RN, CCM, CMGT-BC, CDMS, is the founder of Prime Education, LLC (PRIME), an accredited medical education company advancing the science of learning and behavior change for the interprofessional health care team. She is a past president of the Case Management Society of America, past commissioner of the Commission for Case Manager Certification, and a recipient of the CMSA Case Manager of the Year Award. She has published extensively in peer-reviewed medical journals and has authored two books on nursing case management for the American Nurses Association
- Shelby Sullivan, PharmD, is Director, Scientific Affairs, PRIME Education, LLC, Ft. Lauderdale, FL
- Jeffrey Carter, PhD, is Vice President, Research and Population Heath, PRIME Education, LLC, Ft. Lauderdale, FL
- Cherilyn Heggen, PhD, is Vice President, Scientific Affairs, PRIME Education, LLC, Ft. Lauderdale, FL
| | - Cherilyn Heggen
- Kathleen Moreo, BSN, BHSA, RN, CCM, CMGT-BC, CDMS, is the founder of Prime Education, LLC (PRIME), an accredited medical education company advancing the science of learning and behavior change for the interprofessional health care team. She is a past president of the Case Management Society of America, past commissioner of the Commission for Case Manager Certification, and a recipient of the CMSA Case Manager of the Year Award. She has published extensively in peer-reviewed medical journals and has authored two books on nursing case management for the American Nurses Association
- Shelby Sullivan, PharmD, is Director, Scientific Affairs, PRIME Education, LLC, Ft. Lauderdale, FL
- Jeffrey Carter, PhD, is Vice President, Research and Population Heath, PRIME Education, LLC, Ft. Lauderdale, FL
- Cherilyn Heggen, PhD, is Vice President, Scientific Affairs, PRIME Education, LLC, Ft. Lauderdale, FL
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Moreo K, Llewellyn A, Sands J, Luttrell J, Prince M, Owen M. Can History Change Our Future Course? Lessons From Case Managers Across Time. Prof Case Manag 2023; 28:194-200. [PMID: 37219329 DOI: 10.1097/ncm.0000000000000654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Kathleen Moreo
- Kathleen Moreo, BSN, BHSA, RN, CMGT-BC, CCM, CDMS, is the founder of PRIME Education, LLC, with a 30-year career in educating and mentoring case managers and other members of the health care team. She has been conducting and publishing the results of research-informed quality improvement projects involving case managers in health systems, payer organizations, and community clinics for the past 10 years
- Anne Llewellyn, MS, BHSA, RN, CCM, CRRN, CMGT-BC, BCPA, FCM, is a past president of CMSA with more than 40 years of experience in critical care, risk management, case management, patient advocacy, health care publications, and training and development. Since 2010, she has been a leader in patient advocacy and writes a weekly blog, Nurse Advocate, to empower and educate others
- Judith Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, has more than 30 years of experience in hospitals, managed care, specialty networks, academia, and health IT organizations, as well as hospice care. Her book, Home Hospice Navigation: The Caregiver's Guide is a caregiving resource for making home hospice understandable
- Jody Luttrell, MSN, RN, CCM, is a past director of Care Management and currently director of business development at Kennedy Krieger Institute. She also serves on the National CMSA Board of Directors and the CMSA Chesapeake Board of Directors. Her tips are based upon decades of experience in rehabilitation case management
- Melanie Prince, MSS, MSN, BSN, RN, NE-BC, CCM, FAAN, FCM, is immediate past president of CMSA and copresenter of the 2023 CMSA Case Management Boot Camp. She offers the following guidance from a military case management career spanning more than 30 years
- Mindy Owen, RN, CRRN, CCM, FCM, has been a case management leader for nearly 40 years and more recently has provided extensive consulting in hospital case management for large integrated and academic systems. In 2021, she was awarded the Lifetime Achievement Award by CMSA for her significant impact in the field of case management
| | - Anne Llewellyn
- Kathleen Moreo, BSN, BHSA, RN, CMGT-BC, CCM, CDMS, is the founder of PRIME Education, LLC, with a 30-year career in educating and mentoring case managers and other members of the health care team. She has been conducting and publishing the results of research-informed quality improvement projects involving case managers in health systems, payer organizations, and community clinics for the past 10 years
- Anne Llewellyn, MS, BHSA, RN, CCM, CRRN, CMGT-BC, BCPA, FCM, is a past president of CMSA with more than 40 years of experience in critical care, risk management, case management, patient advocacy, health care publications, and training and development. Since 2010, she has been a leader in patient advocacy and writes a weekly blog, Nurse Advocate, to empower and educate others
- Judith Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, has more than 30 years of experience in hospitals, managed care, specialty networks, academia, and health IT organizations, as well as hospice care. Her book, Home Hospice Navigation: The Caregiver's Guide is a caregiving resource for making home hospice understandable
- Jody Luttrell, MSN, RN, CCM, is a past director of Care Management and currently director of business development at Kennedy Krieger Institute. She also serves on the National CMSA Board of Directors and the CMSA Chesapeake Board of Directors. Her tips are based upon decades of experience in rehabilitation case management
- Melanie Prince, MSS, MSN, BSN, RN, NE-BC, CCM, FAAN, FCM, is immediate past president of CMSA and copresenter of the 2023 CMSA Case Management Boot Camp. She offers the following guidance from a military case management career spanning more than 30 years
- Mindy Owen, RN, CRRN, CCM, FCM, has been a case management leader for nearly 40 years and more recently has provided extensive consulting in hospital case management for large integrated and academic systems. In 2021, she was awarded the Lifetime Achievement Award by CMSA for her significant impact in the field of case management
| | - Judith Sands
- Kathleen Moreo, BSN, BHSA, RN, CMGT-BC, CCM, CDMS, is the founder of PRIME Education, LLC, with a 30-year career in educating and mentoring case managers and other members of the health care team. She has been conducting and publishing the results of research-informed quality improvement projects involving case managers in health systems, payer organizations, and community clinics for the past 10 years
- Anne Llewellyn, MS, BHSA, RN, CCM, CRRN, CMGT-BC, BCPA, FCM, is a past president of CMSA with more than 40 years of experience in critical care, risk management, case management, patient advocacy, health care publications, and training and development. Since 2010, she has been a leader in patient advocacy and writes a weekly blog, Nurse Advocate, to empower and educate others
- Judith Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, has more than 30 years of experience in hospitals, managed care, specialty networks, academia, and health IT organizations, as well as hospice care. Her book, Home Hospice Navigation: The Caregiver's Guide is a caregiving resource for making home hospice understandable
- Jody Luttrell, MSN, RN, CCM, is a past director of Care Management and currently director of business development at Kennedy Krieger Institute. She also serves on the National CMSA Board of Directors and the CMSA Chesapeake Board of Directors. Her tips are based upon decades of experience in rehabilitation case management
- Melanie Prince, MSS, MSN, BSN, RN, NE-BC, CCM, FAAN, FCM, is immediate past president of CMSA and copresenter of the 2023 CMSA Case Management Boot Camp. She offers the following guidance from a military case management career spanning more than 30 years
- Mindy Owen, RN, CRRN, CCM, FCM, has been a case management leader for nearly 40 years and more recently has provided extensive consulting in hospital case management for large integrated and academic systems. In 2021, she was awarded the Lifetime Achievement Award by CMSA for her significant impact in the field of case management
| | - Jody Luttrell
- Kathleen Moreo, BSN, BHSA, RN, CMGT-BC, CCM, CDMS, is the founder of PRIME Education, LLC, with a 30-year career in educating and mentoring case managers and other members of the health care team. She has been conducting and publishing the results of research-informed quality improvement projects involving case managers in health systems, payer organizations, and community clinics for the past 10 years
- Anne Llewellyn, MS, BHSA, RN, CCM, CRRN, CMGT-BC, BCPA, FCM, is a past president of CMSA with more than 40 years of experience in critical care, risk management, case management, patient advocacy, health care publications, and training and development. Since 2010, she has been a leader in patient advocacy and writes a weekly blog, Nurse Advocate, to empower and educate others
- Judith Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, has more than 30 years of experience in hospitals, managed care, specialty networks, academia, and health IT organizations, as well as hospice care. Her book, Home Hospice Navigation: The Caregiver's Guide is a caregiving resource for making home hospice understandable
- Jody Luttrell, MSN, RN, CCM, is a past director of Care Management and currently director of business development at Kennedy Krieger Institute. She also serves on the National CMSA Board of Directors and the CMSA Chesapeake Board of Directors. Her tips are based upon decades of experience in rehabilitation case management
- Melanie Prince, MSS, MSN, BSN, RN, NE-BC, CCM, FAAN, FCM, is immediate past president of CMSA and copresenter of the 2023 CMSA Case Management Boot Camp. She offers the following guidance from a military case management career spanning more than 30 years
- Mindy Owen, RN, CRRN, CCM, FCM, has been a case management leader for nearly 40 years and more recently has provided extensive consulting in hospital case management for large integrated and academic systems. In 2021, she was awarded the Lifetime Achievement Award by CMSA for her significant impact in the field of case management
| | - Melanie Prince
- Kathleen Moreo, BSN, BHSA, RN, CMGT-BC, CCM, CDMS, is the founder of PRIME Education, LLC, with a 30-year career in educating and mentoring case managers and other members of the health care team. She has been conducting and publishing the results of research-informed quality improvement projects involving case managers in health systems, payer organizations, and community clinics for the past 10 years
- Anne Llewellyn, MS, BHSA, RN, CCM, CRRN, CMGT-BC, BCPA, FCM, is a past president of CMSA with more than 40 years of experience in critical care, risk management, case management, patient advocacy, health care publications, and training and development. Since 2010, she has been a leader in patient advocacy and writes a weekly blog, Nurse Advocate, to empower and educate others
- Judith Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, has more than 30 years of experience in hospitals, managed care, specialty networks, academia, and health IT organizations, as well as hospice care. Her book, Home Hospice Navigation: The Caregiver's Guide is a caregiving resource for making home hospice understandable
- Jody Luttrell, MSN, RN, CCM, is a past director of Care Management and currently director of business development at Kennedy Krieger Institute. She also serves on the National CMSA Board of Directors and the CMSA Chesapeake Board of Directors. Her tips are based upon decades of experience in rehabilitation case management
- Melanie Prince, MSS, MSN, BSN, RN, NE-BC, CCM, FAAN, FCM, is immediate past president of CMSA and copresenter of the 2023 CMSA Case Management Boot Camp. She offers the following guidance from a military case management career spanning more than 30 years
- Mindy Owen, RN, CRRN, CCM, FCM, has been a case management leader for nearly 40 years and more recently has provided extensive consulting in hospital case management for large integrated and academic systems. In 2021, she was awarded the Lifetime Achievement Award by CMSA for her significant impact in the field of case management
| | - Mindy Owen
- Kathleen Moreo, BSN, BHSA, RN, CMGT-BC, CCM, CDMS, is the founder of PRIME Education, LLC, with a 30-year career in educating and mentoring case managers and other members of the health care team. She has been conducting and publishing the results of research-informed quality improvement projects involving case managers in health systems, payer organizations, and community clinics for the past 10 years
- Anne Llewellyn, MS, BHSA, RN, CCM, CRRN, CMGT-BC, BCPA, FCM, is a past president of CMSA with more than 40 years of experience in critical care, risk management, case management, patient advocacy, health care publications, and training and development. Since 2010, she has been a leader in patient advocacy and writes a weekly blog, Nurse Advocate, to empower and educate others
- Judith Sands, RN, MSL, BSN, CPHRM, CPHQ, CCM, ARM, has more than 30 years of experience in hospitals, managed care, specialty networks, academia, and health IT organizations, as well as hospice care. Her book, Home Hospice Navigation: The Caregiver's Guide is a caregiving resource for making home hospice understandable
- Jody Luttrell, MSN, RN, CCM, is a past director of Care Management and currently director of business development at Kennedy Krieger Institute. She also serves on the National CMSA Board of Directors and the CMSA Chesapeake Board of Directors. Her tips are based upon decades of experience in rehabilitation case management
- Melanie Prince, MSS, MSN, BSN, RN, NE-BC, CCM, FAAN, FCM, is immediate past president of CMSA and copresenter of the 2023 CMSA Case Management Boot Camp. She offers the following guidance from a military case management career spanning more than 30 years
- Mindy Owen, RN, CRRN, CCM, FCM, has been a case management leader for nearly 40 years and more recently has provided extensive consulting in hospital case management for large integrated and academic systems. In 2021, she was awarded the Lifetime Achievement Award by CMSA for her significant impact in the field of case management
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Moreo K. Addressing Vaccine Hesitancy With an Open Mind and Ethical Approach. Prof Case Manag 2022; 27:33-35. [PMID: 34846324 DOI: 10.1097/ncm.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Kathleen Moreo
- Kathleen Moreo, BSN, RN-BC, BHSA, CCM, CDMS, is the founder of Prime Education, LLC (PRIME), an accredited medical education and research company advancing the science of learning and behavior change for case managers and other health care professionals. She serves as vice president of the board of trustees of the Academy of Managed Care Pharmacy Foundation (2015-2021) and is a past president of the Case Management Society of America, and a commissioner of the Commission for Case Manager Certification. She is the 2001 recipient of the CMSA Case Manager of the Year Award. She has published extensively in peer-reviewed medical journals and has authored two books for the American Nurses Association. The author can be reached at:
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McCormick D, Bhatt DL, Bays HE, Taub PR, Caldwell KA, Guerin CK, Steinhoff J, Ahmad Z, Singh R, Moreo K, Carter J, Heggen CL, Sapir T. A regional analysis of payer and provider views on cholesterol management: PCSK9 inhibitors as an illustrative alignment model. J Manag Care Spec Pharm 2020; 26:1517-1528. [PMID: 33251993 PMCID: PMC10391214 DOI: 10.18553/jmcp.2020.26.12.1517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Multiple barriers exist for appropriate use of the proprotein convertase subtilisin/kexin type 9 enzyme inhibitors (PCSK9i) in patients with atherosclerotic cardiovascular disease (ASCVD) or familial hypercholesterolemia (FH) with inadequately controlled hypercholesterolemia despite standard therapies. Among these barriers, high payer rejection rates and inadequate prior authorization (PA) documentation by providers hinder optimal use of PCSK9i. OBJECTIVES: To (a) identify and discuss provider and payer discordances on barriers to authorization and use of PCSK9i based on clinical and real-world evidence and (b) align understanding and application of clinical, cost, safety, and efficacy data of PCSK9i. METHODS: Local groups of 3 payers and 3 providers met in 6 separate locations across the United States through a collaborative project of AMCP and PRIME Education. Responses to selected pre- and postmeeting survey questions measured changes in attitudes and beliefs regarding treatment barriers, lipid thresholds for considering PCSK9i therapy, and tactics for improving PA processes. Statistical analysis of inter- and intragroup changes in attitudes were performed by Cox proportional hazards test and Fisher's exact test for < 5 variables. RESULTS: The majority of providers and payers (67%-78%) agreed that high patient copayments and inadequate PA documentation were significant barriers to PCSK9i usage. However, payers and providers differed on beliefs that current evidence does not support PCSK9i cost-effectiveness (6% providers, 56% payers; P = 0.003) and that PA presents excessive administrative burden (72% providers, 44% payers; P = 0.09) Average increases pre- to postmeeting were noted in provider beliefs that properly documented PA forms expedite access to PCSK9i (22%-50% increase) and current authorization criteria accurately distinguish patients who benefit most from PCSK9i (6%-22%). Payers decreased in their belief that current authorization criteria accurately distinguish benefiting patients (72%-50%). Providers and payers increased in their belief that PCSK9i are cost-effective (44%-61% and 28%-50%, respectively) and were more willing to consider PCSK9i at the low-density lipoprotein cholesterol threshold of > 70 mg/dL for patients with ASCVD (78%-83% and 44%-67%, respectively) or FH (22%-39% and 22%-33%). Payers were more agreeable to less stringent PA requirements for patients with FH (33%-72%, P = 0.019) and need for standardized PA requirements (50%-83%, P = 0.034); these considerations remained high (89%) among providers after the meeting. Most participants supported educational programs for patient treatment adherence (83%) and physician/staff PA processes (83%-94%). CONCLUSIONS: Provider and payer representatives in 6 distinct geographic locations provided recommendations to improve quality of care in patients eligible for PCSK9i. Participants also provided tactical recommendations for streamlining PA documentation processes and improving awareness of PCSK9i cost-effectiveness and clinical efficacy. The majority of participants supported development of universal, standardized patient eligibility criteria and PA forms. DISCLOSURES: The study reported in this article was part of a continuing education program funded by an independent educational grant awarded by Sanofi US and Regeneron Pharmaceuticals to PRIME Education. The grantor had no role in the study design, execution, analysis, or reporting. AMCP received grant funding from PRIME to assist in the study, as well as in writing the manuscript. McCormick, Bhatt, Bays, Taub, Caldwell, Guerin, Steinhoff, and Ahmad received an honorarium from PRIME for serving as faculty for the continuing education program. McCormick, Bhatt, Bays, Taub, Caldwell, Guerin, Steinhoff, and Ahmad were involved as participants in the study. Bhatt discloses the following relationships: Advisory board: Cardax, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, Level Ex, Medscape Cardiology, PhaseBio, PLx Pharma, Regado Biosciences; Board of directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data monitoring committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Contego Medical (Chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), K2P (Co-Chair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cardax, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Idorsia, Ironwood, Ischemix, Lexicon, Lilly, Medtronic, Pfizer, PhaseBio, PLx Pharma, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); Site co-investigator: Biotronik, Boston Scientific, CSI, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded research: FlowCo, Merck, Novo Nordisk, Takeda. Bays' research site has received research grants from 89Bio, Acasti, Akcea, Allergan, Alon Medtech/Epitomee, Amarin, Amgen, AstraZeneca, Axsome, Boehringer Ingelheim, Civi, Eli Lilly, Esperion, Evidera, Gan and Lee, Home Access, Janssen, Johnson and Johnson, Lexicon, Matinas, Merck, Metavant, Novartis, Novo Nordisk, Pfizer, Regeneron, Sanofi, Selecta, TIMI, and Urovant. Bays has served as a consultant/advisor for 89Bio, Amarin, Esperion, Matinas, and Gelesis, and speaker for Esperion. McCormick, Caldwell, Guerin, Ahmad, Singh, Moreo, Carter, Heggen, and Sapir have nothing to disclose.
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Affiliation(s)
| | - Deepak L Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA
| | - Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY
| | - Pam R Taub
- Division of Cardiovascular Medicine, University of California San Diego School of Medicine
| | | | - Chris K Guerin
- Tri-City Medical Center and University of California San Diego School of Medicine
| | - Jeff Steinhoff
- Largo Medical Center, Largo, FL; HCA Healthcare/USF Morsani College of Medicine, Tampa, FL; and Nova Southeastern University, Davie, FL
| | - Zahid Ahmad
- Division of Nutrition and Metabolic Disease, UT Southwestern Medical Center, Dallas, TX
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Guerin C, Peiffer EO, Eichenbrenner PJ, Heggen C, Carter J, Sapir T, Moreo K. LIPID.CARE WEB APPS: DIGITAL TECHNOLOGY TO FACILITATE COLLABORATIVE LEARNING AND PATIENT-CENTERED PRACTICES AMONG CARDIOLOGY AND LIPID CARE TEAMS AND PATIENTS WITH HYPERCHOLESTEROLEMIA. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)34253-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Martinez F, Thomashow B, Han M, Simone L, Carter J, Moreo K, Sapir T. Disconnects in Physician and Patient Perceptions of COPD Disease Assessment. Chest 2017. [DOI: 10.1016/j.chest.2017.08.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Greene L, Moreo K, Nasrallah H, Tandon R, Sapir T. Self-Reported Training Adequacy, Experience, and Comfort Level in Performing Schizophrenia-Related Clinical Skills among Psychiatry Residents and Fellows. Acad Psychiatry 2017; 41:497-502. [PMID: 27743219 DOI: 10.1007/s40596-016-0612-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In the context of an educational program on schizophrenia for psychiatry trainees, this survey study analyzed associations between self-reported training adequacy, experience in providing patient care, and comfort level in performing schizophrenia-related clinical skills. The influence of the education on comfort level was also assessed for each skill. METHODS Survey respondents were psychiatry residents and fellows who participated in a schizophrenia education program at an in-person workshop or through online videos recorded at the workshop. In a pre-program survey, participants reported their experience in providing schizophrenia patient care and rated their training adequacy and comfort level for performing seven clinical skills involved in diagnosing and treating schizophrenia. The post-program survey included items for reassessing comfort level in performing the skills. RESULTS Across the seven clinical skills, the proportion of respondents (n = 79) who agreed or strongly agreed that their training was adequate ranged from 29 to 88 %. The proportion of high ratings for comfort level in skill performance ranged from 45 to 83 %. Comfort level was significantly associated with training adequacy for all seven clinical skills and with experience in providing patient care for four skills. For all skills, comfort level ratings were significantly higher after versus before the educational workshop. Commonly indicated needs for further training included education on new therapies, exposure to a broader range of patients, and opportunities for longitudinal patient management. CONCLUSIONS Psychiatry trainees' self-reported, disease-specific training adequacy, experiences, and comfort level have unique applications for developing and evaluating graduate medical curriculum.
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Affiliation(s)
| | | | | | - Rajiv Tandon
- University of Florida College of Medicine, Gainesville, FL, USA
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Hurvitz SA, Simone LC, Carter JD, Mateka JJL, Moreo K, Sapir T. Real-world practice patterns in community U.S. oncology practices: A quality improvement approach in HER2-positive breast cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.e18196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18196 Background: In breast cancer (BC), quality measures related to care coordination (CC), HER2 testing (testing) and use of HER2-targeted therapy (Tx), provide parameters for assessing care quality. We assessed the influence of quality improvement education (QIE) on alignment with BC quality indicators. Methods: 20 community oncologists participated in an IRB-approved QIE program. At baseline, 200 randomly selected charts of women with HER2+ invasive BC were retrospectively reviewed for adherence to quality measures pertaining to testing, Tx and CC. The cohort participated in accredited QIE activities for developing action plans for improvement. Follow-up chart reviews were completed 6 months after the QIE. Results: Patient and disease characteristics were generally similar across the 2 cohorts. At baseline, documentation of cancer staging was 90%, ECOG functional status assessment was 67% and cardiac testing was 33%. Treatment in the adjuvant setting was most common, followed by neoadjuvant, and metastatic. Documentation of CC varied greatly across specialties, and was highest for primary care physicians. At follow-up, randomly selected charts (n=60 to date) revealed increases in documentation of patient assessments and care coordination. A shift towards increased treatment in the neoadjuvant setting was also observed. Conclusions: QIE interventions that engaged oncology teams showed a positive impact on documentation across several parameters. A complete analysis of follow-up charts (n=200) will be presented. [Table: see text]
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Affiliation(s)
- Sara A. Hurvitz
- University of California Los Angeles Health, Santa Monica, CA
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Sapir T, Moreo K, Carter JD, Greene L, Patel B, Higgins PDR. Continuing Medical Education Improves Gastroenterologists' Compliance with Inflammatory Bowel Disease Quality Measures. Dig Dis Sci 2016; 61:1862-9. [PMID: 26873536 DOI: 10.1007/s10620-016-4061-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Accepted: 01/26/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND Low rates of compliance with quality measures for inflammatory bowel disease (IBD) have been reported for US gastroenterologists. AIMS We assessed the influence of quality improvement (QI) education on compliance with physician quality reporting system (PQRS) measures for IBD and measures related to National Quality Strategy (NQS) priorities. METHODS Forty community-based gastroenterologists participated in the QI study; 20 were assigned to educational intervention and control groups, respectively. At baseline, randomly selected charts of patients with moderate-to-severe ulcerative colitis were retrospectively reviewed for the gastroenterologists' performance of 8 PQRS IBD measures and 4 NQS-related measures. The intervention group participated in a series of accredited continuing medical education (CME) activities focusing on QI. Follow-up chart reviews were conducted 6 months after the CME activities. Independent t tests were conducted to compare between-group differences in baseline-to-follow-up rates of documented compliance with each measure. RESULTS The analysis included 299 baseline charts and 300 follow-up charts. The intervention group had significantly greater magnitudes of improvement than the control group for the following measures: assessment of IBD type, location, and activity (+14 %, p = 0.009); influenza vaccination (+13 %, p = 0.025); pneumococcal vaccination (+20 %, p = 0.003); testing for latent tuberculosis before anti-TNF-α therapy (+10 %, p = 0.028); assessment of hepatitis B virus status before anti-TNF-α therapy (+9 %, p = 0.010); assessment of side effects (+17 %, p = 0.048), and counseling patients about cancer risks (+13 %, p = 0.013). CONCLUSIONS QI-focused CME improves community-based gastroenterologists' compliance with IBD quality measures and measures aligned with NQS priorities.
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Affiliation(s)
- Tamar Sapir
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA.
| | - Kathleen Moreo
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA
| | - Jeffrey D Carter
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA
| | - Laurence Greene
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA
| | - Barry Patel
- Indegene Total Therapeutic Management, 300 Townpark Dr #100, Kennesaw, GA, 30144, USA
| | - Peter D R Higgins
- Department of Gastroenterology, University of Michigan Health System, 1500 E Medical Center Dr # 391, Ann Arbor, MI, 48109, USA
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Moreo K, Greene L, Sapir T. Improving Interprofessional and Coproductive Outcomes of Care for Patients with Chronic Obstructive Pulmonary Disease. BMJ Qual Improv Rep 2016; 5:bmjquality_uu210329.w4679. [PMID: 27335647 PMCID: PMC4916605 DOI: 10.1136/bmjquality.u210329.w4679] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/01/2016] [Indexed: 01/16/2023]
Abstract
In the U.S., suboptimal care quality for patients with chronic obstructive pulmonary disease (COPD) is reflected by high rates of emergency department visits and hospital readmissions, as well as excessive costs. Moreover, a substantial proportion of COPD patients do not receive guideline-directed therapies. In quality improvement (QI) programs, these types of health care problems are commonly addressed through interventions that primarily or exclusively support physicians in aligning their practices with guidelines and clinical quality measures. However, the root causes of many deficits in health care quality are not necessarily “physician centric.” Instead, they often involve suboptimal collaboration among members of interprofessional health care teams and gaps in coproductive relationships among patients and providers. We conducted a QI project to identify interprofessional and coproductive correlates of COPD care quality in the context of a continuing education program designed to advance knowledge and skill among patients, providers, and the interprofessional COPD team regarding coproductive COPD care. Participants in the program included providers in 30 primary care practices across the U.S. who, along with their own COPD patients and a separate cohort of patients from COPD advocacy groups, completed a patient-provider survey study designed to identify alignments and mismatches in coproductive perceptions and behaviors, a private survey feedback session for each practice's team, and online/mobile educational activities on COPD. In addition, more than 1,000 additional providers and 200 patients participated in just the online/mobile education. From the patient perspective, baseline measures indicated a high rate of dissatisfaction with COPD treatment plans and suboptimal coproductive interaction with members of the interprofessional health care team. Across providers, there were gaps and variation in provision of patient education, attitudes and practices regarding shared decision-making, and care coordination with pulmonary specialists. In addition, relatively low proportions of providers reported high levels of skill in various coproductive processes. The project outcomes indicated mismatches between COPD patients and providers in perceived ability to recognize COPD exacerbations, shared treatment goals, barriers to medication adherence, perceived impact of COPD on quality of life, and other aspects of COPD care. Providers demonstrated improvements in knowledge and attitudes regarding coproductive and coordinated COPD care.
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Moreo K, Sapir T, Greene L. Comparing Patient and Provider Perceptions of Engagement and Care in Chronic Diseases. J Contin Educ Health Prof 2016; 36 Suppl 1:S44-S45. [PMID: 27584070 DOI: 10.1097/ceh.0000000000000102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Kathleen Moreo
- Ms. Moreo: President and CEO, PRIME Education, Inc, Tamarac, FL. Dr. Sapir: Chief Scientific Officer, PRIME Education, Inc, Tamarac, FL. Dr. Greene: Scientific Education Manager, PRIME Education, Inc, Tamarac, FL
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Sapir T, Rusie E, Greene L, Yazdany J, Robbins ML, Ruderman EM, Carter JD, Patel B, Moreo K. Influence of Continuing Medical Education on Rheumatologists' Performance on National Quality Measures for Rheumatoid Arthritis. Rheumatol Ther 2015; 2:141-151. [PMID: 27747535 PMCID: PMC4883265 DOI: 10.1007/s40744-015-0018-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Indexed: 11/29/2022] Open
Abstract
Introduction In recent years researchers have reported deficits in the quality of care provided to patients with rheumatoid arthritis (RA), including low rates of performance on quality measures. We sought to determine the influence of a quality improvement (QI) continuing education program on rheumatologists’ performance on national quality measures for RA, along with other measures aligned with National Quality Strategy priorities. Performance was assessed through baseline and post-education chart audits. Methods Twenty community-based rheumatologists across the United States were recruited to participate in the QI education program and chart audits. Charts were retrospectively audited before (n = 160 charts) and after (n = 160 charts) the rheumatologists participated in a series of accredited QI-focused educational activities that included private audit feedback, small-group webinars, and online- and mobile-accessible print and video activities. The charts were audited for patient demographics and the rheumatologists’ documented performance on the 6 quality measures for RA included in the Physician Quality Reporting System (PQRS). In addition, charts were abstracted for documentation of patient counseling about medication benefits/risks and adherence, lifestyle modifications, and quality of life; assessment of RA medication side effects; and assessment of RA medication adherence. Results Mean rates of documented performance on 4 of the 6 PQRS measures for RA were significantly higher in the post-education versus baseline charts (absolute increases ranged from 9 to 24% of patient charts). In addition, after the intervention, significantly higher mean rates were observed for patient counseling about medications and quality of life, and for assessments of medication side effects and adherence (absolute increases ranged from 9 to 40% of patient charts). Conclusion This pragmatic study provides preliminary evidence for the positive influence of QI-focused education in helping rheumatologists improve performance on national quality measures for RA. Electronic supplementary material The online version of this article (doi:10.1007/s40744-015-0018-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tamar Sapir
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA.
| | - Erica Rusie
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA
| | - Laurence Greene
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA
| | - Jinoos Yazdany
- Division of Rheumatology, Department of Medicine, University of California, San Francisco, Box 0920, 3333, California St., Suite 270, San Francisco, CA, 94143-0920, USA
| | - Mark L Robbins
- Division of Rheumatology, Harvard Vanguard Medical Associates/Atrius Health, 40 Holland Street, Somerville, MA, 02144, USA
| | - Eric M Ruderman
- Division of Rheumatology, Northwestern University Feinberg School of Medicine, 675 N Saint Clair, Suite 14-100, Chicago, IL, 60611, USA
| | - Jeffrey D Carter
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA
| | - Barry Patel
- Indegene, 222 Chastain Meadows Ct, Suite 300, Kennesaw, GA, 30144, USA
| | - Kathleen Moreo
- PRIME Education, Inc., 8201 West McNab Road, Tamarac, FL, 33321, USA
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Moreo K, Sapir T, Greene L. Applying Quality Improvement into Systems-based Learning to Improve Diabetes Outcomes in Primary Care. BMJ Qual Improv Rep 2015; 4:bmjquality_uu208829.w3999. [PMID: 26734436 PMCID: PMC4693094 DOI: 10.1136/bmjquality.u208829.w3999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Revised: 09/09/2015] [Indexed: 12/18/2022]
Abstract
In the U.S., where the prevalence of type 2 diabetes has reached epidemic proportions, many patients with this disease are treated by primary care physicians in community-based systems, including accountable care organisations (ACOs). To address gaps in the quality of diabetes care, national quality measures have been established, including patient-centered measures adopted by the Centers for Medicare and Medicaid Services for its Shared Savings Program for ACOs. From a patient-centered perspective, high-quality diabetes care depends on effective communication between clinicians and patients, along with patient education and counseling about medications and lifestyle. We designed and implemented a quality improvement (QI) program for 30 primary care physicians treating patients with type 2 diabetes in three structurally similar but geographically diverse ACOs. Retrospective chart audits were conducted before (n = 300) and after (n = 300) each physician participated in accredited continuing medical education (CME) courses that focused on QI strategies. Randomly selected charts were audited to measurably assess essential interventions for improved outcomes in type 2 diabetes including the physicians’ documentation of patient counseling and assessment of side effects, and patients’ medication adherence status and changes in hemoglobin A1C (A1C) and body mass index (BMI). Paced educational interventions included a private performance improvement Internet live course conducted for each physician, small-group Internet live courses involving peer discussion, and a set of enduring materials, which were also multi-accredited for all clinicians in the physician's practice. Continual improvement cycles were guided by analysis of the baseline chart audits, quantitative survey data, and qualitative feedback offered by participants. To extend the benefit of the education, the enduring materials were offered to the interprofessional team of clinicians throughout the U.S. who did not participate in the QI program. For brevity, this article presents outcomes of the 30 primary care physicians. Baseline to post-education improvements were observed for percentages of charts with documented assessment of medication side effects (+11%) and counseling about medication risks/benefits (+28%), medication adherence (+13%), and lifestyle modifications (+8%). Improvements were also observed for documented adherence to diabetes medications (+24%) and first-to-last visit changes in A1C (−0.16%) and BMI (−2.1). The findings indicate a positive influence of QI education on primary care physicians’ performance of patient-centered quality measures and patient outcomes.
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Terrault N, Monto A, Stinchon MR, Rusie E, Moreo K. New Therapies, Evidence, and Guidance in Hepatitis C Management: Expert Practices and Insights from an Educational Symposium at the AMCP 27th Annual Meeting Expo. J Manag Care Spec Pharm 2015; 21:S1-14. [PMID: 26308363 PMCID: PMC10408779 DOI: 10.18553/jmcp.2015.21.9.s1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The 2013-2014 approvals of new direct-acting antiviral (DAA) therapies for hepatitis C virus (HCV) infection have engendered a paradigm shift in HCV treatment and management, offering the potential for a cure at a population level. The availability of the highly effective and relatively safe DAAs prompted revisions to guidance recommendations based on new clinical trial evidence. In the context of this paradigm shift and considerations of the costs associated with the new DAAs, managed care professionals face new questions and challenges regarding HCV treatment and management approaches. To address the continuing education needs of this group, PRIME Education, Inc. (PRIME) conducted a symposium on HCV at the 27th Annual Meeting Expo of the Academy of Managed Care Pharmacy. Moderated by Michael R. Stinchon, Jr., RPh, the program panel featured 2 internationally recognized leaders in hepatitis C treatment and research: Norah Terrault, MD, MPH, and Alex Monto, MD. OBJECTIVE To summarize the educational symposium presentations and discussions. METHODS This article is organized by key questions that the panelists and attendees raised for discussion during the 2-hour symposium. The questions addressed methods for assessing liver fibrosis; comprehensive patient assessment to inform treatment decisions; the influence of viral load on decisions about treatment duration; the role of ribavirin in optimizing treatment efficacy; unmet treatment needs for patients with HCV genotype 3 or advanced liver disease; and managed care strategies for patient education, adherence promotion, and care coordination. In answering attendee questions on these issues, the expert panelists presented established evidence, and recognizing limitations to current evidence and guidance recommendations, they discussed applications of clinical judgment and offered their views and practices regarding individualized care for patients with HCV. SUMMARY In response to questions about the utility of noninvasive methods for assessing liver fibrosis, the expert panel presented a comparative overview of the methodology, accuracy, risks, limitations, and costs of noninvasive tests and liver biopsy. Discussion highlighted the strengths of noninvasive methods for diagnosing advanced disease and cirrhosis and the methods' limitations that pose barriers to ensuring that patients receive necessary antiviral therapy. Based on guidance recommendations, treatment should be prioritized in patients with advanced fibrosis or cirrhosis (Metavir score F3 to F4). While acknowledging the importance of this recommendation, the symposium panelists also argued that making effective decisions about whom, and when, to treat requires a more comprehensive clinical approach to patient assessment and adjusting recommended priorities according to individual patient considerations. This approach involves evaluating outcomes such as extrahepatic complications, including those affecting quality of life, functional status, and work productivity. In response to questions regarding decisions about DAA therapy duration based on viral load, the panel engaged the audience in thinking critically about evidence-based cutoff values and natural fluctuations of HCV RNA concentrations. Discussions centered on the importance of clinical judgment to ensure that the treatment duration promotes the highest efficacy and avoids risks of relapse. The panel responded to several audience questions about the role of ribavirin in new DAA regimens. Evidence-based presentations and discussions focused on patient-specific factors that must be considered to inform effective decisions about adding ribavirin. The panel took a similar approach to answering questions about emerging challenges and the difficult-to-treat populations of patients with HCV genotype 3 or advanced liver disease. The symposium concluded with presentation of, and discussion on, managed care strategies for educating patients about appropriate HCV medication use, improving adherence, and coordinating care provided by the interprofessional team. CONCLUSIONS The availability of new DAAs for HCV raises new questions and challenges for managed care professionals, especially regarding prioritizing patients for immediate therapy as well as treatment and management approaches that account for the needs of individual patients and subpopulations. The educational symposium summarized in this article directly addressed key questions and challenges through presentations of evidence, guidance recommendations, and interactive discussions on the views and practices of international leaders in HCV treatment and research.
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Greene L, Moreo K. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities. BMJ Qual Improv Rep 2015; 4:bmjquality_uu208829.w3554. [PMID: 26732044 PMCID: PMC4645809 DOI: 10.1136/bmjquality.u208829.w3554] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 05/19/2015] [Indexed: 11/03/2022]
Abstract
Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high-quality care. The findings indicate the potential for QI education to support gastroenterologists in improving their performance on key measures of care quality for patients with ulcerative colitis.
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Sapir T, Rusie E, Carter JD, Greene L, Moreo K. Tailoring CME with chart audits linked to individual physician performance to improve rheumatoid arthritis quality measures. J Contin Educ Health Prof 2015; 35 Suppl 1:S40-S41. [PMID: 26115246 DOI: 10.1002/chp.21285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Moreo K, Moreo N, Urbano FL, Weeks M, Greene L. Are We Prepared for Affordable Care Act Provisions of Care Coordination? Case Managers' Self-Assessments and Views on Physicians' Roles. Prof Case Manag 2014; 19:18-26; quiz 27-8. [DOI: 10.1097/ncm.0000000000000004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic demyelinating disorder of the central nervous system that is classified as an immune-mediated inflammatory disease. In managed care, patients with MS can be managed through care coordination that engages an interprofessional approach to a comprehensive spectrum of preventive, medical, rehabilitative, cognitive, and long-term health care services. In addition, the management paradigm for MS is currently in a stage of rapid evolution, with a number of new agents, including more oral drugs, expected to become available in the near future. Pharmacy and therapeutic committees may soon be faced with evaluating a hierarchy of new scientific data to differentiate the safety and efficacy of these new agents. Decisions will need to be made regarding the utility of these potential new agents among existing therapies with longer-term safety and efficacy data available in the scientific literature. For those MS patients managed under Medicaid, formulary and medication management decisions may be further impacted by psychosocial, cultural, educational, attitudinal, and/or economic factors that may be unique to the Medicaid population. The need to maximize immediate and long-term resource utilization is usually an important consideration when managing a Medicaid population. There is also an increasing focus on quality measures and quality outcomes by the Centers for Medicare and Medicaid Services. Many managed care professionals can be involved in establishing quality measures and quality improvement processes to effectively appropriate and manage the resources required for Medicaid patients with MS. As a result, medication and medical management of this special population can involve a comprehensive approach by managed care professionals. For purposes of this article, the term "special populations" applies to patients with MS who are managed under Medicaid plans. OBJECTIVES To review (a) particular challenges managed care organizations (MCOs) encounter when managing special populations of Medicaid patients with MS, (b) recent efficacy and safety data for oral therapies for relapsing forms of MS, (c) costs of current MS therapies, and (d) potential strategies for managed care to improve care of their MS patient population and optimize clinical and economic outcomes. METHODS Review of recent published literature, abstracts related to MS presented at major medical conferences, and recommendations from key organizations including the U.S. Department of Health and Human Services and the National Multiple Sclerosis Society. SUMMARY The health economics of MS are a central issue for MCOs managing Medicaid patient populations. Additional challenges include the anticipated expansion of the marketplace to include several new oral agents and the lack of consensus guidelines for management of patients with MS. The benefit-risk profile of new agents will need to be considered in the context of established first-line parenteral drugs. Management of patients with MS should include an individualized approach for each patient as part of a shared decision-making process. In the overall management of special patient populations, case management and collaborative practice models in managed care may help to ensure that critical benchmarks are achieved.
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Affiliation(s)
- Kara Sperandeo
- Gateway Health Plan, 600 Grant St., Fl. 41, Pittsburgh, PA 15219. USA.
| | - Lisa Nogrady
- Gateway Health Plan, 600 Grant St., Fl. 41, Pittsburgh, PA 15219. USA.
| | - Kathleen Moreo
- Gateway Health Plan, 600 Grant St., Fl. 41, Pittsburgh, PA 15219. USA.
| | - Chris R. Prostko
- Gateway Health Plan, 600 Grant St., Fl. 41, Pittsburgh, PA 15219. USA.
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Moreo K, Urbano FL. Dear doctor: is there a case manager in the house? Case Manager 2004; 15:64-7. [PMID: 14961021 DOI: 10.1016/s1061925903003175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
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Moreo K. Consensus paper of the 2003 Physician and Case Management Summit: exploring best practices in physician and case management collaboration to improve patient care. ACTA ACUST UNITED AC 2003; 14:57-61. [PMID: 14593348 DOI: 10.1016/s1061-9259(03)00213-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kathleen Moreo
- Professional Resources in Management Education, Miramar, Florida, USA
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Moreo K. Collaboration between physicians and case managers. Case Manager 2003; 14:62-4. [PMID: 14593349 DOI: 10.1016/s1061-9259(03)00210-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Physicians and case managers are key stakeholders in the health care system. To foster collaboration between these occasionally opposing groups, the Case Management Society of America and Professional Resources in Management Education Inc. held a summit in Miami on April 4, 2003, to bring representatives from each group face to face. Attendees explored many barriers and opportunities involved in achieving and maintaining collaboration.
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Affiliation(s)
- Kathleen Moreo
- Professional Resources in Management Education, Miramar, Florida, USA
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Moreo K, Lamb G. Providing relevant guidelines for case management practice: revised CMSA Standards of Practice for Case Management. Lippincotts Case Manag 2003; 8:122-4. [PMID: 12777972 DOI: 10.1097/00129234-200305000-00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Moreo K. Issues and considerations in pharmacology: a call for case managers. Case Manager 2002; 13:56-9. [PMID: 11901370 DOI: 10.1067/tcmg.2002.122044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kathleen Moreo
- Professional Resources in Management Education, Miramar, FL, USA
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Moreo K. Case management in the bliss zone: overcoming ethical issues to advocate for a catastrophic patient. Case Manager 2001; 12:56-62. [PMID: 11464173 DOI: 10.1067/mcm.2001.117230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- K Moreo
- Professional Resources in Management Education in Miramar, FL, USA
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Ballenger J, Olin JW, Brass LM, Orland BI, Cannon E, Rich SJ, Dresdale A, Stemple C, Moreo K, Zusman R. Antiplatelet pathways development. Panel discussion. Manag Care 2000; 9:18-24. [PMID: 11729409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Moreo K. Case management's role in a Communist health care system. Case Manager 2000; 11:42-5. [PMID: 11935568 DOI: 10.1016/s1061-9259(00)80085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Llewellyn A, Moreo K. Transitioning from basic to advanced case management. Nurs Case Manag 1998; 3:63-6. [PMID: 9709095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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