Cargando…

Impact of care management processes and integration of care on blood pressure control in diabetes

BACKGROUND: Fragmentation within health care systems may negatively impact the quality of chronic disease patient care. We sought to evaluate the relationship between care management processes (CMP), integration of services, and blood pressure (BP) control among diabetic patients. METHODS: Retrospec...

Descripción completa

Detalles Bibliográficos
Autores principales: Wong, Ken, Boulanger, Luke, Smalarz, Amy, Wu, Ning, Fraser, Kimberly, Wogen, Jenifer
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599005/
https://www.ncbi.nlm.nih.gov/pubmed/23445773
http://dx.doi.org/10.1186/1471-2296-14-30
_version_ 1782262869769846784
author Wong, Ken
Boulanger, Luke
Smalarz, Amy
Wu, Ning
Fraser, Kimberly
Wogen, Jenifer
author_facet Wong, Ken
Boulanger, Luke
Smalarz, Amy
Wu, Ning
Fraser, Kimberly
Wogen, Jenifer
author_sort Wong, Ken
collection PubMed
description BACKGROUND: Fragmentation within health care systems may negatively impact the quality of chronic disease patient care. We sought to evaluate the relationship between care management processes (CMP), integration of services, and blood pressure (BP) control among diabetic patients. METHODS: Retrospective chart reviews were performed for a random sample of adult diabetic hypertensive patients (n = 2,162) from 28 physician organizations in the United States (US). A modified version of the Physician Practice Connection Readiness Survey (PPC-RS) was completed by the chief medical officer at each site. The PPC-RS measured health system organization, delivery system redesign, decision support, clinical information systems, and self-management support, and an integration scale measured structure, functions, and financial risk. Correlations between PPC and integration scores and BP outcomes were assessed using Spearman correlation coefficients. RESULTS: Approximately 39.9% of diabetic patients had controlled BP. Mean total PPC score across sites was 55, with highest mean scores for health system organization (81), followed by design support (60), clinical information systems (57), self-management support (39), and delivery system redesign (39). Mean integration score was 46 (SD 27, range 4–93), and means of subscores were 64 for structure, 33 for financial risk, and 42 for function. Clinical information systems subscore was correlated with uncontrolled BP (r = −0.38, p < 0.05), while association with total PPC score was strong but not significant at p < 0.05 (r = −0.32). Total integration score and the structure subscore were significantly correlated with BP control (r = 0.38, p < 0.05, and r = 0.49, p < 0.01). CONCLUSIONS: This study suggests that CMP and service integration may be associated with better outcomes in diabetes, though results were mixed and limited by a small number of participating sites. Primary care implementation of integrated electronic medical records may have a beneficial effect on patient outcomes for diabetes and other chronic diseases.
format Online
Article
Text
id pubmed-3599005
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-35990052013-03-17 Impact of care management processes and integration of care on blood pressure control in diabetes Wong, Ken Boulanger, Luke Smalarz, Amy Wu, Ning Fraser, Kimberly Wogen, Jenifer BMC Fam Pract Research Article BACKGROUND: Fragmentation within health care systems may negatively impact the quality of chronic disease patient care. We sought to evaluate the relationship between care management processes (CMP), integration of services, and blood pressure (BP) control among diabetic patients. METHODS: Retrospective chart reviews were performed for a random sample of adult diabetic hypertensive patients (n = 2,162) from 28 physician organizations in the United States (US). A modified version of the Physician Practice Connection Readiness Survey (PPC-RS) was completed by the chief medical officer at each site. The PPC-RS measured health system organization, delivery system redesign, decision support, clinical information systems, and self-management support, and an integration scale measured structure, functions, and financial risk. Correlations between PPC and integration scores and BP outcomes were assessed using Spearman correlation coefficients. RESULTS: Approximately 39.9% of diabetic patients had controlled BP. Mean total PPC score across sites was 55, with highest mean scores for health system organization (81), followed by design support (60), clinical information systems (57), self-management support (39), and delivery system redesign (39). Mean integration score was 46 (SD 27, range 4–93), and means of subscores were 64 for structure, 33 for financial risk, and 42 for function. Clinical information systems subscore was correlated with uncontrolled BP (r = −0.38, p < 0.05), while association with total PPC score was strong but not significant at p < 0.05 (r = −0.32). Total integration score and the structure subscore were significantly correlated with BP control (r = 0.38, p < 0.05, and r = 0.49, p < 0.01). CONCLUSIONS: This study suggests that CMP and service integration may be associated with better outcomes in diabetes, though results were mixed and limited by a small number of participating sites. Primary care implementation of integrated electronic medical records may have a beneficial effect on patient outcomes for diabetes and other chronic diseases. BioMed Central 2013-02-27 /pmc/articles/PMC3599005/ /pubmed/23445773 http://dx.doi.org/10.1186/1471-2296-14-30 Text en Copyright ©2013 Wong et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Wong, Ken
Boulanger, Luke
Smalarz, Amy
Wu, Ning
Fraser, Kimberly
Wogen, Jenifer
Impact of care management processes and integration of care on blood pressure control in diabetes
title Impact of care management processes and integration of care on blood pressure control in diabetes
title_full Impact of care management processes and integration of care on blood pressure control in diabetes
title_fullStr Impact of care management processes and integration of care on blood pressure control in diabetes
title_full_unstemmed Impact of care management processes and integration of care on blood pressure control in diabetes
title_short Impact of care management processes and integration of care on blood pressure control in diabetes
title_sort impact of care management processes and integration of care on blood pressure control in diabetes
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3599005/
https://www.ncbi.nlm.nih.gov/pubmed/23445773
http://dx.doi.org/10.1186/1471-2296-14-30
work_keys_str_mv AT wongken impactofcaremanagementprocessesandintegrationofcareonbloodpressurecontrolindiabetes
AT boulangerluke impactofcaremanagementprocessesandintegrationofcareonbloodpressurecontrolindiabetes
AT smalarzamy impactofcaremanagementprocessesandintegrationofcareonbloodpressurecontrolindiabetes
AT wuning impactofcaremanagementprocessesandintegrationofcareonbloodpressurecontrolindiabetes
AT fraserkimberly impactofcaremanagementprocessesandintegrationofcareonbloodpressurecontrolindiabetes
AT wogenjenifer impactofcaremanagementprocessesandintegrationofcareonbloodpressurecontrolindiabetes