Overview
CORE conducts outcomes research studies for clinicians, health care researchers and administrators. Through summary reports on patients’ functioning, quality of life and satisfaction, CORE provides insight into the long-term outcomes of clinicians’ care. By combining these patient self-reports with clinical treatment records and cost data for different patient groups, CORE also offers a broader understanding of potential ways to match patients with the most appropriate treatments. These broader reports encompass local epidemiology and experience within a broad population, rather than just a single or a few clinical practice settings.
Recent Studies
CHAMPS
The Community-based Arthritis Management Program for Seniors (CHAMPS) is a collaborative effort between CORE, Providence Center on Aging, Oregon Health and Science University (OHSU), and the Clackamas County Health Division. The three-year study is being funded by the Northwest Health Foundation. NHF funded the entire study. Previous research has demonstrated that self-management programs led by laypeople are effective in helping people with arthritis and other chronic conditions to reduce their pain and symptoms, increase their functional status and reduce their health care utilization. However, these previous studies have focused on patients who attend weekly classes or meetings. The CHAMPS study is designed to evaluate whether a home-based program can offer similar benefits to more impaired arthritis patients – specifically, those who are less able to leave their homes to attend such classes. The study involves three groups: one group of participants receives an “Arthritis Basics for Change” manual and tape and is asked to develop a self-care plan based on the information in the manual. A second group receives a home visit from a nurse care manager, in addition to the manual and tape, to help put their plan into action. A third “control” group receives no education until after the study is over. A research assistant visits each participant at home at the beginning of the study to complete an enrollment questionnaire and to randomly assign the participant to one of the study groups. Participants complete a similar survey six months later. In 2004 we began the enrollment process. Study participants who have enrolled so far are very impaired and have low functional status, high pain levels and high health care utilization. Enrollment will continue through mid-2005, and a final report will be completed in early 2006. CALL Care
CORE had the privilege of serving as the data center for a national demonstration project to provide "Comprehensive, Adaptable, Life-Affirming, Longitudinal" (CALL) services to patients with life-threatening illnesses and their families. The feasibility project demonstrated that it is possible to conduct longitudinal research for this vulnerable population. Data included patient surveys, health care utilization information and individual patient stories, which were collected over an 18-month period. Impressively, patients continued to complete the surveys even as their health worsened. Just as impressively, two years after data collection ended, each of the 11 participating sites continues its commitment to developing and using the CALL Care model to serve these patients and families. The CALL Care project was funded by the Robert Wood Johnson Foundation's National Program Office for Promoting Excellence in End-of-Life Care, and by Supportive Care of the Dying: A Coalition for Compassionate Care. The three-year CALL Care project was completed in 2003, and a final project report was published at that time. To date, one peer-reviewed article is in press and another has been submitted. End-of-Life Quality Index
In 2000, Providence Health & Services’s End-of-Life Care program was asked to identify a measure to reflect the quality of end-of-life care provided by physicians’ offices, hospitals and hospice. The group concluded that a single measure would be inadequate. Instead, a team of program leaders and CORE staff members set out to develop a more comprehensive tool. Their goals were to clarify the mission of the End-of-Life Care program, to establish quantifiable methods of measuring and analyzing quality, to enhance communication about end-of-life care within the health system, and to improve performance. The team developed an “End-of-Life Quality Index,” which is a family of measures that works much the way the Dow Jones does. Knowing the index score alone is insufficient; knowing whether today’s score has increased or decreased from a previous score provides more information; but knowing the performance of each element of the index provides complete understanding. The index is updated annually. To develop the index, managers and staff members identify important measures, determine current performance and establish quantitative objectives. They determine the relative importance of each measure, and weight it accordingly. Results are compiled quarterly and are shared with Providence leaders and staff members in a team meeting focused on identifying action steps. These quarterly meetings are the most critical aspect of the process. Through multidisciplinary discussion, team members gain a better understanding of the impact of each measure on the others, which enables them to develop action steps that will have a positive impact on patient care. During 2002, the index approach spread from hospice and palliative care into ambulatory and inpatient end-of-life care, and by 2003 its use had expanded beyond end-of-life care. As of 2005, the director of Providence Hospice now sees the index as such an essential management tool that we have now develop a related index to monitor that department’s financial performance. CORE staff members have presented the approach at national conferences, and it has been featured in an article in the journal Supportive Voice. Health Risk Screening for Medicare: Health and Risk Tool (HART)
Providence Health Plan (PHP) has delegated responsibility to CORE to identify Medicare + Choice members who are at risk for adverse outcomes such as hospitalization, nursing home placement, high cost of care, and death. Although the Centers for Medicare and Medicaid Services now mandates this risk identification, PHP developed and implemented the Health and Risk Tool (HART) in 1997 for use with new health plan members prior to this mandate. During 2002, CORE processed more than 2,100 completed HARTs, and sent individualized reports to primary care providers and case managers for the 13 percent of respondents who were identified as being at high risk for one or more adverse outcomes. CORE worked with Providence Center on Aging (COA) and PHP to make sure the high-risk reports remained consistent with the evolving role of case management. In 2003, CORE, COA and PHP completed a second HART research study. This study asked who should be re-screened with the HART and when. The study involved sending another HART to 1,500 randomly selected Medicare + Choice members who already had completed one HART when they enrolled in the health plan. Nearly 1,000 of these members completed the second HART for the study. The findings confirmed that most individuals who had been identified as high risk remained high risk, and that most who had been identified as the lowest risk remained the lowest risk. However, some members who were at intermediate risk when they joined PHP had risen to high risk within a few years. CORE is working with PHP now to determine the best way to identify such individuals before they suffer a precipitous decline. Home Health Quality Initiative
Since 1999, CORE has compiled comprehensive quarterly reports on the home health care provided by all 15 Providence home health agencies in Alaska, Washington, Oregon and California. These reports describe each agency’s patient population, including the patients’ utilization patterns, functional status improvement, satisfaction and adverse events. The reports have provided a common, system-wide tool for conducting outcome-based quality-improvement projects, a centerpiece of Medicare’s home health quality program. To date, projects have been conducted in the areas of pain, medication management and wound care.
NICHE: Nurses Improving Care for Health System Elders
NICHE is a multi-year project that started in 2000 within the three Portland-area Providence hospitals. Although NICHE is jointly coordinated by Providence Center on Aging and the regional Nursing Center of Excellence, each facility has a local team dedicated to steering NICHE efforts. Based on the results of a Geriatric Institutional Assessment Profile (GIAP), each team selected different geriatric complications for its first improvement efforts. Since then, the NICHE project has evolved uniquely at each facility. CORE’s role in this exciting project is to help the teams measure the extent to which they have made a difference in hospital care for older adults. In 2004, CORE conducted the Gerontologic Nursing Survey (GNS), a follow-up to the initial GIAP survey. Results of the GNS showed that hospital nurses felt that the care of older adults had grown less difficult and more rewarding than it had been prior to the implementation of NICHE. Beginning in 2005, Providence’s Oregon hospitals will be evaluated annually using the GNS. CORE is excited about continuing to provide support for NICHE as it expands beyond the Portland area. Safe Transitions in Care
In 2004, CORE completed a randomized trial to test whether the services of a clinical pharmacist could improve safety when patients make the transition from acute care to primary care. The project deployed a clinical pharmacist to help reconcile medication information, consult with physicians on the inpatient medication regimen, provide patient education, and transfer information from acute care to primary care. Study results indicate that the pharmacist had a favorable impact on both safety and long-term costs, as measured by readmissions to the hospital. Funding was provided through the Integrated Delivery System Research Network of the Agency for Healthcare Research and Quality. CORE is now using the findings of this study to help a Providence Health & Services Portland Service Area Task Force on Medication Reconciliation to improve the accuracy and availability of information on patient medications in Portland service area hospitals. As medical director of Health Services Research for CORE, Dr. Charles Bentz is responsible for developing a research plan for tobacco cessation and other health services research, submitting grant proposals, publication of research results in peer-reviewed journals, and contributing to CORE’s overall department strategic planning in the area of health services research.
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