The American journal of managed care
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To evaluate and compare the attitudes and preferences of younger and older adults regarding health information exchange with providers, and identify barriers and limitations to meaningful use. ⋯ Although a majority of enrolled older adult patients have positive attitudes about health information exchange, electronic communication platforms must address key issues in consumer education, physician commitment, and adoption of an accessible interface to ensure productive older adult consumer participation.
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Observational Study
Use and perceived value of health information exchange: one public healthcare system's experience.
To describe health information exchange (HIE) use and providers' perceptions of value in a public healthcare system using a commercial electronic health record (EHR). ⋯ Early HIE use varied by care setting, patient characteristics, and insurance. Providers perceived HIE acceptable to patients, and helpful in avoiding redundant testing and unnecessary hospitalizations. Lower HIE use among commercially insured patients reinforces concerns that financial incentives may inhibit adoption.
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To examine regional variation in the service quality of physician practices and to assess the association of this variation with the supply and organization of physicians. ⋯ Cross-site variation in service quality of care in primary care has been large, persistent, and associated with the organization of practices. Areas with higher primary care physician-to-population ratios had longer, not shorter, appointment lags.
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Comparative Study
Outcomes among chronically ill adults in a medical home prototype.
To compare quality, utilization, and cost outcomes for patients with selected chronic illnesses at a patient-centered medical home (PCMH) prototype site with outcomes for patients with the same chronic illnesses at 19 nonintervention control sites. ⋯ A clinic-level population-based PCMH redesign can decrease downstream utilization and reduce total healthcare costs in a subpopulation of patients with common chronic illnesses.
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Improving quality of care for people with multiple chronic conditions (MCCs) requires performance measures reflecting the heterogeneity and scope of their care. Since most existing measures are disease specific, performance measures must be refined and new measures must be developed to address the complexity of care for those with MCCs. ⋯ This model organizes measures into a comprehensive framework and identifies areas where measures are lacking. In this context, performance measures can be prioritized and implemented at different levels, in the context of patients' overall healthcare needs.