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Rethinking the Future of Outpatient Chronic Care

Janice Simmons, for HealthLeaders Media, September 13, 2010
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The next 20 years could be thought of as the next great migration—when 77 million Americans, the biggest group ever, move through the window for ages 55 to 75. It's the Baby Boomers and Generation X getting older, bringing with them new challenges and pressures inside and outside the healthcare system.

"That window is the highest period of healthcare utilization for the average American. It's when most chronic diseases manifest," says C. Martin Harris, MD, MBA, chief information officer with the Cleveland Clinic.

At the same time, the number of physicians and physician offices is not expected to keep pace to provide for that demand for care. "Our ability to deliver the care in the same model that we have today is going to be very tightly constrained?if not impossible," Harris says. "There are many reasons now why to start thinking about how we can deliver this care in a more effective manner going forward."

The current medical model treats continuous disorders, such as hypertension or diabetes, as if they are episodic, maybe calling for visits to a physician three or four times a year, Harris says. "If we could start to manage it in a more continuous way, then we could affect the quality of the care we're delivering?essentially because we could make more adjustments at more appropriate times."

To address this, Cleveland Clinic decided to better track chronic conditions, coordinate treatment, and schedule timely interventions.

In December 2008, the clinic, working with Microsoft, started a physician-driven pilot project to follow patients with multiple chronic diseases in a clinical setting. The hospital paired its EMR system with Microsoft's online HealthVault, a Web-based storage platform, to monitor patients' health conditions.

More than 250 participants enrolled: 26% with diabetes, 6% with heart failure, and 68% with hypertension. The patients used at-home heart rate monitors, glucometers, scales, pedometers, or blood pressure monitors, depending on the disease, to follow their own condition. The devices uploaded the patients' data, which then would be connected to the physicians' EMRs and to the patients' personal health records.

In results released earlier this year, the project found a change in the average number of days between physician office visits for patients. Diabetic and hypertensive patients were able to make doctor's office visits less often—increasing the number of days between appointments by 71% and 26% respectively, indicating that patients had better control of their conditions.

Heart failure patients, though, visited their doctors more often—decreasing the number of days between visits by 27%—indicating that patients were advised to see their healthcare provider in a more timely manner to avoid complications and stay out of the hospital.

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