Chronic Care Model Optimization

Using Patient Portals

HCIN-615-01-SP21 - Advanced Health Care Analysis
Mojdeh Amini
Healthcare Informatics University of San Diego
Instructor: Dr. Razel Milo
05/04/21
 Outlines
• Background
• Research Design
• Results
• Conclusions
• Future-Plans
Background: Scope of Problem
Source: Open Data Portal, Chronic Disease Interactive Data Applications
Project goal: Optimization of the expanded chronic disease
model (eCCM) to design an innovative-based, and data-driven model
to promote self-management care in long-term behavioral health conditions.
Chronic Disease (CD): Conditions that last 1 year or more and require
ongoing medical attention or limit activities of daily living or both.
Statistical Data
• 6 in 10 adults
• 4 in 10 adults have 2 or more CD
• $3.8 trillion in annual national health care costs.

Cardiovascular diseases Cancer : Diabetes

• 1 in 3 deaths • Second cause of death $327 billion
• $214 billion/year • $174 billion
• $138 billion/year lost
productivity
NVSS: Provides the most complete data on births and deaths
Background (Cont.)
Chronic Disease Indicators (CDI)

CDI: Enables public health professionals and policymakers to retrieve uniformly

data for chronic diseases and risk factors with substantial impact on public health.
Child health officials
• Chronic disease program
• Reproductive health and maternal

CDI are a set of 124 indicators in the following 18 topic groups such as:
• Alcohol
• Cancer
• Diabetes
• Cardiovascular disease
https://nccd.cdc.gov/cdi/rdPage.aspx?rdReport=DPH_CDI.ExploreByLocation&rdRequestForwarding=Form
Literature Review:
Search Methodology and Strategy

The methods and strategy of the review Involved searching:

• Healthcare Informatics
• PubMed, MEDLINE-Web of Science
• Elton B. Stephens Company (EBSCO)
• Copley Library + Google Scholar Database

• Inclusion Criteria: Outpatient and in English

• Exclusion Criteria: Non target population < 18 and
studies’ intervention not included patient portals
• MeSH Terms/Query Box associated with related
Keywords: Chronic care model , engagement, digital
literacy, patient portals, elements
Literature Review: Scale of the Problem

Patient portals: An emerging term is widely defined in

supporting patient within communities via mobile devices
• Using Input-Output Model for Classifying articles

Input Output
Processing
Portal Design Benefits
Using Portal
Synthesis
Various elements of portals were assessed:
• Major problems: Poor self-management care, lack of digital literacy and
internet connection within the communities
• Low patient portals engagement: healthcare providers/patients
Design and Methods
•eCCM: A conceptual framework
Preliminary review of accumulated data
analysis appear to support implementation
eCCM:
•Associated with important improvements in
measures of processes of chronic care, in
intermediate or long-term outcomes.
•Most challenging CCM element to
implement in primary care has been clinical
information systems.
•Missed opportunities
• Failure in Medication refill and Explained
the paradox of improved system
performance without improved patient
outcomes.
http://www.pitt.edu/~super1/lecture/lec38621/011.htm
Portal Plus Model (PPM)
Secondary review of data analysis
suggested) integration of eCCM into:
• Patient Portals,
• Guidelines, communities’ protocols
• the Merit-based Incentive Payment
System (MIPS) programs.
 No Patient Portal Questionnaire Yes No
1. Do you have internet access?
Phone survey Questionnaire: Pre 2. Did you have experience using the internet?
and Post PPM Implementation 3. Do you have patient portals?

4. Do you have more than one patient portals?

• To examine and predict the care model's 5. Do you have trouble accessing the portal?
success and challenges or failures 6. Did you adopt patient portals?

• To determine different levels of 7. What is your or your caregiver's highest education level?

adaptation processes via the outpatient X X

clinic. 8. Do you need help using the patient portal?

9. Which language do you prefer to use?

• Descriptive analysis: Performed to X X
determine the frequency of various causes 10. Do you prefer to speak to a health care provider directly?

for poor portal engagement 11. Are you concern about privacy?

• To test the strength of cause effect 12. Do you have trouble remembering passwords?

13. Are you concern about video-visit?

correlation between PPM and the patient
14. Do you have any questions?
portals
15. *Patient question or recommendation here:
X X
 Discussion and Evaluation Methods
• Data mining and uncovered powerful insights from the statistical
data survey responders
• Summative evaluation method (SEM), leading to exploring a
productive solution

Significance of the Discussion and the Evaluation Method

• 1) Outcome evaluation: Measured the clinic efficiency performances

and benefits of the PPM project with patient satisfaction.
• PPM improved providers' engagement by encouraging patients to
sign up for the portal
• 2) Impact evaluation: PPM reduced missing appointments,
reminding phone calls, thus lowered readmissions
 Legend

Cost-Benefit Legend
Legend Subtitle
Legend Subtitle
Symbol Count Description
Symbol Count Description
2 Video phone
2 Video phone
Wireless access
1 Wireless
point access
• Using the cost and benefit 2
1

2
point
Time
Time

effectiveness analysis (CBA) tools

• The benefit of PPM while there were
limited resources
• Cost-Benefit= $26,400 patient/yr.
$3.00/min
$3.00/min
Cost of Physion time
Cost of Physion time ++ $1.00/min
$1.00/min
Cost of Staff time
Cost of Staff time
== 220 days/year
220 days/year
Clinic days/year
Clinic days/year

• Improved provider-patient loads and

fulfilled standard office visit
reimbursement criteria

++
$26.400

==
$26.400
30 min/day
30 min/day
30 min/day
30 min/day
60 min/day
60 min/day
Time saved
Time saved == Annua; saving
Annua; saving
With Video Visit
With Video Visit
 Conclusion
• This EBP project identified the gaps within eCCM for self-management
• Determined the need for optimizing eCCM
• PPM a novel proposed solution
• PPM is a new cost-benefit for management of chronic diseases
• However, further EBP research require for more improvement and better outcomes

• Future action-plan and recommendation

• Empower patients as healthcare partners
• New office workflow for managing and handling patient portal tasks and messages
• Smooth transition from fee-for-service to value-based care and risk-based payment models
• Patient preference languages via telephone text messages and using portals during hospital stays.
• Future EBP research with machine learning and datamining might be beneficial with faster and better
outcomes for chronically ill condition with ethical code of professional consideration.
References
American Medical Association. (2019). Most of your patients still aren't using the portal. Here'swhy. American Medical

Association. https://www.ama-assn.org/practice-management/digital/most-your-patients-still-aren-t-using-portal- here-s-

why

Baldwin, J. L., Singh, H., Sittig, D. F., & Giardina, T. D. Patient portals and health apps: Pitfalls, promises, and what one

might learn from the other. Healthc (Amst) 2016 Oct 3;: x–x. doi: 10.1016/j. hjdsi. 2016.08. 004.

Bush, R. A., Barlow, H., Pérez, A., Vazquez, B., Mack, J., & Connelly, C. D. (2018). Internet access influences community

clinic portal use. Health equity, 2(1), 161-166.

Centers for Disease Control and Prevention. (2021). Chronic diseases in America.

https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm
 References
Coughlin, S. S., Prochaska, J. J., Williams, L. B., Besenyi, G. M., Heboyan, V., Goggans, D. S., Yoo, W., & De Leo, G. (2017).

Patient web portals, disease management, and primaryprevention. Risk management and healthcare policy, 10, 33–40.

https://doi.org/10.2147/RMHP.S130431

Dendere, R., Slade, C., Burton-Jones, A., Sullivan, C., Staib, A., & Janda, M. (2019). Patient Portals Facilitating Engagement With

Inpatient Electronic Medical Records: A Systematic Review. Journal of medical Internet research, 21(4), e12779.

https://doi.org/10.2196/12779

HealthIT.gov. (2018). How to OPTIMIZE patient portals for patient engagement and Meet meaningful use requirements. Retrieved from

\https://www.healthit.gov/resource/how-optimize-patient-portals-patient- engagement-and-meet- meaningful-use-requirements

References

HealthIT. (2017). What is a patient portal? HealthIT.gov. https://www.healthit.gov/faq/what-patient-portal.

Hulter, P., Pluut, B., Leenen-Brinkhuis, C., de Mul, M., Ahaus, K., & Weggelaar-Jansen, A. M. (2020). Adopting

patient portals in hospitals: qualitative study. Journal of medical Internet research, 22(5), e16921.

Irizarry, T., Shoemake, J., Nilsen, M. L., Czaja, S., Beach, S., & DeVito Dabbs, A. (2017). Patient Portals as a Tool

for Health Care Engagement: A Mixed-Method Study of Older Adults With Varying Levels of Health Literacy and

Prior Patient Portal Use. Journal of medical Internet research, 19(3), e99. https://doi.org/10.2196/jmir.7099

Nambisan P. (2017). Factors that impact Patient Web Portal Readiness (PWPR) among theunderserved. International

journal of medical informatics, 102, 62–70. https://doi.org/10.1016/j.ijmedinf.2017.03.004

References
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theory to practice. Healthcare informatics research, 22(4), 255.

Son, H., & Nahm, E. S. (2019). Older Adults' Experience Using Patient Portals in Communities: Challenges and Opportunities. Computers,

informatics, nursing: CIN, 37(1), 4–10. https://doi.org/10.1097/CIN.0000000000000476

Sieck, C. J., Hefner, J. L., & McAlearney, A. S. (2018). Improving the patient experiencethrough patient portals: Insights from experienced

portal users. Patient Experience Journal, 5(3), 47-54.

Tieu, L., Schillinger, D., Sarkar, U., Hoskote, M., Hahn, K. J., Ratanawongsa, N., Ralston, J. D., & Lyles, C. R. (2017). Online patient websites

for electronic health record access among vulnerable populations: portals to nowhere?. Journal of the American Medical Informatics

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 Q&A

Thank you!
mamini@sandiego.edu