scholarly journals Quality of Care Improves for Patients with Diabetes in Medicare Shared Savings Accountable Care Organizations: Organizational Characteristics Associated with Performance

2018 ◽  
Vol 21 (5) ◽  
pp. 401-408 ◽  
Author(s):  
Taressa K. Fraze ◽  
Valerie A. Lewis ◽  
Emily Tierney ◽  
Carrie H. Colla
Keyword(s):  
Quality Of Care ◽  
Accountable Care Organizations ◽  
Organizational Characteristics ◽  
Accountable Care ◽  
Patients With Diabetes ◽  
Shared Savings

scholarly journals Barriers and Facilitators To Implementation and Sustainment of 17 New Medicaid Accountable Care Organizations in Massachusetts: A Study Protocol

2020 ◽  
Author(s):  
Sarah L. Goff ◽  
Deborah Gurewich ◽  
Matthew Alcusky ◽  
Aparna G. Kachoria ◽  
Joanne Nicholson ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Large Scale ◽  
Healthcare Delivery ◽  
Accountable Care Organizations ◽  
Barriers And Facilitators ◽  
Accountable Care ◽  
Community Partner ◽  
Number Of Patients ◽  
The Impact

Abstract Background: Accountable care organizations (ACOs) utilize value-based payment models, which incentivize quality of care and cost reduction through shared financial risk contracts for payers and providers. The impact of ACOs on cost and quality has been mixed for Medicare and commercial insurers, but the model has yet to be extensively tested in the Medicaid system, which insures a large number of patients in socioeconomically disadvantaged populations. Additionally, despite substantial heterogeneity in ACO models, the majority of ACO studies have examined ACO outcomes without exploring the potential impact of implementation and sustainment on these outcomes. Understanding barriers and facilitators to implementation and sustainment of Medicaid ACOs will help to better understand their impact on patient care, outcomes and costs for a vulnerable population.Methods and Design: The state of Massachusetts (MA) approved 17 new Medicaid ACOs and associated Community Partner (CP) organizations in 2018 as part of a large-scale pragmatic experiment in healthcare reform. The new ACOs will receive $1.8 billion dollars in state and federal funds over five years aimed at supporting implementation and sustainment the new model. This study aims to identify barriers and facilitators to implementation and sustainment of activities supported by these funds using the Consolidated Framework for Implementation Science (CFIR) as a guiding framework through: (1) review of administrative documents classify organizational characteristics of the ACOs and CPs including plans for innovation; (2) key informant interviews (KII) with ACO and CP leaders, governmental administrative leaders, and patients; (3) case studies of ACOs and CPs; and (4) a survey of front-line providers and staff in the ACOs and CPs. Descriptive quantitative statistics will be used to analyze document and survey data and framework analysis will be used to analyze KII and site visit data.Discussion: The new Medicaid ACOs in MA aim to improve care integration, quality of care, and patient experience while reducing costs through innovations in healthcare delivery and payment. Understanding the barriers and facilitators to implementing and sustaining the ACO model will provide critical context for understanding the overall impact of the Medicaid ACO experiment in MA.

Quality of Care for Patients With Diabetes and Mulitmorbidity Registered at Nurse Practitioner-Led Clinics

2017 ◽  
Vol 50 (1) ◽  
pp. 20-27 ◽  
Author(s):  
Roberta Heale ◽  
Elizabeth Wenghofer ◽  
Susan James ◽  
Marie-Luce Garceau
Keyword(s):  
Quality Of Care ◽  
Nurse Practitioners ◽  
Nurse Practitioner ◽  
Diabetes Care ◽  
Primary Care Providers ◽  
Organizational Characteristics ◽  
Care Providers ◽  
Patients With Diabetes ◽  
The Impact

Background Nurse Practitioner-Led Clinics are a new model of primary healthcare in Ontario. Nurse Practitioner-Led Clinics are distinctive in that nurse practitioners are the primary care providers working with an interprofessional team. There have been no evaluations of the quality of care within the Nurse Practitioner-Led Clinic model. Purpose Evaluation of the Nurse Practitioner-Led Clinic model, specifically for complex clinical presentations, will provide insights that may be used to inform improvements to the delivery of care in the Nurse Practitioner-Led Clinics. The aim of this study was to evaluate the extent to which diabetes care was complete and to determine the impact of organizational tools, including electronic medical record tracking, diabetes care template, and referral to community programs, on the completeness of care for patients with diabetes and multimorbidity at Nurse Practitioner-Led Clinics. Methods An audit of 30 charts was conducted at five different Nurse Practitioner-Led Clinics (n = 150) for patients with diabetes and at least one other chronic condition. Indicators included patient and organizational characteristics as well as diabetes care items taken from diabetes clinical guidelines. Results Overall, care for patients with diabetes and multimorbidity in Nurse Practitioner-Led Clinics was complete. However, there were no significant associations between patient or organizational characteristics and the extent to which diabetes care was complete.

Analysis Of Early Accountable Care Organizations Defines Patient, Structural, Cost, And Quality-Of-Care Characteristics

2014 ◽  
Vol 33 (1) ◽  
pp. 95-102 ◽  
Author(s):  
Arnold M. Epstein ◽  
Ashish K. Jha ◽  
E. John Orav ◽  
Daniel L. Liebman ◽  
Anne-Marie J. Audet ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Accountable Care Organizations ◽  
Accountable Care

Review of Medicare, Medicaid, and Commercial Quality of Care Measures: Considerations for Assessing Accountable Care Organizations

2015 ◽  
Vol 40 (4) ◽  
pp. 761-796 ◽  
Author(s):  
E. Kessell ◽  
V. Pegany ◽  
B. Keolanui ◽  
B. D. Fulton ◽  
R. M. Scheffler ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Accountable Care Organizations ◽  
Accountable Care

scholarly journals Quality of care for patients with diabetes mellitus type 2 in ‘model practices’ in Slovenia – first results

2016 ◽  
Vol 55 (3) ◽  
pp. 179-184 ◽  
Author(s):  
Davorina Petek ◽  
Mitja Mlakar
Keyword(s):  
Diabetes Mellitus ◽  
Quality Of Care ◽  
Quality Indicators ◽  
Diabetes Mellitus Type 2 ◽  
Process Quality ◽  
Diabetes Mellitus Type ◽  
Before And After ◽  
Patients With Diabetes

Abstract Background A new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the team. Nurse practitioners are in charge of registers of chronic patients, and implement an active approach into medical care. Selected quality indicators define the quality of management. The majority of studies confirm the effectiveness of the extended team in the quality of care, which is similar or improved when compared to care performed by the physician alone. The aim of the study is to compare the quality of management of patients with diabetes mellitus type 2 before and after the introduction of model practices. Methods A cohort retrospective study was based on medical records from three practices. Process quality indicators, such as regularity of HbA1c measurement, blood pressure measurement, foot exam, referral to eye exam, performance of yearly laboratory tests and HbA1c level before and after the introduction of model practices were compared. Results The final sample consisted of 132 patients, whose diabetes care was exclusively performed at the primary care level. The process of care has significantly improved after the delivery of model practices. The most outstanding is the increase of foot exam and HbA1c testing. We could not prove better glycaemic control (p>0.1). Nevertheless, the proposed benchmark for the suggested quality process and outcome indicators were mostly exceeded in this cohort. Conclusion The introduction of a nurse into the team improves the process quality of care. Benchmarks for quality indicators are obtainable. Better outcomes of care need further confirmation.

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