ACTS

Assets Currently Available Related to the Future Vision

The following tables identify assets available to support the future vision as of the writing of the future vision in 2019.

Current AHRQ Assets That Support Future Vision Interventions

#

Intervention

Current State/AHRQ Guidance, Evidence, Tools

1

Patient Portal

Funded research on patient portals (209)

2

Patient Education and Self-Management Tool

Consumer information from AHRQ’s Effective healthcare (210) (based on EPC reports (77)) and USPSTF recommendations (78)

3

Referrals to Community Support Resources

AHRQ challenge to visualize/address SDOH (211) (212); Case study of online social service referral platform (213)

4

Symptom Evaluation Tool

Funded evaluation of symptoms checkers (214)

5

Patient Parameter Tracking Journal

AHRQ Step-up Challenge: Advancing Care Through Patient Self-Assessments (215); PROMIS Reporting and Insight System from Minnesota (PRISM), a winning tool for gathering patient-reported outcomes (216) (217)

6

Screening/Assessment Tool

Guide for health assessments in primary care (218)

7

Pre-Visit Questionnaire

AHRQ Step-up Challenge: Advancing Care Through Patient Self-Assessments (211) (see also Intervention 5, Patient Parameter Tracking Journal); AHRQ pre-visit question builder (219) and related patient involvement resources (220)

8

Care Guidelines

EPC reports (221)

9

Telehealth

AHRQ Project ECHO (222) (223)

10

Documentation Template

Pediatric documentation templates funded by AHRQ (224); Eye care documentation template (on CDS Connect) (225)

11

Shared Decision- Making Tool

AHRQ SHARE Approach training on shared decision making (226)

12

Patient Monitoring/ Management Dashboard

Patient-specific Pain Management Summary (CDS intervention available on CDS Connect) (227) see also Intervention 8, Care Guidelines)

13

Condition Management Policy/ Procedure/ Protocol

AHRQ EPC Program (228) (229)

14

Care Plan

AHRQ/NIDDK Initiative: Building Data Capacity to Conduct Pragmatic, Patient-Centered Outcomes Research by Developing an Interoperable Electronic (eCare) Plan (143); Care plan for preventing falls in hospitals (230)

15

Clinical Calculator

Heart Risk Calculator (231)

16

PDMP Tool

AHRQ-funded PDMP toolkit for community pharmacy (232)

17

Order Set

Order sets on CDS Connect (233)

18

Patient Registry

Registries for Evaluating Patient Outcomes: A User’s Guide: 3rd Edition (234)

19

Care Gap, Need, or Issue Detection and Notification Tool

(see Intervention 8, Care Guidelines)

20

Provider Selection Tool

Creates transparency by providing information on care quality, care experience and cost to the patient of alternative care providers, allowing patients to select a provider based on these attributes.

Assets From Others Besides AHRQ That Support Future Vision Interventions[1]

#

Intervention

Current State (Others)

1

Patient Portal

Portals are underused (235) because they do not have perceived value, they often provide data that are difficult for patients to interpret, they are fragmented (patients usually have to deal with multiple portals to access data from multiple providers), and they provide an incomplete view of patient health information. In order to increase their usefulness, portals must have more features, be user-friendly, and provide interoperability with other sources of data to bring as much of patients’ data together at one point of access as possible.

2

Patient Education and Self-Management Tool

NLM MedlinePlus Connect (236); Third-party vendors interfaced with EHRs (Epic’s MyChart e.g., with Healthwise, Elsevier)

3

Referrals to Community Support Resources

The HL7 Gravity Project (237) (238) is identifying and harmonizing social risk and protective factor data for interoperable electronic HIE

AAFP Tool to identify patients’ SDOH (239); UNITE US platform (240)

4

Symptom Evaluation Tool

American College of Obstetricians and Gynecologists (ACOG) incorporates a number of questionnaires into our care pathways. Useful for evaluation, management, and documenting response to therapy. Problems include copyrights, lack of validation, and inconsistent bindings of reference terminologies.

5

Patient Parameter Tracking Journal


6

Screening/ Assessment Tool

·       ACOG has built several of these, including a new OB visit questionnaire

·       Depression screening (Patient Health Questionnaire [PHQ]-9), Fall Risk, General Anxiety Disorder (GAD)-7

·       Study of between-visit use of assessment tools for patients with multiple chronic conditions (241)

7

Pre-Visit Questionnaire


8

Care Guidelines

·       ACOG has a database of over 1,500 of these for OB alone

·       UpToDate offers “pathways” through limited number of EHRs

·       Choosing Wisely campaigns used by Stanson Health and Avhana Health, available in some EHRs for added cost

9

Telehealth

Numerous vendors in the marketplace with varying degrees of integration into HER

10

Documentation Template

·       Helpful if these documentation templates are “SMART” and can launch care pathways on their own

·       EHR vendors allow clients to build/configure, time consuming effort and often limited

11

Shared Decision-Making Tool

Mayo Clinic Care That Fits (242)

12

Patient Monitoring/ Management Dashboard

How this is done is up to the vendor and the content is up to the professional society/established guidelines

13

Condition Management Policy/ Procedure/ Protocol

Mandated CDS checks with appropriate use criteria for advanced radiological studies (243)

14

Care Plan

·       HL7 care plan resource (244)

·       NIDDK Care Plan effort (245)

·       Pharmacist eCare Plan (246)

·       Shared care plans in New Zealand (247)

·       ONC Certification Companion Guide: Care plan (248)

·       Duodecim (249)

·       2018 HIMSS Presentation: “Embracing Longitudinal Person-Centered Care Plans” (250)

·       Care plan templates (e.g., National Institute for Children’s Health Quality (NICHQ) Care Plan template (251))

15

Clinical Calculator

Multiple calculators exist:

·       ePrognosis (252)

·       ARISCAT (253)

·       NIH National Cancer Institute (NCI) Breast Cancer Risk Assessment Tool (254)

·       BiliTool (255)

·       Wells’ Criteria for Pulmonary Embolism (256)

·       Centor Score (Modified/McIsaac) for Strep Pharyngitis (257)

16

PDMP Tool

Currently state specific. Some states (e.g., CA DOJ) do not interface (yet) with EHRs, requiring double logins, and reentry of patient information. Third-party vendors are selling access to PDMP, offering dashboards and consolidation of multiple states.

17

Order Set

ACOG incorporates these into our CPs. Can be built/configured in most EHRs, but it’s a time-consuming process and needs to be maintained.

18

Patient Registry

The app is the registry, the registry is the app. Post-coordinated measures are not scalable. If it is important enough for the registry, have the provider document it directly.

19

Care Gap, Need, or Issue Detection and Notification Tool

Easy to build into BPM+ care pathways. Tasks sit until completed.

20

Provider Selection Tool


AHRQ Assets for Addressing the Specific Needs of “Mae Scenario”

Condition

AHRQ Assets

Preventive Care

USPSTF Recommendations (258); CDS Connect/MITRE work with b.well to get USPSTF recommendations into their infrastructure

Hypertension

EvidenceNOW tools (75) (e.g., hypertension care plan template (259))

Pain/Opioid Use

·       Patient-specific Pain Management Summary (227) (CDS intervention available on CDS Connect and AHRQ director blog (260) about this dashboard)

·       PSNet (261) released a primer on opioids (262)

·       OAP (56)

·       The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain (263) (CDC Guidelines on the use of opioids for chronic pain (264) are based on EPC reports)

·       Nonopioid Pharmacologic Treatment for Chronic Pain (265)

·       Noninvasive Nonpharmacological Treatment for Chronic Pain (266)

·       Investigator-initiated Grant: Team-based Safe Opioid Prescribing (R18 HS23750), a detailed IG with associated tools and resources for safe opioid prescribing in primary care (267)

·       Ongoing Cooperative grant; Evaluating and Implementing the Six Building Blocks Team Approach to Improve Opioid Management in Primary Care

OUD Treatment

Medication-Assisted Treatment Models of Care for OUD in Primary Care Setting (268); AHRQ Academy Opioid and Substance Use Resources (269)

Depression

AHRQ Academy: Integrating Behavioral Health and Primary Care (270)

Osteoarthritis

[Pertinent EPC reports] (221)

CKD

[Pertinent EPC reports] (221)

Multiple Chronic Conditions

AHRQ Multiple Chronic Conditions Research Network (271); Articles in Health Psychology (272) and in The Lancet (273) from an AHRQ leader on preventing and managing multimorbidity

Non-AHRQ Assets for Addressing Specific Needs of Mae Scenario

Condition

Other Assets

Preventive Care

Review of current status (e.g., last dT, last mammogram, last colonoscopy)

Hypertension

Pharmacy interface on fill rate to assist in assessing compliance with medications; Patient questionnaire regarding side effects and concerns around treatment.

Pain/ Opioid Use

Review of exercise log; visits to other members of the care team (e.g., physical therapy, dietician). What about visits around nontraditional therapy? Has she also been seeing an herbalist? A chiropractor?

OUD Treatment


Depression


Osteoarthritis


CKD


Multiple Chronic Conditions

Article in the Journal of the American Geriatrics Society on the feasibility of implementing patient priorities care for older adults with MCCs (274)


[1]A recent Frost and Sullivan report (348) on the growth and growing importance in the CDS market asserts predicts growing importance and use of CDS interventions of this sort; this Care Delivery Future Vision the broader ACTS Roadmap can help ensure this evolution delivers optimal benefits.