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Objective: To review evidence regarding the use of Health Information Technology (health IT) interventions aimed at improving care for people living with multiple chronic conditions (PLWMCC) in order to identify critical knowledge gaps. Data Sources: We searched MEDLINE, CINAHL, PsyclNFO, EMBASE, Compendex, and IEEE Xplore databases for studies published in English between 2010 and 2020. Study Design: We identified studies of health IT interventions for PLWMCC across three domains as follows: self-management support, care coordination, and algorithms to support clinical decision making. Data Collection/Extraction Methods: Structured search queries were created and validated. Abstracts were reviewed iteratively to refine inclusion and exclusion criteria. The search was supplemented by manually searching the bibliographic sections of the included studies. The search included a forward citation search of studies nested within a clinical trial to identify the clinical trial protocol and published clinical trial results. Data were extracted independently by two reviewers. Principal Findings: The search yielded 1907 articles; 44 were included. Nine randomized controlled trials (RCTs) and 35 other studies including quasi-experimental, usability, feasibility, qualitative studies, or development/validation studies of analytic models were included. Five RCTs had positive results, and the remaining four RCTs showed that the interventions had no effect. The studies address individual patient engagement and assess patient-centered outcomes such as quality of life. Few RCTs assess outcomes such as disability and none assess mortality. Conclusions: Despite a growing body of literature on health IT interventions or multicomponent interventions including a health IT component for chronic disease management, current evidence for applying health IT solutions to improve care for PLWMCC is limited. The body of literature included in this review provides critical information on the state of the science as well as the many gaps that need to be filled for digital health to fulfill its promise in supporting care delivery that meets the needs of PLWMCC. KEYWORDS algorithms, care coordination, caregivers, delivery of health care, health information technology, multiple chronic conditions, self-management What is known on this topic * People living with multiple chronic conditions have worse clinical outcomes than those without and often experience fragmented and/or burdensome care. * Health information technology has shown promise in bringing knowledge and information to the point of care to improve care processes and, to some extent, clinical outcomes and quality of life outcomes. * Little is known about effective uses of health information technology to improve these outcomes for people living with multiple chronic conditions. What this study adds * This study summarizes and defines three domains where health information technology may help people living with multiple chronic conditions--in self-management, in care coordination, and algorithms to support clinical decision making. * Evidence for the effectiveness of health information technology in these areas is still limited despite promising initial studies. * Research studies specific to the use of health information technology in people living with multiple chronic conditions are needed., 1 | INTRODUCTION In 2018, the Center for Disease Control and Prevention (CDC) estimated that one in four Americans have at least two chronic conditions requiring ongoing medical care. (1) [...]

It is this author's opinion that longevity trends in the United States are peaking and that over the next decade they will begin declining. The direction of longevity is potentially [...]

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1532-5415.2008.02005.x Byline: David A. Dorr (*), Adam B. Wilcox ([dagger]), Cherie P. Brunker ([double dagger]s.), Rachel E. Burdon (*), Steven M. Donnelly ([parallel]) Keywords: chronic disease/illness; care manager; comorbidity; utilization; medical home Abstract: OBJECTIVES: To explore changes in mortality and hospital usage for chronically ill seniors enrolled in a multidisease care management program, Care Management Plus (CMP). DESIGN: Controlled clinical trial with seven intervention and six control clinics with additional patient-level matching. SETTING: Intermountain Health Care, a large health system in Utah; seven intervention and six control clinics. PARTICIPANTS: Three thousand four hundred thirty-two senior patients ([greater than or equal to]65) enrolled in Medicare. INTERVENTION: The intervention employed nurse care managers supported by specialized information technology in primary care to manage chronically ill patients (2002-2005). MEASUREMENTS: Mortality and hospitalization data were collected from clinical records and Medicare billing. RESULTS: One thousand one hundred forty-four intervention patients were matched to 2,288 controls. Average age was 76.2; average comorbidity score was 2.3[+ or -]1.1; 75% of patients had two or more chronic diseases. Survival analyses showed lower mortality and slightly more emergency department visits for care managed patients than for controls. In patients with diabetes mellitus, the intervention resulted in significantly lower mortality at 1 year (6.2%, vs 10.6% for controls) and at 2 years (12.9% vs 18.2%). Hospitalization rate was lower (21.0%, vs. 24.2% for controls) at 1 year and substantially more so at the 2-year follow-up. CONCLUSION: CMP was successful in reducing death for all patients. For complex patients with diabetes mellitus in the intervention group, death and hospital usage were lower. Per clinic, hypothesized savings from decreased hospitalizations was $17,384 to $70,349. Author Affiliation: (*)Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon ([dagger])Department of Biomedical Informatics, Columbia University, New York, New York ([double dagger])Department of Geriatrics, University of Utah, Salt Lake City, Utah (s.)Intermountain Healthcare, Salt Lake City, Utah ([parallel])HealthInsight, Salt Lake City, Utah. Article note: Address correspondence to Dr. David A. Dorr, 3181 SW Sam Jackson Park Boulevard, Portland, OR 97239. E-mail: dorrd@ohsu.edu

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Trading is a fundamental part of commerce and an elemental part of any strong economy. The recent ability to trade longevity risk through the use of life settlements, whether for [...]

Objective. To determine how the addition of generalist care managers and collaborative information technology to an ambulatory team affects the care of patients with diabetes. Study Setting. Multiple ambulatory clinics within Intermountain Health Care (IHC), a large integrated delivery network. Study Design. A retrospective cohort study comparing diabetic patients treated by generalist care managers with matched controls was completed. Exposure patients had one or more contacts with a care manager; controls were matched on utilization, demographics, testing, and baseline glucose control. Using role-specific information technology to support their efforts, care managers assessed patients&apos; readiness for change, followed guidelines, and educated and motivated patients. Data Collection. Patient data collected as part of an electronic patient record were combined with care manager created databases to assess timely testing of glycosylated hemoglobin (HbA1c) and low density lipoprotein (LDL) levels and changes in LDL and HbA1c levels. Principal Findings. In a multivariable model, the odds of being overdue for testing for HbA1c decreased by 21 percent in the exposure group (n = 1,185) versus the control group (n = 4,740). The odds of being tested when overdue for HbA1c or LDL increased by 49 and 26 percent, respectively, and the odds of HbA1c < 7.0 percent also increased by 19 percent in the exposure group. The average HbA1c levels decreased more in the exposure group than in the controls. The effect on LDL was not significant. Conclusions. Generalist care managers using computer-supported diabetes management helped increase adherence to guidelines for testing and control of HbA1c levels, leading to improved health status of patients with diabetes. Key Words. Patient care management, chronic illness, diabetes mellitus, medical informatics, Diabetes mellitus and its complications comprise one of the most expensive categories of chronic disease in the United States, contributing to at least 213,062 deaths in 2000 and $132 billion [...]

A study is conducted to find out weather health-related quality-of-life (HRQoL) scores of population, in predicting the future hospitality and mortality rate.

A retrospective cost study examining the potential cost savings from decreased adverse resident outcomes versus additional wages of nurses when nursing homes have adequate staffing is presented.