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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

Institutional investors are constantly pursuing better methods to increase portfolio returns while simultaneously reducing the amount of risk they take to achieve those returns. From diversifying into emerging markets and [...]

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 [...]

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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.

Multimorbidity, the presence of multiple chronic health conditions, generally starts in middle and older age but there is considerable heterogeneity in the trajectory of morbidity accumulation. This study aimed to clarify the number of distinct trajectories and the potential associations between race/ethnicity and socioeconomic status and these trajectories.

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The general objective of this feasibility study is to demonstrate the plausibility of developing organisational capabilities-based framework and demonstrate that the right mix of theories and methodologies have been considered. The small field study was conducted at Oregon Health and Science University (OHSU) with the Care Management Plus (CMP) Team. CMP is an evidence-based HIT application for older adults and chronically ill patients with multiple conditions and the innovation includes software, clinic processes and training. Use of qualitative research-based case study, with application of diffusion theory and dynamic capabilities using the unified modelling language (UML) notation are demonstrated in this field study. In the following sections, data collection, analysis, results, conclusions and limitations of research along with propositions for future research are discussed.

Post-acute sequelae of SARS-CoV-2 infection, known as long COVID, have severely affected recovery from the COVID-19 pandemic for patients and society alike. Long COVID is characterised by evolving, heterogeneous symptoms, making it challenging to derive an unambiguous definition. Studies of electronic health records are a crucial element of the US National Institutes of Health's RECOVER Initiative, which is addressing the urgent need to understand long COVID, identify treatments, and accurately identify who has it—the latter is the aim of this study.

The article discusses the studies about the publications in Educational/Instructional Technology that were perceived as valuable by educational technology professionals in the U.S. The study employed a Web-based survey that listed 30 journals with a five-point Likert scale for evaluating each journal. The survey was administered to members of the Association for Educational Communications & Technology and Computer Education and Cognitive System faculty at the University of North Texas. Findings have shown that among of the 30 journals that have been surveyed, seven were nonrefereed and twenty-three were refereed.

The purpose of this study was to determine whether elastotic degeneration of the elastin component of the lamina cribrosa occurs in optic neuropathy associated with different types of glaucoma. Human optic nerve heads with primary open-angle, neovascular, chronic angle closure and pseudoexfoliation glaucoma, and with varying duration of disease were compared with age-matched normal eyes, using electron microscopy and immunogold labeling of elastin. The percent area occupied by immunogold-labeled elastin material was determined using a digital image analysis system. In all eyes with a history of glaucoma, elastosis was found in the lamina cribrosa and there was a significantly greater percentage of area occupied by elastin compared with age-matched control eyes (P<0.0001). Among the glaucomatous eyes, pseudoexfoliation glaucoma had the largest area of elastosis, followed by primary open-angle and secondary glaucoma (neovascular and chronic angle closure). In all glaucoma samples, large, confluent elastin aggregates of irregular and varied shapes (elastosis) were observed in the lamina cribrosa and insertion region. These results demonstrate that glaucomatous optic neuropathy is associated with elastosis of the lamina cribrosa, which may contribute to the changes in compliance of the optic nerve heads of glaucomatous eyes.

A report on an initial genome screen on 540 individuals in 97 families was collected as part of the NIMH Genetics Initiative on Bipolar Disorder. Families were ascertained to be informative for genetic linkage and underwent a common ascertainment and assessment protocol at four clinical sites. The sample was genotyped for 65 highly polymorphic markers from chromosomes 1, 6, 8, 10, and 12. The average intermarker interval was 16 cM. Genotypic data was analyzed using affected sib pair, multipoint affected sib pair, and pedigree analysis methods. Multipoint methods gave lod scores of approximately two on chromosomes 1, 6, and 10. The peak lod score on chromosome 6 occurred at the end of the q-arm, at some distance from the 6p24-22 area previously implicated for schizophrenia. We are currently genotyping additional markers to reduce the intermarker interval around the signals. The interpretation of results from a genome screen of a complex disorder and the problem of achieving a balance between detecting false positive results and the ability to detect genes of modest effect are discussed. Am. J. Med. Genet. 74:247–253, 1997. © 1997 Wiley-Liss, Inc.

The article focuses on the future of the life settlement market in the U.S. It mentions that portfolios of life insurance carriers are influenced by stock market prices and interest rates. It states that modern life settlement investors are sophisticated and that they are already aware of the various risks involved in the asset class. It notes that a healthy life settlement market requires 14% of yield to keep the liquidity moving and the market to rebound.

Gaps in information about patient medication adherence may contribute to preventable adverse drug events and patient harm. Hence, health-quality advocacy groups, including the Joint Commission, have called for the implementation of standardized processes to collect and compare patient medication lists. This manuscript describes the implementation of a self-service patient kiosk intended to check in patients for a clinic appointment and collect a medication adherence history, which is then available through the electronic health record. We used business process engineering and simulation modeling to analyze existing workflow, evaluate technology impact on clinic throughput, and predict future infrastructure needs. Our empiric data indicated that a multi-function healthcare kiosk offers a feasible platform to collect medical history data. Furthermore, our simulation model showed a non-linear association between patient arrival rate, kiosk number, and estimated patient wait times. This study provides important data to help administrators and healthcare executives predict infrastructure needs when considering the use of self-service kiosks.

Current FDA and pharmaceutical industry drug safety efforts rely on statistical review of large databases populated with voluntary reports of sADRs. These data are limited by low rates of complete reporting and high rates of underreporting. Improved post-marketing drug surveillance efforts are needed to improve patient safety. The RADAR project is an academic pharmacovigilance program that focuses on small numbers of thoroughly researched cases of sADRs. In the last decade, RADAR has utilized the resources of a comprehensive cancer center and a global network of collaborators to evaluate and disseminate information on sADRs, many of which are related to hematology. Between 1998 and 2007, RADAR investigated and reported 16 hematology-associated sADRs. RADAR disseminated information on over half of the sADRs within 2 years of FDA approval, compared to half of all new sADRs documented in the Physician's Desk Reference within 7 years of FDA approval. RADAR's novel pharmacovigilance methods identified previously undetected sADRs based on small numbers of completely described reports. The RADAR project's experience shows that private sector programs that utilize small yet comprehensive datasets can significantly contribute to pharmacovigilance networks in hematology. As the FDA develops public-private networks to evaluate safety concerns associated with new drugs, focused independent efforts can assume increasing importance to address unmet needs.

The article focuses on the new federal draft guidance, which recommends that requires investigators notify the U.S. Institutional Review Board regarding the presence of adverse events (AE) in clinical trials. However, the regulation only requires the notification when there are unanticipated problems involving risks to subjects. This is due to the increasing reports of AEs which has diminished the trust of the public regarding clinical trials over the years.