Feedback Reporting Research Articles

Abstract A030: Identifying LGBTQ+-related barriers and gaps in patient and workplace environments: An LGBTQ+ environmental needs assessment at Perlmutter Cancer Center

Abstract Background: The LGBTQ+ community faces disproportionately higher cancer-related health disparities compared to the general population. Lack of access, knowledge, and cultural attitudes are known factors attributing to lower rates of receiving cancer-preventative services, as well as higher rates of later-stage cancer diagnoses. Many factors contribute to these disparities, including finding a trusted provider, poor visual representation at clinics, missing sexual orientation and gender identity (SOGI) data, and negative patient experiences. To address these issues and to promote equitable care it is important to identify gaps and barriers that present in patient and healthcare staff environments. The LGBTQ+ Staff Task Force (STF) at NYU Langone Health Perlmutter Cancer Center (PCC) will utilize the Exploration, Planning, Implementation, Sustainment (EPIS) framework to address these inequities. Methods: As part of the “Exploratory” phase, the STF will deploy an environmental needs assessment survey, to evaluate patient and employee areas. The assessment includes the following LGBTQ+ domains to evaluate the environments: Policy; Visualization and Safety; Knowledge and awareness education; Complaint and Feedback Reporting; Workplace Inclusions and Non-discrimination; Resources. The survey will be administered to all clinical and non-clinical departments of PCC and will be completed by STF members from their respective departments and by managers or supervisors from each department location. Surveys will be submitted electronically via REDCap Data will be analyzed by the research team and discussed in small focus groups. Discussion: The LGBTQ+ Needs Assessment will be carried out across all PCC departments and locations within an 8-week period between May and July 2023. The findings from utilizing the EPIS framework will enable the identification of gaps and barriers to inclusive patient care and evaluate the efficacy of current processes and resources in place for LGBTQ+ patients and employees. Findings will inform strategies and planning to decrease identified factors impacting access to equitable healthcare. Citation Format: Alexandr Trifonov, Rachel Monahan, Megan C. Haseltine, Kevin Moore, Gwendolyn P. Quinn, Rachel Nelson, Abraham Chachoua, Jason Domogauer. Identifying LGBTQ+-related barriers and gaps in patient and workplace environments: An LGBTQ+ environmental needs assessment at Perlmutter Cancer Center [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A030.

A Novel Method of Patient Narrative Feedback Reporting and Learning: Results from a Field Experiment

A Novel Method of Patient Narrative Feedback Reporting and Learning: Results from a Field Experiment

User-centered design of feedback regarding health-related behaviors derived from wearables: An approach targeting older adults and persons living with neurodegenerative disease.

There has been tremendous growth in wearable technologies for health monitoring but limited efforts to optimize methods for sharing wearables-derived information with older adults and clinical cohorts. This study aimed to co-develop, design and evaluate a personalized approach for information-sharing regarding daily health-related behaviors captured with wearables. A participatory research approach was adopted with: (a) iterative stakeholder, and evidence-led development of feedback reporting; and (b) evaluation in a sample of older adults (n = 15) and persons living with neurodegenerative disease (NDD) (n = 25). Stakeholders included persons with lived experience, healthcare providers, health charity representatives and individuals involved in aging/NDD research. Feedback report information was custom-derived from two limb-mounted inertial measurement units and a mobile electrocardiography device worn by participants for 7-10 days. Mixed methods were used to evaluate reporting 2 weeks following delivery. Data were summarized using descriptive statistics for the group and stratified by cohort and cognitive status. Participants (n = 40) were 60% female (median 72 (60-87) years). A total of 82.5% found the report easy to read or understand, 80% reported the right amount of information was shared, 90% found the information helpful, 92% shared the information with a family member or friend and 57.5% made a behavior change. Differences emerged in sub-group comparisons. A range of participant profiles existed in terms of interest, uptake and utility. The reporting approach was generally well-received with perceived value that translated into enhanced self-awareness and self-management of daily health-related behaviors. Future work should examine potential for scale, and the capacity for wearables-derived feedback to influence longer-term behavior change.

Integrating Population-Wide Laboratory Testing Data with Audit and Feedback Reports for Ontario Physicians.

Audit and feedback reports, distributed by Health Quality Ontario to consenting primary care physicians, provide doctors with a confidential summary of how they manage patients with diabetes; these reports currently lack clinical information. We examined the feasibility of linking the Ontario Laboratories Information System (OLIS), a large provincial database of laboratory test results, with the existing provincial audit and feedback reporting structure to integrate measures of glycemic and cholesterol control among patients with diabetes. We found that we could ascertain glycated hemoglobin (69.9%) and low-density lipoprotein cholesterol (64.1%) test results in the previous year for most patients and that there was wide variation among physicians in the proportion of patients who exceeded clinical thresholds for these measures. Our study highlights the potential value of reporting more clinically rich information to physicians to improve diabetes care and management and demonstrates the feasibility of using OLIS data at the population level to enhance ongoing research and quality improvement.

Abstract WP370: Breaking Barriers for Fast Acute Stroke Treatment

Background: Timeliness of acute stroke treatment is imperative. Our 384 bed, Midwestern community hospital seeks to treat ischemic stroke tPA patients within 45 minutes of arrival. However, individual staff attitudes toward use of tPA, early treatment and teamwork appeared to be barriers to timely treatment. Purpose: To understand what the barriers are for fast treatment and to give staff tools to overcome. Methods: A carefully designed, but brief, set of survey questions concerning individual views and attitudes toward the timeliness and smooth treatment between EDP/ED nurses/Neurology was completed by EDP’s, ED Nurses and Neurologists. The data from this survey was analyzed and provided information to implement changes: 1] Immediate and collaborative feedback reporting timing and outcomes; 2] Provision of a stroke-alert algorithm attached to tPA; and, 3] Accessible education information for patients and family. Results: 56 staff completed the survey pre intervention (PRE) and 72 post intervention (POST). In most cases the barriers were reduced POST. Top barriers identified were: Slow ED to Neurology Contact time PRE 38% and POST 21%; EDP reluctance to treat PRE 32% and POST 18%; Difficulty identifying stroke patients PRE 30% and POST 26%; Losing track of time PRE 29% and POST 19%; Delay due to time to educate patients PRE 18% and POST 19%. Treatment times PRE were an average of 52 minutes door to needle and POST an average of 45 minutes. Door to neurology contact was PRE an average 20 minutes and POST an average of 11 minutes. There was a shift of the EDP’s attitude towards tPA use for acute stroke. PRE 50% answered that tPA use for stroke is not based on existing science. POST this was reduced to 20%. Conclusions: While treatment time, neurology contact time, and reported barriers were improved, the clear shift in EDP collective attitude toward tPA was most important. Keeping stroke at the forefront by communicating through collaborative feedback reports appeared to keep staff engaged and accountable. Keeping algorithms and tPA education material immediately available also assisted in our treatment goals.

Data for Improvement and Clinical Excellence: a report of an interrupted time series trial of feedback in home care

BackgroundThere is substantial evidence about the effectiveness of audit with feedback, but none that we know have been conducted in home care settings. The primary purpose of the Data for Improvement and Clinical Excellence – Home Care (DICE-HC) project was to evaluate the effects of an audit and feedback delivered to care providers on home care client outcomes. The objective of this paper is to report the effects of feedback on four specific quality indicators: pain, falls, delirium, and hospital visits.MethodsA 10-month audit with feedback intervention study was conducted with care providers in seven home care offices in Alberta, Canada, which involved delivery of four quarterly feedback reports consisting of data derived from the Resident Assessment Instrument – Home Care (RAI-HC). The primary evaluation employed an interrupted time series design using segmented regression analysis to assess the effects of feedback reporting on the four quality indicators: pain, falls, delirium, and hospitalization. Changes in level and trend of the quality indicators were measured before, during, and after the implementation of feedback reports. Pressure ulcer reporting was analyzed as a comparator condition not included in the feedback report. Care providers were surveyed on responses to feedback reporting which informed a process evaluation.ResultsAt initiation of feedback report implementation, the percentage of clients reporting pain and falls significantly increased. Though the percentage of clients reporting pain and falls tended to increase and reporting of delirium and hospital visits tended to decrease relative to the pre-intervention period, there was no significant effect of feedback reporting on quality indicators during the 10-month intervention. The percentage of clients reporting falls, delirium, and hospital visits significantly increased in the 6-month period following feedback reporting relative to the intervention period. About 50% of the care providers that read and understand the feedback reports found the reports useful to make changes to the way clients are cared for.ConclusionsRoutinely collected data used over time for feedback is feasible in home care settings. A high proportion of care providers find feedback reports useful for informing how they care for clients. Since reporting on the frequency of quality indicators increased in the post-intervention period, this study suggests that ongoing use of audit with feedback to enhance health outcomes in home care may promote improved reporting on standardized instruments.

Using mHealth App to Support Treatment Decision-Making for Knee Arthritis: Patient Perspective.

Introduction:Mobile health (mHealth) technology can be used to integrate into medical decisionmaking for patients with advanced knee arthritis. We explored patient preferences on content and design of a mobile health app to facilitate daily symptom capture and summary feedback reporting, in order to inform treatment decisions, including use of total knee replacement surgery (TKR).Methods:Patient focus groups were conducted to gather requirements for mHealth app development and to refine the design and content of the app. Clinician (physical therapist, surgeon) interviews were conducted to understand clinician expectations from the summary trend report generated by the app.Results:Sixteen patients attended focus groups with an average age of 67 and 63% female, and three clinicians participated in clinician interviews. The preliminary findings revealed that the patients preferred easy tap user interfaces to multitap or slider methods, and vertical question layout to horizontal orientation. Patients liked to be engaged by progress feedback reports and educational tips. Both patients and clinicians found a trended outcome summary report helpful which provides more precise details on whether and how the symptoms are changing over time.Discussion:User input can inform the design and implementation of mHealth technology to meet patient needs for their treatment decisions. Patient priorities must be considered through patient-centered app design.

Quarterly Reporting of Computed Tomography Ordering History Reduces the Use of Imaging in an Emergency Department

BackgroundComputed tomography (CT) is a useful and necessary part of many emergency department (ED) assessments. However, the costs of imaging and the health risks associated with radiation exposure have sparked national efforts to reduce CT ordering in EDs. Study ObjectiveWe analyzed CT ordering habits prior to and following implementation of a feedback tool at a community hospital. MethodsIn this intervention study, we identified the CT-ordering habits of physicians and mid-level care providers (physician assistants and nurse practitioners) at baseline and after implementation of a system that sent quarterly feedback reports comparing their ordering habits with those of their peers. Variability in ordering and subgroup analyses by body region were included in these reports. ResultsWe examined the records of 104,454 patients seen between October 1, 2013 and December 31, 2014. There were 5552 or 21.0% of patients seen during the baseline period that underwent CT imaging. We observed an absolute reduction in imaging of 2.3% (95% confidence interval 1.7–2.8%) after implementation, avoiding approximately $400,000 in costs, 22 days of scanning time, and radiation exposure equivalent to 33,000 chest films annually. These changes occurred across physicians and mid-level providers, regardless of the number years of practice or board certification. ConclusionsImplementation of a feedback mechanism reduced CT use by emergency medicine practitioners, with concomitant reductions in cost and radiation exposure. The change was similar across levels of medical care. Future studies will examine the effect of the feedback reporting system at other institutions in our hospital network.

Effects of Performance Feedback Reports on Adherence to Evidence-Based Guidelines in Use of CT for Evaluation of Pulmonary Embolism in the Emergency Department: A Randomized Trial.

The purpose of this study was to assess whether implementing emergency department (ED) physician performance feedback reports improves adherence to evidence-based guidelines for use of CT for evaluation of pulmonary embolism (PE) beyond that achieved with clinical decision support (CDS) alone. This prospective randomized controlled trial was conducted from January 1, 2012, to December 31, 2013, at an urban level 1 adult trauma center ED. Attending physicians were stratified into quartiles by use of CT for evaluation of PE in 2012 and were randomized to receive quarterly feedback reporting or not, beginning January 2013. Reports consisted of individual and anonymized group data on guideline adherence (using the Wells criteria), use of CT for PE (number of CT examinations for PE per 1000 patients), and yield (percentage of CT examinations for PE with positive findings). We compared guideline adherence (primary outcome) and use and yield (secondary outcomes) of CT for PE between the control and intervention groups in 2013 and with historical imaging data from 2012. Of 109,793 ED patients during the control and intervention periods, 2167 (2.0%) underwent CT for evaluation of PE. In the control group, guideline adherence remained unchanged between 2012 (78.8% [476/604]) and 2013 (77.2% [421/545]) (p = 0.5); in the intervention group, guideline adherence increased 8.8% after feedback report implementation, from 78.3% (426/544) to 85.2% (404/474) (p < 0.05). Use and yield were unchanged in both groups. Implementation of quarterly feedback reporting resulted in a modest but significant increase in adherence to evidence-based guidelines for use of CT for evaluation of PE in ED patients, enhancing the impact of CDS alone. These results suggest potentially synergistic effects of traditional performance improvement tools with CDS to improve guideline adherence.

PD19-10 IMPLEMENTATION OF A WEB-BASED, PROCEDURE-SPECIFIC, ROBOTIC TRAINING EXPERIENCE LOG WITH FEEDBACK AND LONGITUDINAL REPORTING FEATURES

You have accessJournal of UrologyTechnology & Instruments: Surgical Education & Skills Assessment III1 Apr 2015PD19-10 IMPLEMENTATION OF A WEB-BASED, PROCEDURE-SPECIFIC, ROBOTIC TRAINING EXPERIENCE LOG WITH FEEDBACK AND LONGITUDINAL REPORTING FEATURES Ryan Thorwarth, Marcus Quek, and Gopal Gupta Ryan ThorwarthRyan Thorwarth More articles by this author , Marcus QuekMarcus Quek More articles by this author , and Gopal GuptaGopal Gupta More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.709AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The ability to distinguish areas of weakness, receive feedback, and track progress is vital to resident education. It has been shown that residents do not agree with supervising physicians about the frequency and specificity of feedback. Currently, residents are inaccurately logging cases for ACGME as “primary surgeon”, there is no mandated logging of cases at the step-specific level of the procedure, and no integration of feedback. These conditions suggest that the current mechanism of tracking true operative experience and surgical skill progression is inadequate. It was our objective to establish such a tool for surgical training. METHODS We propose a tool to log surgical skill progression, experience, and feedback with four major features: 1) A log of robotic case involvement, with nine common procedures deconstructed to their major steps, and a record of program-specific information 2) A built-in function where the resident may request the supervising attending quantitatively review their performance on four surgical skills, and add short notes 3) A function by which a sample video of the case can be reviewed in a blind fashion 4) Have this be accessible on any device, and be of minimal time burden. RESULTS The web-based app was successfully developed and piloted for 2 months with 6 residents and 5 attendings. A total of 81 cases were logged. A reporting structure was developed where individual residents or administrators could view statistics on several data points including, but not limited to: - Frequency of each procedure done - Resident involvement, step-for-step, for each procedure - Statistics broken down by supervising attending - A summary of scores for the four surgical skills reviewed There was a small time burden on residents (84.2 sec +/- 64.3 per case) and supervisors (122 +/- 100 sec per case requested for review). Insightful, granular, data on resident experience, skill progression, and learning environment was obtained. For instance, 91% of the 33 robotic prostatectomies logged were logged as primary surgeon, yet bladder neck dissection, dropping of the rectum, and transection of the urethra had <25% involvement. CONCLUSIONS In hopes of advancing the granularity and ease with which residents/surgeons track their training, we developed a modern, accessible logging system that is ready for multifaceted use at other institutions. We believe this system will enhance the awareness of residents and program directors about weaknesses in training curricula. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e395-e396 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ryan Thorwarth More articles by this author Marcus Quek More articles by this author Gopal Gupta More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

National Clinical Database feedback implementation for quality improvement of cancer treatment in Japan: from good to great through transparency.

The National Clinical Database (NCD) of Japan was established in April, 2010 with ten surgical subspecialty societies on the platform of the Japan Surgical Society. Registrations began in 2011 and over 4,000,000 cases from more than 4100 facilities were registered over a 3-year period. The gastroenterological section of the NCD collaborates with the American College of Surgeons’ National Surgical Quality Improvement Program, which shares a similar goal of developing a standardized surgical database for surgical quality improvement, with similar variables for risk adjustment. Risk models of mortality for eight procedures; namely, esophagectomy, partial/total gastrectomy, right hemicolectomy, low anterior resection, hepatectomy, pancreaticoduodenectomy, and surgery for acute diffuse peritonitis, have been established, and feedback reports to participants will be implemented. The outcome measures of this study were 30-day mortality and operative mortality. In this review, we examine the eight risk models, compare the procedural outcomes, outline the feedback reporting, and discuss the future evolution of the NCD.

Data for improvement and clinical excellence: report of an interrupted time series trial of feedback in long-term care.

BackgroundThere is considerable evidence about the effectiveness of audit coupled with feedback for provider behavior change, although few feedback interventions have been conducted in long-term care settings. The primary purpose of the Data for Improvement and Clinical Excellence-Long-Term Care (DICE-LTC) project was to assess the effects of a feedback intervention delivered to all direct care providers on resident outcomes. Our objective in this report is to assess the effect of feedback reporting on rates of pain assessment, depression screening, and falls over time.MethodsThe intervention consisted of monthly feedback reports delivered to all direct care providers, facility and unit administrators, and support staff, delivered over 13 months in nine LTC units across four facilities. Data for feedback reports came from the Resident Assessment Instrument Minimum Data Set (RAI) version 2.0, a standardized instrument mandated in LTC facilities throughout Alberta. The primary evaluation used an interrupted time series design with a comparison group (units not included in the feedback intervention) and a comparison condition (pressure ulcers). We used segmented regression analysis to assess the effect of the feedback intervention.ResultsThe primary outcome of the study, falls, showed little change over the period of the intervention, except for a small increase in the rate of falls during the intervention period. The only outcome that improved during the intervention period was the proportion of residents with high pain scores, which decreased at the beginning of the intervention. The proportion of residents with high depression scores appeared to worsen during the intervention.ConclusionsMaintaining all nine units in the study for its 13-month duration was a positive outcome. The feedback reports, without any other intervention included, did not achieve the desired reduction in proportion of falls and elevated depression scores. The survey on intention to change pain assessment practice which was conducted shortly after most of the feedback distribution cycles may have acted as a co-intervention supporting a reduction in pain scores. The processing and delivery of feedback reports could be accomplished at relatively low cost because the data are mandated and could be added to other intervention approaches to support implementation of evidence-based practices.Electronic supplementary materialThe online version of this article (doi:10.1186/s13012-014-0161-5) contains supplementary material, which is available to authorized users.

Feedback reporting of survey data to healthcare aides

BackgroundThis project occurred during the course of the Translating Research in Elder Care (TREC) program of research. TREC is a multilevel and longitudinal research program being conducted in the three Canadian Prairie Provinces of Alberta, Saskatchewan, and Manitoba. The main purpose of TREC is to increase understanding about the role of organizational context in influencing knowledge use in residential long-term care settings. The purpose of this study was to evaluate healthcare aides’ (HCAs) perceptions of a one-page poster designed to feed back aggregated data (including demographic information and perceptions about influences on best practice) from the TREC survey they had recently completed.MethodsA convenience sample of 7 of the 15 nursing homes participating in the TREC research program in Alberta were invited to participate. Specific facility-level summary data were provided to each facility in the form of a one-page poster report. Two weeks following delivery of the report, a convenience sample of HCAs was surveyed using one-to-one structured interviews.ResultsOne hundred twenty-three HCAs responded to the evaluation survey. Overall, HCAs’ opinions about presentation of the feedback report and the understandability, usability, and usefulness of the content were positive. For each report, analysis of data and production and inspection of the report took up to one hour. Information sessions to introduce and explain the reports averaged 18 minutes. Two feedback reports (minimum) were supplied to each facility at a cost of CAN$2.39 per report, for printing and laminating.ConclusionsThis study highlights not only the feasibility of producing understandable, usable, and useful feedback reports of survey data but also the value and importance of providing feedback to survey respondents. More broadly, the findings suggest that modest strategies may have a positive and desirable effect in participating sites.

Improving Use of Prehospital 12-Lead ECG for Early Identification and Treatment of Acute Coronary Syndrome and ST-Elevation Myocardial Infarction

Performance of prehospital ECGs expedites identification of ST-elevation myocardial infarction and reduces door-to-balloon times for patients receiving reperfusion therapy. To fully realize this benefit, emergency medical service performance must be measured and used in feedback reporting and quality improvement. This quasi-experimental design trial tested an approach to improving emergency medical service prehospital ECGs using feedback reporting and quality improvement interventions in 2 cities' emergency medical service agencies and receiving hospitals. All patients age > or =30 years, calling 9-1-1 with possible acute coronary syndrome, were included. In total, 6994 patients were included: 1589 patients in the baseline period without feedback and 5405 in the intervention period when there were feedback reports and quality improvement interventions. Mean age was 66+/-17 years, and women represented 51%. Feedback and quality improvement increased prehospital ECG performance for patients with acute coronary syndrome from 76% to 93% (P=<0.0001) and for patients with ST-elevation myocardial infarction from 77% to 99% (P=<0.0001). Aspirin administration increased from 75% to 82% (P=0.001), but the median total emergency medical service run time remained the same at 22 minutes. The proportion of patients with door-to-balloon times of < or =90 minutes increased from 27% to 67% (P=0.006). Feedback reports and quality improvement improved prehospital ECG performance for patients with acute coronary syndrome and ST-elevation myocardial infarction and increased aspirin administration without prehospital transport delays. Improvements in door-to-balloon times were also seen.

Development of a System for the Evaluation of the Teaching Qualities of Anesthesiology Faculty

GRADUATE medical education is one of the core missions of academic medical centers, wherein medical specialists are responsible for teaching and supervising their future colleagues. However, being a medical specialist is no longer a sufficient qualification or proxy for competence in medical education aimed at training residents. This is particularly true given the modernization requirements for competency-based teaching and training promoted by accreditation institutions in some countries (such as the Accreditation for Council for Graduate Medical Education in the United States). These modernization efforts accelerate faculty development of clinicianeducators needed to achieve and maintain the highest standard of postgraduate medical education. An effective faculty development track should include measuring medical teaching effectiveness. This requires valid and reliable instruments, as well as providing the findings in a clear and concise format to faculty. Several studies have found that systematic and constructive feedback can result in improved teaching. There are few published and validated evaluation systems or even instruments aimed at supporting the graduate medical education qualities of clinical faculty. In anesthesiology, there are few published instruments and systems, and the existing ones tend to focus on faculty evaluation by residents only without any self-evaluations by faculty. To ensure actual behavioral change, individuals must usually undergo a stepwise change process. Evaluation insights obtained from feedback should be followed by creating positive intentions to change, trying out new behaviors and integrating them into practice. Supporting this change process has been shown to be effective. To support the specialty-specific evaluation of teaching qualities of anesthesiology faculty in an academic medical center, we developed the System for Evaluation of Teaching Qualities (SETQ) comprising (1) a Webbased self-evaluation by faculty, (2) a Web-based residents’ evaluation of faculty, (3) individualized faculty feedback, and (4) individualized faculty follow-up support. This paper has three main objectives: (1) to investigate the psychometric properties of the two instruments underlying the SETQ system, (2) to explore the relationship between residents’ evaluation and faculty self-evaluation, and (3) to gauge the feasibility of reliably using residents’ evaluation of faculty by estimating the number of such evaluations needed per faculty. We also place these objectives in context by describing SETQ. SETQ was initially developed in the anesthesiology department of a large academic medical center that has over 7,000 staff (including about 500 faculty and 400 residents) in the Netherlands. It was later expanded to include specialty-specific modules for internal medicine, surgery, and obstetrics and gynecology. At the time of writing, most of the remaining specialties have signed up for SETQ, resulting in more than 90% faculty coverage in 2009. SETQ is receiving nationwide attention.

Integrated risk assessment and feedback reporting for clinical decision making in a Medicare Risk plan.

The challenge of tapping into the rich resource of population-based, aggregated data to inform and guide clinical processes remains one of the largely unrealized potentials of managed care. This article describes a multifaceted approach of using health-related data to support providers in clinical decision making as an adjunct to case management and primary care delivery. The goal is to provide data that can be used for clinical decision making that is population based, yet individualized for specific patient care situations. Information reporting holds great potential in the clinical care of patients because it can be used to identify persons who could benefit from early detection, intervention, or treatment. It has been suggested that one of the keys to success in managed Medicare is the timely use of information that is detailed, comprehensive, and real-time describing key parameters of clinical encounters.