Collaborative Care Intervention for Stable Ischemic Heart Disease

Fihn, Stephan D.; Bucher, Joy B.; McDonell, Mary B.; Diehr, Paula; Rumsfeld, John S.; Doak, Melanie N.; Dougherty, Cynthia M.; Gerrity, Martha S.; Heidenreich, Paul A.; Larsen, Greg C.; Lee, Peter I.; Lucas, Linda M.; McBryde, Connor; Nelson, Karin M.; Plomondon, Mary E.; Stadius, Michael L.; Bryson, Christopher L.

doi:10.1001/archinternmed.2011.372

Cited by 33 publications

(19 citation statements)

References 22 publications

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“…114 However, a nurse practitioner-led angina clinic in which the SAQ was used as a foundation for titration of antianginal medications was able to demonstrate significant improvements in patients' health status compared with those patients before enrollment in the clinic and compared with other angina patients managed with routine clinical care. 115 Although more research is needed, assessing patient health status as part of clinical care, training clinicians in the interpretation of health status data, and creating treatment protocols for optimizing patients' health status are potentially important strategies for improving care.…”

Section: Clinical Use Of Health Status Assessmentsmentioning

confidence: 99%

Cardiovascular Health: The Importance of Measuring Patient-Reported Health Status

Rumsfeld¹,

Alexander²,

Goff³

et al. 2013

Circulation

472

406

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Section: Clinical Use Of Health Status Assessmentsmentioning

confidence: 99%

Cardiovascular Health: The Importance of Measuring Patient-Reported Health Status

Rumsfeld¹,

Alexander²,

Goff³

et al. 2013

Circulation

472

406

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“…Unsigned orders were placed for primary care providers to review and sign at their discretion. This methodology was successfully used within the VA in a study of collaborative care for patients with angina [15]. …”

Section: Methodsmentioning

confidence: 99%

“…Primary medications to be evaluated will be angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, beta-blockers, aldosterone antagonists, statins, digoxin, diuretics, and antidepressants. For a given patient, the proportion of guideline-concordant care will be determined using criteria mapping [15,22]. The guideline-concordant care analysis will be restricted to those patients who have a guideline indication for a medication class, such as beta-blockers for HF with left ventricular systolic dysfunction.…”

Section: Methodsmentioning

confidence: 99%

Patient-centered disease management (PCDM) for heart failure: study protocol for a randomised controlled trial

Bekelman

Plomondon

Sullivan

et al. 2013

BMC Cardiovasc Disord

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BackgroundChronic heart failure (HF) disease management programs have reported inconsistent results and have not included comorbid depression management or specifically focused on improving patient-reported outcomes. The Patient Centered Disease Management (PCDM) trial was designed to test the effectiveness of collaborative care disease management in improving health status (symptoms, functioning, and quality of life) in patients with HF who reported poor HF-specific health status.Methods/designPatients with a HF diagnosis at four VA Medical Centers were identified through population-based sampling. Patients with a Kansas City Cardiomyopathy Questionnaire (KCCQ, a measure of HF-specific health status) score of < 60 (heavy symptom burden and impaired quality of life) were invited to enroll in the PCDM trial. Enrolled patients were randomized to receive usual care or the PCDM intervention, which included: (1) collaborative care management by VA clinicians including a nurse, cardiologist, internist, and psychiatrist, who worked with patients and their primary care providers to provide guideline-concordant care management, (2) home telemonitoring and guided patient self-management support, and (3) screening and treatment for comorbid depression. The primary study outcome is change in overall KCCQ score. Secondary outcomes include depression, medication adherence, guideline-based care, hospitalizations, and mortality.DiscussionThe PCDM trial builds on previous studies of HF disease management by prioritizing patient health status, implementing a collaborative care model of health care delivery, and addressing depression, a key barrier to optimal disease management. The study has been designed as an ‘effectiveness trial’ to support broader implementation in the healthcare system if it is successful.Trial registrationUnique identifier: NCT00461513

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“…The mean age of patients ranged between 30 and 83 years. In terms of gender distribution, most studies had a slight female predilection except for studies conducted in Veterans Affairs (VA) primary care settings [16,50,52,53,56]. The duration of follow-up varied from 3 to 48 months.…”

Section: Descriptive Data Synthesismentioning

confidence: 99%

The effectiveness of patient-centred medical home-based models of care versus standard primary care in chronic disease management: a systematic review and meta-analysis of randomised and non-randomised controlled trials

John

Jani

Peters

et al. 2020

Preprint

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Background Patient-centred care by a coordinated primary care team may be more effective than standard care in chronic disease management. We synthesised evidence to determine whether patient-centred medical home (PCMH)-based care models are more effective than standard general practitioner (GP) care in improving clinical, hospital, and economic outcomes. Methods MEDLINE, CINAHL, Embase, Cochrane Library, and Scopus were searched to identify randomised (RCTs) and non-randomised controlled trials that evaluated two or more principles of PCMH among primary care patients with chronic diseases. Study selection, data extraction, quality assessment using Joanna Briggs Institute (JBI) appraisal tools, and grading of evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach were conducted independently. A quantitative synthesis, where possible, was pooled using random effects models and the effect size estimates of standardised mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals were reported. Results Of the 13820 citations, we identified 78 eligible RCTs and 7 quasi trials which included 60617 patients. The findings suggested that PCMH-based care was associated with significant improvements in depression episodes (SMD − 0.24; 95% CI -0.35, -0.14) and increased odds of remission (OR 1.79; 95% CI 1.46, 2.21). There were significant improvements in the health-related quality of life (SMD 0.10; 95% CI 0.04, 0.15); self-management outcomes (SMD 0.24; 95% CI 0.03, 0.44) and hospital admissions (OR 0.83; 95% CI 0.70, 0.98). In terms of clinical outcomes, with exception to total cholesterol, PCMH-based care led to significant improvements in blood pressure, glycated haemoglobin, and low-density lipoprotein cholesterol outcomes. The incremental cost of PCMH care was identified to be small and significantly higher than standard care (SMD 0.17; 95% CI 0.08, 0.26). The quality of individual studies ranged from ‘fair’ to ‘good’ by meeting at least 60% of items on the quality appraisal checklist. Additionally, moderate to high heterogeneity across studies in outcomes resulted in downgrading the included studies as moderate or low grade of evidence. Conclusion PCMH-based care has been found to be superior to standard GP care in chronic disease management. Results of the review have important implications that may inform patient, practice, and policy-level changes.

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Collaborative Care Intervention for Stable Ischemic Heart Disease

Abstract: A collaborative care intervention was well accepted by primary care providers and modestly improved receipt of guideline-concordant care but not symptoms or self-perceived health in patients with stable angina.

Cited by 33 publications

References 22 publications

Cardiovascular Health: The Importance of Measuring Patient-Reported Health Status

Cardiovascular Health: The Importance of Measuring Patient-Reported Health Status

Patient-centered disease management (PCDM) for heart failure: study protocol for a randomised controlled trial

The effectiveness of patient-centred medical home-based models of care versus standard primary care in chronic disease management: a systematic review and meta-analysis of randomised and non-randomised controlled trials

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