Patient-Centered Plan-of-Care Tool for Improving Clinical Outcomes

Abstract

Patients receiving a POC showed significant improvement in 3 of 5 clinical outcomes compared with those without the tool, and those with more fully completed forms had significant improvement in 2 of 5 clinical outcomes compared with those with partially completed forms.

Individualized Plans of Care to Improve Outcomes Among Children and Adults With Chronic Illness: A Systematic Review

“…not identify other variations in outcomes or effect size by IPC et al, 2004;Rocco et al, 2011;Unützer et al, 2002); and a mixcomponents.…”

“…Rocco et al's a range of outcomes, although the strongest study designs, and (2011) IPC assigned specific tasks to the patient and PCP, with time therefore the strongest evidence for improved outcomes, were conframes for completion. The intervention achieved clinically small ducted among adults with mixed levels of complexity (Counsell but statistically significant decreases in LDL cholesterol and hemoet al, 2007;Katon et al, 2010) and adults or children with a single globin A1C (Rocco et al, 2011). The AAP suggests the IPC should chronic illness (Katon et al, 2001;Lozano, et al, 2004; Unützer include "clear articulation" of the roles of primary and subspecialty et al, 2002).…”

“…Intervention patients had fewer symptom days, conditions with evidence-based treatment approaches. We did Casey et al, 2011;Dorr et al, 2008;Lozano et al, 2004;Palfrey et al, 2004;Rocco et al, 2011 Medication list 2 0 Casey et al, 2011;Lozano et al, 2004 Anticipated acute medical management plans 1 1 Aiken et al, 2006;Cady et al, 2009 Medical management plan for chronic or 1 6 Adam et al, 2010;Casey et al, 2011;Counsell et al, general problems 2007;Dorr et al, 2008;Katon et al, 2010;Katon et al, 2001;Unützer et al, 2002 Protocol-based medical management plans 1 6 Aiken et al, 2006;Counsell et al, 2007;Dorr et al, 2008;Katon et al, 2010;Katon et al, 2001;Lozano et al, 2004;Unützer et al, 2002 Goal-setting 2 4 Aiken et al, 2006;Farmer et al, 2005;Farmer et al, 2011;Katon et al, 2010;Katon et al, 2001;Rocco et al, 2011 List of community services 3 0 Casey et al, 2011;Farmer et al, 2005;Gordon et al, 2007 Self-monitoring plans 1 1 Katon et al, 2001;Lozano et al, 2004 Note. IPC 5 individualized plan of care.…”

“…The second cohort study retrospectively evaluated an IPC tool within a medical home, compared to patients in another clinic without the IPC or the medical home (Rocco et al, 2011). Primary care providers (PCPs) and patients used the tool to list diagnoses, specific goals, and specific actions with a time frame for completion.…”

“…C omprehensive, well-coordinated care improves patient and family experiences with care (Farmer, Clark, Drewel, Swenson, & Ge, 2011;Farmer, Clark, Sherman, Marien, & Selva, 2005;Palfrey et al, 2004), patient health outcomes (Counsell et al, 2007;Farmer et al, 2011;Farmer et al, 2005;Rocco, Scher, Basberg, Yalamanchi, & Baker-Genaw, 2011), and decreases hospitalizations and cost (Casey et al, 2011;Counsell et al, 2007;Dorr, Wilcox, Brunker, Burdon, & Donnelly, 2008;Gordon et al, 2007;Palfrey et al, 2004). However, care coordination requires substantial investment of personnel and infrastructure, and it is unknown which aspects are most likely to benefit patients.…”