University of Wisconsin–Madison

Keystone Beacon Community Proposal for a Rural Community-Wide Medical Home

  • Overview: As part of the Beacon Community Program funded by the Office of the National Coordinator for Health IT, Geisinger Health System began an innovative program in April 2010 to improve the health of chronically ill patients in a five-county region of central Pennsylvania. The Keystone Beacon Community (KBC) project is a three-year initiative to improve care coordination within and across healthcare organizations such as hospitals, primary care clinics, skilled nursing facilities, and home health agencies. By sharing new and existing health IT applications, Keystone Beacon proactively identifies patients who have heart failure (HF) or chronic obstructive pulmonary disease (COPD) and assigns nurse care managers to work with these patients as a complement to their established healthcare team. The goal is to thereby achieve better health and a more satisfying care experience. By leveraging technology, the nurse care managers keep in close contact with their patients to engage them in their day-to-day care along with their long-term wellness.

    Aims: One of the goals of Keystone Beacon is to demonstrate how integrated care can be coordinated community-wide through the use of patient-focused technology and specialized nurse care managers.

    Methods: CQPI researchers evaluated parts of the KBC project, particularly barriers and facilitators of KBC care management implementation and the role of health IT in supporting care coordination. Using an action research design, the CQPI research team analyzed these and other aspects of the project and provided feedback to KBC project management in a continuous improvement loop. We used various human factors engineering methods, including observations, interviews, focus groups, and questionnaire surveys, to collect data. In all, 12 site visits were completed, several surveys were conducted using both web-based and paper distribution methods, and numerous telephone interviews were completed. Archival documents were analyzed and a complex dataset was extracted from the KBC care manager documentation system. This research was completed in September 2013.

    Beacon Blog: HealthITBuzz

    Findings:

    Final Report, Keystone Beacon Community, University of Wisconsin Research Team

    Factsheet on the Keystone Beacon Community

    Funding: Office of the National Coordinator for Health Information Technology

    The Center for Quality and Productivity Improvement (CQPI) at the University of Wisconsin–Madison is subcontracted from the primary recipient, Geisinger Health System.

  • Pascale Carayon, PhD
    Procter & Gamble Bascom Professor in Total Quality
    Department of Industrial and Systems Engineering
    Director, Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Randi Cartmill, MS
    Researcher, Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Peter Hoonakker, PhD
    Research Scientist, Associate Director of Research
    Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Ann Schoofs Hundt, PhD
    Research Scientist, Associate Director of Education
    Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Bashar Alyousef, PhD (former doctoral student)
    Industrial and Systems Engineering
    Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Sarah Kianfar, Doctoral Student
    Industrial and Systems Engineering
    Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Yaqiong Li, Doctoral Student
    Industrial and Systems Engineering
    Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Dan Nathan-Roberts, PhD
    Postdoctoral Research Fellow
    Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Abigail Wooldridge
    Former Graduate Student
    Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Ruth Den Herder, MS (former graduate student)
    Department of Industrial and Systems Engineering
    Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

    Lauren Kern, BS (former undergraduate student)
    Department of Industrial and Systems Engineering
    Center for Quality and Productivity Improvement
    University of Wisconsin-Madison

  • Carayon, P., Cartmill, R., Hoonakker, P.L.T., Hundt, A.S., Salek, D., Walker, J., Tomcavage, J. (2016). Collaborative processes of care managers in the detection and recovery of medication errors. In Mollo, V. and Falzon, P. (Ed), Proceedings of the Healthcare Systems Ergonomics and Patient Safety Conference, Toulouse, France, October 5-7, 2016, pp. 87-92.

    Carayon, P., Hundt, A.S., Hoonakker, P.L.T., Kianfar, S., Alyousef, B., Salek, D., Cartmill, R., Walker, J.W., Tomcavage, J. (2015). Perceived impact of care managers’ work on patient and clinician outcomes. European Journal for Person Centered Healthcare, 3(2), 158-167.

    Holden, R.J., McDougald Scott, A., Hoonakker, P., Hundt, A.S., & Carayon, P. (2015). Data collection challenges in community settings: Insights from two field studies of patients with chronic disease. Quality of Life Research, 24, 1043-1055 PMCID: PMC4342308

    Kianfar, S., Li, Y., Carayon, P., Hundt, A.S., & Hoonakker, P. (2014). Understanding care coordination for chronically ill patients? Paper presented at the Human Factors and Ergonomics (HFES) Society’s 58th Annual Meeting, Chicago, IL.

    Hundt, A.S., Carayon, P., Alyousef, B., Cartmill, R.S., Hoonakker, P., Kianfar, S., Tomcavage, J., Salek, D., Petrucci, J., & Walker, J. (2014). Community ergonomics applied to the implementation of a region-wise care coordination program. Proceedings of the 11th International Symposium on Human Factors in Organizational Design and Management (ODAM) Copenhagen, Denmark. pp. 475-480.

    Li, Y., Carayon, P, Hundt, A.S., Kianfar, S., Hoonakker, P., Salek, D., & Tomcavage, J. (2014). Levels of strategies used by care managers to deal with health IT-related barriers. Proceedings of the 11th International Symposium on Human Factors in Organizational Design and Management (ODAM) Conference, Copenhagen, Denmark. pp 469-474.

    Hoonakker, P., Carayon, P., Hundt, A.S., Cartmill, R.S., & Nathan-Roberts, D. (2014). Challenges of doing research that involves patients. Proceedings of the 11th International Symposium on Human Factors in Organizational Design and Management (ODAM) Conference, Copenhagen, Denmark. pp. 19-24.

    Hoonakker, P., Carayon, P., McGuire, K., Khunlertkit, A., Wiegmann, D., Alyousef, B. Xie, A. & Wood, K. (2013). Motivation and job satisfaction of Tele-ICU Nurses. Journal of Critical Care, 28 (3), 315.e13–315.e21. PMID: 23159143

    Hoonakker, P., Carayon, P., Cartmill, R.S., Kern, L., Hundt, A.S., Salek, D., Petrucci, J., Tomcavage, J., Topper, J., Hassol, A., & Walker, J. (2013). Inside the black box: What do inpatient case managers do? Paper presented at the Human Factors and Ergonomics Society (HFES) Symposium on Health Care, Baltimore, MD.

    Alyousef, B. (2013). Human factors challenges of patient-related information management for care coordination. PhD Dissertation, (Order No. 3592941), University of Wisconsin – Madison.

    Kianfar, S., Carayon, P., Hundt, A.S., Hoonakker, P., Alyousef, B., Tomcavage, J., Salek, D., Petrucci, J., Hassol, A., Walker, J. (2013). Care providers’ perception of care coordination team members. Poster presented at the Human Factors and Ergonomics Society (HFES) Symposium on Health Care, Baltimore, MD.

    Hoonakker, P., Alyousef, B., Kianfar, S., Carayon, P. Cartmill, R.S., Hassol, Hundt, A.S., Ladd, I., Yule, C., Chaundy, K., Honicker, M., Younkin, J., & Walker, J. (2013). Assessment of use, usability, and clinicians’ satisfaction with the Keystone Health Information Exchange. Poster presented at the Human Factors and Ergonomics Society (HFES) Symposium on Health Care, Baltimore, MD.

    Carayon, P. (2013). Reengineering Health Care Through a Human Factors Systems Approach. Paper presented at the 2013 Symposium on Human Factors and Ergonomics in Health Care, Baltimore, MD.

    Carayon, P., Kianfar, S., Hundt, A.S., Tomcavage, J., Salek, D., Petrucci, J., Hoonakker, P., Alyousef, B., Walker, J. (2013). Health IT-related obstacles and facilitators in coordinating care for patients with chronic illness: A longitudinal study. Paper presented at the 11th International Conference on Naturalistic Decision Making, Marseille, France

    Alyousef, B., Carayon, P., Hoonakker, P., Hundt, A.S., Cartmill, R.S., Tomcavage, J., Hassol, A., Chaundy, K., Younkin, J., & Walker, J. (2012). Care managers’ challenges in using multiple health IT applications. Proceedings of the Human Factors and Ergonomics Society (HFES) 56th Annual Meeting, Boston, MA. pp. 1748-1752.

    Hundt, A.S., Carayon, P., Hoonakker, P., Cartmill, R.S., Den Herder, R., Topper, J., Younkin, J., & Walker, J. (2012). Organizational learning in a large-scale complex health IT project. Proceedings of the Human Factors and Ergonomics Society (HFES) Annual Meeting, Boston, MA. pp. 1288-1292.

    Hassol, A., Woo, M., Ball, S., Izrael, D., Carayon, P., Hoonakker, P., Ladd, I., Yule, C, Younkin, J., Chaundy, K., Larson, S., Walker, J.M. (2012). Chronic Care Patients’ Attitudes Regarding Electronic Health Information Exchange. Paper presented at the American Medical Informatics Association Meeting.

    Carayon, P., Hoonakker, P., Tomcavage, J., Salek, D., Hassol, A., Cartmill, R.S., Hundt, A.S., Ladd, I., Yule, C., Younkin, J., Chaundy, K., & Walker J. (2012). Case managers’ acceptance of health IT applications. Poster presented at the American Medical Informatics Association Meeting.

    Carayon, P., Alyousef, B., Hoonakker, P., Hundt, A.S., Cartmill, R.S., Tomcavage, J., Hassol, A., Chaundy, K., Larson, S., Younkin, J. & Walker J. (2012). Challenges to care coordination posed by the use of multiple health IT applications.Work, 41 (2), 4468-4473. PMID: 22317409

  • Baseline Health Information Exchange Questionnaire – Clinicians
    Beacon Clinician Questionnaire
    Care Manager Questionnaire
    Care Manager and Clinician Questionnaire
    KBC Process Evaluation Questionnaire
    Patient Satisfaction with Hospital Care Questionnaire
    Case Manager Observation Guide
    KBC MMA’s Interview/Observation Guide
    Care Coordination Interview Guide – Case Managers
    Care Coordination Interview Guide – Others
    Case Manager Interview Guide
    Case Manager Final Interview Guide
    KBC Management Team Interview Guide
    Patient Satisfaction with KBC Care Management Interview Guide
    KBC Care Manager Focus Groups Process
    Patient Focus Group

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