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

2018

Wooldridge, A., Carayon, P., Eagan, B. and Shaffer, D.W. “Quantifying the qualitative with Epistemic Network Analysis: A human factors case study of task-allocation communication in a primary care team”, 2018,  IIE Transactions on Healthcare Systems Engineering, 8(1): 72-82.

2017

Wooldridge, A., Carayon, P. Hundt, A.S., Hoonakker, P.L.T. (2017). SEIPS-Based Process Modeling in Primary Care. Applied Ergonomics, 60, pp. 240-254. DOI: http://dx.doi.org/10.1016/j.apergo.2016.11.010

2016

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.

2015

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

2014

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.

2013

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.

2012

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