Impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization.

PURPOSE: The impact of a pharmacist-physician collaborative care model on patient outcomes and health services utilization is described. METHODS: Six hospitals from the Carilion Clinic health system in southwest Virginia, along with 22 patient-centered medical home (PCMH) practices affiliated with Carilion Clinic, participated in this project. Eligibility criteria included documented diagnosis of 2 or more of the 7 targeted chronic conditions (congestive heart failure, hypertension, hyperlipidemia, diabetes mellitus, asthma, chronic obstructive pulmonary disease, and depression), prescriptions for 4 or more medications, and having a primary care physician in the Carilion Clinic health system. A total of 2,480 evaluable patients were included in both the collaborative care group and the usual care group. The primary clinical outcomes measured were the absolute change in values associated with diabetes mellitus, hypertension, and hyperlipidemia management from baseline within and between the collaborative care and usual care groups. RESULTS: Significant improvements (p < 0.01) in glycosylated hemoglobin, blood pressure, low-density-lipoprotein cholesterol, and total cholesterol were observed in the collaborative care group compared with the usual care group. Hospitalizations declined significantly in the collaborative care group (23.4%), yielding an estimated cost savings of $2,619 per patient. The return on investment (net savings divided by program cost) was 504%. CONCLUSION: Inclusion of clinical pharmacists in this physician-pharmacist collaborative care-based PCMH model was associated with significant improvements in patients' medication-related clinical health outcomes and a reduction in hospitalizations.

The ADAPT online education program: A tool for practicing pharmacists delivering patient-centered care.

OBJECTIVES: The ADapting pharmacists' skills and Approaches to maximize Patient's drug Therapy effectiveness (ADAPT) e-learning program was developed by a consortium of Canadian pharmacy educators and researchers to prepare practicing pharmacists for patient-centered care. We selected this education program to provide training for pharmacists as the workforce transformation component of a Center for Medicare and Medicaid Innovation project. In this report we share our experiences with this educational program. SETTING: Online educational program. PRACTICE DESCRIPTION: ADAPT presents a standard approach to medication assessment, team collaboration, patient assessment, evidence-based decision making, and documentation. PRACTICE INNOVATIONS: ADAPT was used to prepare practicing pharmacists for new roles in direct patient care in patient-centered medical homes. EVALUATION: Participants were surveyed at the midpoint and end of the program to determine its impact on their confidence in providing patient-centered care and to elicit feedback about their perceptions of the program. Participants completed written action plans for each module that included their reflections on the course material and the skills they desired to implement in practice. Descriptive statistics were used to analyze Likert-type questions, and a content analysis was performed to analyze responses to open-ended questions and action plan responses. RESULTS: Two pharmacist cohorts completed the 20-week program from October 2012 to March 2013 (n = 13) and from August 2013 to January 2014 (n = 10). Pharmacists' perceived that their confidence in providing patient-centered care improved for all modules. Almost all pharmacists reported improved confidence in patient interviewing (89%), documentation (88%), and collaboration skills (83%). The content analysis identified the modules on interviewing and documentation as the most valuable and likely to result in changes to the pharmacists' practice. The opportunity to learn from colleagues was cited as a strength of the program. CONCLUSION: The ADAPT educational program provided pharmacists with the tools necessary to deliver patient-centered care in ambulatory care settings.

Improving Health of At-Risk Rural Patients project: A collaborative care model.

PURPOSE: The design elements of the Improving Health of At-Risk Rural Patients (IHARP) care model are described. SUMMARY: The IHARP project evaluated the clinical, economic, and humanistic outcomes associated with the collaborative care model relative to usual care in the community. The care model was initiated in 22 level 3- certified patient-centered medical homes. The primary outcomes are the absolute change in all relevant clinical and laboratory values of patients with hypertension, hyperlipidemia, and diabetes within and between the intervention and comparator groups; the change in the absolute number of emergency department visits and hospitalizations; and the change in the cost of care among the Medicare and Medicaid intervention patients. The lessons learned during the implementation and conduction of this project over the past three years are also presented. Patient enrollment ended in December 2014, final patient care visits were concluded in the fall of 2015, and results are expected in late 2016 or early 2017. CONCLUSION: This project will provide information from patients, physicians, and midlevel providers regarding their perceptions of clinical pharmacists as collaborative care team members. Data on health outcomes, health services utilization, and costs of care drawn from over 1600 Medicare beneficiaries will provide a robust assessment of the value of the IHARP care delivery model.

Writing DNA with GenoCAD.

Chemical synthesis of custom DNA made to order calls for software streamlining the design of synthetic DNA sequences. GenoCAD (www.genocad.org) is a free web-based application to design protein expression vectors, artificial gene networks and other genetic constructs composed of multiple functional blocks called genetic parts. By capturing design strategies in grammatical models of DNA sequences, GenoCAD guides the user through the design process. By successively clicking on icons representing structural features or actual genetic parts, complex constructs composed of dozens of functional blocks can be designed in a matter of minutes. GenoCAD automatically derives the construct sequence from its comprehensive libraries of genetic parts. Upon completion of the design process, users can download the sequence for synthesis or further analysis. Users who elect to create a personal account on the system can customize their workspace by creating their own parts libraries, adding new parts to the libraries, or reusing designs to quickly generate sets of related constructs.

Measuring the activity of BioBrick promoters using an in vivo reference standard.

BACKGROUND: The engineering of many-component, synthetic biological systems is being made easier by the development of collections of reusable, standard biological parts. However, the complexity of biology makes it difficult to predict the extent to which such efforts will succeed. As a first practical example, the Registry of Standard Biological Parts started at MIT now maintains and distributes thousands of BioBrick standard biological parts. However, BioBrick parts are only standardized in terms of how individual parts are physically assembled into multi-component systems, and most parts remain uncharacterized. Standardized tools, techniques, and units of measurement are needed to facilitate the characterization and reuse of parts by independent researchers across many laboratories. RESULTS: We found that the absolute activity of BioBrick promoters varies across experimental conditions and measurement instruments. We choose one promoter (BBa_J23101) to serve as an in vivo reference standard for promoter activity. We demonstrated that, by measuring the activity of promoters relative to BBa_J23101, we could reduce variation in reported promoter activity due to differences in test conditions and measurement instruments by approximately 50%. We defined a Relative Promoter Unit (RPU) in order to report promoter characterization data in compatible units and developed a measurement kit so that researchers might more easily adopt RPU as a standard unit for reporting promoter activity. We distributed a set of test promoters to multiple labs and found good agreement in the reported relative activities of promoters so measured. We also characterized the relative activities of a reference collection of BioBrick promoters in order to further support adoption of RPU-based measurement standards. CONCLUSION: Relative activity measurements based on an in vivoreference standard enables improved measurement of promoter activity given variation in measurement conditions and instruments. These improvements are sufficient to begin to support the measurement of promoter activities across many laboratories. Additional in vivo reference standards for other types of biological functions would seem likely to have similar utility, and could thus improve research on the design, production, and reuse of standard biological parts.

Gene synthesis demystified.

DNA fabrication of genetic cassettes at base-level precision is transforming genetic engineering from a laborious art to an information-driven discipline. Although substantial advances have been made in the development of DNA fabrication, the methods employed vary widely based on the length of the DNA. All of these methods are available commercially, but can also be performed at the molecular biology bench using typical reagents and procedures. Because the technology is not mature and is still evolving rapidly, it is helpful to gain some understanding of the different steps in this process and the associated technical challenges to successfully take advantage of DNA fabrication in a research project.