Query+Health+Consumer+Perspective+User+Story

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Consumer Perspective User Story #1

Question to be answered: Are all patients experiencing equitable outcomes/receiving equal treatment in a defined geographical area for a specific diagnosis?

All patients will have race, ethnicity, primary language, and gender recorded in EHR (or in practice management system; ability to interface practice management system with EHR is key). Query will be run using diagnosis codes (or other potential disparities outcomes targets) to determine aggregate outcomes, process, or composite measures by various groups and to compare differences to determine if they are statistically significant. This will enable communities, cities, states, and our nation to determine where disparities occur and to understand more about what contributes to them so that interventions can be targeted to eliminate them. This is a critical component of meeting our national quality goals.

Example: To what degree do citizens of the District of Columbia experience disparities in heart failure care?


 * Patients with Dx of Heart Failure || Received ACE Inhibitor || Did not Receive ACE Inhibitor || Readmitted w/in 30 days ||
 * Caucasian ||  ||   ||   ||
 * African American ||  ||   ||   ||
 * Hispanic ||  ||   ||   ||
 * Asian-Pacific Islander ||  ||   ||   ||

Consumer Perspective Use Story #2

Question to be answered: Should I seek surgical intervention (CABG) or manage my cardiac symptoms with medication therapy and diet? What have been the outcomes/experiences of patients like me with each option?

This story is absolutely critical for cost reduction, patient engagement, improved patient experience, and better care coordination, but would require significant advancements in the kind of data that is captured in and reported out of an EHR. In the context of shared decision-making, a physician or other care team member may have access to the latest evidence in the literature. But often, there is no definitive evidence indicating that one treatment is more likely to lead to better outcomes than another, and regardless of the evidence, randomized, controlled trials do not provide information that can necessarily be generalized to them or the kind of information that helps patients make decisions based on what is most important to them. The net result is that clinicians simply have no way of answering some of the most urgent questions their patient shave. The ability to query this system by variables that are deemed relevant by both the clinician and the patient for outcomes that reflect agreed upon goals will result in better decision-making that is likely to result in fewer invasive procedures (subsequently leading to reduced costs).

Example: I am a 35 year old African American who is 30 lbs overweight and have been recently been told I have 2 vessels occluded, one at 50%, and the other at 60%. The cardiac surgeon consulting on my case recommends bypass surgery, but I am scared to have surgery, and I cannot afford to be out of work for so long, because I do not have paid leave and I have 3 children to support. What are the most likely outcomes for patients like me who pursued each option?


 * CABG || Incidence of SSI || Worsening of diabetes/control of HBa1c || Functional status at 1 week/1 month/6 months || Mortality at 6 months/1 yr/5 years ||
 * African American ||  ||   ||   ||   ||
 * 35 years old ||  ||   ||   ||   ||
 * 30 lbs overweight ||  ||   ||   ||   ||
 * Diabetic: controlled with oral meds ||  ||   ||   ||   ||


 * Stent || Incidence of SSI || Worsening of diabetes/control of HBa1c || Functional status at 1 week/1 month/6 months || Mortality at 6 months/1 yr/5 years ||
 * African American ||  ||   ||   ||   ||
 * 35 years old ||  ||   ||   ||   ||
 * 30 lbs overweight ||  ||   ||   ||   ||
 * Diabetic: controlled with oral meds ||  ||   ||   ||   ||


 * Diet and Exercise + statin || Incidence of SSI || Worsening of diabetes/control of HBa1c || Functional status at 1 week/1 month/6 months || Mortality at 6 months/1 yr/5 years ||
 * African American ||  ||   ||   ||   ||
 * 35 years old ||  ||   ||   ||   ||
 * 30 lbs overweight ||  ||   ||   ||   ||
 * Diabetic: controlled with oral meds ||  ||   ||   ||   ||

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