Lance's Corner

AHRQ Issues CDSiC Newsletter

Oct 30, 2024

The Agency for Healthcare Research and Quality (AHRQ) has issued its Clinical Decision Support Innovation Collaborative (CDSiC) newsletter.

Issue Number 23 | October 30, 2024
In this edition of the Insider, we highlight a blog post co-authored by members of the AHRQ CDSiC leadership team, a report on incorporating social determinants of health (SDOH) into patient-centered clinical decision support (PC CDS), and visual resources on co-design and the use of patient preferences data in PC CDS.
Table of Contents:
The National Patient Advocate Foundation blog recently published a post co-authored by patient advocate members of the AHRQ CDSiC Steering Committee, AcademyHealth, and NORC leadership. The blog explains the concept of PC CDS, describes how it relates to patients, and highlights three key areas to advancing PC CDS: trust, co-design, and ensuring tools fit into patients' lives to offer more value. Read the blog here!
PC CDS tools that leverage SDOH data can provide more holistic care recommendations, which can then positively impact clinical and quality of care outcomes. However, while there is agreement that SDOH are important to PC CDS, there is a need to identify opportunities that will advance the use of this critical information.

In response, the AHRQ CDSiC's Trust and Patient-Centeredness Workgroup developed a comprehensive action plan that identifies needs, key challenges, current efforts, and future opportunities to support the collection and use of SDOH data for PC CDS. This action plan can be used to better understand the barriers associated with their use in PC CDS, as well as methods for overcoming these barriers to make care delivery more equitable, impactful, and tailored to the diverse needs of patients. Read the action plan here!
Co-design is a key method of ensuring that PC CDS tools align with clinician workflows or patient lifeflows. To advance the use of co-design methods throughout the development of PC CDS, the AHRQ CDSiC released a new chartbook on this important topic.

The chartbook summarizes key takeaways from a detailed report, highlighting six methods that can be used to involve diverse stakeholders in PC CDS co-design: consultative groups, surveys, focus groups, empathy interviews, prototypes, and usability tests. Read the chartbook here!
The AHRQ CDSiC created a new infographic that highlights findings from a key project report, the Taxonomy of Patient Preferences. It depicts the six domains of patient preference information most relevant to PC CDS, as well as major considerations for collecting and incorporating patient preferences.

Developers, evaluators, patient advocates, and healthcare organizations can use this resource as an organizing framework for advancing patient-centered care through the use of patient preferences. Check out the infographic here!
The work of the AHRQ CDSiC will be showcased in a panel, podium presentation, and two posters at the upcoming AMIA Annual Symposium taking place in San Francisco, CA from November 9-13. The theme this year is Informatics in the Age of Generative Artificial Intelligence. See below for an overview of these exciting presentations – we hope to see you there!
Quartz App to Support Medication Adherence: Usability and Feasibility Assessment

Few studies have explored the deployment and use of PC CDS interventions in real-world practice settings. The AHRQ CDSiC Innovation Center designed and developed a PC CDS prototype, known as Quartz, that leverages healthcare standards, text messaging, and chatbot technology to support patients with taking their hypertension medications. This report assesses the design, development, deployment, and future use of this PC CDS application.
PAIGE Chatbot for Patient-Clinician Communication: Usability and Utility Assessment

Large language model (LLM) tools can potentially reduce back-and-forth messaging to respond to patient questions more efficiently. The AHRQ CDSiC Innovation Center designed and developed a PC CDS prototype known as PAIGE that leverages an LLM to improve and streamline patient-clinician communication on the patient portal. This report assesses the future use of this prototype.
 
The Clinical Decision Support Innovation Collaborative (CDSiC) is a community of broad, diverse stakeholders at the forefront of using technology to better support care teams, patients, and caregivers. The CDSiC is working toward healthcare decisions that are driven by both patient-centered and patient-specific information and that align with patient needs, preferences, and values. The CDSiC is funded by the Agency for Healthcare Research and Quality (AHRQ) as part of a multi-component initiative to help advance patient-centered outcomes research into practice through CDS. For any inquiries regarding the CDSiC you may contact the project team at CDSiC@norc.org.

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc