Payment policies often discourage health care providers from investing in quality-enhancing interventions.⁽⁶⁾ To quantify the financial gap that must be closed to make quality-enhancing interventions feasible, Kerry Kilpatrick, based at the University of North Carolina School of Public Health, will team up with Sheila Leatherman to conduct in-depth financial analyses of Medicaid managed care organizations and state primary care case management programs. Their goal is to devise a robust method for analyzing the business case for quality improvement and to develop recommendations for eliminating barriers to improvement in care to Medicaid patients.

Chronic health conditions afflict an estimated 100 million Americans and account for as much as one-quarter of U.S. national health care expenditures. Yet the management of chronic illnesses has lagged behind advances in technology and medicine, with quality and effectiveness compromised by poor communication and a general lack of coordination among the clinicians caring for individual patients. Researchers Stephen Ross, M.D., and C.T. Lin, M.D., of the University of Colorado Health Sciences Center, have been studying the effects of giving patients with congestive heart disease access to their own electronic medical record and letting them communicate with their physicians through e-mail.^(7),(8) For his work on this project, C.T. Lin was named one of nine National IT Innovators of the Year for 2003.

The Fund is also supporting a project led by John Wiecha, M.D., at Boston Medical Center to evaluate the impact on care of an interactive Web site that helps patients participate in the management of their illness. The project will be exploring how such Internet-based technology can be used to create a "virtual" interdisciplinary team, foster teamwork, and even improve clinical outcomes. If successful, this work could serve as a model for management of other chronic conditions.

Another model for improving care—this one targeting high-risk older patients making the difficult transition from hospital to home—has already been successfully tested in controlled trials and is now ready for implementation within a major health insurance plan. Developed by a multidisciplinary research team headed by Mary Naylor at the University of Pennsylvania School of Nursing, the model relies on the care coordination efforts of advanced practice nurses. The Fund-supported project will be evaluating its effectiveness and economic feasibility.

The Fund will also continue to foster adoption of a national infrastructure for health information technology. In May 2004, a Fund-supported Alliance for Health Reform briefing in Washington, D.C., drew more than 250 people from Capitol Hill to hear from experts about promising new developments toward achieving this goal—including the announcement by the Department of Health and Human Services of over 20 IT standards, the doubling of the budget allotted to AHRQ for research and demonstrations, and the appointment of the first "national health information technology coordinator." While this progress is encouraging, barriers still exist to widespread adoption of IT by health care professionals. Currently, the Fund is supporting research at the University of California, San Francisco, to determine the costs and the benefits of implementing electronic medical records in solo or small group physician practices.