Using Health IT to Enhance the Care of Patients With Multiple Chronic Conditions
James Ralston, M.D., M.P.H.
Internal Medicine Physician and Senior Investigator
Kaiser Permanente Washington Health Research Institute
“AHRQ funding helped me to build an extensive body of knowledge by using health IT to identify new ways to enhance the communication between patients with multiple chronic conditions and their providers.”
James Ralston, M.D., M.P.H., an internal medicine physician and senior investigator at the Kaiser Permanente Washington Health Research Institute in Seattle, Washington, has dedicated his career to researching effective models of care to improve the health outcomes of people with multiple chronic conditions (MCCs) like diabetes, depression, and asthma. His AHRQ-funded work has influenced policy, fostered self-management of chronic conditions, and impacted health outcomes.
Effective communication between patients and providers is an important component of healthcare. Dr. Ralston, who is also an affiliate professor at the University of Washington Schools of Medicine and Public Health, initiated his AHRQ research career in 2004 with a small grant to study the role of secure email messaging to help support communication between patients with chronic illnesses and their providers. He incorporated information technology (IT) solutions as a resource to facilitate ongoing communication and care for patients outside of the brief, traditional in-person physician visits.
After completing his first AHRQ project, a second grant in 2007 with larger funding, allowed Dr. Ralston to assess the association between the quality of care among patients with diabetes and other MCCs and the use of web-based shared electronic medical records. The study showed that ongoing messaging via a web patient portal was linked to better control of blood glucose levels among diabetes patients. This research helped to inform policy and promote the adoption and meaningful use of certified electronic health record technology as part of the Centers for Medicare & Medicaid Services’ Electronic Health Record Incentive Program.
In 2013, Dr. Ralston conducted an AHRQ-funded study to examine optimal ways to meet the needs and preferences of patients with MCCs and their preventive care requirements. Together with his team, he interviewed and compared the experiences of older adults with diabetes and mothers of children with asthma to understand the role of patient reminder systems for at-home chronic disease management. In addition to improving communication among providers and patients, this research helped him evaluate how MCC patients could use patient reminder systems to reach their health goals. As a result of this AHRQ-funded study, Dr. Ralston helped develop a Conceptual Model of Shared Health Informatics to help patients self-manage and track their MCCs as part of their daily living, using tools like management calendars.
Patients with MCCs may experience complex care planning and treatments may conflict at times. Continuing his research to enhance care for people with MCCs, Dr. Ralston received AHRQ funding in 2014 to assess how elderly patients with diabetes, who have some combination of osteoarthritis, coronary artery disease, and depression, understand and set priorities for care. Dr. Ralston and a multidisciplinary team of researchers developed VITAL (Valuing Important Things in Active Lives), a care approach focusing on the needs and priorities of patients and their families. “The starting point when planning care is what matters to the patient,” said Dr. Ralston. “Before we can develop useful new technology, we must first understand what is most important to people,” he added.
Dr. Ralston is a member of the Society for General Internal Medicine, the American College of Physicians and the American Medical Informatics Association. Throughout his career, Dr. Ralston has also mentored other grantees studying innovative approaches to improve chronic conditions.
Principal Investigator: James Ralston, M.D., M.P.H.
Institution: Kaiser Permanente Washington Health Research Institute
Grantee Since: 2004
Type of Grant: Various
Consistent with its mission, AHRQ provides a broad range of extramural research grants and contracts, research training, conference grants, and intramural research activities. AHRQ is committed to fostering the next generation of health services researchers who can focus on some of the most important challenges facing our Nation's health care system.
To learn more about AHRQ's Research Education and Training Programs, please visit https://www.ahrq.gov/training.