Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For the non medicare elderly with multiple comorbidities, what is the comparative effectiveness of patent advocates in large HMO systems that support the provider?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Inoperability between departments/individuals supporting the providers in large care systems.

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Individuals with co-morbities under 65 that are not currently under the medicare or medicaid legislation.

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

Patients with multiple contacts with the support systems that support the provider visits in large health systems.

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Errors are corrected, stress is reduced. I'm able to live, thrive, and be health as my HMO says.

Describe any health-related risks, side effects, or harms that you are concerned about.

I spend more time with appointment check-in, member services, and billing than I ever spend in the clinic office or with the provider. Errors go uncorrected due to lack of accuracy in the organization, and the ability of the individual patient to catch them and their ability to spend hours, days, and months trying to get them correct. I've been asking for a care coordinator. My HMO can simply ignore the requests. I need technology to track my office visit, codes, billing and medications and tests, so when thing go astray, I have the documentation. Currently, my HMO has had on-going system failures in contributing to the inoperability of the care provider.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Arthritis and nontraumatic joint disorders
• Cardiovascular disease, including stroke and hypertension
• Diabetes mellitus
• Obesity

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Elderly

Federal Health Care Program

• Other

Importance

Describe why this topic is important.

Limited accountability in large organizations. The neglect is more about billable hours and less about the individuals in the HMO.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

I'm the patient in a large healthcare organization, where little holds them accountable for their care.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Yes as long as large health care organization can block transparency and accountability. As long as they can be held not accountable.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

To hold accountable large health systems to ensure patient coordination with the provider care and the supporting services that support them. Help consumers stop and correct the errors in the clinic, in the emr, in the pharmacy, and in the billing.

Describe the timeframe in which an answer to your question is needed.

Open-ended.

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

With co-morbities, my guess is that the consumers in this type of organization dies earlier and at great numbers in large un-cooridinated health providers as my HMO.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

To hold accountable large health systems to ensure patient coordination with the provider care and the supporting services that support them. Help consumers stop and correct the errors in the clinic, in the emr, in the pharmacy, and in the billing.

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

website