Chronic Conditions

Hewner SJ, Seo JY. Informatics’ role in integrating population and patient-level knowledge to improve care transitions in complex chronic disease. OJNI 2014;18(2).

Hewner S, Seo JY, Gothard SE, et al. Aligning population-based care management with chronic disease complexity. Nurs Outlook. 2014 Jul-Aug;62(4):250-8. PMID: 24882573.

Castner J, Wu YW, Mehrok N, et. Frequent emergency department utilization and behavioral health diagnoses. Nurs Res 2015 Jan-Feb;64(1):3-12. PMID: 25502056.

Hewner S, Wu YW, Castner J. Comparative effectiveness of risk-stratified care management in reducing readmissions in Medicaid adults with chronic disease. J Healthc Qual 2016 Jan-Feb;38(1):3-16. PMID: 26730804.

Hewner S, Casucci S, Sullivan S, et al. Integrating social determinants of health into primary care clinical and informational workflow during care transitions. eGEMs 2017;5(2):2. DOI: http://doi.org/10.13063/2327-9214.1282

Juckett D. Phenotype Modeling and Outcome Mapping for Pain Management Decision Support - Final Report. (Prepared by Michigan State University under Grant No. R21 HS022335). Rockville, MD: Agency for Healthcare Research and Quality, 2017.

Mitchell S. Treating Comorbid Depression During Care Transitions with Relational Agents - Final Report. (Prepared by Boston Medical Center under Grant No. R21 HS022938). Rockville, MD: Agency for Healthcare Research and Quality, 2017.

Lim CY, Berry ABL, Hirsch T, et al. Understanding what is most important to individuals with multiple chronic conditions: a qualitative study of patients' perspectives. J Gen Intern Med 2017 Aug 28. doi: 10.1007/s11606-017-4154-3. PMID: 28849368.

Gustafson D. Bringing Communities and Technology Together for Healthy Aging - Final Report. (Prepared by the University of Wisconsin - Madison under Grant No. P50 HS019917). Rockville, MD: Agency for Healthcare Research and Quality, 2017.

Walker J, Crotty BH, O'Brien J, et al. Addressing the challenges of aging: how elders and their care partners seek information. Gerontologist 2017 Oct 1;57(5):955-962. PMID: 27053506.