MBL Biomedical MBL Biomedical InformaticsInformaticsSpring 2006Spring 2006

Student PresentationStudent Presentation

Project Staff/ RoleProject Staff/ Role

……

…… …… …… …… Shannon Anna Potter, MLIS research and content Shannon Anna Potter, MLIS research and content

managementmanagement

ObjectivesObjectives

Increase the use of Evidence Based Increase the use of Evidence Based Clinical Guidelines for diabetes Clinical Guidelines for diabetes identification and management identification and management among Mississippi residents among Mississippi residents receiving receiving Medicaid (do we receiving receiving Medicaid (do we need a % goal?). need a % goal?).

Evaluate efficacy of the project Evaluate efficacy of the project annually.annually.

Statement of NeedStatement of Need

[ADD: concise statement of problems [ADD: concise statement of problems and description of the problem with and description of the problem with statistics of poor basic healthcare for statistics of poor basic healthcare for vulnerable populations, healthcare vulnerable populations, healthcare delivery disparities, lack of medical delivery disparities, lack of medical informatics in rural, minority informatics in rural, minority communities]communities]

Proposal descriptionProposal description

Use informatics to facilitate adaptation of a national Use informatics to facilitate adaptation of a national guideline for implementation in a community settingguideline for implementation in a community setting One setting per year OROne setting per year OR Same setting but different guidelines for each yearSame setting but different guidelines for each year

Diabetes Disease Management as the domain for Diabetes Disease Management as the domain for investigating the utility of IT in integrating EBP investigating the utility of IT in integrating EBP (guidelines)(guidelines)

Add an IT component/product to public health Add an IT component/product to public health programprogram

Have the greatest impact on the quality of life for Have the greatest impact on the quality of life for the underservedthe underserved

Primary end user is clinician, secondary is Primary end user is clinician, secondary is community liaisons and patients directly.community liaisons and patients directly.

What do we have to work What do we have to work with?with?

Funding and support (1mil per yr, 5 yrs)Funding and support (1mil per yr, 5 yrs) Other existing projects [insert research Other existing projects [insert research

citations here]citations here] KNOWLDEGE and COLLABORATIONKNOWLDEGE and COLLABORATION Assumptions: guidelines work, an existing Assumptions: guidelines work, an existing

successful ph program with community successful ph program with community rapport rapport

Barriers: educational, socioeconomic, cultural, Barriers: educational, socioeconomic, cultural, and technological disparities and differencesand technological disparities and differences

MethodsMethods

Create an informatics product/ process Create an informatics product/ process with both clinical and patient components? with both clinical and patient components? ((is this fiscally feasible) is this fiscally feasible)

Target specific groups (providers, case Target specific groups (providers, case managers, community leaders) most likely managers, community leaders) most likely to adopt or easy to get on boardto adopt or easy to get on board

Target populations with the greatest Target populations with the greatest opportunity for improved healthopportunity for improved health

CollaborationCollaboration

Outcomes and Outcomes and MeasurablesMeasurables

IT is 10% of a public health program IT is 10% of a public health program with a current track record with a with a current track record with a minority population.minority population.

[need to elaborate or offer [need to elaborate or offer alternative measurables here]alternative measurables here]

Contribute 5 million to an existing Contribute 5 million to an existing public health program?public health program?

IssuesIssues

Terminologies, interoperabilityTerminologies, interoperability Content addressed to those populations. Establish revised Content addressed to those populations. Establish revised

content, guidelines for different groups (eg. Black skin content, guidelines for different groups (eg. Black skin dermatology)dermatology)

Measuring impactMeasuring impact Incorporating the content into expert systems and Incorporating the content into expert systems and

established healthcare systemsestablished healthcare systems Rural, underprivileged communities receiving even basic Rural, underprivileged communities receiving even basic

care?care? Technical aspects of this integrationTechnical aspects of this integration Economic barriers- socioeconomic issues Economic barriers- socioeconomic issues Adoption barriersAdoption barriers Patient compliancePatient compliance

ResourcesResources Guidelines.gov and other guidelines Guidelines.gov and other guidelines

resources resources (see last slide)(see last slide) GINGIN Healthcare Quality and Disparities ReportHealthcare Quality and Disparities Report Other free resources, low cost and easy to Other free resources, low cost and easy to

access access LiteratureLiterature TerminologiesTerminologies ExpertsExperts

FeasibilityFeasibility

How to begin assessing the utility of this How to begin assessing the utility of this initiativeinitiative Some has been already addressed by CDC, etc.Some has been already addressed by CDC, etc. Examples, increase in prostate cancer screeningExamples, increase in prostate cancer screening Chronic disease managementChronic disease management

Many previous initiatives cancelled due to Many previous initiatives cancelled due to non-compliancenon-compliance Consumer informatics must be an integral Consumer informatics must be an integral

componentcomponent Given these limitations and resources what Given these limitations and resources what

is the feasiblity?is the feasiblity?

Case or modelCase or model

Should we base this presentation on a Should we base this presentation on a specific topic or case?specific topic or case? Vaccinations programs in poor or specific Vaccinations programs in poor or specific

communitiescommunities ScreeningScreening Diabetes- crosses over many health aspects Diabetes- crosses over many health aspects

and cuts across many groupsand cuts across many groups Problems with diabetes guidelines: source of most of Problems with diabetes guidelines: source of most of

the existing guidelines are from the Diabetes the existing guidelines are from the Diabetes AssociationAssociation

Education and Patient Education and Patient InformationInformation

Patient education and compliance are Patient education and compliance are essential to successful outcomesessential to successful outcomes

Meeting place for telehealth, internet Meeting place for telehealth, internet Communication barriers transversed with Communication barriers transversed with

IT toolsIT tools Limitations of applying guideline to the Limitations of applying guideline to the

health of a communityhealth of a community Internet technology is a good free mode of Internet technology is a good free mode of

communicationcommunication

CliniciansClinicians

Getting clinicians on-boardGetting clinicians on-board Gaining the trust of their patientsGaining the trust of their patients Training the clinicians who serve Training the clinicians who serve

rural, underprivileged population rural, underprivileged population Identify championsIdentify champions

How do we measure our How do we measure our impactimpact

IT is 10% of a public health program IT is 10% of a public health program with a current track record with a with a current track record with a minority population.minority population.

Need a concurrent and ongoing Need a concurrent and ongoing measurement/assessment of the measurement/assessment of the quality and impactquality and impact

Brainstorming our approachBrainstorming our approach

Identify vulnerable patient populations and Identify vulnerable patient populations and apply evidence based guidelines designed apply evidence based guidelines designed specifically for that populationspecifically for that population

At least one guideline applicable to at At least one guideline applicable to at least a few populationsleast a few populations

Domain: United States onlyDomain: United States only How do we deal with multiple guidelines, How do we deal with multiple guidelines,

make choices about the “best”make choices about the “best” Design methodology for comparing Design methodology for comparing

recommendations from different groupsrecommendations from different groups

Problems and AssumptionsProblems and Assumptions

Quality of guidelines varyQuality of guidelines vary Discrepancies in outcome evaluationDiscrepancies in outcome evaluation Adoption and complianceAdoption and compliance Ensuring continued fundingEnsuring continued funding

ResourcesResources

Here's the list of additional guideline sites around the world from my HTAi Vortal:  http://www.htai.org/vortalhttp://www.g-i-n.net/http://www.gradeworkinggroup.org/http://mdm.ca/cpgsnew/cpgs/index.asphttp://www.eguidelines.co.uk/http://www.ebm-guidelines.com/pls/kotisivut/sivut.koti?p_sivusto=57http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstathttp://www.nice.org.uk/http://www.library.nhs.uk/guidelinesFinder/Default.aspxhttp://medicine.ucsf.edu/resources/guidelineshttp://www.prodigy.nhs.uk/http://www7.health.gov.au/nhmrc/publications/synopses/cp69syn.htmhttp://www.sign.ac.uk/guidelines/fulltext/50/index.html

Program Program Patients accessed two ways:Patients accessed two ways:1.1. EBT Receipt has message about EBT Receipt has message about

signs/symptoms/ risk of DM from DM signs/symptoms/ risk of DM from DM guideline.guideline.

2.2. Kiosks in offices (information portals) Kiosks in offices (information portals) providing DM education for patients. providing DM education for patients.

Patient receives discount coupon to Patient receives discount coupon to see provider for DM care when see provider for DM care when accessed either way. accessed either way.

Radio and TV publicize above Radio and TV publicize above programprogram

Program used by care providers who Program used by care providers who treat Medicaid patients. Some follow treat Medicaid patients. Some follow up appointments can be with up appointments can be with Telehealth clinicians who make Telehealth clinicians who make “rounds” to public clinics.“rounds” to public clinics.Diabetes Educator(s) available to Diabetes Educator(s) available to provide information to providers and provide information to providers and staffstaffPDAs/CDs loaded with guidelines PDAs/CDs loaded with guidelines and screening tools given to all and screening tools given to all participating providers. participating providers. CDs provided for any patient who CDs provided for any patient who wants one.wants one.

Staffing Needs:Staffing Needs: Program CoordinatorProgram Coordinator Diabetes Educator(s)Diabetes Educator(s) Telehealth cliniciansTelehealth clinicians IT CoordinatorIT Coordinator

Outcome Measurements: Outcome Measurements: Number of new cases diagnosed in Number of new cases diagnosed in

population each yearpopulation each year Number of patients maintaining HgA1c Number of patients maintaining HgA1c

every six monthsevery six months Mortality stats? Mortality stats?