The Kentucky Diabetes and Obesity Collaborative (KDOC) Kevin Pearce, MD, MPH UK Department of Family...
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Transcript of The Kentucky Diabetes and Obesity Collaborative (KDOC) Kevin Pearce, MD, MPH UK Department of Family...
The Kentucky Diabetes and ObesityCollaborative (KDOC)
Kevin Pearce, MD, MPHUK Department of Family and Community Medicine
Jeff Talbert, PhDUK Department of Pharmacy Practice and Science
Mark Dignan, PhD, MPHUK Department of Internal Medicine
David Bolt, MA Kentucky Primary Care Association
F. Douglas Scutchfield, MDUK College of Public Health
Supported by NIH grants:NIDDK # 1RC4DK809866NCATS # UL1TR000117
The Kentucky Diabetes and Obesity
Collaborative (KDOC)
KDOC partnering organizations
• Kentucky Primary Care Association (KPCA)• Individual FQHCs
• Kentucky Medicaid• University of Kentucky
• Academic Health Center • Center for Clinical and Translational Science• Center for Public Health Systems and Services
Research
Overarching goal: Activate new collaborations to improve
quality and create opportunities for research
PayersQI
Cost-Effectiveness
KPCAQI
Support IPAGain-sharing
ACA Expansion
UKDevelop
Community Based
Translational Research Network
The Kentucky Diabetes and Obesity
Collaborative (KDOC)
Vision: Develop a healthcare data repository that will be used to improve the health of Kentuckians via QI activities and research.
The KDOC data repository will bring together up-to-date clinical data from multiple primary care safety-net providers, plus Medicaid claims data, all linked at patient level. Secure web-based portals and special software will facilitate use while maintaining appropriate levels of privacy and security.
The Kentucky Diabetes and Obesity
Collaborative (KDOC)
Project Rationale
• High prevalence of obesity and diabetes in a large rural and medically-underserved population; much of which relies on “safety-net” providers, such as FQHCs
• Utility of being able to monitor and use clinical and claims data linked at patient level, and across healthcare facilities
• Built-in utility for more broadly improving healthcare
The Kentucky Diabetes and Obesity
Collaborative (KDOC) Project goals • Develop a secure data repository
• clinical data from rural PCPs• Linked Medicaid claims data
• Develop secure, user-friendly data interfaces for providers and researchers
• Assess related training and support needs, and provide the training/ support to KDOC users
• Facilitate research and healthcare QI collaborations
The Kentucky Diabetes and Obesity
Collaborative (KDOC) Project goals (cont’d)
Address gaps in generalizable knowledge about:
• The effective use of HIT for chronic care coordination and related research in rural settings
• Systems-oriented collaborative QI strategies for improving the management of chronic conditions in primary care
• Effectively connecting AHC-based researchers and rural health disparity populations
Participating Federally-Qualified Community Health
Centers
Eight Community Health Centers (FQHCs) serving 39 mostly rural Kentucky counties; diabetes prevalence as high as 17% and obesity prevalence as high as 51%
2 to 15 clinic sites / FQHC with 6 to 31 providers / FQHC
19,900 to 143,000 annual patient visits per FQHC
Approx 124,000 patients served by the 8 FQHCs, total
Five different EMR brands across the 8 FQHCs; time since EMR implementation: from < 1 year to several years
KDOC 3-Yr Project Approach
1. Establish leadership, steering and advisory groups
2. Simultaneously pursue interpersonal and technical aspects of KDOC development
Interpersonalbuild KDOC-specific collaborative relationships (BAAs, MOUs)establish stakeholder priorities for HIT tools and functionsunderstand stakeholder opportunities and barriers related to collaboration around QI and research
TechnicalUnderstand technical aspects of data storage and sharing capabilities of each EMR systemestablish HIPAA compliant methods for developing and using the KDOC Data Warehouseexplore utility of KHIE for KDOCbuild or buy user-friendly data interfaces for QI and research
KDOC Project Approach (cont’d)
3. Simultaneously: (a) Obtain IRB approval for data transmission, storage, and general use (b) design and pilot a DM QI project involving the FQHCs
4. Populate KDOC data repository with clinical data from each FQHC, and with Medicaid claims data for matching time periods; data de-identified but coded for linkage at patient level
5. Simultaneously: (a) Perform pilot clinical QI project(b) facilitate use of KDOC infrastructure for research
Throughout: plan for sustainability of infrastructure
KDOC Focus Groups
Conducted at 6 FQHC offices in rural Kentucky
Included providers, office staff, IT representatives
45-60 minutes
Tape recorded, transcript analysis
Focus Group Discussion Topics
Perceptions about obesity and diabetes rates in rural Kentucky
Perceived role of research in prevention and control of diabetes and obesity…probing:
Experience with research Barriers and facilitators of research with rural FQHCs What is needed to increase participation in research
Communication and collaboration between providers and researchers
Implementation of Evidence Based Practices in DM mgmt
Focus Group Findings
• There is interest in participating in and promoting research in FQHCs (and in partnering with UK)
• Research is most likely to be successful when initiated by researchers
• Participating with KDOC can help FQHCs with capturing clinical data, developing reporting, and perhaps QI
• Use of EHR, or similar mechanism, for data collection is preferred – something that can be integrated into the flow of the practice
• FQHCs not hesitant to share data as long as patient privacy protections are in place
More Focus Group Findings
• Mild concern that KDOC will not be able to deliver information needed for HEDIS reporting – concern about responsiveness of KDOC to changes in guidelines
• FQHC experience with EHRs and government has been mixed• Ability to better manage practice is a plus• Concern about monitoring by those outside the practice is a concern
• Employee time for research is a barrier, need outside resources and staffing
• IT assistance is needed for most projects
• Research partnerships are built on trust between patients and clinics – and then researchers
Technical Strategy
KDOC vision: build QI tools that also serve as a research platform
FQHCs – de-identified data beyond own site—need for regional benchmark and peer comparisonUK-infrastructure for rural translational research network
8 initial FQHCs: using 5 EMR vendorsKentucky Medicaid as a project partner
Technical Process
Diverse site technical infrastructure
Very vendor dependent (new EMR users)Limited site IT staff (contractors, part time, busy with day job)Limited site database capacity (required flexible after hours connectivity, multiple small reports)
Process: 1)Special KDOC data extracts 2)Core database access 3)Core EMR reporting tool
Technical Workflow
Complete regulatory documents
Select data extraction process
Load into ETL staging area
ETL process to standardize data models
Load into KDOC data repository-enable Tableau reporting tools
Regulatory: QI/ operations use
All sites have MOU and BAA with UKSites limited access to their own data, with regional and national benchmarks for most measures Research use requires additional limits and protections
Regulatory: using data for research
BAA and MOU required for each siteIRB #10-0493 The Kentucky Diabetes and Obesity Collaborative (KDOC)Uses UK EDT third party “honest broker”
Researcher access to de-identified data IRB #13-0275-F6A, Kentucky Diabetes and Obesity Collaborative (KDOC)All users sign DUA, Complete HIPAA trainingData Use Advisory Committee reviews research protocols
DUAC: Data Use Advisory Committee
Address concerns over use of dataFunction to advise on research data used from the collaborationComposed of providers and administrators representing sitesAll research protocols will be reviewed by committee
KDOC Data Repository: Claims Data Progress and
Challenges
Medicaid MCOs established during first project yearNow working with Ky Medicaid QA/QI Department to goal of having claims data linked to clinical data in repository with proper security
Reporting Tools for QI
Intent: develop custom reporting toolsGo beyond current reporting platforms (greater flexibility than ‘canned’ reports)Adopted Tableau analytic platformAllows dashboards that are dynamic and interactive---allows visualization of data to generate new questions
Diabetes Care Monitoring
Tableau reporting models
Hypertension Care Monitoring
Conclusions so far
Interfacing with EMRs for data transfer into a shared repository cannot yet be standardized. EMR vendor characteristics and practice-based concerns must be addressed one-by-one
Expert technical assistance is required for practices to share clinical data for QI or research
EMR Vendors should be at the table from the beginning
Conclusions so far
Benefits for each collaborating practice, payer and research stakeholder cannot all be anticipated; they will fluctuate, but staying focused on benefits and value to each stakeholder is essential
e.g. Initial QI focus on UDS reporting, but later expanded to HEDIS measures and MCO gain sharing
Research and QI uses require different restrictions and protections…..development of shared trust among stakeholders across organizations is critical
And the biggest lessons…
Building a shared healthcare data repository for multiple stakeholders:
is a very complex undertaking that takes much longer than you imagine it willhas reward potentials that will grow and evolve takes you outside your comfort zone, links you with fascinating new colleagues and opens up new vistas
Next steps
Expand into a much larger co-op that stakeholders can use for
QA/QIQuality indicator capture and reporting Gainsharing with payersResearch
Questions?