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Tuesday, November 23, 2010
Fwd: Attention Scholars and Trainees! Reminder Submit your Abstract for the 2011 ACRT/SCTS Annual Meeting
Monday, November 22, 2010
Fwd: Informatics Grand Rounds - Tuesday, December 14th 4PM-5PM
INFORMATICS GRAND ROUNDS
"ADVANCED INFORMATICS FOR QUALITY IMPROVEMENT AND RESEARCH: ENHANCED REGISTRIES TO CREATE A LEARNING HEALTH CARE SYSTEM"
Richard B. Colletti, MD (Department of Pediatrics, University of Vermont; Vermont Children's Hospital, Fletcher Allen Health Care)
Keith Marsolo, PhD (Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center; Department of Pediatrics, University of Cincinnati)
Date/Time:
Tuesday, December 14th, 2010
4:00 PM – 5:00 PM
Location:
Medical Education Center Room 300 (Reardon Classroom)
(For remote attendees: http://jadeweb.streamguys.com/~uvm/jwplayer/live.html)
Abstract:
We will describe a project that was recently funded by the Agency for Healthcare Research and Quality (AHRQ). A learning healthcare system comprises a community of front-line clinicians, patients, and scientists who view each clinical encounter as an opportunity to learn and to improve patient outcomes. In its most advanced state, it combines comparative effectiveness (CE) research with quality improvement (QI) science to ensure the delivery of new knowledge at the point of care. Electronic health records have the potential to become the tool for learning at the point-of-care, although most are patient-focused and do not natively support the population management required by a learning healthcare system. Registries are designed to do this, but generally operate independently of institutional EHRs. Over the next 3 years, we will work to change this by building upon existing open-source software to create a modular, versatile, and scalable registry that can be populated by EHRs. We will test its ability to support QI and CE research within the ImproveCareNow practice-based research and improvement initiative. Our specific aims are to: (Aim 1) enhance an existing registry to support a learning healthcare system for pediatric inflammatory bowel disease (IBD) by capturing needed data directly from electronic health records, improving the quality of collected data using new tools we have developed for recording clinical data during a patient encounter, and facilitating interventions to improve the quality of care for children; (Aim 2) use quality improvement methods to implement enhanced IBD-registry features to enable management of IBD care center populations and increase patient participation in care; (Aim 3) use data from the enhanced registry to compare the effectiveness of alternative treatment strategies for pediatric Crohn's Disease patients, with a special focus on timing of biologic agents; (Aim 4) develop governance structures for the network that engages patients and provides oversight of privacy, confidentiality, and data access, as well as scientific and technical concerns. The project will form a unique community of children, families, clinicians, informaticians, QI specialists, and CE researchers who work together to improve patient outcomes using learning healthcare system principles. Our long-term goal is to extend this work to other chronic disease communities devoted to advancing the health of children.
Speaker Bios:
Dr. Richard B. Colletti is the Vice-Chair for Clinical and Research Affairs and Professor of Pediatrics at the University of Vermont, and the Associate Chief of Vermont Children's Hospital at Fletcher Allen Health Care. He is a graduate of the University of Pittsburgh School of Medicine, and completed his residency at Yale University and his fellowship at Texas Children's Hospital, Houston. He is actively engaged in quality improvement and research in pediatric Crohn's disease and ulcerative colitis, and is the Network Director of the national ImproveCareNow Collaborative. He has been the President of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN), on the Board of Directors of the Children's Digestive Health and Nutrition Foundation, and Secretary-Treasurer of the Federation of International Societies for Pediatric Gastroenterology, Hepatology and Nutrition. He has co-authored over 90 papers, book chapters and monographs, including five evidence-based clinical practice guidelines, and has given over 140 national and international presentations.
Dr. Keith Marsolo is an Assistant Professor of Pediatrics at Cincinnati Children's Hospital Medical Center and is the Director of Data Warehousing and Software Development in the Division of Biomedical Informatics. He holds a PhD in computer science from The Ohio State University and is an expert in data mining and biological data modeling. Dr. Marsolo is leading the implementation of a research data warehouse at Cincinnati Children's based on the i2b2 informatics framework, as well as development efforts to expand the capabilities of i2b2 to make it a suitable platform for patient registries. As head of Software Development, Dr. Marsolo and his team focus primarily on developing systems for electronic data capture and reporting, creating collaborative Web sites for clients within the Research Foundation, and developing applications in support of grant-funded research.
Other Links:
Informatics Grand Rounds is a joint initiative between the University of Vermont (Center for Clinical and Translational Science Informatics Unit, Continuing Education, and Dana Medical Library), Fletcher Allen Health Care, and the State of Vermont.
Tuesday, November 9, 2010
Clinical Research Oriented Workshop (CROW) Meeting: Nov 5, 2010
Present: Abby Crocker, Kairn Kelley, Ben Littenberg, Charlie MacLean, Carole McBride, Connie van Eeghen
1. Round Table:
a. Fall schedule to continue, but Connie will not be back to Workshop until 2011. See the bottom of this posting for a schedule of dates, holiday cancellations, and scholars leading discussion.
b. Spring schedule proposed around Thursdays or Fridays; Abby to send out Doodle poll; focus is Thursdays 9 – 10 or Thursdays 2:30 – 4:00 or Fridays 1:30 – 4:00 as likely choices.
c. Connie was allowed to experiment with a hands on presentation exercise and got great feedback
2. Abby’s Topic
a. More published studies about weaning babies born with drug dependency
b. Predicting which kids need help is a good study question that has current data to support it. The research question is ~ “What are the prenatal characteristics that could predict requiring treatment?” Or “What are the prenatal predictors of NAS among women using narcotics pre-natally?” This is novel and important (relevant).
i. Reasons this is valuable: more appropriate prenatal treatment, better quality of life for baby and parents
ii. Outcome variable: did babies need treatment (not Finnegan score)
iii. Predictor variables (based on lit review): gestational age at time of delivery, gestational age at onset of prenatal care, maternal opiate treatment type (methadone or bupenorphine), abuse of Schedule 2 drugs (or prescribed drugs that were not prescribed), infant’s sex, infant’s birth weight, breast feeding or breast milk in hospital, plan to continue to breast feed, parity (live births), gravity (pregnancies), and maternal age. Others to consider: partner/spouse, employment, smoking, ETOH use, institution of treatment, date.
iv. Analytic plan:
1. Univariate analysis on just the drugs: prescribed vs. street drugs (with or without interactions). This tests the hypothesis that the drugs matter and their potencies may be different.
2. Best prediction model: use the current data set to develop a model using any/all criterion/a to create it. For another study, test the model using a new data set OR separate the data sets into two groups and use one set to develop the model and the other to test it. The FAHC population =~550 patients; others may be available.
3. Talk to clinical experts to help sort out the most significant variables.
c. Caring for these kids is a separate question and a good future study
3. Next Workshop Meeting(s): Friday, 11:00 a.m. – 12:00 p.m., at Given Courtyard Level 4
a. Nov 12: Abby to lead discussion (no Connie, Amanda, Rodger)
b. Nov 19: Abby to lead discussion (no Connie, Rodger)
c. Nov 26: Cancelled
d. Dec 3: Abby to lead discussion (no Connie, Rodger)
e. Dec 10: Abby to lead discussion (no Connie, Rodger)
f. Dec 17: Rodger to lead discussion (no Connie)
g. Dec 24: Cancelled
h. Dec 31: Cancelled
i. Future agenda to consider:
i. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished)
ii. Future: Review of different types of journal articles (lit review, case study, original article, letter to editor…), when each is appropriate, tips on planning/writing (Abby)
iii. Future: Informed consent QI: Connie to follow up with Nancy Stalnaker, Alan Rubin will follow up with Alan Wortheimer or Rob McCauly
iv. Kairn will ask a librarian to join us for selected issues
4. Fellows document – to be reviewed in the future. We trialed Wednesday meeting times, which started May 5, 2010 and continued until August 25, 2010. We returned to Friday meetings on Sept 3, 2010
Recorder: Connie van Eeghen
Wednesday, November 3, 2010
Clinical Research Oriented Workshop (CROW) Meeting: Oct 29, 2010
Present: Rodger Kessler, Ben Littenberg, Charlie MacLean, Connie van Eeghen
1. Round Table: The complexities of grant administration between departments are amazing.
2. Rodger’s Data
a. Past article submission has been returned with suggestions; new data from an additional site has meantime become available. May turn the paper into a “Brief Report” for the journal where it is under review. Two ways to look at incorporating the data from the additional site:
i. Compare the two sites, at least at a relatively simple level, to show that this approach worked in both
ii. Explain the two sites as a progression of implementing the same approach in two different practices with successful outcomes.
1. The sites are three years apart in time; this was the outcome of the practical issues around setting up the sites with this model. The message should be “you can do this in your practice,” so currency of data and process is important.
iii. Be able to discuss some of the details of patient condition: primary and secondary diagnoses, co-morbidities, payer mix, zip code, income, referrer (through the insurance claim), etc.
iv. Regardless of which strategy above is used, the journal will probably push for side by side comparisons. Anticipate questions that can’t be answered because of limits to generalizations preemptively, by stating that these limits exist and identifying the need for future studies.
b. AHRQ funded R24, “Connect” has two steps
i. Enroll practices, linked to EHR data abstraction and National Research Network “DARTnet” which has hooked up practices and pulled data (not MH data), in a collaborative around MH. Goal: enroll 30-40 organizations, some with multiple sites, with a goal of 100 sites in total. Ben Miller is the PI. Goal: can the data be abstracted?
ii. Descriptive data study, supported by DARTnet subcontractor, looking for practices with MH services on site that can be compared to other DARTnet practices not in the CCRN collaborative. Goal: is there a difference in the treatment conditions?
1. Identifies MH services that have been initiated based on diagnoses from the problem list – although this is still being sorted out with DARTnet. Not sure if the clinician providing the MH services matters (BH clinician or PCP).
2. The eligible population (i.e. the denominator for the study) is under question: a set of behavioral health and medical diagnoses provided by a list which has been true for the patient for an undetermined period of time.
3. Outcomes research study is outside the scope of this study and an important future study.
4. That there was a referral is one item to track; another is identifying the outcome of that referral, a.k.a. “treatment initiation” (which is a question that may be answerable only by the patient) or “care process” (which could include a range of steps that might include medication, counseling, and have a range of sources for collecting data). However, the only source of data available are through DARTnet as part of this step of the study.
3. Next Workshop Meeting(s): Friday, 11:00 a.m. – 12:00 p.m., at Given Courtyard Level 4
a. Nov 5: Abby: update on research study.
b. Nov 12: (no Connie)
c. Nov 19: (no Connie)
d. Nov 26: (day after Thanksgiving – cancel?)
e. Dec 3: (no Connie)
f. Dec 10: (no Connie)
g. Dec 17: (no Connie)
h. Dec 24: ???
i. Dec 31: ???
j. Future agenda to consider:
i. Rodger: Mixed methods article; article on Behavior’s Influence on Medical Conditions (unpublished)
ii. Future: Review of different types of journal articles (lit review, case study, original article, letter to editor…), when each is appropriate, tips on planning/writing (Abby)
iii. Future: Informed consent QI: Connie to follow up with Nancy Stalnaker, Alan Rubin will follow up with Alan Wortheimer or Rob McCauly
iv. Kairn will ask a librarian to join us for selected issues
4. Fellows document – to be reviewed in the future. We trialed Wednesday meeting times, which started May 5, 2010 and continued until August 25, 2010. We returned to Friday meetings on Sept 3, 2010
Recorder: Connie van Eeghen
Fwd: AHRQ Health IT Update--New Report on Health IT and Workflow Redesign
New Report Examines Impacts of Health IT on Workflow in Outpatient Settings
AHRQ released a new summary report, Incorporating Health IT into Workflow Redesign, prepared by the University of Wisconsin-Madison's Center for Quality and Productivity Improvement. The report summarizes existing research and evidence related to the impact of health IT on workflow in outpatient settings. Key information obtained from the research will be incorporated into a toolkit to assist small and medium-sized practices in workflow analysis and redesign before, during, and after health IT implementation. The toolkit, Workflow Assessment for Health IT, is expected to be available in January 2011. Select to access the Incorporating Health IT into Workflow Redesign Summary Report (PDF file; PDF Help) and the associated appendix, Incorporating Health IT Into Workflow Redesign Summary Report Appendix F: Tool Compendium (PDF file; PDF Help).
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