MBL Biomedical Informatics Spring 2006

1. MBL Biomedical InformaticsSpring 2006 Student Presentation

2. Project Staff/ Role • … • … • … • … • … • Shannon Anna Potter, MLIS research and content management

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

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

5. Proposal description • Use informatics to facilitate adaptation of a national guideline for implementation in a community setting • One setting per year OR • Same setting but different guidelines for each year • Diabetes Disease Management as the domain for investigating the utility of IT in integrating EBP (guidelines) • Add an IT component/product to public health program • Have the greatest impact on the quality of life for the underserved • Primary end user is clinician, secondary is community liaisons and patients directly.

6. What do we have to work with? • Funding and support (1mil per yr, 5 yrs) • Other existing projects [insert research citations here] • KNOWLDEGE and COLLABORATION • Assumptions: guidelines work, an existing successful ph program with community rapport • Barriers: educational, socioeconomic, cultural, and technological disparities and differences

7. Methods • Create an informatics product/ process with both clinical and patient components? (is this fiscally feasible) • Target specific groups (providers, case managers, community leaders) most likely to adopt or easy to get on board • Target populations with the greatest opportunity for improved health • Collaboration

8. Outcomes and Measurables • IT is 10% of a public health program with a current track record with a minority population. • [need to elaborate or offer alternative measurables here] • Contribute 5 million to an existing public health program?

9. Issues • Terminologies, interoperability • Content addressed to those populations. Establish revised content, guidelines for different groups (eg. Black skin dermatology) • Measuring impact • Incorporating the content into expert systems and established healthcare systems • Rural, underprivileged communities receiving even basic care? • Technical aspects of this integration • Economic barriers- socioeconomic issues • Adoption barriers • Patient compliance

10. Resources • Guidelines.gov and other guidelines resources (see last slide) • GIN • Healthcare Quality and Disparities Report • Other free resources, low cost and easy to access • Literature • Terminologies • Experts

11. Feasibility • How to begin assessing the utility of this initiative • Some has been already addressed by CDC, etc. • Examples, increase in prostate cancer screening • Chronic disease management • Many previous initiatives cancelled due to non-compliance • Consumer informatics must be an integral component • Given these limitations and resources what is the feasiblity?

12. Case or model • Should we base this presentation on a specific topic or case? • Vaccinations programs in poor or specific communities • Screening • Diabetes- crosses over many health aspects and cuts across many groups • Problems with diabetes guidelines: source of most of the existing guidelines are from the Diabetes Association

13. Education and Patient Information • Patient education and compliance are essential to successful outcomes • Meeting place for telehealth, internet • Communication barriers transversed with IT tools • Limitations of applying guideline to the health of a community • Internet technology is a good free mode of communication

14. Clinicians • Getting clinicians on-board • Gaining the trust of their patients • Training the clinicians who serve rural, underprivileged population • Identify champions

15. How do we measure our impact • IT is 10% of a public health program with a current track record with a minority population. • Need a concurrent and ongoing measurement/assessment of the quality and impact

16. Brainstorming our approach • Identify vulnerable patient populations and apply evidence based guidelines designed specifically for that population • At least one guideline applicable to at least a few populations • Domain: United States only • How do we deal with multiple guidelines, make choices about the “best” • Design methodology for comparing recommendations from different groups

17. Problems and Assumptions • Quality of guidelines vary • Discrepancies in outcome evaluation • Adoption and compliance • Ensuring continued funding

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

19. Program • Patients accessed two ways: • EBT Receipt has message about signs/symptoms/ risk of DM from DM guideline. • Kiosks in offices (information portals) providing DM education for patients. • Patient receives discount coupon to see provider for DM care when accessed either way. • Radio and TV publicize above program

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

21. Staffing Needs: • Program Coordinator • Diabetes Educator(s) • Telehealth clinicians • IT Coordinator • Outcome Measurements: • Number of new cases diagnosed in population each year • Number of patients maintaining HgA1c every six months • Mortality stats?