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Role/Potential of LOINC in Comparative Effectiveness Research: Case Studies

Role/Potential of LOINC in Comparative Effectiveness Research: Case Studies. Suzanne Bakken Manuel Co, Jr. Columbia University Clinical LOINC Committee January 27 , 2011. Comparative Effectiveness Research Context.

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Role/Potential of LOINC in Comparative Effectiveness Research: Case Studies

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  1. Role/Potential of LOINC in Comparative Effectiveness Research: Case Studies Suzanne Bakken Manuel Co, Jr. Columbia University Clinical LOINC Committee January 27 , 2011

  2. Comparative Effectiveness Research Context • CER is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat and monitor a clinical condition, or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels. IOM, 2009, Sox & Greenfield, 2009 • Multiple agencies received targeted ARRA-funding for CER: AHRQ, NIH, HRSA - $1.1 billion • Patient-Centered Outcomes Research Institute (PCORI) – private, non-profit entity – created through Patient Protection and Affordable Care Act • Establish an objective research agenda • Develop research methodological standards • Contract with eligible entities to conduct the research • Ensure transparency by requesting public input • Disseminate the results to patients and healthcare providers

  3. AHRQ PROSPECT Grants • Comparative Outcomes Management with Electronic Data Technology (COMET) Study- CleteA. Kushida, Stanford University (R01 HS19738-01) - Obstructive Sleep Apnea • Enhancing Clinical Effectiveness Research with Natural Language Processing of EMR - Brian L. Hazlehurst, Kaiser Foundation Research Institute (R01 HS19828-01) – Asthma and Smoking Cessation • Indiana PROSPECT - J. M. Overhage, Indiana University-Purdue University at Indianapolis (R01 HS19818-01) – Alzheimer’s Disease • Multi-Institutional Consortium for CER in Diabetes Treatment and Prevention - Joseph V. Selby, Kaiser Foundation Research Institute (R01 HS19859-01) • The Population-Based Effectiveness in Asthma and Lung Disease -Tracy A. Lieu, Harvard Pilgrim Health Care, Inc. (R01 HS19669-01) • Washington Heights Initiative Community-based Comparative Effectiveness Research - Adam B. Wilcox, Columbia University Health Sciences (R01 HS19853-01) - Hypertension

  4. WICER Overview • Overall goal - advance comparative effectiveness research designed to improve hypertension care delivery and population outcomes by building on an existing institution-focused data infrastructure to create a robust community-focused data infrastructure that will support the kinds of innovative studies needed to effectively tackle seemingly intractable public health problems • Data • Clinical Data Warehouse • Skilled Nursing Facility • Visiting Nurses of New York City • BP screening in multiple settings (using variety of devices) • Survey – 8,000 households; 2,000 community center; 2,000 ambulatory care setting • Tools • Research Data Explorer • EHR plugin for finding eligible patients • CER Studies - diagnosis, treatment, and management of hypertension

  5. WICER Data Needs • Basic demographics; additional demographics: measures of acculturation (e.g., time in country, language preference) • BP, anthropometric measures • Survey content areas • Physical activity • Sleep habits and patterns • Nutrition – fruit and vegetable consumption (i.e., meet FDA guidelines) • Health literacy – Newest Vital Sign (others – REALM, TOFLA, S-TOFLA) • Adherence related to particular type of medication • Survey levels of standardization • Included in PROMIS • Standardized, but not in PROMIS • Validated in research study, but not widely adopted yet • Study-specific

  6. Blunt Head Trauma- KT • Pediatric Emergency Care Applied Research Network (PECARN) – HRSA-funded, Peter Dayan (PI) • Time series design – 8 sites • Epic integration of validated rule aimed at influencing CT ordering behavior • Web service for inference for some sites • Potential messaging approaches for web service • Continuity of Care Document extension • Blunt Head Trauma LOINC mixed data type panel – age, Glasgow Coma Scale, other predictors as yes/no

  7. Conclusions • Many data elements required for comparative effectiveness research are already in LOINC: demographics, standardized surveys • Some new content areas may needed – e.g., health literacy, adherence, physical activity • Guidance on level of survey use for inclusion in LOINC • Potential new role for mixed data type panel • National agendas for health information technology and health disparities require additional points of intersection

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