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LSU Health Services Research Program LSU HSRP

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LSU Health Services Research Program LSU HSRP

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    1. LSU Health Services Research Program (LSU HSRP) Ron Horswell, PhD

    2. LSU HSRP Mission: Accelerating translation of evidence into practice, emphasizing topics of importance to the LSU Health Care Services Division (LSU HCSD), a provider system serving low-income, predominantly uninsured patients. Funded by AHRQ from 2001 to 2006 Original P.I. was Fred Cerise, MD

    3. LSU HCSD System

    4. LSU HCSD Disease Management and Population Health Programs

    5. LSU HSRP Methods and Program Elements (initially): Recruit (largely clinical faculty) participants Pair participants with research mentors Core Program Office Works in Progress meetings Affiliated with the Harvard Pediatric Helath Services Research Program Sharon Muret-Wagstaff, PhD Donald Goldman, MD

    6. LSU HSRP Results (by Sept 2006): 25 projects $680,000 in additional funding Published 11 papers, probably approximately 15 by now, with some still in progress.

    7. LSU HSRP Core Program Office: Most successful of the original program elements Shannon McNabb, MA MPH Managed IRB relationships Managed the Works in Progress meeting process Participated in research oversight committes at HCSD sites Helped instigate much higher LSU HCSD participation in “external” research

    8. Selected Projects DIABETES: Evaluation of a telemedicine diabetes foot program DIABETES: Barriers to diabetic eye care DIABETES: Effect of indigent pharmacy medication program HF: Mortality benefit of a HF disease management program HF patient registry development HF: Cost effectiveness of using BNP as a screener for heart failure HF: Heart failure acute event prediction model TOBACCO: Survey assessing patterns of tobacco use among HCSD patients HTN: Hypertension management using group visits NEONATES: IT network supporting preventive services for at-risk infants DISPARITIES: Racial disparities and qualify of care in disease management programs. DISPARITIES: Decomposition of sources of variation in disease management performance measures CANCER: Comparison of mammography screening levels across three population (Medicare, Medicaid, and the Uninsured.) CANCER: Relationship of screening mammography to tumor stage at diagnosis CANCER: Relationship of tumor stage at diagnosis to survival.

    9. Selected Projects DIABETES: Evaluation of a telemedicine diabetes foot program DIABETES: Barriers to diabetic eye care DIABETES: Effect of indigent pharmacy medication program HF: Mortality benefit of a HF disease management program HF patient registry development HF: Cost effectiveness of using BNP as a screener for heart failure HF: Heart failure acute event prediction model TOBACCO: Survey assessing patterns of tobacco use among HCSD patients HTN: Hypertension management using group visits NEONATES: IT network supporting preventive services for at-risk infants DISPARITIES: Racial disparities and qualify of care in disease management programs. DISPARITIES: Decomposition of sources of variation in disease management performance measures CANCER: Comparison of mammography screening levels across three population (Medicare, Medicaid, and the Uninsured.) CANCER: Relationship of screening mammography to tumor stage at diagnosis CANCER: Relationship of tumor stage at diagnosis to survival.

    10. LSU HSRP themes: Disparities and Underserved Patient Groups Conclusions: “self pay” does worst small racial disparities on processes more disparities on outcomes variation across clinics within sites is greater than variation across sites focus on patient subgroups with persistent problems need to get patients to “in-care” status and keep them there

    15. Selected Projects DIABETES: Evaluation of a telemedicine diabetes foot program DIABETES: Barriers to diabetic eye care DIABETES: Effect of indigent pharmacy medication program HF: Mortality benefit of a HF disease management program HF patient registry development HF: Cost effectiveness of using BNP as a screener for heart failure HF: Heart failure acute event prediction model TOBACCO: Survey assessing patterns of tobacco use among HCSD patients HTN: Hypertension management using group visits NEONATES: IT network supporting preventive services for at-risk infants DISPARITIES: Racial disparities and qualify of care in disease management programs. DISPARITIES: Decomposition of sources of variation in disease management performance measures CANCER: Comparison of mammography screening levels across three population (Medicare, Medicaid, and the Uninsured.) CANCER: Relationship of screening mammography to tumor stage at diagnosis CANCER: Relationship of tumor stage at diagnosis to survival.

    18. Selected Projects DIABETES: Evaluation of a telemedicine diabetes foot program DIABETES: Barriers to diabetic eye care DIABETES: Effect of indigent pharmacy medication program HF: Mortality benefit of a HF disease management program HF patient registry development HF: Cost effectiveness of using BNP as a screener for heart failure HF: Heart failure acute event prediction model TOBACCO: Survey assessing patterns of tobacco use among HCSD patients HTN: Hypertension management using group visits NEONATES: IT network supporting preventive services for at-risk infants DISPARITIES: Racial disparities and qualify of care in disease management programs. DISPARITIES: Decomposition of sources of variation in disease management performance measures CANCER: Comparison of mammography screening levels across three population (Medicare, Medicaid, and the Uninsured.) CANCER: Relationship of screening mammography to tumor stage at diagnosis CANCER: Relationship of tumor stage at diagnosis to survival.

    20. Selected Projects DIABETES: Evaluation of a telemedicine diabetes foot program DIABETES: Barriers to diabetic eye care DIABETES: Effect of indigent pharmacy medication program HF: Mortality benefit of a HF disease management program HF patient registry development HF: Cost effectiveness of using BNP as a screener for heart failure HF: Heart failure acute event prediction model TOBACCO: Survey assessing patterns of tobacco use among HCSD patients HTN: Hypertension management using group visits NEONATES: IT network supporting preventive services for at-risk infants DISPARITIES: Racial disparities and qualify of care in disease management programs. DISPARITIES: Decomposition of sources of variation in disease management performance measures CANCER: Comparison of mammography screening levels across three population (Medicare, Medicaid, and the Uninsured.) CANCER: Relationship of screening mammography to tumor stage at diagnosis CANCER: Relationship of tumor stage at diagnosis to survival.

    25. Selected Projects DIABETES: Evaluation of a telemedicine diabetes foot program DIABETES: Barriers to diabetic eye care DIABETES: Effect of indigent pharmacy medication program HF: Mortality benefit of a HF disease management program HF patient registry development HF: Cost effectiveness of using BNP as a screener for heart failure HF: Heart failure acute event prediction model TOBACCO: Survey assessing patterns of tobacco use among HCSD patients HTN: Hypertension management using group visits NEONATES: IT network supporting preventive services for at-risk infants DISPARITIES: Racial disparities and qualify of care in disease management programs. DISPARITIES: Decomposition of sources of variation in disease management performance measures CANCER: Comparison of mammography screening levels across three population (Medicare, Medicaid, and the Uninsured.) CANCER: Relationship of screening mammography to tumor stage at diagnosis CANCER: Relationship of tumor stage at diagnosis to survival.

    26. Distribution of Stage at Diagnosis

    28. Screening and Tumor Stage

    30. LSU HSRP Our recommendations to the LSU HCSD when the LSU HSRP program concluded: Maintain Core Office (partially done) Abandon mentoring concept (done) Create an analysis department (partially done) Become programmatic and purposeful (not done)

    31. LSU HSRP Observation: “. . . A distinction exists between: a research program designed to mentor individual researchers and move them along their career paths, and a research program designed to address major needs within client organizations’ patient populations.”

    32. Purposeful and Programmatic

    33. LSU HSRP Our recommendations to the LSU HCSD when the LSU HSRP program concluded: Maintain Core Office Abandon mentoring concept Create an analysis department Become programmatic and purposeful Maintain chronic disease patient registries Systematic analysis to identify sources of variation (potential opportunities) Create a practice-based research network Identify patient subgroups with persistent problems and develop interventions Develop and test means of patient empowerment

    34. Practice-based Research Network We suggested: LSU HSCD “medical home”-like clinics as participants Both QIPs and research projects Would provide the platform for mutually beneficial collaboration with other organizations and with various faculty This would enhance funding prospects Flow: Idea Retrospective Pilot Larger project Funding

    35. Reasons for LSU PBRN Tele-monitoring projects HF patients with history of ED/IP events Diabetes patients with persistently high HbA1c levels Medical home development

    38. Reasons for LSU PBRN Tele-monitoring projects HF patients with history of ED/IP events Diabetes patients with persistently high HbA1c levels Medical home development Need to link quality improvement and access improvement to business model

    39. LSU HCSD Screening Colonoscopy Capacity Requirements

    40. END

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