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Site Training

Adult Emergency Department Patients with Acute Asthma and Survey of Local Asthma Centers: 36 th Multicenter Airway Research Collaboration (MARC-36) Study. Site Training. Web & Audio Meeting. Webinar has no audio function For audio function: Please dial 800-501-8979

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  1. Adult Emergency Department Patients with Acute Asthmaand Survey of Local Asthma Centers: 36th Multicenter Airway Research Collaboration (MARC-36) Study Site Training

  2. Web & Audio Meeting • Webinar has no audio function • For audio function: • Please dial 800-501-8979 • Then enter the access code (7265276)

  3. Study Leadership Carlos Camargo, MD, DrPH (Principal Investigator) Kohei Hasegawa, MD, MPH (Co-investigator) Project Coordination: Dr Hasegawa & Ms Sullivan. Funded by a grant from Novartis to MGH (Camargo). Emergency Medicine Network (www.emnet-usa.org), Dept. of Emergency Medicine, MGH, Boston, MA

  4. Overview Chart review Survey REDCap Outline of Presentation

  5. Overview Chart review Survey REDCap Outline of Presentation

  6. Aims • To describe adult ED patients with acute asthma, with a focus on the characteristics of patients with a high number of ED asthma visits in the 12 months before their index visit

  7. 2. To evaluate the concordance of current ED management of acute asthma with the 2007 National Asthma Education and Prevention Program (NAEPP) guideline. 3. To determine the characteristics of local hospital-affiliated asthma centers and the services they provide. Aims(continued)

  8. Acute asthma accounts for almost 2 million ED visits/yr, representing a high-risk population. Our survey of 177 US asthma centers in 2004 demonstrated suboptimal care in the asthma centers Current data are scarce on the epidemiology of this patient population, asthma care in ED, and the status of asthma centers. MARC-36 will address these knowledge gaps. Significance

  9. Study Design The MARC-36 study consists of two parts: • Chart review of 2,000 ED asthma patients in 50 EDs across the USA • Online survey about asthma centers affiliated with participating hospitals • Conducted by EMNet Coordinating Center

  10. Overview Chart review Survey REDCAP Outline of Presentation

  11. Identification of Visits • Use ICD-9-CM codes 493.xx to identify all visits with a principalED or hospital discharge diagnosis of asthma during a 12-month period • Identify 12-month period from January 1, 2011 to December 31, 2012 (i.e., 24-month window) • We encourage all sites to start with calendar year 2012 (i.e., January 2012 to December 2012) • The ED visit chosen for chart review will be selected at random from all asthma-related ED visits over the 12-month period

  12. Asthma ED visit made by adult patient aged 18 to 54 years AND 2) a history of asthma before the index visit Inclusion Criteria

  13. History of COPD, emphysema, or chronic bronchitis Transfer visits Repeat visit by the same subject -- the visit that was randomly chosen first will be retained for chart review Visits not prompted, in large part, by an asthma exacerbation, per judgment of the chart reviewer Exclusion Criteria

  14. Random Sampling • Create a list of eligible ED visits during a 12-month period • Send the number of eligible visits to EMNet Coordinating Center • EMNet will assign randomly-generated Study IDs to the visits, and send a list of them to the site • Sites review the charts in order (ie, ID 1, 2, 3, ….) until they have reviewed 40 eligible cases

  15. Random Sampling1. Creating a list at the site

  16. Random Sampling 2. Sending running # to EMNet

  17. Random Sampling3. Random ID assigned by EMNet

  18. Random Sampling4. Reviewing charts in order

  19. Repeated visits?the visit that was randomly chosen first will be retained for chart review

  20. 1 1 1 0 1 Site-specific 3 digit number Study ID# Patient number 0

  21. All data to be entered into Research Electronic Data Capture (REDCap) We will review basics of REDCap in the final section of this presentation. Data Entry: REDCap

  22. General informationED records vs. Non-ED records • Most of the information should be available in the ED records • Some variables may require review of non-ED records, such as primary care physicians, specialists, and hospitalizations Examples age of first asthma diagnosis, number of hospitalizations, medication non-adherence, laboratory tests, and weight

  23. Decision rules for conflicting results Among the patient’s records • Inpatient > specialist > PCP > ED record Between providers within the same visit • Attending > resident > PA/NP > student

  24. No vs. Not Documented/Unknown • “NO”-- if, after review of all charts, the treatment was not consistently documented • eg, there is the patient medication list and an inhaled corticosteroid is not listed • “Not documented/Unknown”-- if insufficient documentation was available to inform the variable • eg, if the medication list is missing, do not assume “No”

  25. Variables • Demographics • Past asthma history • Chronic asthma medications • ED presentation • ED treatments • ED disposition • Laboratory testing over 12 mo

  26. Using the Excel sheet (Chart Review Log), enter patient PHI (eg, name, date of birth, medical record number, home ZIP code, visit date) Maintain the tracking form locally; do NOT send it to the EMNet Coordinating Center. Excel Log - Site Use Only

  27. Season of ED visit • Date of ED visit is PHI • Collected on Chart Review Log • Enter the season of ED visit based on the month of ED visit (triage) date • Fall: Sep, Oct, Nov • Winter: Dec, Jan, Feb • Spring: Mar, Apr, May • Summer: June, July, Aug

  28. Median Household Income • Estimated by ZIP code (=PHI) • ZIP code will be collected on the Chart Review Log • Conversion table (ZIP code – Income) will be posted online www.emnet-usa.org/Marc_36/M36_resources.htm • Please call EMNet Coordinating Center if the patient’s ZIP code is not on the table.

  29. Ethnicity and Race • Consider ethnicity a separate concept from race • Hispanic Ethnicity • Enter “Yes” if Hispanic, Latino, Spanish origin • Persons of Hispanic origin may be of any race • Race (check all that apply) • eg, white, black, Asian, other

  30. Standard Treatment • Calculate the number of “standard treatments” of inhaled beta-agonist given. • “Standard treatment” is equal to • 2.5 mg albuterol neb • 4-6 puffs from MDI • e.g., 10 mg albuterol neb = 4 standard treatments

  31. Practice Charts • Abstractors will complete 2 practice charts • assessed vs. ‘‘criterion standard’’ • If an abstractor’s accuracy is less than 80% per chart, the individual will be retrained • After confirming the accuracy >=80%, 40 chart review can be started. • Online tools will be available • eg, Manual of Procedures, ZIP-income table, FAQ

  32. Practice Charts(continued) • Practice charts will be posted online (password-secured). • www.emnet-usa.org/Marc_36/login.cfm • Enter the data to REDCap (PRACTICE DATABASE)

  33. Practice Chart ID # Patient number (P1 and P2) 1 1 1 X P 1 Reviewer initial or # at the study site (you can decide) Site-specific 3 digit number

  34. Overview Chart review Survey REDCap Outline of Presentation 34

  35. Surveys 1. Site survey 2. Asthma center survey (conducted by EMNet Coordinating Center)

  36. 1) Site Survey Online survey of each site will collect data on ED and hospital characteristics, including: • Annual ED visits for acute asthma • Order sets, clinical pathways • Whether or not the hospital has an asthma center • Contact information of asthma center director

  37. Asthma center • A stand-alone clinic focusing on asthma OR • A usual allergy or pulmonary clinic that has time set aside for preferential scheduling of individuals with asthma.

  38. Surveys 1. Site survey 2. Asthma center survey (conducted by EMNet Coordinating Center)

  39. 2) Asthma center survey • Background: Our survey in 2004 and 2006 showed suboptimal coordination of care w/I asthma centers • Objective: To determine the characteristics of local hospital-affiliated asthma centers • Methods: Online survey to asthma center directors, collecting the characteristics (eg, staffing, services available, allergy testing) • Conducted by EMNet Coordinating Center

  40. Overview Chart review Survey REDCap Outline of Presentation 40

  41. 41

  42. Background REDCap (Research Electronic Data Capture) is a secure, web-based application designed exclusively to support data capture for research studies Initiated at Vanderbilt University and includes >600 active institutional partners (http://project-redcap.org/)

  43. Features Validation/pop-up alerts to minimize data-entry errors Save forms as PDF and print as needed No need to transmit data to EMNet Coordinating Center

  44. Getting Started Sign User Agreement Send to EMNet Access granted by Partners (MGH) Log in at https://redcap.partners.org

  45. Getting Started (continued)

  46. Data Entry Select database from “My Projects” Use the left-hand toolbar to initiate data entry (Chart Review Form)

  47. Data Entry (continued)

  48. Data Entry (continued) • Use your mouse to move from field to field (Note: pressing “Enter” will save and kick you out of the form) • Do not use the browser arrows to move back and forth between screens/forms

  49. Data Entry (continued)

  50. Changing Responses “reset value” Response changes to questions with branching logic result in a pop-up box asking for confirmation of the change

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