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Integration of Population and Clinical Data at UW-Madison

Integration of Population and Clinical Data at UW-Madison. Maureen A. Smith, MD MPH PhD Associate Director for Population Sciences University of Wisconsin-Madison. Outline. NHIN conceptualization UWCCC projects Example project EHR as a resource Future plans at UW. UWCCC Projects.

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Integration of Population and Clinical Data at UW-Madison

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  1. Integration of Population and Clinical Data at UW-Madison Maureen A. Smith, MD MPH PhD Associate Director for Population Sciences University of Wisconsin-Madison

  2. Outline • NHIN conceptualization • UWCCC projects • Example project • EHR as a resource • Future plans at UW

  3. UWCCC Projects • Healthcare providers – “Health services research” • R01 CA144835 – Smith/Pickhardt • The impact of virtual colonoscopy on CRC screening • Personal health – “Behavior change research” • P50 CA143188 – Fiore • Seizing the EHR to enhance tobacco dependence treatment • Population health – “Epidemiology” • Survey of the Health of Wisconsin – Engelman • K07 CA109361 – Skinner • Molecular markers in pancreatic and colon cancer

  4. Example Project Virtual Colonoscopy and Colorectal Cancer Screening Pickhardt/Smith

  5. The Problem • Colorectal cancer should be almost entirely preventable, yet… • 148,000 diagnosed annually • 50,000 deaths annually • Nationally, less than 50% of eligible patients are screened for colorectal cancer • Locally, two-thirds of eligible UW Health patients are screened

  6. Modalities for CRC Screening at UW

  7. VC Screening at UW • New technology! • Coverage for screening VC since April, 2004 • Only program in U.S. with insurance coverage • Unique insight into VC implementation • Volume: • Over 7,000 patients screened

  8. Virtual Colonoscopy (VC) CT Colonography (CTC)

  9. Research Questions • Does insurance coverage for VC increase CRC screening rates? • Does a PCP’s use of VC change over time (and why)? • How do PCP perceptions of VC advantages and disadvantages affect VC use?

  10. Population Patients eligible for CRC screening between 50-79 yrs who are “medically homed” at UW Health each year between 2003 and 2010 N ~ 38,000 patients N ~ 131,100 patient-years during 2003-2010

  11. Data Source - the EHR at UW Epic Software Organizations UWMF One of 10 largest medical groups in the nation 60 clinics in Wisconsin 550,000 outpatient visits/yr > 900 physicians (~300 PCPs) UWHC 471 beds 25,000 inpatient admissions/yr • Joint implementation • UWMF (practice plan) • UWHC (hospital) • Clarity Data Warehouse • 7,000 tables • 90,000 fields • Data • Demographics • Diagnoses, procedures • Meds, labs, vital signs

  12. Linked Data - PCP Survey • Sample: • UWMF primary care providers: MDs/DOs/NPs/PAs • N = 322 – 70% response • Administered February 2010 – March 2010 • Questions about VC and OC to measure: • Innovation attributes • Communication channels • Social system • PCP characteristics • Link to EHR data

  13. Main Variables Dependent Variable • Did the patient receive a CRC screening test? • What type of test was performed? Explanatory Variables • Does the patient have insurance that covers VC? • % of a PCP’s eligible patients screened with VC

  14. Control Variables Patient Characteristics • Age, gender, race, marital status • Census tract data • Baseline co-morbidities Clinic Characteristics • CRC screening rates per clinic • # of PCPs per clinic per year • % of eligible patients per clinic per year PCP Characteristics • CRC screening rates per year • Age, gender, specialty, years in practice • % of patients receiving preventive visits per year

  15. Pyramid Summary Report Quality Measure Overall Report – Summary Report, Quality Measure Analysis Dataset – Chronic disease condition, WCHQ numerator, Research Data Restructured Data Element Visit, DX, Procedure, Rx, Payer, Person Basic Data Element – Encounter/service, operation, lab, medication Sample – WCHQ preventive measure, Chronic or acute disease measure, population from claims data, physician panel, hospital discharge Data Warehouse – Clinic, Provider, Patient Chronic disease condition WCHQ numerator Research data Visit DX Procedure Rx Payer Person Encounter/ Service Operation Lab Medication WCHQ preventive measure Chronic or acute disease measure Population from claims data Physician panel Hospital Discharge Provider Patient Clinic

  16. Total CRC Screening by Clinic

  17. VC Screening by Clinic

  18. The Future

  19. Role of the Electronic Health Record Health Services Research Behavior Change Research Epidemiology?

  20. What Does it Mean to Use EHRs for Research? • We are awash in data for effectiveness research • Massive increase in data on clinical results/outcomes • As researchers, we could spend the next several decades swimming in data and publishing papers • The Opportunity (and Challenge) “Take research findings from the printed pages of professional journals to everyday application by healthcare institutions, clinicians, and patients” (Eisenberg, 2002)

  21. A Continuum of EHR-based Effectiveness Research at UW EHR-enhanced Effectiveness Research EHR-based Effectiveness Research Research in Clinical Decision Support Evidence-based Clinical Decision Support Implementation Research Claims Intervene Intervene EHR + + EHR EHR EHR EHR Intervene EHR Add EHRdata to claims EHR data only Intervene ---- Track outcome in EHR Intervene in EHR ----Track outcome in EHR Use EHR data to tailor intervention content ---- Intervene in EHR ---- Track outcome in EHR

  22. Why do we need Clinical Decision Support that is Evidence-based? Clinical Knowledge Management. Researcher Efforts in Developing Clinical Decision Support at the Point of Care (Bali 2005, p.288)

  23. New Resources at UW • System wide quality improvement • Links inpatient and ambulatory • Multiple federally-funded research projects • Health information management center • Dimensional data warehouse based on EHR • Dedicated team to build marts for research • Center for clinical knowledge management • Development of evidence-based practices • Potential to study implementation

  24. The EHR-PopSci Future at UW EHR MyChart • Data • Linkages • Tumor registry • Population data

  25. Other UWCCC Projects • Healthcare providers – “Health services research” • R01 CA144835 – Smith/Pickhardt • The impact of virtual colonoscopy on CRC screening • Personal health – “Behavior change research” • P50 CA143188 – Fiore • Seizing the EHR to enhance tobacco dependence treatment • Population health – “Epidemiology” • Survey of the Health of Wisconsin – Engelman • K07 CA109361 – Skinner • Molecular markers in pancreatic and colon cancer

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