1. MBL Biomedical Informatics Spring 2006 Student Presentation

2. Project Staff/ Role … … … … … Shannon Anna Potter, MLIS research and content management 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?). 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. 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] [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 Use informatics to facilitate adaptation of a national guideline for implementation in a community setting One setting per year OR One setting per year OR Same setting but different guidelines for each year Same setting but different guidelines for each year Diabetes Disease Management as the domain for investigating the utility of IT in integrating EBP (guidelines) 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 Add an IT component/product to public health program Have the greatest impact on the quality of life for the underserved Have the greatest impact on the quality of life for the underserved Primary end user is clinician, secondary is community liaisons and patients directly. 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) Funding and support (1mil per yr, 5 yrs) Other existing projects [insert research citations here] Other existing projects [insert research citations here] KNOWLDEGE and COLLABORATION KNOWLDEGE and COLLABORATION Assumptions: guidelines work, an existing successful ph program with community rapport Assumptions: guidelines work, an existing successful ph program with community rapport Barriers: educational, socioeconomic, cultural, and technological disparities and differences 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) 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 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 Target populations with the greatest opportunity for improved health Collaboration Collaboration

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

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

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

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

12. Case or model Should we base this presentation on a specific topic or case? Should we base this presentation on a specific topic or case? Vaccinations programs in poor or specific communities Vaccinations programs in poor or specific communities Screening Screening Diabetes- crosses over many health aspects and cuts across many groups 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 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 Patient education and compliance are essential to successful outcomes Meeting place for telehealth, internet Meeting place for telehealth, internet Communication barriers transversed with IT tools Communication barriers transversed with IT tools Limitations of applying guideline to the health of a community Limitations of applying guideline to the health of a community Internet technology is a good free mode of communication Internet technology is a good free mode of communication

14. Clinicians Getting clinicians on-board Getting clinicians on-board Gaining the trust of their patients Gaining the trust of their patients Training the clinicians who serve rural, underprivileged population Training the clinicians who serve rural, underprivileged population Identify champions 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. 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 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 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 At least one guideline applicable to at least a few populations Domain: United States only Domain: United States only How do we deal with multiple guidelines, make choices about the “best” How do we deal with multiple guidelines, make choices about the “best” Design methodology for comparing recommendations from different groups Design methodology for comparing recommendations from different groups

17. Problems and Assumptions Quality of guidelines vary Quality of guidelines vary Discrepancies in outcome evaluation Discrepancies in outcome evaluation Adoption and compliance Adoption and compliance Ensuring continued funding 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: Patients accessed two ways: 1. EBT Receipt has message about signs/symptoms/ risk of DM from DM guideline. 2. Kiosks in offices (information portals) providing DM education for patients. Patient receives discount coupon to see provider for DM care when accessed either way. Patient receives discount coupon to see provider for DM care when accessed either way. Radio and TV publicize above program 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: Staffing Needs: Program Coordinator Program Coordinator Diabetes Educator(s) Diabetes Educator(s) Telehealth clinicians Telehealth clinicians IT Coordinator IT Coordinator Outcome Measurements: Outcome Measurements: Number of new cases diagnosed in population each year Number of new cases diagnosed in population each year Number of patients maintaining HgA1c every six months Number of patients maintaining HgA1c every six months Mortality stats? Mortality stats?