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Farah Kidwai-Khan, Janet Tate, Cynthia Brandt, Amy Justice

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Presentation on theme: "Farah Kidwai-Khan, Janet Tate, Cynthia Brandt, Amy Justice"— Presentation transcript:

1 VACS e-Health APPLICATIONS  VACS Index Calculator and Timeline Follow back
Farah Kidwai-Khan, Janet Tate, Cynthia Brandt, Amy Justice on behalf of the Veterans Aging Cohort Study (VACS)

2 Veterans Health Administration Data
Largest electronic health record system Healthcare facilities across US 827 VA community-based outpatient clinics 151 VA hospitals 126 VA nursing homes 8.8 million veterans currently enrolled

3 HIV care at the VA VA: largest provider of care for HIV in US
25,000 HIV-infected in care (2012) 48% Black, 40% White, 7% Hispanic 70% over age of 50 years 87% on ART 36% history of AIDS-defining event 1,000 new HIV patients enrolled yearly 44,000 in VA care since 1996 State of Care for Veterans with HIV/AIDS-2011

4 Veterans Aging Cohort Study(VACS)
~50,000 HIV+ matched to ~100,000 HIV- Nested in-depth cohort of >8,000 (half HIV+) ~15 yrs. of longitudinal data on alcohol and MSU Survey sites - electronic baseline (~4000)

5 Informatics at VACS VACS data is rich and heterogeneous
Multiple data sources and analyses repertoire Variety of tools – electronic surveys, NLP initiatives, adjudication websites, chart review interfaces and others

6 VACS Data (1997-Present) VA Data Other Data
Diagnoses US National Death Index VACS Cohort ~50,000 HIV+ ~100,000 HIV- Procedures VA Cancer Registry Pharmacy Medicaid, Medicare Lab Results AUDIT-C MD Notes

7 Two e-Health VACS Projects
VACS Index Calculator – Mobile tool based on the VACS Index and used by providers, patients and researchers Timeline Follow back – Web based too used by patients to recall their alcohol consumption

8 Application 1 VACS Index Calculator

9 What is the VACS Index? A scoring system for predicting mortality in patients in treatment for 1 + years Responsive to treatment Responsive to differences in treatment

10 What is the VACS Index? Predicts other clinical outcomes -
Cognitive performance Fragility fracture Cardiovascular mortality Functional performance Hospitalization and MICU admission

11 What is the VACS Index? Correlated with biomarkers of inflammation
Responds to changes in physiologic status Example: ART initiation 3-5 point higher score in current vs former smokers

12 VACS Index Calculator Provides an Interface to the VACS Index
Used as a patient management tool in several EHR based health systems Promotes behavior change and prioritizing treatment Informs decision making for clinical management

13 VACS Index Calculator Mobile version Standard PC version

14 https://vacs-apps2.med.yale.edu/calculator
VACS Index Calculator

15 Usage statistics Total First Time Visitors over 6 months 277
Hits Since Opening (6/1/12) 77,722 Total First Time Visitors 6,056

16 Application 2 Timeline Follow back

17 Timeline Follow back (TLFB)
Gold standard to assess self reported alcohol consumption Calendar based method to collect data on self reported behaviors Widely used as a clinical & research tool

18 VACS Electronic surveys
9 VACS SITES Bronx Houston E-Survey + Web based Timeline Follow back Washington DC Pittsburgh Baltimore Atlanta Brooklyn Los Angeles Dallas

19 VACS Electronic surveys
Behaviors Alcohol, tobacco and drug use Risky sex Standard measures Depression SF12 Functional status and pain Other Homelessness, incarceration Education, marital status

20 VACS Timeline Follow back (TLFB)
Paper version was not a viable option Electronic versions were not database friendly No readily available “off the shelf” product Feasibility assessment for custom product Develop a generalizable web based tool

21 VACS Timeline Follow back

22 VACS Timeline Follow back

23 VACS Timeline Follow back

24 VACS Timeline Follow back
Usability testing with VACS site coordinators Phase 1 data analysis Phase 2 roll out – Improved usability and data integrity

25 VACS Timeline Follow back
Data snapshot Quantity of consumption What was consumed Date of consumption Additional comments studyid,substance,quantity,start,end,Completion_Date 110909,Prescription Pills,2, , 110386,1 Beer, ,1, , , 110920,2 Wine, ,2, , , 110920,1 Wine, ,1, , , 110920,1 Wine, ,1, , ,

26 Timeline Follow back (TLFB)
Future goals – Explore use as an intervention tool Data analysis to compare to older paper based methods Use programming to create a mobile app as an intervention tool

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