Community Conversations Highlights NMF Community Conversations 2010.
Diabetes Interventions: Creating Patient-Centered Conversations
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SE Minnesota Beacon Program Working Together to Improve Health Ca Program Partners: Agilex Technologies; Dodge County & Public Health Department; Fillmore County & Public Health Department; Freeborn County Board & Public Health Department; Goodhue County Board & Public Health Department; Houston County Board & Public Health Department; Mayo Clinic; Mayo Health System [Albert Lea Medical Center, Austin Medical Center, Cannon Falls Medical Center, Cannon Valley Clinic, Fairmont Medical Center, Lake City Medical Center, Owatonna Clinic]; Minnesota Department of Health; Minnesota Counties Computer Cooperative; Mower County Board & Public Health Department; Olmsted County Board & Public Health Department; Olmsted Medical Center& Clinics; Prairie Island Health Services & Prairie Island Clinic; Rochester Veterans Affairs Community-based Outpatient Clinic; Rice County Board & Public Health Department; SE MN Public School Districts; SE MN School Nurse Association; Stratis Health; Steele County Board & Public Health Department; Wabasha County Board & Public Health Department; Winona County Board & Public Health Department; Winona Health Services Prototype: Incorporating the Patient Voice via PROs Background Diabetes Interventions: Creating Patient-Centered Conversations Jeff Sloan, PhD Timothy Beebe, PhD David Eton, PhD Annie LeBlanc, PhD Jennifer Ridgeway, MPP Kari Ruud, MEd Kathleen Yost, PhD Jeanette Y. Ziegenfuss, PhD Victor Montori, MD, MSc PROs as Integrated Vital Signs 2011 Mayo Foundation for Medical Education and Research Background/Need: Diabetes prevalence has been rising in the past few decades due to increasing obesity and population aging. The aim of this project is to have a meaningful impact on care of the diabetic population by incorporating the patient voice as a major driver towards realistic care plans that account for a patient’s reality. Shared Decision Making Intervention Project Overview DA Background Development of Hypertension DA Metabolic parameters (HbA1c, cholesterol, BP) Hard outcomes (e.g., MI) and utilization (e.g., ED visits) Medication use (aspirin, statins, antiBP, antiglu) • Self report (medication reconciliation, prescribed) • Adherence Patient reported outcomes • Quality of life and functional capacity • Burden of treatment Decision making quality • Knowledge transfer (topic dependent) • Quality of deliberation (OPTION, COMRADE, DELIBERATE) • Satisfaction (generic, but less meaningful) Measures of Interest Objective Task #1: Complete formative research: review alternative measurement tools, select core generic and disease-specific tool set, conduct cognitive interviews, finalize tools. Task #2: Develop user interface: review existing structures, devise output formats iteratively, mock output run. Task #3: Develop patient and provider report formats: review existing formats, add/modify report formats. Task #4: Clinical integration feasibility testing: Beta-test of PRO reporting system. Task #5: Design analytic framework (create analysis plans): produce clinical pathway algorithms, dynamic real-time triggers. Task #6: Benchmarking of BEACON population well-being estimates: produce summary system reports of population estimates for BEACON sites. PRO Intervention Project Overview Real-Time Quality of Life (QOL) “What is your single biggest concern right now?” Decision Aids (DA) Systematic review of 55 RCTs of 30 decision aids (DA) Increased patient involvement: RR 1.7 (95% CI 1.3, 2.0) Improved patient knowledge: 15% (95% CI 12, 19) Reduced decisional conflict by 9.3/100 (95% CI 6, 13) Reduced proportion undecided: RR 0.5 (95% 0.3, 0.8) No difference in satisfaction, health outcomes Exchange Deliberate Consensus Objective Provide the means by which patients with type 2 diabetes can tailor their medicines to reduce their risk of heart disease to their context, improving adherence to therapy and cardiovascular risk reduction. Specific Aims Aim #1: Develop and adapt tailored decision aids for diabetes to the EHR environment (eDecision Aids). Task #1: Develop hypertension decision aid Task #2: Adapt Wiser Choices decision aids to the EHR Task #3: Implement measures of interest Aim #2: Assess the impact of implementation of eDecision Aids on diabetes performance measures and patient important outcomes in a multi-center randomized control trial. •Use of eDAs during the clinical encounter vs. usual care •Measure of outcomes at post encounter and at 3, 6, 12 months Wiser Choices Program: Our Work Thus Far 13 decision aids Chronic and acute care Primary care, subspecialty, and ER In/out patient settings Rural and urban communities > 50 sites > 200 clinicians > 600 patients Adaption of eDecision Aids Integrate patient-reported outcomes (PROs) consistently and efficiently into the BEACON network with minimum burden to the patient, clinicians, and affiliated systems to improve clinical outcomes including patient well- being, quality of life and treatment outcomes in primary and secondary care. Chronic conditions account for > 60% of Medicare costs. One in three Americans is at risk of developing diabetes. PRO = Patient-reported outcome QOL = Quality of life
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Jeff Sloan, PhD Timothy Beebe, PhD David Eton, PhD Annie LeBlanc, PhD Jennifer Ridgeway, MPP Kari Ruud, MEd Kathleen Yost, PhD Jeanette Y. Ziegenfuss, PhD Victor Montori, MD, MSc. Diabetes Interventions: Creating Patient-Centered Conversations. Adaption of e Decision Aids. - PowerPoint PPT Presentation
Transcript of Diabetes Interventions: Creating Patient-Centered Conversations
SE Minnesota Beacon ProgramWorking Together to Improve Health CareProgram Partners: Agilex Technologies; Dodge County & Public Health Department; Fillmore County & Public Health Department; Freeborn County Board & Public Health Department; Goodhue County Board & Public Health Department; Houston County Board & Public Health Department; Mayo Clinic; Mayo Health System [Albert Lea Medical Center, Austin Medical Center, Cannon Falls Medical Center, Cannon Valley Clinic, Fairmont Medical Center, Lake City Medical Center, Owatonna Clinic]; Minnesota Department of Health; Minnesota Counties Computer Cooperative; Mower County Board & Public Health Department; Olmsted County Board & Public Health Department; Olmsted Medical Center& Clinics; Prairie Island Health Services & Prairie Island Clinic; Rochester Veterans Affairs Community-based Outpatient Clinic; Rice County Board & Public Health Department; SE MN Public School Districts; SE MN School Nurse Association; Stratis Health; Steele County Board & Public Health Department; Wabasha County Board & Public Health Department; Winona County Board & Public Health Department; Winona Health Services
Prototype: Incorporating the Patient Voice via PROs
Background
Diabetes Interventions: Creating Patient-Centered Conversations
Jeff Sloan, PhD Timothy Beebe, PhD David Eton, PhD Annie LeBlanc, PhD Jennifer Ridgeway, MPP
Kari Ruud, MEd Kathleen Yost, PhD Jeanette Y. Ziegenfuss, PhD Victor Montori, MD, MSc
PROs as Integrated Vital Signs
2011 Mayo Foundation for Medical Education and Research
Background/Need: Diabetes prevalence has been rising in the past few decades due to increasing obesity and population aging. The aim of this project is to have a meaningful impact on care of the diabetic population by incorporating the patient voice as a major driver towards realistic care plans that account for a patient’s reality.
Shared Decision Making InterventionProject Overview
DA Background
Development of Hypertension DA
Metabolic parameters (HbA1c, cholesterol, BP) Hard outcomes (e.g., MI) and utilization (e.g., ED visits) Medication use (aspirin, statins, antiBP, antiglu)
• Self report (medication reconciliation, prescribed) • Adherence
Patient reported outcomes• Quality of life and functional capacity• Burden of treatment
Decision making quality• Knowledge transfer (topic dependent)• Quality of deliberation (OPTION, COMRADE,
DELIBERATE)• Satisfaction (generic, but less meaningful)
Measures of Interest
Objective
Task #1: Complete formative research: review alternative measurement tools, select core generic and disease-specific tool set, conduct cognitive interviews, finalize tools.
Task #2: Develop user interface: review existing structures, devise output formats iteratively, mock output run.
Task #3: Develop patient and provider report formats: review existing formats, add/modify report formats.
Task #4: Clinical integration feasibility testing: Beta-test of PRO reporting system.
Task #5: Design analytic framework (create analysis plans): produce clinical pathway algorithms, dynamic real-time triggers.
Task #6: Benchmarking of BEACON population well-being estimates: produce summary system reports of population estimates for BEACON sites.
PRO Intervention Project Overview
Real-Time Quality of Life (QOL)
“What is your single biggest concern right now?”
Decision Aids (DA)
Systematic review of 55 RCTs of 30 decision aids (DA)
Increased patient involvement: RR 1.7 (95% CI 1.3, 2.0)Improved patient knowledge: 15% (95% CI 12, 19)
Reduced decisional conflict by 9.3/100 (95% CI 6, 13)Reduced proportion undecided: RR 0.5 (95% 0.3, 0.8)
No difference in satisfaction, health outcomes Exchange Deliberate Consensus
Objective
Provide the means by which patients with type 2 diabetes can tailor their medicines to reduce their risk of heart disease to their context, improving adherence to therapy and cardiovascular risk reduction.
Specific Aims
Aim #1: Develop and adapt tailored decision aids for diabetes to the EHR environment (eDecision Aids).
Task #1: Develop hypertension decision aid
Task #2: Adapt Wiser Choices decision aids to the EHR
Task #3: Implement measures of interest
Aim #2: Assess the impact of implementation of eDecision Aids on diabetes performance measures and patient important outcomes in a multi-center randomized control trial.
•Use of eDAs during the clinical encounter vs. usual care
•Measure of outcomes at post encounter and at 3, 6, 12 months
Wiser Choices Program: Our Work Thus Far
13 decision aidsChronic and acute care
Primary care, subspecialty, and ERIn/out patient settings
Rural and urban communities> 50 sites
> 200 clinicians> 600 patients
Adaption of eDecision Aids
Integrate patient-reported outcomes (PROs) consistently and efficiently into the BEACON network with minimum burden to the patient, clinicians, and affiliated systems to improve clinical outcomes including patient well-being, quality of life and treatment outcomes in primary and secondary care.
Chronic conditions account for > 60% of Medicare costs.One in three Americans is at risk of developing diabetes.
PRO = Patient-reported outcome QOL = Quality of life
