beacon ic 3 communities project from theory to practice association of utah diabetes educators...
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Beacon IC3 Communities Project From Theory to Practice
Association of Utah Diabetes EducatorsNovember 4th, 2011
Korey Capozza, M.P.H. andSarah Woolsey, M.D.
Learning Objectives
• Describe the Utah Beacon Communities project
• Review highlights of the Utah Diabetes Practice Recommendations 2011
• Introduce Utah Healthscape • Introduce mobile health tools being
used in the Beacon Communities project
• Demonstrate the benefits of the Utah Clinical Health Information Exchange for care providers and patients
Utah Beacon IC3
Improving Care through Connectivity and Collaboration
• 1/17 in the U.S.• Project Dates: May 2010 –Mar 2013• GOALS: Utilizing technology, improve
health care delivery outcomes while reducing costs
• Targets: Patients with Diabetes Type II in the Salt Lake MSA, Communicable Disease Reporting, End of Life issues
Partners
• UDOH; Public Health, Epidemiology, Diabetes Program, Vital Records
• University of Utah Community Clinics• Utah Health Information Network• Intermountain Healthcare• Utah Medical Association• Commission on Aging in Utah• Community Healthcare Providers
More visits needed
Colwill J M et al. Health Aff 27:w232 (2008)
©2008 by Project HOPE - The People-to-People Health Foundation, Inc.
What is it like in the trenches?
• More visits/Less Time for visits• More diagnoses per patient• More medications prescribed• More preventive services required• More transitions• New Technology does not always “fit”• Patient outcomes not satisfactory
Not just about the technology-Ideal
Trained People, Efficient
Processes and Easy Tools
Data Systems, Structure
d Data
Health Information Exchange
Quality Analysis,
Interventions
Understand
Outcomes, Reassess
$
Not just about the technology-Current State
Informal process, Poor
Training, Digitized
Paper
Paper Based
Systems, Non-
structured Data
Fragmented Health
Information Exchange
Labor Intensive Quality
Analysis, Interventions
Limited Understanding of Outcomes, Labor
Intense Reassessment
Not just about the technology-Ideal
Trained People, Efficient
Processes and Easy Tools
Data Systems, Structure
d Data
Health Information Exchange
Quality Analysis,
Interventions
Understand
Outcomes, Reassess
IC3
Beacon Utah-who we are
Commission on Aging• Using web-based technology to connect patients’
end of life wishes to EMTs, ERs, and hospitalsUtah Health Information Exchange
• With UDOH making easier to report communicable diseases through our electronic records
• Connecting health information for all Utahns and health providers
Intermountain Healthcare• Making the Patient Worksheet available through
Health Information Exchange for DM patientsUniversity of Utah
• Studying effects of patient portal connections and care mangers to improving patient engagement and health
Beacon Utah-who we areClinical Interventions Team
• 62 Primary Care clinics• 330 providers• Potential to impact 50,000
patients with Diabetes• Eye care specialists-in
recruitment• YOU
Aims of the IC3 Beacon Community
• To demonstrate that health IT-enabled quality, cost/efficiency, and population health improvements are possible in diverse communities by 2013.
• To support lasting innovation networks in our community through which a wide range of stakeholders can continue to collaborate, design, and implement new technology-enabled ideas that improve health care beyond 2013.
• To provide lessons, implementation insights, and best practices for other communities eager to improve health, health care, and cost-efficiency in their communities.
Beacon Clinic Intervention QI Process
Select Clinic
Provider Champion
Designate the
clinic QI team
Feedback session,
review clinical data, Set
SMART QI aim
Begin PDSA
cycle with HI support
DATA
IC3 Beacon Community
cHIE
UCIT LearningSessions
Public Health registry
HealthScapewebsite
Other BeaconSites
State, national political arena
Complete assessment with HI
coach
Population Health Improvement Interventions
• Performance feedback to providers• Provider Reminders• Clinical Guideline Use/Dissemination• Patient Reminders• Care Managers• Depression Screening and Treatment• Provider Communication Skill Improvement• Low cost medications/diabetes products• Tailoring care to specific demographics of populations• Patient self-management support
• Diabetes Educator Availability
• Authored by a multidisciplinary panel • Resources for providers and patients• http://
health.utah.gov/diabetes/diabetespracticerecommendations/udpr.htm
Utah Diabetes Practice Recommendations
Diabetes Management for Adults 2011
What’s New in 2011• Diabetes screening protocol
– Clarifies the role of A1C in diagnosis
• Cardiovascular disease– Addresses the controversy concerning ASA
• New insulin protocols for type 2 diabetes• Updated medication summary• New sections
– Depression and vaccinations
• New tools– Active links, referral forms, CKD management,
updated protocols for lipids, extensive references and blood pressure management
Key Treatment Targets
UDPRs, 2011
Initiating a Basal Insulin
Page 12, UDPR for Adults 2011
UDPR Appendices
• Comprehensive foot examination form
• Foot care information for patients
• Medication summaries
• CKD management• Referral form for eye
examination• Tobacco quit line
information
• Healthy eating tips for patients
• Glucose monitoring• State certified self
management programs, topics covered and when to refer patients
• Vaccination guidelines• Diabetes and
depression
Intermountain Diabetes Worksheet
Utah Beacon Consumer Engagement
In the Clinic Outside the Clinic
• A ratio problem: 1% to 99%• How can we support patients beyond the
physician office to improve self care and diabetes management?
“Look, it’s very simple: Lose weight, take your meds, stop smoking, eat right…and try not to be so depressed about it.” Easy, right? Great, see you in six months!
?
Behavior Change: The $3 Trillion Dollar Question
• How can we leverage technology to help patients change behaviors?
• How can we improve health care decision making – from choice of a health plan to daily self-care practices?
Beacon Patient Engagement Tools
• Performance reporting Web site
• Support patient healthcare decision making
• Diabetes tracking Web tools
• Organize, simplify care regimens
• Provide ongoing, data-driven feedback to pt
• Improve self-tracking and focus on improvement
• Smartphone innovations
• Can we make tracking and self management fun???
• Mobile Health
• “Care Manager-lite”• Cost-effective• Address health
disparities
Utah HealthScape
• Patient decisions about health plans and providers impact the care they receive and the system they receive it in
• Goal: To develop a consumer-directed website• Educates consumers about quality variation; Helps
consumers find and demand high quality care• Increases competition, accountability to consumers of
healthcare, and lowers costs• Motivates consumers to advocate for public reporting on
nationally-recognized indicators of quality care
“I need to find a Spanish-speaking doctor in my area.”
“My husband and I work full time. We need an eye clinic with
extended hours.”
Multi-Channel Health Tracker
• A Beacon primary care clinic requested our help in designing an online patient tool to help with self-management
• Health 2.0 invitation to meet with health care technology start-ups
• We met “The Carrot”
Health Tracking Support
EMR Integration
Social Media Component
Integrated “App”
Mobile Phone Tools
• Utah Department of Health Program, co-branded with Utah Beacon
• Studies: Text messaging support can double the quit rate.
• Free and available now to any patient in Utah.
Free C, Knight R, Robertson S, et al. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomized trial.
Lancet 2011;378(9785):49-55.
Text to Quit• Smoking increases the risk for Type 2
diabetes and makes it harder to manage
• Text to Quit = text messaging service that offers patients daily tips to help get through the quitting process
• Used in Utah since 2009• Content developed by New Zealand
government
Text to Quit (cont’d)• Messages both encourage and educate
participants how to manage day-to-day stresses associated with quitting and offers useful tips for avoiding triggers and controlling cravings
• Free and available across cellular networks
• 2 messages per day x 21 days (one way)
• For Beacon partnership, tracking reported outcomes at exit
Your Turn
hLog For Diabetes
hLog For Diabetes
Confidential
How is it Different?• Users cannot track all
metrics from day one
• They have to achieve mastery of simple tracking
• Unlock higher levels to track multiple metrics
• Compete with other diabetics to be on time in tracking and medication
Confidential
Features• Users start with
blood sugar tracking to earn yellow belt
• Consistently track once a day to earn green stripe
• Goal is to reach black belt where they track blood sugar, insulin, carbs and exercise
Confidential
Badges and Milestones• Users earn
badges for continuous tracking
• They can share these on Facebook and Twitter for motivation
• Signing up beta testers: See me if you are interested
Confidential
Rationale
• Diabetes education and care management have been shown to improve patient engagement and self-care activities
• mHealth may be able serve this function at much lower cost, thus increasing access to care management services
• Cluster-Randomized Trial, Mobile Coaching– University of MD, 163 patients, 1 year– Showed 1.9% HbA1c reduction vs 0.7%
in usual control (p>0.001)
C. C. Quinn, M. D. Shardell, M. L. Terrin, E. A. Barr, S. H. Ballew, A. L. Gruber-Baldini. Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control. Diabetes Care, 2011
Care4Life
• Adapted from 2 systems deployed in Mexico
• Interaction is customized and two-way. “Pocket care manager”.
• Developed with content from the National Institutes of Health and the Centers for Disease Control and Prevention
• Testing in 66 Beacon clinics• Implementation and Evaluation Sept.
2011-Dec. 2012• Received IRB approval October 2011• Preparing to sign up clinics in November
2011
Tailored to Individual
Targeted Messages
Targeted Med and App. Reminders
Personal Health Portal
Key Features
Personal Web Portal
Manage Subscriptions
Exercise Progress
Weight Loss Progress
Medication Adherence
Glucose Readings
Medication Reminders
Appointment Reminders
68
a) User can set glucose reminders according to their doctor’s recommendations (i.e. before breakfast daily)
b) System sends glucose reminders & provides immediate feedbackc) User can track all glucose recordings on web portald) System sends education messages & tips
Care4Life | Increase Blood Glucose Monitoring
Care4Life. Reminder: Time to check your BEFORE meal glucose. Reply with your BEFORE meal glucose reading (e.g. 125).
Care4Life. Before meal readings under 70 can be dangerous. Do you know what to do when readings fall below your target? Text LOW for more info
Glucose recordings graph on web portal
Glucose reminder System feedback
Things you can do now
1. Tell your patients about Text to Quit2. Check out www.UtahHealthscape.org3. Tell me if you or someone you know
would like to be a beta tester for hLog4. kcapozza@healthinsight.org5. Attend our Learning Session,
November 10th
Clinical Health Information Exchange (CHIE)
PROVIDERS
• E-prescribe• E-referrals to any other
participating cHIE clinician• Electronically order and
deliver reports• Share with other cHIE
clinicians through the Virtual Health Record (VHR)• Hospital reports• Lab results• Medication histories• Allergies• Clinician documents• Patient Worksheet
PATIENTS• Patient consent required• All or Emergency options• Free• Recommended for
• Chronic Conditions• Multiple medications• Children (vaccination
records)• Anyone
Clinical Health Information Exchange (CHIE)
Data Source(s) General Lab
Micro Reports
Radiology Reports
Transcription Reports
Medication History
Brigham City Community Hospital 10/2010 8/2010 6/2010
Central Utah Clinic 1/2010
Lakeview Hospital 8/2011 2/2011 2/2011
Medicaid 1/2010
Moab Regional Hospital 8/2009
Mountain View Hospital 3/2011 2/2011 2/2011
Ogden Regional Hospital 8/2011 2/2011 2/2011
PAML 5/2011 5/2011
St. Marks Hospital 8/2011 2/2011 2/2011
Timpanogos Hospital 3/2011 2/2011 2/2011
Not just about the technology-Ideal
Trained People, Efficient
Processes and Easy Tools
Data Systems, Structure
d Data
Health Information Exchange
Quality Analysis,
Interventions
Understand
Outcomes, Reassess
Better care for Patients
June 22, 2011
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