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Improving Care in a Learning Health Care System

Improving Care in a Learning Health Care System. Richard B. Colletti , MD Vice Chair for Clinical and Research Affairs. Overview. Reliability in health care Application of the Model for Improvement to pediatric IBD ImproveCareNow

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Improving Care in a Learning Health Care System

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  1. Improving Care in a Learning Health Care System Richard B. Colletti, MD Vice Chair for Clinical and Research Affairs

  2. Overview • Reliability in health care • Application of the Model for Improvement to pediatric IBD • ImproveCareNow • Improving care and outcomes for children with Crohn’s disease and ulcerative colitis • Collaborative Chronic Care Network (C3N) • Learning Health Care System

  3. How I did I get to Vancouver?

  4. What was the probability… • that my plane would crash?1 in 1,000,000 (failure rate)Reliability rate: 99.9999% • that my bag would not arrive?1 in 100 (failure rate)Reliability rate: 99% • that my plane would arrive late?1 in 10 or worse (failure rate)Reliability rate: 90%

  5. What is the reliability of medical care? • Patients receive only 60% of recommended care • Patients take only 60% of recommended medications • There is a gap between recommended care and the care actually carried out • If medical care and patient self-management were more reliable, would outcomes be better? 5

  6. Remission rate Centers with >75% enrolled % of patients by disease status 77% 18% 5% ••Inactive•• ••Mild•• ••Moderate-Severe••

  7. How we improve care and outcomes PracticeGuideline • Establish Aims and MeasuresWhat are we trying to accomplish? How would we know if a change is an improvement? • Measure performance • Identify gaps between standard and actual performance • Make changes to close the gaps using tools to increase reliability

  8. 46 Pediatric GI Centers

  9. 14,200 IBD patients 46 centers 425 Ped GI 30%

  10. How many patients in the registry? 8,700 enrolled A gold mine of data for learning 45,000 visits Largest and fastest growing in the world

  11. Data collection and entry • Enroll every patient with inflammatory bowel disease • Enter data for every outpatient visit • 50 to 75 data elements each visit • Manual web-based data entry into registry

  12. 9 process measures: Classification bundle 5 classifications: disease severity, extent, phenotype; nutrition & growth

  13. 6 outcome measures: Remission rate 2007 2010 2011 2008 2009

  14. Data entry Data collection Data storage Patient visit Plan and carry out changes Act Plan Data analysis Report analysis Study Do Reports to sites R.Colletti 2009

  15. MONTHLY KEY MEASURES REPORT

  16. MONTHLY KEY MEASURES REPORT

  17. MONTHLY DATA QUALITY REPORT Control charts and Exceptions Report

  18. Communicate & Collaborate 2007 R.Colletti 2004 19

  19. Communications • Listserv • ImproveCareNow Portal (on-line resource center) • www.ImproveCareNow.org • Weekly Digest • eNewsletter: Circle • Blog: Loop • eNewsletter for practitioners: Scope • Facebook, Twitter, YouTube

  20. Interventions • Registry enrollment and data quality • Model IBD Care guideline • Population management • Care stratification • Pre-visit planning • Self-management support

  21. TWICE-MONTHLY POPULATION MANAGEMENT REPORT

  22. TWICE-MONTHLY POPULATION MANAGEMENT REPORT

  23. Population management: care stratification

  24. COMING SOON: AUTOMATED POPULATION MANAGEMENT & CARE STRATIFICATION

  25. PRE-VISIT PLANNING

  26. COMING SOON: AUTOMATED PRE-VISIT PLANNING

  27. ImproveCareNow Current State: Data Recorded Three Times Encounter Data Entry Abstraction

  28. ImproveCareNow Coming Soon:Data-in-Once, Files Uploaded Analysis QI CER Encounter

  29. C3N ProjectCollaborative Chronic Care Networks • NIH TR01 grant • Transform ImproveCareNow into a C3N • Join patients, parents, clinicians and researchers in a shared collaborative network • Improve clinical practice, patient self-management, and disease outcomes • Innovative prototypes • YouMeIBD.com, Passive PRO app, mentoring program, N of 1 Trials with PRO app, Peer Produced Practice Knowledge, mobile social games • Patient Advisory Council, Parent Working Group, Building Community Leadership, patient platform: create a patient- and family-centered network

  30. Learning Healthcare System “Designed to generate and apply the best evidence for the collaborative choices of each patient and provider; to drive the process of discovery as a natural outgrowth of patient care; and to ensure innovation, quality, safety, and value in health care”

  31. Learning Health Care System • Community • Focus on the outcome • Data-in-once • Quality improvement • Comparative effectiveness • Governance

  32. Using data for research as well as QI: Simulated trial Outcomes ImproveCareNow n=96; REACH n=112 NS NS

  33. Simulated trial with control group

  34. The value equation Value = outcomes cost

  35. Purpose of ImproveCareNow Transformthe health, care and costs for allchildren and adolescents with Crohn’s disease and ulcerative colitis by building a sustainablecollaborative chronic care network, enabling patients, families, clinicians and researchers to work together in a learning health care system to accelerate innovation, discovery and the application of new knowledge. September 2012

  36. https://improvecarenow.org/joinus

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