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1. LSU Health Services Research Program(LSU HSRP)
Ron Horswell, PhD
2. LSU HSRP Mission: Accelerating translation of evidence into practice, emphasizing topics of importance to the LSU Health Care Services Division (LSU HCSD), a provider system serving low-income, predominantly uninsured patients.
Funded by AHRQ from 2001 to 2006
Original P.I. was Fred Cerise, MD
3. LSU HCSD System
4. LSU HCSD Disease Management and Population Health Programs
5. LSU HSRP Methods and Program Elements (initially):
Recruit (largely clinical faculty) participants
Pair participants with research mentors
Core Program Office
Works in Progress meetings
Affiliated with the Harvard Pediatric Helath Services Research Program
Sharon Muret-Wagstaff, PhD
Donald Goldman, MD
6. LSU HSRP Results (by Sept 2006):
25 projects
$680,000 in additional funding
Published 11 papers, probably approximately 15 by now, with some still in progress.
7. LSU HSRP Core Program Office:
Most successful of the original program elements
Shannon McNabb, MA MPH
Managed IRB relationships
Managed the Works in Progress meeting process
Participated in research oversight committes at HCSD sites
Helped instigate much higher LSU HCSD participation in “external” research
8. Selected Projects DIABETES: Evaluation of a telemedicine diabetes foot program
DIABETES: Barriers to diabetic eye care
DIABETES: Effect of indigent pharmacy medication program
HF: Mortality benefit of a HF disease management program
HF patient registry development
HF: Cost effectiveness of using BNP as a screener for heart failure
HF: Heart failure acute event prediction model
TOBACCO: Survey assessing patterns of tobacco use among HCSD patients
HTN: Hypertension management using group visits
NEONATES: IT network supporting preventive services for at-risk infants
DISPARITIES: Racial disparities and qualify of care in disease management programs.
DISPARITIES: Decomposition of sources of variation in disease management performance measures
CANCER: Comparison of mammography screening levels across three population (Medicare, Medicaid, and the Uninsured.)
CANCER: Relationship of screening mammography to tumor stage at diagnosis
CANCER: Relationship of tumor stage at diagnosis to survival.
9. Selected Projects DIABETES: Evaluation of a telemedicine diabetes foot program
DIABETES: Barriers to diabetic eye care
DIABETES: Effect of indigent pharmacy medication program
HF: Mortality benefit of a HF disease management program
HF patient registry development
HF: Cost effectiveness of using BNP as a screener for heart failure
HF: Heart failure acute event prediction model
TOBACCO: Survey assessing patterns of tobacco use among HCSD patients
HTN: Hypertension management using group visits
NEONATES: IT network supporting preventive services for at-risk infants
DISPARITIES: Racial disparities and qualify of care in disease management programs.
DISPARITIES: Decomposition of sources of variation in disease management performance measures
CANCER: Comparison of mammography screening levels across three population (Medicare, Medicaid, and the Uninsured.)
CANCER: Relationship of screening mammography to tumor stage at diagnosis
CANCER: Relationship of tumor stage at diagnosis to survival.
10. LSU HSRP themes: Disparities and Underserved Patient Groups Conclusions:
“self pay” does worst
small racial disparities on processes
more disparities on outcomes
variation across clinics within sites is greater than variation across sites
focus on patient subgroups with persistent problems
need to get patients to “in-care” status and keep them there
15. Selected Projects DIABETES: Evaluation of a telemedicine diabetes foot program
DIABETES: Barriers to diabetic eye care
DIABETES: Effect of indigent pharmacy medication program
HF: Mortality benefit of a HF disease management program
HF patient registry development
HF: Cost effectiveness of using BNP as a screener for heart failure
HF: Heart failure acute event prediction model
TOBACCO: Survey assessing patterns of tobacco use among HCSD patients
HTN: Hypertension management using group visits
NEONATES: IT network supporting preventive services for at-risk infants
DISPARITIES: Racial disparities and qualify of care in disease management programs.
DISPARITIES: Decomposition of sources of variation in disease management performance measures
CANCER: Comparison of mammography screening levels across three population (Medicare, Medicaid, and the Uninsured.)
CANCER: Relationship of screening mammography to tumor stage at diagnosis
CANCER: Relationship of tumor stage at diagnosis to survival.
18. Selected Projects DIABETES: Evaluation of a telemedicine diabetes foot program
DIABETES: Barriers to diabetic eye care
DIABETES: Effect of indigent pharmacy medication program
HF: Mortality benefit of a HF disease management program
HF patient registry development
HF: Cost effectiveness of using BNP as a screener for heart failure
HF: Heart failure acute event prediction model
TOBACCO: Survey assessing patterns of tobacco use among HCSD patients
HTN: Hypertension management using group visits
NEONATES: IT network supporting preventive services for at-risk infants
DISPARITIES: Racial disparities and qualify of care in disease management programs.
DISPARITIES: Decomposition of sources of variation in disease management performance measures
CANCER: Comparison of mammography screening levels across three population (Medicare, Medicaid, and the Uninsured.)
CANCER: Relationship of screening mammography to tumor stage at diagnosis
CANCER: Relationship of tumor stage at diagnosis to survival.
20. Selected Projects DIABETES: Evaluation of a telemedicine diabetes foot program
DIABETES: Barriers to diabetic eye care
DIABETES: Effect of indigent pharmacy medication program
HF: Mortality benefit of a HF disease management program
HF patient registry development
HF: Cost effectiveness of using BNP as a screener for heart failure
HF: Heart failure acute event prediction model
TOBACCO: Survey assessing patterns of tobacco use among HCSD patients
HTN: Hypertension management using group visits
NEONATES: IT network supporting preventive services for at-risk infants
DISPARITIES: Racial disparities and qualify of care in disease management programs.
DISPARITIES: Decomposition of sources of variation in disease management performance measures
CANCER: Comparison of mammography screening levels across three population (Medicare, Medicaid, and the Uninsured.)
CANCER: Relationship of screening mammography to tumor stage at diagnosis
CANCER: Relationship of tumor stage at diagnosis to survival.
25. Selected Projects DIABETES: Evaluation of a telemedicine diabetes foot program
DIABETES: Barriers to diabetic eye care
DIABETES: Effect of indigent pharmacy medication program
HF: Mortality benefit of a HF disease management program
HF patient registry development
HF: Cost effectiveness of using BNP as a screener for heart failure
HF: Heart failure acute event prediction model
TOBACCO: Survey assessing patterns of tobacco use among HCSD patients
HTN: Hypertension management using group visits
NEONATES: IT network supporting preventive services for at-risk infants
DISPARITIES: Racial disparities and qualify of care in disease management programs.
DISPARITIES: Decomposition of sources of variation in disease management performance measures
CANCER: Comparison of mammography screening levels across three population (Medicare, Medicaid, and the Uninsured.)
CANCER: Relationship of screening mammography to tumor stage at diagnosis
CANCER: Relationship of tumor stage at diagnosis to survival.
26. Distribution of Stage at Diagnosis
28. Screening and Tumor Stage
30. LSU HSRP Our recommendations to the LSU HCSD when the LSU HSRP program concluded:
Maintain Core Office (partially done)
Abandon mentoring concept (done)
Create an analysis department (partially done)
Become programmatic and purposeful (not done)
31. LSU HSRP Observation:
“. . . A distinction exists between:
a research program designed to mentor individual researchers and move them along their career paths, and
a research program designed to address major needs within client organizations’ patient populations.”
32. Purposeful and Programmatic
33. LSU HSRP Our recommendations to the LSU HCSD when the LSU HSRP program concluded:
Maintain Core Office
Abandon mentoring concept
Create an analysis department
Become programmatic and purposeful
Maintain chronic disease patient registries
Systematic analysis to identify sources of variation (potential opportunities)
Create a practice-based research network
Identify patient subgroups with persistent problems and develop interventions
Develop and test means of patient empowerment
34. Practice-based Research Network We suggested:
LSU HSCD “medical home”-like clinics as participants
Both QIPs and research projects
Would provide the platform for mutually beneficial collaboration with other organizations and with various faculty
This would enhance funding prospects
Flow:
Idea
Retrospective
Pilot
Larger project
Funding
35. Reasons for LSU PBRN Tele-monitoring projects
HF patients with history of ED/IP events
Diabetes patients with persistently high HbA1c levels
Medical home development
38. Reasons for LSU PBRN Tele-monitoring projects
HF patients with history of ED/IP events
Diabetes patients with persistently high HbA1c levels
Medical home development
Need to link quality improvement and access improvement to business model
39. LSU HCSD Screening Colonoscopy Capacity Requirements
40. END