LSU Health Services Research Program LSU HSRP

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LSU Health Services Research Program(LSU HSRP)

• Ron Horswell, PhD

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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

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LSU HCSD System
LSU Medical Center, Shreveport
E.A. Conway Medical Center, Monroe
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LSU HCSD Disease Management and Population Health
Programs
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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

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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.

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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

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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.

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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.

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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

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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.

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Y-axis Accumulative Average Events per Patient
Average event per patient 413/1883 .22
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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.

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• Relative cost effectiveness a function of
• Cost of BNP
• Cost of Echocardiography
• Prevalence of undiagnosed HF
• Sensitivity of status quo
• Specificity of status quo

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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.

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HEDIS Measure BCS
NOTE Graph shows only providers with 10
recipients. Symbol size
proportional to of recipients.
Green line is State Average
ULM ? College of Pharmacy ? Office of Outcomes
Research Evaluation January 10, 2008
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HEDIS Measure BCS
BCS Breast Cancer Screening measures the
percentage of women 40 - 69 years of age who had
a mammogram to screen for breast cancer.
ULM ? College of Pharmacy ? Office of Outcomes
Research Evaluation January 10, 2008
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HEDIS Measure CDC Eye Exam
NOTE Graph shows only providers with 10
recipients. Symbol size
proportional to of recipients.
Green line is State Average
ULM ? College of Pharmacy ? Office of Outcomes
Research Evaluation January 10, 2008
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HEDIS Measure CDC Eye Exam
CDC Comprehensive Diabetes Care is a set of
measures for members 18-75 years of age with type
1 or type 2 diabetes. The measures include eye
exam, HbA1c, LDL-C and screening for nephropathy.
Each measure is calculated individually.
Presented in this chart is the CDC-Eye Exam
measure.
ULM ? College of Pharmacy ? Office of Outcomes
Research Evaluation January 10, 2008
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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.

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Distribution of Stage at Diagnosis
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Screening and Tumor Stage
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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)

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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.

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Purposeful and Programmatic
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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

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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

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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

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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

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LSU HCSD Screening Colonoscopy Capacity
Requirements
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