This document summarizes plans to implement SBIRT (Screening, Brief Intervention, and Referral to Treatment) screening for risky alcohol and substance use at Kaiser Permanente Colorado (KPCO). It describes two pilot programs - the first involved stakeholder input and the second aims to implement SBIRT at one clinic. Challenges include engaging busy providers, developing workflows, and integrating SBIRT into existing initiatives and roles. Evaluation of the second pilot will assess screening rates and compare outcomes between clinics with and without behavioral health support. Addressing stakeholder concerns is key to successful implementation.
SBIRT and SAMHSA's 8 Strategic Initiativessideponytail
Slides from a webinar held by the National SBIRT ATTC. Video is on TheIRETAChannel on Youtube: http://www.youtube.com/watch?v=f6NrKuGlGRs&feature=share&list=PLiML4AFpuB72LBaPShcu2yQv_WpsGY9a9
Geriatric care managers are professionals who help families caring for older relatives. They are trained in fields like nursing, social work, and psychology with a focus on aging. A comprehensive assessment evaluates areas like cognition, medical history, functioning, and finances to develop a care plan. Care managers provide services like care planning, placement assistance, counseling, education, and advocacy. They can help determine if a family is at high risk of struggles from issues like caregiver stress, denial, finances, or lack of information. Placement in options like assisted living or nursing homes depends on abilities and medical needs. Understanding payer sources like Medicaid is also important.
The document discusses unleashing dynamism in healthcare through integrated care. It describes Trafford's principles of integrated care, which focus on general practice as the locus of integration and involving social care. Clinical panels are discussed as a way to build relationships between primary and secondary care clinicians around patient care. Shared information and risk stratification of patients are presented as ways to support integrated care. Program management, communication, and addressing unscheduled care are also discussed as important elements of unleashing dynamism.
Identify 3 to 5 terms used in conjunction with the MDS 3.0 and how they can be used in care planning.
Define the expectations of person centered care planning.
Identify the seven components of the care plan and at least one key factor of each as it relates to RAI expectations.
Determine the three primary content areas to be considered in care planning
The document discusses advance care planning (ACP), which involves discussing future medical care preferences with health providers. Key points include:
- ACP is a voluntary process that considers a person's values and wishes for end-of-life care if they become unable to communicate themselves.
- Discussing future care preferences can align treatment with a person's goals and values and may reduce family stress after death.
- Valid advance decisions to refuse treatment must be in writing, signed, and witnessed to be legally binding if a person loses capacity.
This document discusses integrating behavioral health services into the medical continuum. It proposes embedding behavioral health specialists called "hybrid clinicians" throughout the healthcare system. These clinicians would be trained to work across different care settings from primary care to specialty and hospital care. The goal is to synchronize behavioral health treatment across the medical continuum by having specialists meet patients' needs wherever they interface with the healthcare system, with the aim of improving outcomes and reducing costs. Barriers to integration like regulations, financing and buy-in are addressed through strategies like champion identification, hybrid clinician training, and an emphasis on an organic system rather than new standalone services.
This document provides information about a webinar on treating mental health issues in long-term care facilities. The webinar will discuss the unique characteristics of the long-term care environment and challenges in treating older adults with acute mental health issues. It will also cover issues around diagnoses, behaviors, and insurance coverage for psychiatric hospitalization of older patients. The document also outlines recommendations for protocols to improve cooperation between long-term care facilities and community mental health agencies before, during, and after a psychiatric crisis occurs with a resident.
SBIRT and SAMHSA's 8 Strategic Initiativessideponytail
Slides from a webinar held by the National SBIRT ATTC. Video is on TheIRETAChannel on Youtube: http://www.youtube.com/watch?v=f6NrKuGlGRs&feature=share&list=PLiML4AFpuB72LBaPShcu2yQv_WpsGY9a9
Geriatric care managers are professionals who help families caring for older relatives. They are trained in fields like nursing, social work, and psychology with a focus on aging. A comprehensive assessment evaluates areas like cognition, medical history, functioning, and finances to develop a care plan. Care managers provide services like care planning, placement assistance, counseling, education, and advocacy. They can help determine if a family is at high risk of struggles from issues like caregiver stress, denial, finances, or lack of information. Placement in options like assisted living or nursing homes depends on abilities and medical needs. Understanding payer sources like Medicaid is also important.
The document discusses unleashing dynamism in healthcare through integrated care. It describes Trafford's principles of integrated care, which focus on general practice as the locus of integration and involving social care. Clinical panels are discussed as a way to build relationships between primary and secondary care clinicians around patient care. Shared information and risk stratification of patients are presented as ways to support integrated care. Program management, communication, and addressing unscheduled care are also discussed as important elements of unleashing dynamism.
Identify 3 to 5 terms used in conjunction with the MDS 3.0 and how they can be used in care planning.
Define the expectations of person centered care planning.
Identify the seven components of the care plan and at least one key factor of each as it relates to RAI expectations.
Determine the three primary content areas to be considered in care planning
The document discusses advance care planning (ACP), which involves discussing future medical care preferences with health providers. Key points include:
- ACP is a voluntary process that considers a person's values and wishes for end-of-life care if they become unable to communicate themselves.
- Discussing future care preferences can align treatment with a person's goals and values and may reduce family stress after death.
- Valid advance decisions to refuse treatment must be in writing, signed, and witnessed to be legally binding if a person loses capacity.
This document discusses integrating behavioral health services into the medical continuum. It proposes embedding behavioral health specialists called "hybrid clinicians" throughout the healthcare system. These clinicians would be trained to work across different care settings from primary care to specialty and hospital care. The goal is to synchronize behavioral health treatment across the medical continuum by having specialists meet patients' needs wherever they interface with the healthcare system, with the aim of improving outcomes and reducing costs. Barriers to integration like regulations, financing and buy-in are addressed through strategies like champion identification, hybrid clinician training, and an emphasis on an organic system rather than new standalone services.
This document provides information about a webinar on treating mental health issues in long-term care facilities. The webinar will discuss the unique characteristics of the long-term care environment and challenges in treating older adults with acute mental health issues. It will also cover issues around diagnoses, behaviors, and insurance coverage for psychiatric hospitalization of older patients. The document also outlines recommendations for protocols to improve cooperation between long-term care facilities and community mental health agencies before, during, and after a psychiatric crisis occurs with a resident.
What We're Working On Now: Getting the "System" to be a Real System for Heart...3GDR
The document discusses the efforts of Partners HealthCare to create an integrated system for managing heart failure patients. It outlines several components of the heart failure program including enrollment numbers in remote monitoring programs over time, readmission outcomes, and an overview of the heart failure population within Partners. It also discusses challenges in patient identification, engagement, determining the most effective care delivery approach, managing patients efficiently across different care settings and providers, and integrating different systems and communications channels.
BrightStar offers private duty home care programs like HANDS and Clinical Pathways to reduce hospital readmissions and improve quality of life. HANDS provides home care after discharge to address issues that arise. Clinical Pathways is a condition-specific, transitional care program focused on reducing negative outcomes and optimizing quality of life through RN visits, education, and monitoring. These programs aim to address the top reasons for readmissions like medication management and lack of home support. They utilize technology, evidence-based practices, and specially trained staff to benefit patients, healthcare systems, and providers through better outcomes and efficiencies.
The DSM-5: A Postmodern Re-Vision for Counseling (PowerPoint)Jeffrey Guterman
PowerPoint for Education Session, "The DSM-5: A Postmodern Re-Vision for Counseling" presented by Jeffrey Guterman Ph.D. and Clayton V. Martin, M.S. at the American Counseling Association's 2014 Conference & Exposition, Orlando on March 15, 2015. More information: http://jeffreyguterman.com/dsm2015.html
The future of market access – the local picture PM Society
David Thorne, CEO of Newcastle West CCG, discussed the challenges and opportunities for clinical commissioning groups in shaping local healthcare. He outlined the CCG's responsibilities to identify local health needs, meet national priorities, commission services through performance-managed contracts, and maintain budgets and public confidence in the NHS. Thorne also described Newcastle West CCG's population as aging with high dependency on benefits and life expectancies comparable to developing nations. Key health issues included cancers, heart disease, and COPD. The presentation emphasized using local data and engaging with patients, providers and other stakeholders to design effective local care pathways.
Introduction to Competency-based Medical EducationImad Hassan
This document discusses competency-based medical education (CBME) and key related concepts. It provides an overview of CBME, defining it as an outcomes-based approach using a framework of competencies. Key terms are defined, including competence, competency, and competent. The importance of entrustable professional activities (EPAs) and milestones in assessing competencies is described. The relationship between competencies, EPAs, and milestones is explained. An example case scenario is provided to illustrate how these concepts integrate in clinical practice.
This document outlines an initiative by the Michigan Primary Care Association (MPCA) to help health centers achieve Patient-Centered Medical Home (PCMH) recognition and meet Meaningful Use (MU) requirements through a 12-month learning collaborative program led by national experts at the Primary Care Development Corporation (PCDC). The goals of the program are to help health centers submit for NCQA PCMH recognition, attest to MU objectives to receive incentive payments, and identify future improvement areas. Health centers will receive guidance, tools, resources and consultations to achieve these goals in a cost-effective way through a collaborative learning approach.
MS Trust annual conference welcome, Amy BowenMS Trust
The document summarizes several government initiatives relevant to multiple sclerosis (MS) in the UK, including the Department of Health Risk Sharing Scheme. It provides details on the scheme's basic principles, timetable, benefits for people with MS and MS services, and current developments. It also reviews evidence on the impact and value of MS specialist nurses and introduces the GEMSS project, which aims to evaluate four MS nurse services over one year to demonstrate their value through organized data collection and reporting.
Pre-admission Screening of Older Adults with Cognitive Impairment: Considerat...wef
Presentation made by Elizabeth Kirkland and Amy S. Powell on the 17th of May 2012 (event supported by the Virginia Center on Aging's GTE Initiative). All rights reserved.
This document discusses the PTRS (Probability of Technical and Regulatory Success) risk assessment process used to evaluate projects in a pharmaceutical portfolio. It provides examples of how risk is assessed at different phases of development and how that informs the likelihood of success and expected value. Key aspects of the process include identifying development risks, mitigation strategies, determining the probability of progressing through each phase given risks, and the probability of regulatory approval. Qualitative and quantitative factors are considered. The goal is not to derive an exact probability but have discussions to understand risks and make informed decisions.
The document summarizes a webinar presentation on discharge follow-up appointments and care transitions. It provides an overview of the Office of the National Coordinator's i2 program which aims to spur innovation and highlight excellence. It then discusses the problem of care transitions and the opportunity to improve follow-up appointments. The document outlines elements of high-quality transitions and impacts on patients. It introduces the Critical Transitions Challenge to create a tool to improve post-discharge scheduling. It provides details on the challenge including desired tool components, pilot planning advice, and judging criteria.
This document provides an overview and agenda for a training on screening and assessment of clients with co-occurring disorders. The training will be delivered in 5 modules over several sessions and aim to teach clinicians how to conduct a thorough 12-step screening and assessment process using the GAIN-SS tool. The training facilitator emphasizes the importance of engaging participants as adult learners and addressing any resistance to change. Resource materials are included to support the training content.
Behavioral health integration (va 12 14-12)cobalttx
The document discusses a web-based platform that provides cognitive behavioral therapy programs for various behavioral health conditions like anxiety, insomnia, depression, and substance use through interactive online modules with clinician support, highlighting the programs' efficacy, security, and ability to improve access and efficiency of care delivery compared to traditional face-to-face therapy.
This document summarizes guidance on improving polypharmacy and mindful prescribing through multidisciplinary collaboration. Key points include:
1) Rates of multimorbidity and polypharmacy are projected to rise significantly in Scotland, increasing costs and risks.
2) A multidisciplinary model is proposed involving health boards, clinicians, pharmacists, patients, and decision support tools to conduct regular medication reviews targeting high-risk patients.
3) The goal is to improve understanding of medications, discontinue those no longer valid or causing harm, and sustain safe, effective, and person-centered care associated with medicines through a multi-professional approach.
Case Study "Dignity Health: Implementation of an EHR Alliance Bridging Acute and Ambulatory Care"
This session will provide a unique learning opportunity focusing on the Dignity Health $1.8B implementation program to meet horizon 2020 as we transform healthcare. The initiative encompassed a 42 hospital health IT implementation in the acute care setting. Mr. Lowe will also review the challenges associated with governance and review lessons Learned from the project.
Learning Objectives:
∙ Key implementation points
∙ Integration with Ambulatory strategies for a full market approach
∙ What’s next – business intelligence
This document discusses several initiatives relevant to multiple sclerosis (MS) in the UK, including:
- The Department of Health Risk Sharing Scheme which provides access to disease-modifying therapies on the NHS and has shown positive results in clinical trials.
- Current developments in MS-related UK policy including guidelines under review and technology appraisals by NICE.
- Evidence that MS specialist nurses improve outcomes, provide complex care, and reduce costs through activities like avoided hospitalizations. However, they struggle to demonstrate their value to managers and commissioners.
- Challenges nurses face in justifying their roles and services as the NHS aims to make 4% annual efficiency savings through job cuts and other measures
The document discusses the role of a patient coordinator in a dental practice. A patient coordinator can enhance patient communication and experience. They help exceed patient expectations by communicating treatment plans clearly, discussing financial options, and following up with patients after their initial consultation. Key responsibilities of a patient coordinator include communicating effectively with patients, delivering excellent customer service, discussing treatment and financial options, and helping patients decide on and commit to a treatment plan. Hiring a patient coordinator or training an existing staff member can improve practice communication, increase treatment uptake, and boost business outcomes.
Learn From the Experts: Critical Elements of Effective Environmental PoliciesEDR
With scrutiny on lenders’ risk management policies intensifying, more and more community banks are writing their first policies or updating old ones. The OCC just raised the bar for the banks it regulates with the August release of expanded guidelines for environmental risk management that bring their policy requirements in line with those of the FDIC. What are the critical components that should be in every policy? What elements are common to most institution’s policies? How does your institution measure up to industry best practices? How is policy administered across organizations?
Join us for this webinar as seasoned insiders selected from the ranks of a mid-sized bank and small community lender share their experiences in writing and updating environmental policies. Learn what these experts are doing to protect their institutions from environmental risk exposure, and the dangers that lenders face by not have adequate policies in place to protect them from financial and legal liability.
Tuesday, October 29, 2013
2pm EST
75 minutes
Presented by:
Georgina Dannatt
VP, Environmental Risk Manager
Bank of the West
Brian A. Ginter, VP & CCIM
Appraisal/Environmental Group
Burke & Herbert Bank
Larry Schnapf, Attorney, Schnapf Law
New Rules Dealing with Conflicts of Interest in Public Health Service Funded ...HMO Research Network
The new federal regulations regarding financial conflicts of interest in research expand disclosure requirements for researchers. Key differences from the 1995 regulations include lowering the financial disclosure threshold, requiring disclosure of all reimbursed travel, and mandating public access to conflict of interest information. Institutions must now determine if researchers' financial interests constitute actual conflicts and develop management plans if needed. Complying with the new rules requires informing stakeholders, revising policies and procedures, and addressing implementation challenges around identifying researchers, assessing financial interest relationships to research, and policy infrastructure.
The document discusses the mission and goals of the Patient-Centered Outcomes Research Institute (PCORI). PCORI was established through the Affordable Care Act to help patients make informed healthcare decisions through comparative clinical effectiveness research. The organization aims to produce high-quality evidence by involving patients and caregivers throughout the research process, from developing research questions to disseminating results. PCORI also seeks to address treatment heterogeneity and improve outcomes for various patient subgroups through its research.
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What We're Working On Now: Getting the "System" to be a Real System for Heart...3GDR
The document discusses the efforts of Partners HealthCare to create an integrated system for managing heart failure patients. It outlines several components of the heart failure program including enrollment numbers in remote monitoring programs over time, readmission outcomes, and an overview of the heart failure population within Partners. It also discusses challenges in patient identification, engagement, determining the most effective care delivery approach, managing patients efficiently across different care settings and providers, and integrating different systems and communications channels.
BrightStar offers private duty home care programs like HANDS and Clinical Pathways to reduce hospital readmissions and improve quality of life. HANDS provides home care after discharge to address issues that arise. Clinical Pathways is a condition-specific, transitional care program focused on reducing negative outcomes and optimizing quality of life through RN visits, education, and monitoring. These programs aim to address the top reasons for readmissions like medication management and lack of home support. They utilize technology, evidence-based practices, and specially trained staff to benefit patients, healthcare systems, and providers through better outcomes and efficiencies.
The DSM-5: A Postmodern Re-Vision for Counseling (PowerPoint)Jeffrey Guterman
PowerPoint for Education Session, "The DSM-5: A Postmodern Re-Vision for Counseling" presented by Jeffrey Guterman Ph.D. and Clayton V. Martin, M.S. at the American Counseling Association's 2014 Conference & Exposition, Orlando on March 15, 2015. More information: http://jeffreyguterman.com/dsm2015.html
The future of market access – the local picture PM Society
David Thorne, CEO of Newcastle West CCG, discussed the challenges and opportunities for clinical commissioning groups in shaping local healthcare. He outlined the CCG's responsibilities to identify local health needs, meet national priorities, commission services through performance-managed contracts, and maintain budgets and public confidence in the NHS. Thorne also described Newcastle West CCG's population as aging with high dependency on benefits and life expectancies comparable to developing nations. Key health issues included cancers, heart disease, and COPD. The presentation emphasized using local data and engaging with patients, providers and other stakeholders to design effective local care pathways.
Introduction to Competency-based Medical EducationImad Hassan
This document discusses competency-based medical education (CBME) and key related concepts. It provides an overview of CBME, defining it as an outcomes-based approach using a framework of competencies. Key terms are defined, including competence, competency, and competent. The importance of entrustable professional activities (EPAs) and milestones in assessing competencies is described. The relationship between competencies, EPAs, and milestones is explained. An example case scenario is provided to illustrate how these concepts integrate in clinical practice.
This document outlines an initiative by the Michigan Primary Care Association (MPCA) to help health centers achieve Patient-Centered Medical Home (PCMH) recognition and meet Meaningful Use (MU) requirements through a 12-month learning collaborative program led by national experts at the Primary Care Development Corporation (PCDC). The goals of the program are to help health centers submit for NCQA PCMH recognition, attest to MU objectives to receive incentive payments, and identify future improvement areas. Health centers will receive guidance, tools, resources and consultations to achieve these goals in a cost-effective way through a collaborative learning approach.
MS Trust annual conference welcome, Amy BowenMS Trust
The document summarizes several government initiatives relevant to multiple sclerosis (MS) in the UK, including the Department of Health Risk Sharing Scheme. It provides details on the scheme's basic principles, timetable, benefits for people with MS and MS services, and current developments. It also reviews evidence on the impact and value of MS specialist nurses and introduces the GEMSS project, which aims to evaluate four MS nurse services over one year to demonstrate their value through organized data collection and reporting.
Pre-admission Screening of Older Adults with Cognitive Impairment: Considerat...wef
Presentation made by Elizabeth Kirkland and Amy S. Powell on the 17th of May 2012 (event supported by the Virginia Center on Aging's GTE Initiative). All rights reserved.
This document discusses the PTRS (Probability of Technical and Regulatory Success) risk assessment process used to evaluate projects in a pharmaceutical portfolio. It provides examples of how risk is assessed at different phases of development and how that informs the likelihood of success and expected value. Key aspects of the process include identifying development risks, mitigation strategies, determining the probability of progressing through each phase given risks, and the probability of regulatory approval. Qualitative and quantitative factors are considered. The goal is not to derive an exact probability but have discussions to understand risks and make informed decisions.
The document summarizes a webinar presentation on discharge follow-up appointments and care transitions. It provides an overview of the Office of the National Coordinator's i2 program which aims to spur innovation and highlight excellence. It then discusses the problem of care transitions and the opportunity to improve follow-up appointments. The document outlines elements of high-quality transitions and impacts on patients. It introduces the Critical Transitions Challenge to create a tool to improve post-discharge scheduling. It provides details on the challenge including desired tool components, pilot planning advice, and judging criteria.
This document provides an overview and agenda for a training on screening and assessment of clients with co-occurring disorders. The training will be delivered in 5 modules over several sessions and aim to teach clinicians how to conduct a thorough 12-step screening and assessment process using the GAIN-SS tool. The training facilitator emphasizes the importance of engaging participants as adult learners and addressing any resistance to change. Resource materials are included to support the training content.
Behavioral health integration (va 12 14-12)cobalttx
The document discusses a web-based platform that provides cognitive behavioral therapy programs for various behavioral health conditions like anxiety, insomnia, depression, and substance use through interactive online modules with clinician support, highlighting the programs' efficacy, security, and ability to improve access and efficiency of care delivery compared to traditional face-to-face therapy.
This document summarizes guidance on improving polypharmacy and mindful prescribing through multidisciplinary collaboration. Key points include:
1) Rates of multimorbidity and polypharmacy are projected to rise significantly in Scotland, increasing costs and risks.
2) A multidisciplinary model is proposed involving health boards, clinicians, pharmacists, patients, and decision support tools to conduct regular medication reviews targeting high-risk patients.
3) The goal is to improve understanding of medications, discontinue those no longer valid or causing harm, and sustain safe, effective, and person-centered care associated with medicines through a multi-professional approach.
Case Study "Dignity Health: Implementation of an EHR Alliance Bridging Acute and Ambulatory Care"
This session will provide a unique learning opportunity focusing on the Dignity Health $1.8B implementation program to meet horizon 2020 as we transform healthcare. The initiative encompassed a 42 hospital health IT implementation in the acute care setting. Mr. Lowe will also review the challenges associated with governance and review lessons Learned from the project.
Learning Objectives:
∙ Key implementation points
∙ Integration with Ambulatory strategies for a full market approach
∙ What’s next – business intelligence
This document discusses several initiatives relevant to multiple sclerosis (MS) in the UK, including:
- The Department of Health Risk Sharing Scheme which provides access to disease-modifying therapies on the NHS and has shown positive results in clinical trials.
- Current developments in MS-related UK policy including guidelines under review and technology appraisals by NICE.
- Evidence that MS specialist nurses improve outcomes, provide complex care, and reduce costs through activities like avoided hospitalizations. However, they struggle to demonstrate their value to managers and commissioners.
- Challenges nurses face in justifying their roles and services as the NHS aims to make 4% annual efficiency savings through job cuts and other measures
The document discusses the role of a patient coordinator in a dental practice. A patient coordinator can enhance patient communication and experience. They help exceed patient expectations by communicating treatment plans clearly, discussing financial options, and following up with patients after their initial consultation. Key responsibilities of a patient coordinator include communicating effectively with patients, delivering excellent customer service, discussing treatment and financial options, and helping patients decide on and commit to a treatment plan. Hiring a patient coordinator or training an existing staff member can improve practice communication, increase treatment uptake, and boost business outcomes.
Learn From the Experts: Critical Elements of Effective Environmental PoliciesEDR
With scrutiny on lenders’ risk management policies intensifying, more and more community banks are writing their first policies or updating old ones. The OCC just raised the bar for the banks it regulates with the August release of expanded guidelines for environmental risk management that bring their policy requirements in line with those of the FDIC. What are the critical components that should be in every policy? What elements are common to most institution’s policies? How does your institution measure up to industry best practices? How is policy administered across organizations?
Join us for this webinar as seasoned insiders selected from the ranks of a mid-sized bank and small community lender share their experiences in writing and updating environmental policies. Learn what these experts are doing to protect their institutions from environmental risk exposure, and the dangers that lenders face by not have adequate policies in place to protect them from financial and legal liability.
Tuesday, October 29, 2013
2pm EST
75 minutes
Presented by:
Georgina Dannatt
VP, Environmental Risk Manager
Bank of the West
Brian A. Ginter, VP & CCIM
Appraisal/Environmental Group
Burke & Herbert Bank
Larry Schnapf, Attorney, Schnapf Law
New Rules Dealing with Conflicts of Interest in Public Health Service Funded ...HMO Research Network
The new federal regulations regarding financial conflicts of interest in research expand disclosure requirements for researchers. Key differences from the 1995 regulations include lowering the financial disclosure threshold, requiring disclosure of all reimbursed travel, and mandating public access to conflict of interest information. Institutions must now determine if researchers' financial interests constitute actual conflicts and develop management plans if needed. Complying with the new rules requires informing stakeholders, revising policies and procedures, and addressing implementation challenges around identifying researchers, assessing financial interest relationships to research, and policy infrastructure.
The document discusses the mission and goals of the Patient-Centered Outcomes Research Institute (PCORI). PCORI was established through the Affordable Care Act to help patients make informed healthcare decisions through comparative clinical effectiveness research. The organization aims to produce high-quality evidence by involving patients and caregivers throughout the research process, from developing research questions to disseminating results. PCORI also seeks to address treatment heterogeneity and improve outcomes for various patient subgroups through its research.
Evaluation of the Validity of the Gestational Length Assumptions Based Upon A...HMO Research Network
The study evaluated the validity of an algorithm to estimate gestational length and determine prenatal medication exposure based on electronic health plan data. The algorithm underestimated gestational length by an average of 5.5 days and underestimated the prevalence of preterm births compared to measures from linked birth certificates. The algorithm correctly classified exposure status for most women taking antidepressants but had poorer performance for antibiotics due to their sporadic use. While the algorithm provided reasonable estimates, its accuracy may vary for other medications beyond the two antidepressants and two antibiotics evaluated in this study.
Comparative Safety of Infliximaband Etanercept on the Risk of Serious Infecti...HMO Research Network
This study assessed whether the relative risk of serious infections from infliximab versus etanercept varies by patient characteristics. The study used data from a large US claims database to compare rates of serious infection requiring hospitalization in patients initiating infliximab or etanercept. Cox models adjusting for potential confounders were used to estimate hazard ratios for serious infection associated with each treatment overall and stratified by age, sex, race, BMI, and smoking status. The results suggested the increased risk of serious infection with infliximab compared to etanercept may be modified by age, with a higher risk seen only in patients under 65, but not other characteristics examined. Limitations included potential residual confounding and exposure
A Multi State Markov Model for Analyzing Patterns of Use of Opiod Treatments ...HMO Research Network
This document describes a study that used a multi-state Markov model to analyze patterns of use of three opioid dependence treatments: methadone, buprenorphine, and other drug-free outpatient treatments. The study followed 30,080 Medicaid patients diagnosed with opioid dependence from 2003 to 2007. The model estimated transition probabilities between the three treatment states and discontinuation over time. Results found the probability of discontinuing methadone treatment was 20% after 6 months, while survival probabilities on each treatment after 30 months were 30% for methadone, 9% for buprenorphine, and 5% for other treatments. The study concluded multi-state Markov models are useful for investigating treatment switching and compliance over long
A Descriptive Study of Vaccinations Occuring During Pregnancy HENNINGERHMO Research Network
This study analyzed vaccination rates during pregnancy within the Vaccine Safety Datalink population between 2002-2006. It found that the influenza vaccine was the most commonly administered vaccine as recommended, with a rate of 98 doses per 1,000 pregnancies. Vaccines considered conditionally recommended if otherwise indicated, such as tetanus and hepatitis B, were administered at lower rates. Some contraindicated vaccines like MMR and varicella were also administered, more often in the first trimester likely due to initial unawareness of pregnancy. The study concludes clearer recommendations and provider education could help reduce unintended vaccination during pregnancy.
The Use of Administrative Data and Natural Language Processing to Estimate th...HMO Research Network
This study aimed to evaluate the use of administrative data to identify cases of statin-related rhabdomyolysis and determine the risk associated with high-dose simvastatin use. The researchers identified 29 validated cases of rhabdomyolysis among statin users using multiple methods including ICD-9 codes, lab data, and natural language processing of medical records. They found a higher incidence with simvastatin use, especially doses of 80mg or more daily, compared to other statins. While administrative data can provide estimates of rare adverse events, medical record review is still needed to validate potential cases.
Patient Views of KRAS Testing for Treatment of Metastatic Colorectal Cancer L...HMO Research Network
This document summarizes findings from a study examining patient understanding of KRAS testing and its relationship to treatment decisions for metastatic colorectal cancer (mCRC). Most participants did not recall having the KRAS test but generally had positive views of genetic testing. While the KRAS test provided guidance on anti-EGFR therapy eligibility, imaging scans and physicians' treatment recommendations seemed more salient to patients' experiences. Patients prioritized physician expertise over test results and preferred physicians make treatment decisions.
Comparative Effectiveness of Chemotherapy Regimens for Advanced Lung Cancer C...HMO Research Network
1) The study examined the comparative effectiveness of chemotherapy regimens for advanced lung cancer patients in terms of survival, number of hospitalizations, and total hospital days.
2) It found that patients receiving triplet therapy (combination of 3 drugs) had longer survival and fewer hospitalizations and hospital days than those receiving doublet (2 drugs) or singlet (1 drug) therapies.
3) The distribution of chemotherapy regimens changed over time, with more patients receiving triplet and targeted therapies like erlotinib in later years, which may impact future comparative effectiveness findings.
CER HUB An Informatics Platform for Conducting Compartive Effectiveness with ...HMO Research Network
The document describes the CER Hub, an informatics platform for conducting comparative effectiveness research using electronic medical record data. The CER Hub allows researchers to develop standardized processors to generate research datasets from heterogeneous EMR systems. It facilitates collaborative projects to address questions like evaluating asthma control and smoking cessation treatments. Initial projects through the CER Hub involve developing measures of asthma control and comparing the effectiveness of treatment intensification options using EMR data from six health systems.
This study applied doubly robust estimation to assess the causal effect of angiotensin converting enzyme inhibitors (ACEIs) versus angiotensin receptor blockers (ARBs) on follow-up hemoglobin (Hgb) levels. The study found evidence of confounding factors like heart failure status and sex that differed between treatment groups and affected Hgb levels. Doubly robust estimation was used to estimate average causal effects while addressing confounding. The results suggested that average follow-up Hgb levels may be higher when ARBs rather than ACEIs are prescribed, though the mean difference was small and not clearly clinically significant. Further analysis was recommended to refine the models.
Risk Factors for Short Term Virologic Outcomes Among HIV Infected Patients Un...HMO Research Network
This study investigated risk factors for virologic outcomes among HIV patients who switched combination antiretroviral therapy regimens. The study found that about 24% of patients failed to achieve maximal viral suppression 6 months after switching regimens. Younger age, lower CD4 counts, heterosexual transmission risk, NRTI-only regimens, and previous virologic failure were associated with increased risk of advanced virologic failure. New class-based regimens were protective against low-level viremia. Rates of treatment failure decreased in more recent calendar years.
Expanding SEER Reporting with Comorbidity Data Colorectal Cancer HORNBROOKHMO Research Network
This document discusses adding comorbidity data from Kaiser Permanente Hawai'i members to the Hawai'i SEER cancer registry. It achieved a high match rate between KPH tumor records and those in the SEER registry. Analysis found that 37% of cancers had comorbidities, with diabetes, COPD, and complications of diabetes being most common. Adding comorbidity data would provide useful context for understanding cancer treatment and outcomes. Addressing privacy issues is important for full data sharing between organizations.
Drug Characteristics Associated with Medication Adherence Across Eight Diseas...HMO Research Network
This study analyzed medication adherence across 8 disease states based on drug characteristics. Researchers found that adherence varied significantly based on whether drugs were generic or brand name, with generic drugs generally having higher adherence rates. Adherence also decreased as out-of-pocket costs for patients increased. When examining specific conditions, adherence was highest for hypertension drugs and lowest for asthma/COPD medications. Certain drug classes within conditions demonstrated different adherence levels as well. Overall, the study identified drug characteristics and costs as important factors influencing medication adherence across multiple diseases.
eCare for Heart Wellness A Trial to Test the Feasibility of Web Based Dietici...HMO Research Network
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Feasibility of Implementing Screening Brief Intervention and Referral to Treatment at Kaiser Permanente Colorado RAHM
1. Feasibility of SBIRT at KPCO
Carmen R Martin, MPH
Jennifer Boggs, MSW
HMORN Conference
May 2nd, 2012
2. What is SBIRT?
Screening, Brief Intervention and Referral to Treatment
– Broadly supported by SAMHSA; adapted into multiple sets of questions
– Validated, now applied millions of times
SBIRT is a universal screening protocol that requires little time of the
patient, the provider, or the healthcare system
Target : the 25% of Americans who are “risky’ drinkers/substance
users (not the 4% with dependencies, nor the 70% of abstainers/low
risk)
One of a class of screener protocols for risks of various kinds
(alcohol, drugs, inactivity, poor mental health, etc)
3. SBIRT Implementation at KPCO
Pilot 1: Implementation Planning
Pilot 2: Pilot Implementation
Pilot 3: Implementation Planning Outside
KPCO
Dissemination Studies
4. Design: SBIRT Pilot 1
Members
English-Speaking Spanish-Speaking
Behavioral Health
Behavioral Medicine
Mental Health
Chemical Specialists
Dependency
Primary Care
Physicians Nurse Managers Front Line Nurses
4
5. Member Focus Groups
• Well visit in past 3 months
Participants • 2 groups, various membership duration
• Privacy concerns in medical record
English-Speaking • Pre-screen…“ would help realize what
‘too much’ is”
• Asked at every visit, including Rx use
Spanish-Speaking • “Grateful” because doc is best person to
help & direct to resources
• Decision support in EMR for positive
screening/Brief intervention use
Recommendations • Normalize as standard care for all; avoid
“profiling”
5
6. Behavioral Health
Behavioral Chemical Mental Health
Medicine Dependency
Specialists
• MDs, RNs, • Supervisors, psyc
• Psychologists counselors hologists, counsel
• Clinic-based • Moderate risk ors, therapists
• All follow-up after should be • Brief Intervention
PCP prescribes followed in impossible unless
meds Primary Care done by BMS
• Want to prove • Referral stigma to • Need workflow
value to KPCO CD pre-defined
• SBIRT good fit • “providers don’t
7. Primary Care - Nursing
Nurses and Nurse managers
– Generally supportive
– To gain buy in, need to discuss SBIRT validity
– Could be added to workflow of Health Maintenance Visit
(already do PHQ9)
– Workflow important: 6-8 min for rooming in a 20 min visit
– MD or Behavioral Medicine Specialist for Brief Intervention
and Referral to Treatment, not part of nursing role
– Concern: liability
8. Primary Care - Physicians
“Intellectually” support the idea
Where to go for help? (BMS vs MH vs CD)
Perceived patient resistance
Fear of time sink
Motivational interviewing skills
Validity of SBIRT tool vs other quicker methodologies
– Cost/benefit analysis – evidence that better then status quo
Confidentiality of patient information for life insurance, or other
releases of information.
9. REFERRALS REFERRALS
“What relationship?”
Need more MI training
CD shuts down pt
Prior CD Individual
BMS Supervisor
MH CD BMS
D
Overwhelmed with Crisis only setup Want closer
oe
sn
Referrals that Not open to relationship w/ CD
’t
should go to CD moderate risk Open to CD training
kn
ow
ho
w
to
ge
tt
o
C
D
REFERRALS REFERRALS
May be stigma
associated w/
referral to CD
Primary
Care
10. KPCO Systems Issues – Pilot 1
Appropriate timing – Depression Governance Council , Rx
Drug Abuse Pilot, KP’s “New Reality.”
Recommendations
– Higher level support needed – insert into already existing initiative
that has leadership support (Physical Activity Vital Sign Group)
– Clinic champions important
– Stakeholders co-create workflow
– Pilot in one clinic initially
11. KPCO Pilot 2 Plan – Implementation at one clinic
– Literature review - Executive Summary for Clinic Staff
– Collaboration with SBIRT – Colorado and NIAAA funded
SBIRT KP Northern California region study.
– Address stakeholder concerns determined in Pilot 1
– Convene stakeholder group to develop workflow
– Identify one clinic to pilot for 4-6 months
– PDSA Cycles for iterations of workflow
– Provider training through SBIRT Colorado program
12. KPCO Pilot 2 Plan
Evaluation
– Members screened vs. members eligible, %BI, %RT
– Compare to matched non-implementation clinic with BMS and
one without BMS through chart review
Documentation: codes used, screening tools, alerts, after-visit
summary with alcohol/drug advice, variables vs. text.
– Pre-implementation survey on teamness and importance of
alcohol and drug screening.
– Key informant interviews from clinic leaders (Chief, Nurse
Manager, other leaders).
– “What Happened” Qualitative Tracking of Implementation
13. KPCO Pilot 2 so far…..
Clinic is in midst of new roles from the “New Reality” and
trying to introduce SBIRT.
“This is overwhelming” vs. “good to do all changes together.”
– How is this different from what I already do?
– Role of physician in SBIRT (if BMS going to do the Brief
Intervention) – process of hand-off to BMS?
– Scripting for introducing SBIRT and transitions between
staff.
14. Pilot 1 recommendations vs. REALITY
Gain high level leadership Hard to do with short time
involvement and support. line, important to start small and gain
clinic support.
Recommendation to insert Px Vital Sign had high level
SBIRT into a new initiative (Px support, but lacked clinic
Vital Sign) that had high level support, ended up going grass roots
support already. with clinics choosing to implement or
not.
Stakeholders should create
workflow In order to have Stakeholders wanted input on
“ownership” of workflow. workflow, but wanted detailed draft
to start with from research team.
15. Thank you to our study team: Alanna Kulchak Rahm, Arne
Beck, David Price, James W Dearing, Thomas E Backer, L
Kendall Krause.
Thank you to SBIRT Colorado for their collaboration and
support of the project.
Questions?
Editor's Notes
Overall – not knowledgable about SBIRT, Very positive as group about use in primary care to identify moderate risk individuals
Once we review key facilitators and barriers by each stakeholder group, we’ll need to incorporate this information into our implementation strategies, e.g., if RNs’ concern is liability, we’ll want to address this directly and show the limits of their liability, and who can back them up (for example BMS, BH, etc.)
Last Carmen slide, transition to Jenn. Competing demands (clinical priorities, initiatives)
Hard when you have a funding timeline that doesn’t line up with clinic timeline.
Defin SBIRT CO. A 3 month post-implementation follow-up period (months 10-12) will follow. Measures of the number of patients screened and numbers referred for brief intervention or treatment at the implementation clinic will be compared with those at a matched non-implementation clinic. Brief intervention utilization will be determined for the implementation and usual care clinics through chart review of all identified at-risk individuals for delivery of brief intervention elements. This chart review will also record type of provider delivering the brief intervention (e.g. physician, nurse, BMS). Qualitative measures of implementation will include exit interviews or focus groups with all implementation clinic staff related to satisfaction with care pathway, challenges and successes of implementation, unintended consequences, and intention to continue SBIRT as part of standard care. Similar interviews and focus groups will be conducted with BMSs, Chemical Dependency, and Mental Health providers.
A 3 month post-implementation follow-up period (months 10-12) will follow. Measures of the number of patients screened and numbers referred for brief intervention or treatment at the implementation clinic will be compared with those at a matched non-implementation clinic. Brief intervention utilization will be determined for the implementation and usual care clinics through chart review of all identified at-risk individuals for delivery of brief intervention elements. This chart review will also record type of provider delivering the brief intervention (e.g. physician, nurse, BMS). Qualitative measures of implementation will include exit interviews or focus groups with all implementation clinic staff related to satisfaction with care pathway, challenges and successes of implementation, unintended consequences, and intention to continue SBIRT as part of standard care. Similar interviews and focus groups will be conducted with BMSs, Chemical Dependency, and Mental Health providers.
Talk about helpful learnings from Pilot 1, such as…..Executive Summary of literature as being helpful in addressing evidence for SBIRT, confidentiality concerns for patient diagnostic data of alcohol and drug use, PCP will not want anything added to their HMV agenda, BMS instrumental for delivering MI and doing assessment for further treatment.