23
ImproveCareNow Collaborative Chronic Care Network Peter A. Margolis, MD PhD Richard B. Colletti, MD NIH NIDDK R01DK085719 AHRQ R01HS020024 AHRQ U18HS016957 ImproveCareNow Network Care Centers

ImproveCareNow Collaborative Chronic Care · PDF fileImproveCareNow Collaborative Chronic Care Network ... Management Support Site 1 - - - ... Crohn’s disease Chris Forrest, MD,

  • Upload
    hahanh

  • View
    216

  • Download
    1

Embed Size (px)

Citation preview

ImproveCareNow Collaborative Chronic Care Network

Peter A. Margolis, MD PhD

Richard B. Colletti, MD

NIH NIDDK R01DK085719 AHRQ R01HS020024 AHRQ U18HS016957 ImproveCareNow Network Care Centers

.5 x .5 = .25

Learning Healthcare System

• Patients and providers work together to choose care based on best evidence

• Drive discovery as natural outgrowth of patient care

• Ensure innovation, quality, safety and value

• All in real-time

Network-Based Production

Yochai Benkler, “The Wealth of Networks”

30%

40%

50%

60%

70%

80%

90%

Percent of Patients in Remission

Crandall, Margolis, Colletti et al Pediatrics 2012;129:1030

2007 2008 2009 2010 2011 2012

Network Organization • ImproveCareNow, Inc

• Clinical hub

• Cincinnati Children’s Anderson Center for Health Systems Excellence C3N Project • Accelerator

• Budget • ImproveCareNow operating costs

supported by fees -$1,000,000/year • Center costs - $35-100,000/year • Research and innovation - $2 mil/year • Limited commercialization funds

Patients

Care Centers

Building community

• Compelling purpose • Core leadership – patients, clinicians,

researchers • Sharing stories

• Many ways to contribute

Jill Plevinsky, Chair, PAC

Effective use of technology

Example: Data Collection

Data capture at clinical visit

“Enhanced” Registry

Data-in-once

• Automate chronic care processes

• Measure performance for QI and learning

• Generate high quality data

• Create new knowledge at three levels • care center, population and individual level

John Hutton, MD; Keith Marsolo, PhD; Charles Bailey, MD; Christopher Forrest, MD, PhD;

Marshall Joffe, MD, PhD; Wallace Crandall, MD; Mike Kappleman, MD, MPH; Eileen King, PhD

Performance Report - QI

10. Thiopurine dose

according to Model Care

(75%, 80%, n=509)

3. Sustained remission

rate

(57%, 45%, n=1352)

1. Remission rate

(76%, 80%, n=2435)

Key Measures

Monthly Report – December 2011

Advanced TrackAll Sites Performance

8. Documented visit in

last 6 months

(79%, 80%, n=3031)

2. Steroid free

remission rate

(72%, 76%, n=2424)

9. Starting thiopurine and

TPMT measured

(67%, 90%, n=6)

(score, goal, n)

7.Complete documentation

bundle

(94%, 95%, n=502)

15.Methotrexate dose >=

10 mg/square-meter/w eek

(91%, 95%, n=65)

14. Infliximab trough

level measured

(55%, 75%, n=11)

6. Satisfactory grow th

status

(93%, 90%, n=1851)

13. Infliximab dose

according to Model Care

(95%, 95%, n=535)

4. Off prednisone

(91%, 95%, n=2542)

11. 6-TGN level measured

according to Model Care

(17%, 75%, n=12)

5. Satisfactory nutritional

status

(90%, 90%, n=2615)

12. Infliximab initiation and

prior PPD or chest X-ray

3-month moving average

(79%, 95%, n=34)

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

04/

07

08/

07

12/

07

04/

08

08/

08

12/

08

04/

09

08/

09

12/

09

04/

10

08/

10

12/

10

04/

11

08/

11

12/

11

75%

80%

85%

90%

95%

100%

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

0%

20%

40%

60%

80%

100%

75%

80%

85%

90%

95%

100%

0%

20%

40%

60%

80%

100%

04/

07

08/

07

12/

07

04/

08

08/

08

12/

08

04/

09

08/

09

12/

09

04/

10

08/

10

12/

10

04/

11

08/

11

12/

11

Re-design Care - Care Center Level Studies

Treatment

Combination

Pre-visit

Planning

Population

Management

Self-

Management

Support

Site 1 - - -

Site 2 + - -

Site 3 - + -

Site 4 - - +

Site 5 + - +

Site 6 - + +

Site 7 + + -

Site 8 + + +

% in Remission

Comparative Effectiveness Research – Population Level

2 4 6 8 11 14 17 20 23 26

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

Clinical Remission

Number of Weeks

Pro

babi

lity

Treatment

Control

2 4 6 8 11 14 17 20 23 26

0.0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

1.0

Steroid-free Remission

Number of Weeks

Pro

babi

lity

Treatment

ControlSimulated Trial

Cumulative Probability of

Achieving Remission with

Biologic Therapy vs.

controls for patients with

moderate/severe pediatric

Crohn’s disease

Chris Forrest, MD, PhD, Charles Bailey, MD,

Marshall Joffe, MD, PhD. Univ of Pennsylvania

01234567

10/1

…1

0/2

…1

0/2

…1

0/2

…1

0/2

…1

0/2

…1

0/3

…1

1/2

/11

11/4

/11

11/6

/11

11/8

/11

11/1

…1

1/1

…1

1/1

…1

1/1

…1

1/1

…1

1/2

…1

1/2

…1

1/2

…1

1/2

…1

1/2

…1

1/3

…1

2/2

/11

12/4

/11

12/6

/11

12/8

/11

12/1

…1

2/1

…1

2/1

…1

2/1

…1

2/1

…1

2/2

…1

2/2

…1

2/2

…1

2/2

…1

2/2

…1

2/3

…1

/1/1

31

/3/1

31

/5/1

21

/7/1

21

/9/1

21

/11

/12

1/1

3/1

21

/15

/12

1/1

7/1

21

/19

/12

1/2

1/1

21

/23

/12

1/2

5/1

21

/27

/12

1/2

9/1

21

/31

/12

2/2

/12

2/4

/12

2/6

/12

2/8

/12

2/1

0/1

22

/12

/12

2/1

4/1

22

/16

/12

2/1

8/1

22

/20

/12

Nocturnal (I chart) Infliximab PT sick, took amoxicillin 12/9-

12/16

PT sick, took Augmentin 1/25 - 2/1

19 yr. old with Crohn’s colitis

Colectomy with ileo-anal anastomosis (10 yrs)

Chronic diarrhea, nocturnal stools, fatigue, poor quality of life

Current medications: Infliximab & PRN imodium

Personalized Care

Heather Kaplan, MD, MPH, Jeremy Adler, MD, MPH, Shehzad Saeed, MD, Ian Eslick, MS,

Lloyd Provost, MS, Tom Nolan, PhD, Peter Margolis, MD, PhD

MyIBD.c3nproject.org

What’s Next? Inter-visit Planning

Mentoring

Community Building/Organizing

Passive Patient Reported Outcomes

Lisa Opipari, PhD, John Chaffins, David Fore, Michael Seid, PhD, Keith Marsolo, PhD, Tania Moon, Jill Plevinsky

Collaborators

Be part of the solution

• Help test patient-engagement interventions using network as ‘lab’ • Better outcomes and lower costs • Kauffman Foundation Health Network Trust Project

• Be part of the scale up • 10,000 more in remission

• Be part of the scale out • Adults with IBD • Another disease

• Accelerate • Technology strategy and partnerships