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May 2008
Using AHRQ's Health Care Innovations Exchange to Take on the Challenges of Care Delivery

The Agency for Healthcare Research and Quality conducted a Webinar to introduce the Health Care Innovations Exchange to its new users and highlight a few examples of the many innovations described on the site.

The Webinar walks you through the features of the site and explains the ways in which users can learn about innovation and participate in the Innovations Exchange.

Presenters:

Overview of Innovations Exchange - Carolyn M. Clancy MD, Director of the Agency for Healthcare Research and Quality

Introduction to Innovations Exchange 2.0: Background, Functionality, and Features: Mary P. Nix, MS, MT(ASCP)SBB, Project Officer for the AHRQ Healthcare Innovations Exchange

Innovators

Innovation Attempt: Diabetes Management Wireless Messaging System: Michael Leu, MD, MS, Children's Hospital and Regional Medical Center, Seattle, Washington

Innovation Submitter: Heart Failure Disease Management Improves Outcomes and Reduces Costs: Linda Wick, NP, St. Mary's Duluth Clinic Health System, Duluth, Minnesota

Disparities/Innovator Learning Network: The Community Health Access Project Employing Community Health Workers: Mark Redding, MD, Mansfield Pediatrics, Mansfield, Ohio

Presentation

Play audio/video archive of Web seminar. The free Adobe Reader External Web Site Policy is required.

Please note: While there were some difficulties with the audio portion of Dr. Clancy's introduction, the remainder of the audio presentation is clear.
Panel Slides

Jump to Slides:
Mary Nix 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
Michael Leu 26 27 28 29 30 31 32
Linda Wick 33 34 35 36 37 38
Mark Redding 39 40 41 42 43 44 45 46 47 48

Slide 1

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Introducing Version 2.0
of the AHRQ Health Care Innovations Exchange:
Finding, Sharing, Stimulating, Supporting

Mary Nix, Project Officer

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Slide 2

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Vision: An Information Hub for Health Care Change Agents

Diagram shows that the objective is to be useful to everyone, provide a way both to share ideas and find them. AHRQ's Innovation Exchange is an information hub for health care providers, government, health plans, other change agents, funders, provider associations, and researchers.

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Slide 3

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Primary Goal: To Facilitate the Exchange of Information

Through content:

  • Descriptions of innovations in service delivery – some successful (“Innovation Profiles”), some not (“Innovation Attempts”)
  • Lessons learned by innovators
  • Stories about the impetus for innovations and their impact
  • Contact information for innovators
  • Commentaries from experts

Through design:

  • Multiple ways to explore content
  • Opportunities for users to comment, share experiences, discuss challenges

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Slide 4

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Polling Question

You have joined an event using audio broadcasting. You will see a dialog box at the upper-left of your screen. This dialog box controls the audio being transmitted to your computer speakers.

How often do you wish you had an innovative solution to a problem related to health care delivery?

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Slide 5

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Home Page: See What’s New – Or Find What You Need

The home page is designed to achieve two goals: -- to let users immediately see what’s new on the site (updated every two weeks with new innovations and new QualityTools) -- to enable users to dive right into find whatever they need – that is, to browse the site using specified terms or search using their own terms.

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Slide 6

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Innovations Exchange Includes QualityTools

Long Description: Note that Innovations Exchange is not limited to innovations, but incorporates the QualityTools that used to be a separate AHRQ product. There are similar options for searching and browsing the large database of tools – or just seeing what’s new.

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Slide 7

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Browse Options

    Sort content of the site by:
  • Patient population
  • Stage of care
  • Setting of care
  • Patient care process
  • IOM domains of quality
  • Organizational process
  • Disease or clinical category

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Slide 8

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Browse by Subject

An illustration of the list you just provided. Note that users are seeing only what currently exists in our database. None of these terms will get you “0 ” results (although you may find only QualityTools, or only innovations).

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Slide 9

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More Browse Options: Disease or Clinical Category

This is the last category on the Browse page. It illustrates the user’s ability to choose a very specific topic. Note that users can also view all innovations or all QualityTools.

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Slide 10

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Narrow the List by Selecting Multiple Subjects

Another option is to use multiple subjects to narrow down the choices. This example shows a user choosing: -- Setting of Care = Hospital Outpatient. -- Stage of Care = Chronic Care (Next slide shows results.)

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Slide 11

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Review Results of Browsing: Innovations & Tools

Results of the multiple subject search. Note that results include both innovations and QualityTools. If relevant, content from the “Learn & Network” section would show up here too.

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Slide 12

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Select Profile to Read

This is an example of an Innovation Profile – one of the ones being presented in the Webinar. We made it easy to share these ideas with colleagues; note that users can print it or email a link.

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Slide 13

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Detailed Descriptions of Innovation Profiles

Snapshot

  • Summary
  • Developing organizations
  • Date first implemented
  • Patient population

What They Did

  • Problem addressed
  • Description of the innovative activity
  • Contact the innovator

Did It Work?

  • Results
  • Evidence rating

How They Did It

  • Context
  • Planning and development
  • Resources used
  • Funding sources
  • Tools and other resources

Adoption Considerations

  • Getting started
  • Sustaining this innovation
  • Additional considerations and lessons
  • Use by other organizations

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Slide 14

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Comment on the Innovation: Share, Stimulate, Support…

To help encourage the exchange of ideas, users are invited to comment on individual innovations. We hope that you will share your experiences with a similar idea, or concerns about its implementation.

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Slide 15

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Read Comments Submitted by Other Users

You can comment on the innovation itself, or reply to comments submitted earlier by others. Some innovations are also accompanied by a commentary by an expert in the issue that the innovation addresses. Users are welcome to comment on the commentary as well.

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Slide 16

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Finding All Innovations

Beyond browsing and searching, we offer a way to find all innovations posted to the site from a link provided on the home page, beneath the publication issue announcement. The total number of innovation profiles (successes) is provided (currently 108) and quick access to all innovation attempts is available. Note that you can limit the number to those posed to the site in a particular month and year.

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Slide 17

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Finding All Attempts

We currently only have 4 attempts in the Innovations Exchange. We seek many more and hope that you’ll submit your innovative attempts to change care delivery. Others will benefit. Today, we are fortunate to have Michael Leu, an attempt submitter, speak to you about his attempt and, perhaps more importantly, why he felt it was important to participate.

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Slide 18

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Select Attempt to Read

Point here is that the Innovation Attempt appears slightly different: color and sections.

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Slide 19

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Detailed Descriptions of Innovation Attempts

Snapshot

  • Summary
  • Developing organizations
  • Date first implemented
  • Patient population

What They Did

  • Problem addressed
  • Description of the innovative activity
  • Contact the innovator

Did It Work?

  • Results

What They Learned

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Slide 20

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Share Your Own Innovation

If you would like to submit a candidate innovation (success or attempt), send an e-mail to info@innovations.ahrq.gov with the following information:

  • Name of the participating organizations.
  • Name and title of the submitter.
  • Contact information for the submitter.
  • Brief description of the innovation.
  • Brief description of results, including any impact on the delivery of patient care.
  • Description of the health care setting.
  • Description of the population.
  • Any funding sources for the innovation.

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Slide 21

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Polling Question

How do you like to learn about new concepts and strategies?

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Slide 22

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Multiple Ways to Learn and Network

We’ve set up the “Learn & Network” section of the site to provide users with alternative ways of learning and interacting. In the “Learn” box, you see a number of written pieces on a variety of topic, most authored by experts in innovation. We expect to add to this library every other month. In the “Participate” box, you’ll be able to see upcoming and archived events – which are likely to include Webinars, brief lectures (probably in the form of podcasts), and discussion groups centered around specific innovations. In the “Network” box, you’ll see a list of ongoing learning networks, where members can work collaboratively to tackle a shared concern. We’ve started up one so far on coordinating care at the community level, and plan to add more over time as we get a better feel for what interests users of the site. (The next slide says the same thing; could cut one of these.)

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Slide 23

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Options for Learning and Networking

Browse articles and expert perspectives on the process of innovating and adopting new ideas

Participate in the Innovations Exchange:

  • Attend Webinars
  • Hear directly from experts in innovation
  • Contribute to discussion groups

Network with peers: Join a learning community to collaborate with others in tackling a shared challenge.

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Slide 24

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Learning Networks: Activities, Ideas

The learning network page of the Learning and Networking section identifies the active learning networks and an invitation for you to share your ideas for new learning networks. We have one active learning network at this time; Mark Redding, one of our speakers today will be highlighting his experience thus far with that learning network. We have many ideas for future learning networks and have an open invitation to you for additional ideas. What topics regarding innovation in health care delivery would you like to collaborate with others on and work toward a goal? Send us your idea; we’re developing a systematic process for making informed selections.

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Slide 25

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Polling question

Please select the activities that interest you. (Choose one or more.)

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Slide 26

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Automated Wireless Messaging System for Diabetes

Michael Leu, M.D., M.S., M.H.S.
Seattle Children’s Hospital

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Slide 27

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Study

  • Five clinics, Greater Seattle area
  • Adults with type 1 or type 2 diabetes
  • Invited by PCP or endocrinologist
  • Randomized trial
    • Intervention vs usual care, 3 to 6 months
    • Twenty-five patients per group
    • Hgb A1c, blood pressure, surveys

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Slide 28

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Intervention

Intake visit

  • Two-way pager issued, brief training
  • Reminders programmed

Reminders sent, plus messages

  • Informational
  • Rapport building
  • Administrative

Responses filtered, some sent on to PI

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Slide 29

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Messages

Reminders – times/days predetermined

  • Check blood glucose – 67%
  • Take insulin/medicine – 54%
  • Eat (snack or meal) – 50%
  • Exercise – 42%

Statistics

  • 12,025 messages sent
  • 1,676 responses, 114 sent on to PI
  • 16 responses required action

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Slide 30

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Results

Similar changes in Hgb A1c

Pager group became more normotensive, believed health improved

Patients

  • Comforted, cared for; reported being more able to deal with acute life changes
  • Found system convenient, helpful

Providers

  • Can reach patients easily, conversations recorded
  • Minimal need to act on patient responses

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Slide 31

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Considerations

Target populations

Training for patients, providers

System configurability, reliability

Security, privacy (HIPAA)

Other issues

  • Outcome measures
  • Intellectual property
  • Living with condition vs being defined by it

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Slide 32

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Acknowledgements

Funded by: American Diabetes Association, Warren G. Magnuson Institute for Biomedical Research and Health Professional Training, Alpha Omega Alpha

Thanks to participants, clinic physicians and staff, research team and advisors including Dr. Thomas E. Norris, Dr. Jeff Hummel, Dr. Peter Dunbar, Dr. Peter Tarczy-Hornoch, Dr. Harold Goldberg, Dr. Irl Hirsch, Dr. Margaret Isaac, Dr. Michael Brogan, Wai Man Ip

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Slide 33

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SMDC Heart Failure Program concept to reality

Linda Wick, MSN, CNP
Manager Heart Failure Program

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Slide 34

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Heart Failure Disease Management

WHO:

  • Class III-IV Heart Failure Patients

WHY:

  • Heart Failure care is expensive for payers/patients/health care systems
  • Traditional care inefficient for chronic disease management

WHAT:

  • Standard clinic visit protocol/standard education-improves outcomes
  • Team approach to visits
  • Frequent follow up
  • Home Monitoring on select patients
  • Quarterly community support group
  • Quarterly newsletter
  • Opportunity for research

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Slide 35

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Percent of Patients on Appropriate Treatment Protocol SMDC CHF

Percent of Patients on Appropriate Treatment Protocol SMDC CHF

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Slide 36

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6 Month Readmission rate at SMDC for HF patients N=452 FY 05, FY 06, FY 07

6-Month Readmission Rate at SMDC for HF Patients (n=452)

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Slide 37

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Admission rate/year for pt’s on telescale

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Slide 38

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Experience with Web Innovations

  • Easy
  • User friendly
  • Knowledgeable

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Slide 39

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PATHWAYS

Connecting at Risk to Care
Connecting Dollars to Results
Mark Redding, M.D., Mansfield Pediatrics

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Slide 40

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Pathways

  • Find at Risk
  • Treat
  • Measure

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Slide 41

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Pathways

Every birth certificate from the last 10 years in Richland County, OH was plotted out on a plot map and it was found that two of the census tracks actually had low birth rates lower than 24%. We hired, we went right to the most impoverished census tracts, identified women, primarily from churches, directly from part of the community, trained them with college credit, fully integrating them into the medical home where they would be supervised by nurses and physicians. And they reached out to their neighbors within that community, especially those most at risk, the homeless, those in the most impoverished housing complexes and connected them to care.

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Slide 42

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Pathways

A pathway gives the specific benchmarks and care coordination that are critical. The first step essentially identifies that the woman is from an at-risk census track, the next step education, the next step barriers. The next step is a very important step to us, confirms they connect to care, that they have overcome those barriers of language, transportation, culture, fear of the doctor's office and they've connected. And the final is to measure the final outcome.

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Slide 43

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Initial Results

Low Birth Weight

Summary: The reduction that was demonstrated within the enroll population for low birth weight. We went with a population with low birth rate great than 20 and our initial population 20 and over we stayed at less than 5% for over three years. Chart title: LBW Rate For Mansfield CHAP Participants 1999-2004 LBW Rate: 1999 was 20; 2000 was 15.4; 2001 was 11.5; 2002 was 7.8; 2003 was 0; 2004 was 5.5

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Slide 44

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Initial Results

2005-2006 – and Forward 19 → 146 At Risk Connected to Care Without Duplication

The chart demonstrates that across the community people could be connected to care without duplication and with the financing and dollars focused on results. 2005-2006 – and forward 19 >> 146 At Risk Connected to care without duplication No. of Pregnancy Pathways in calendar year 2005-06: Jul-Sep 26, Oct-Dec 18, Jan-Mar 47, Apr-Jun 55

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Slide 45

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Initial Results

Funding and Delivery Change

  • Duplication -> No Duplication
  • Non Risk -> Risk Focus
  • Process Pmt -> Care Connection**

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Slide 46

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Initial Results

This concept is called the community hub and this is what the innovation exchange is supporting.

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Slide 47

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Pathways

Opportunity for Health Care Reform

  • Those at greatest risk need to connect to care – No one is paying for that.
  • Funding for coordination can begin to purchase work products meaningful to the individual served.
  • Assure connection for those at greatest risk

1988 Institute of Medicine

  • Assessment
  • Assurance
  • Policy Change

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Slide 48

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Communities Implementing Community Hubs as Part of a Learning Network

Communities Implementing Community Hubs as Part of a Learning Network: Portland, OR; Placerville, CA; Albuquerque and Rio Arriba, NM; Lincoln, NE; Indianapolis, IN; Oklahoma City, OK; Mansfield and Toledo and Cincinnati, OH

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