research 101: primary care research and ochin’s practice-based research network sonja likumahuwa,...
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Research 101:Primary Care Research
and OCHIN’s Practice-Based Research Network
Sonja Likumahuwa, MID, MPH OCHIN PBRN Coordinator
OCHIN Learning Forum November 15, 2012
Overview
• OCHIN Data Challenge!• What is research? • About OCHIN – what makes OCHIN unique for
research?• About practice-based research• Learning from YOU!
The OCHIN Data Challenge
1. OCHIN members
How many active member organizations does OCHIN now have on Epic (i.e., live on the system)?
a.63b.57c.35d.99e.None of the above
1. OCHIN members
How many active member organizations does OCHIN now have (i.e., live on the system)?
a.63 (with 310 clinics and 446 departments – 68 orgs signed)b.57c.35d.99e.None of the above
2. Total patients
How many distinct patients with one or more visits are in the OCHIN database (through 9/30/2012)?
a.490,398b.885,863c.1,221,597d.1,807,3789e.None of the abovef.All of the above
2. Total patients
How many distinct patients with one or more visits are in the OCHIN Epic database (through 9/30/2011)?
a.490,398b.885,863c.1.2 million (with 11 million visits). d.1,807,3789e.None of the abovef.All of the above
3. Total patients in past year
How many distinct patients were seen in OCHIN Epic member clinics in the past year (10/1/2011 - 9/30/2012)?
a.350,823b.539,366c.778,340d.999,999,992e.None of the above
3. Total patients in past year
How many distinct patients were seen in OCHIN member clinics in the past year (10/1/2011 - 9/30/2012)?
a.350,823b.539K patients seen in past year (with 2.2m visits)c.778,340d.999,999,992e.None of the above
4. Diabetics
What percentage of all patients seen in OCHIN clinics with Epic EMR have a recorded diagnosis of diabetes?
a.6.1%b.2.7%c.8.6%d.50%e.None of the above
4. Diabetics
What percentage of all patients seen in OCHIN clinics with Epic EMR have a recorded diagnosis of diabetes?
a.6.1% b.2.7%c.8.6%d.50%e.None of the above
5. Race
What percentage of patients in the OCHIN database have a recorded race?
a.5%b.21%c.85%d.95%e.None of the above
5. Race
What percentage of patients in the OCHIN database have a recorded race?
a.5%b.21%c.85%d.95%e.None of the above
6. Payor mix
What percentage of patients in the OCHIN database were self-pay at their last visit?
a.21%b.32%c.50%d.75%e.None of the above
6. Payor mix
What percentage patients in the OCHIN database were self-pay at their last visit?
a.21%b.32%c.50%d.75%e.None of the above – 41% (40% were Medicaid)
7. Tobacco use
What percentage of patients in the OCHIN database have documented tobacco use ( > 12 yo)?
a.15%b.19%c.23%d.28%
7. Tobacco use
What percentage of patients in the OCHIN database have documented tobacco use ( > 12 yo)?
a.15%b.19%c.23%d.28%
Anybody surprised by the data?
What questions did the data raise for you?
What is Research?
A systematic investigation, including research development, testing and evaluation, designed to develop or contribute to generalizable knowledge.
Research and QI – what’s the connection?
• QI: small-scale, unknown applicability to other settings.
• Research: generalizable to other settings• QI becomes research when you start thinking:
– “I want to test to find out why this QI intervention was/wasn’t successful.”
– “I wonder if our successful QI initiative would work in another
clinic/department?”
OCHIN• Formed in 2001 with $2 million grant from HRSA• 501c(3) collaborative• Community Health Center-Controlled Network• Organized Health Care Arrangement• State-of-the-art electronic clinical record-keeping in
safety net clinics • Hosted platform using Epic Systems, Inc. – linked across
all clinic sites• Grown to $20 million national collaborative• Members: FQHCs, FQHC look-alikes, rural and school-
based health centers
OCHIN
• 65 member organizations, 11 states • Over 300 individual clinics• Over 3000 providers• 1 million patients, 2.1 million annual visits• Provides economies of scale for high-quality
health information technology products
Serving the Safety Net
• Federally Qualified Health Centers (FQHC)• School-based Health Centers• Nonprofit Community Health Centers• County and Public Health Departments• Rural Health Centers• Mobile Health Centers• Field-based Migrant Health Clinics• Homeless Clinics
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Where We Are
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Diverse Patient Population (n=1.2 million patients) July 1, 2002 – September 30, 2012
Sex EthnicityFemale 55% Hispanic 27%Male 45% Non-Hispanic 61%Women & Children 74% Not Collected/Unknown 12%
Federal Poverty Line Race100% and below 55% American Indian 1%101% - 150% 9% Asian 3%151% - 200% 4% Black 8%Over 200% 12% White 72%Unknown 21% Not Collected/Unknown 15%
Other 1%Visits by PayorCommercial 12%Medicaid 40% Patients: 1,221,597 Medicare 7% Visits: 11,664,224Other 1%Self-pay 41%Unknown 0%
OCHIN’s Research Potential
• Master Patient Index (one record across the network)
• Large, diverse patient population• Linked data that’s easy to query (back-end)• Patient continuity in the network• Hard-to-reach patients (uninsured, poor,
migrant, homeless, women and children)
OCHIN Safety Net PBRN
• OCHIN is the founding member and administrative home to a PBRN that is focused on the safety net
• The OCHIN PBRN is an AHRQ-registered primary care research network
• Works together with COG and Data Stewardship Committee to oversee research at OCHIN
PBRN Definition
A group of practices devoted principally to the primary care of patients, and affiliated in their mission to
– Investigate questions related to community-based practice
– Improve the quality of primary care
• Ongoing commitment to network activities
• Linking practicing clinicians with investigators
• Working to enhance the skills of network members
http://www.ahrq.gov/research/pbrn/pbrnfact.htm
1000 persons
800 report symptoms
327 consider seeking medical care
217 visit a physician’s office (113 visit a primary care physician’s
office) PBRN Research
65 visit a complementary or alternative medical care provider
21 visit a hospital outpatient clinic
14 receive home health care
13 visit an emergency dept
8 are hospitalized
<1 are hospitalized in an academic medical center
Fig. Results of a reanalysis of the monthly prevalence of illness in the community and the roles of various sources of health care. (Green LA et al., N Engl J Med 2001, 344:2021-2024)
“If we want more Evidence-Based Practice, we need
more Practice-Based Evidence”
Larry W. GreenUS-PSTF, CDC, HHS
The OCHIN PBRN Mission
• Our mission is to:• Improve the health of underserved populations• Enhance their quality of care• Inform health policy through research
• We are unique among PBRNs• Housed at a community nonprofit organization• Made up exclusively of health centers that serve a safety
net population
OCHIN Research Infrastructure• OCHIN research team• Key partnerships with Kaiser Permanente
Center for Health Research and Oregon Health & Science University
• Building new partnerships as we speak
Our OCHIN Research Team
Jen DeVoeVance BauerChristine NelsonStuart CowburnJon PuroTrisha VakarcsSonja LikumahuwaJennifer LembachJill Arkind
Our Research PrioritiesStudies that examine effective interventions and
delivery system improvements • Understanding and addressing health conditions with known
health disparities that are common in safety net populations;• Improving health outcomes in safety net populations;• Evaluating interventions that have potential to improve safety
net practice;• Testing health IT interventions to improve population health;• Implementing evidence-based practices within the clinic
network.
Current OCHIN Research and Infrastructure Projects
Research• 12 active studies• 17 submitted grants in 2011-2012Infrastructure• 2 Infrastructure GrantsNational Networks/Collaborations• 4 National Networks
National Research Collaborations
• CHARN– Community Health Applied Research
Network – HRSA
• CER-HUB– Enhancing Clinical Effectiveness
Research with Natural Language Processing of EMR – AHRQ R01
• N2: A Network of the Safety Net• Meta-LARC
Types of Research Studies
• Data-only• Intervention
Linking EHR & Medicaid Data
• OCHIN’s EHR data contains >85% of FQHC visits in Oregon
• We linked– safety net clinic EHR data (>50 clinics in Oregon)– state Medicaid claims data
utilization data for all adult patients with diabetes in Oregon
… Regardless of insurance status!
Higher Receipt of Cholesterol Screening Associated With Continuous Medicaid
Coverage
Among partially insured, more coverage is no better than less coverage.
% of time insured, 2005-2007* Adjusted for gender, age, race / ethnicity, and Federal Poverty Level.
Types of Research Studies
• Data-only• Intervention
The A.L.L. Project
• “Translating” a very successful Kaiser national program (aspirin, lovastatin, lisinopril)– Significant reduction in cardiovascular events in
diabetics
• Using HIT Tools and other interventions to identify diabetic patients who may benefit from a specific drug regimen.
A.L.L. study: impact thus far!
Research Next Steps• Using the power of our data combined with other data
sources– National research datasets (NAMCS)– Claims datasets (Medicaid, All Payors/All Claims (APAC))– Other EHR systems and health organizations– GIS (Geographic Information System) – geocoding
• Disseminating and translating evidence-based, ‘tried and true’ projects into the safety net
• Studying ‘natural experiments’: ACOs/CCOs, Payment Reform, HIEs, etc.
• Working to engage clinicians, patients and other stakeholders
Practice Transformation
Quality ImprovementsWorkflow RedesignHealth Information Technology Support & DevelopmentTeam-based CareClinical Decision ToolsPatient Self-Care Personal Med Records
Research
Electronic Health Record Data, RegistriesPBRN InfrastructureMethodological & Data ExpertiseInforming PolicyInforming PracticeDisseminating Findings
Learner’s Bridge
How can you be involved?
• Sign-up sheet to be added to distribution list• Call into monthly PBRN meetings (4th Fridays,
7:30am – 8:30am Pacific)– NEXT MEETING: NOVEMBER 30
• Tell us about your research and QI projects and ideas!
Email: [email protected]
Learning From You – Small Groups• What has your experience been with research? • Based on your experience, what are best practices and
preferences for recruiting and compensating clinics, providers and patients for research studies?
• We are looking for ways to engage patients in our research. How have you involved the patient perspective in your own research or QI initiatives?
• What are your top research priorities?• How can researchers learn about (and study!) the
innovative things that your organization is doing?• What successful initiatives could be ‘translated’ from
your organization to others?
707 SW Washington Street Suite 1200 • Portland OR 97205 • Phone 503.943.2500 • Fax: 503.943.2501 Email: [email protected] • www.ochin.org
Thank you!
Questions?