Data and Analytics Fair
All are welcome at Group Health's Data and Analytics Fair, to be held at Group Health Cooperative Headquarters at 320 Westlake Avenue North in Seattle. The event will take place from 1:30 to 4 p.m. in rooms W281, W283, and W285. Registration is now closed for posters and presentations. For more information about the event, please contact Christopher Mack.
Sustainable well-being: Fixing a fragmented health care system using technology
Presented by Marc West, Consultant, Innovation Strategy, Group Health Physicians
4 p.m. to 5 p.m., Room 1509A, Group Health Research Institute, 1730 Minor Ave., Seattle.
Marc West is currently working as a Consultant for Innovation Strategy for Group Health Physicians. He was diagnosed with ALS in 2011, and was the first recipient of the Inspirational Leadership Award in 2013. Marc served as executive vice president of Group Health Physicians (GHP) from 2005–2012, during which time his responsibilities also included Executive Vice President of Care Systems Development for Group Health Cooperative.
As the EVP of Group Health Physicians, Marc provided long-range strategic guidance to the GHP Board and led the Administrative Team in areas of Finance, Human Resources, and Information Technology. In his leadership role in Care Systems Development he was responsible for partnering with the health plan, group practice, and other divisions as they developed and implemented improvements in Group Health’s integrated care system. Prior to his current roles, Marc was chief financial and administrative officer for GHP and served in a variety of positions within Group Health Cooperative, including director of Regional Finance and Planning, manager of Business Systems, and regional cost consultant. He earned a bachelor's degree in business administration and accounting from the University of Washington in 1990, and completed a CPA certificate program in 1992. He completed his MBA degree from Kaplan University in April of 2011.
The U.S. ranks last nationally in the Long, Healthy Productivity Lives metric in the Commonwealth Fund. Building on his vast experience in health care and his now personal experience with telehealth, Marc has envisioned a new way for coordinated care systems to support complex chronically ill, and ultimately other patients, to live full lives using technology to link providers and patients in new ways.
The Telehealth Accountable Care Organization (T-ACOTM) vision may provide a route for Washington state to improve the health care system and even close budget gaps by leveraging technology in progressive and pioneering ways, combined with proven population management tactics.
This presentation will outline the vision for the T-ACOTM, and demonstrate some of the technological components of the Imagine Telecommunication Telehealth System (ITTS), its technology bundle. It will consider data on potential target populations and impacts to cost of care, current regulatory requirements and research on the use of telehealth in health care to-date, and imagine how this vision could inform the future of health care, health information technology, and telecommunications in our state and beyond.
The patient as agent: Examining the role of the "activated patient" in chronic illness care
Presented by Mark Sullivan, UW professor of psychiatry and adjunct professor of bioethics and humanities
4 p.m. to 5 p.m., Room 1509A, Group Health Research Institute, 1730 Minor Ave., Seattle.
“Applying the Tools of Health Services and Operations Research to Designing and Evaluating the Patient-Centered Medical Home”
Room 1509A, Metropolitan Park East, 1730 Minor Ave., Seattle, WA 98101-1448: Paul Fishman, PhD, Senior Investigator at Group Research Institute and Affiliate Associate Professor at the University of Washington's School of Public Health and Community Medicine.
Abstract: Health services are financed, produced and delivered through a complex and multi-layered system whose constituent parts too often act independently of one other. The lack of integrated and coordination among elements of the health services sector results in inefficiencies that lead to increased costs to producers and consumers and errors in care that effect patient health and safety. In response to the challenges created or amplified by the way in which health services have been organized as well as by incentives contained in legislation at the federal and state levels the industry is attempting to recreate itself and build more financial and clinical integration between and among health services providers. The industry has little evidence about how to effect this transformation and there are experiments throughout the country attempting to find ways to create a more efficient, safer and productive health care sector that is responsive to patient needs.
We present a research framework and initial results of collaboration between the economists, health services and operations researchers designed to identify and test opportunities for achieving the triple aims of lower cost, improved quality and better patient satisfaction that has been established as the outcome of a successful reform of the US health care system. We present results of a model that capture the manner in which patients transition through the health care system that allows us to test for the impact of alternative delivery system design principles and identify opportunities for improved cost results and health outcomes.
1st Seattle Symposium on Health Care Data Analytics: Confronting statistical challenges of using health record data to conduct health research.
Hosted by GHRI and the University of Washington Department of Biostatistics.
“On the front lines of a paradigm shift: The value of qualitative perspectives for the emerging field of Patient Centered Outcomes Research (PCOR).”
Clarissa Hsu, PhD, Research Associate/Research Program Manager, Center for Community Health and Evaluation (CCHE), Group Health Research Institute
Abstract: Patient centered care and patient centered research has received increasing attention as a result of the Affordable Care Act’s (ACA) focus on the Triple Aim of improving the quality of patient care, advancing population-based health and cost containment. By prescribing the formation of the Patient Centered Outcomes Research Institute (PCORI) and related funds for dissemination of PCOR results, the ACA is supporting the emergence of PCOR as a new approach to health care research. PCOR asks both researchers and those delivering care to fundamentally rethink their assumptions and values regarding what they know and the methods used to gather evidence to inform future innovations aimed at improving health and health care.
Qualitative methods use open-ended inquiry and observation to learn about lived experiences and how people make sense and derive meaning from those experiences. As such, these methods offer unique perspectives and approaches that are well suited to gaining new insights about what matters to patients and how patients and clinical staff experience health care processes.
This presentation will explore the different ways that qualitative work can inform both the way we conceptualize PCOR and insights that are generated in this emerging field. Dr. Hsu will highlight several projects she has led or worked on that have an explicit focus on PCOR and/or patient perspectives. Her goal is to provide concrete examples of how our work at GHRI is intersecting with the field of PCOR and launch a dialog around how researchers at GHRI can continue to be leaders and innovators in this exciting new area of research.
15th Annual Hilde and Bill Birnbaum Endowed Lecture and Panel Discussion
“Affordable health care for all: How will our nation and region deliver on the promise?”
2014 Latino Health Conference
“Development and evaluation of prognostic models in chronic heart failure.”
Benjamin French, PhD, Assistant Professor, Biostatistics and Epidemiology, University of Pennsylvania
Abstract: Recent clinical research regarding chronic heart failure has focused on identifying prognostic models to predict future morbidity and mortality. Accurate models could be used to counsel patients more effectively and to guide personalized treatment strategies over time. Development of a prognostic model typically requires specification of an appropriate statistical model and is most frequently achieved using standard regression methods such as Cox regression. The prognostic model can be evaluated using time-dependent receiver operating characteristic methods, or risk reclassification methods adapted for censored survival outcomes. In this seminar, Dr. French will
“Consistent estimation of covariate effects for some between-/within-cluster covariate decomposition methods when data are missing at random.”
John Neuhaus, PhD, Professor of Biostatistics, Division of Biostatistics, University of California, San Francisco
Abstract: Investigators often gather longitudinal data to assess changes in responses over time within subjects and to relate these changes to within-subject changes in predictors. Missing data are common in such studies and predictors can be correlated with subject-specific effects. Maximum likelihood methods for generalized linear mixed models provide consistent estimates when the data are “missing at random” (MAR) but can produce inconsistent estimates in settings where the random effects are correlated with one of the predictors. On the other hand, conditional maximum likelihood methods (and closely related maximum likelihood methods that partition covariates into between- and within-cluster components) provide consistent estimation when random effects are correlated with predictors but can produce inconsistent covariate effect estimates when data are MAR. Using theory, simulation studies, and fits to example data this talk shows that decomposition methods using complete covariate information produce consistent estimates. In some practical cases these methods, that ostensibly require complete covariate information, actually only involve the observed covariates. These results offer an easy-to-use approach to simultaneously protect against bias from either cluster-level confounding or MAR missingness in assessments of change.
“Improving diagnosis and monitoring in primary care: new technologies, new methods.”
Matthew J. Thompson, MBChB, MPH, DPhil, MRCGP,
Helen D. Cohen Endowed Professorship in Family Medicine, Vice Chair for Research, Department of Family Medicine, University of Washington
Abstract: Diagnostic research has been an under researched area of primary care practice and is emerging from a focus on diagnostic accuracy to consider wider aspects and implications of testing. Meanwhile, many of the technological advances in diagnostics (speed, scope, size, availability, cost) have largely bypassed primary care in most countries. Dr. Thompson will be presenting results from a portfolio of research conducted in the UK at the Centre for Monitoring and Diagnosis in Oxford, which aims to improve the accuracy and efficiency of diagnosis and monitoring in primary care settings. Thompson plans to cover three main areas
New diagnostic technologies in primary care—what to learn from prioritizing, assessing evidence, and conducting field studies across multiple clinical areas—where are the gaps in the ‘bench to bedside/clinic’ pathways, and why does the diagnostics industry need our help?
Monitoring of chronic disease has emerged as a major component of workload in primary care, yet evidence on frequency and actions based on monitoring have not been evidence based. How can applying statistical processes to monitoring improve efficiency of care?
An update on some new methodological issues in diagnostic research—including diagnostic systematic reviews, handling intermediate test results, and communicating diagnostic accuracy.
“Will the true BP (blood pressure) please stand up?”
Beverly B. Green, MD, MPH, Associate Investigator, GHRI and Family Physician, Group Health
Andrea Cook, PhD, Associate Investigator, GHRI
Melissa Anderson, MS, Biostatistician, GHRI
Abstract: The Electronic Communications and Home Blood Pressure Monitoring Trial (e-BP), four-year results, and differences in BP outcomes based on electronic health record data and research measurements.
The e-BP Comparative Effectiveness Trial compared home BP monitoring, this plus pharmacist team care delivered via secure e-mail to usual care and results were published in JAMA. The study was chosen by the British Medical Journal as a finalist for 1 of the 10 most important studies of 2008. We will discuss long-term results of the trial, methodological questions, and result implications.
“Impact of mandatory behavioral screening for children insured by Medicaid in Massachusetts.”
Robert Penfold, PhD, Assistant Investigator, GHRI
Abstract: In Massachusetts, as part of a settlement of a class action suit, Rosie D vs. Patrick, the state mandated behavioral health (BH) screening in primary care for all children up to 21 years of age who were covered by MassHealth (Medicaid). Clinicians were required to conduct behavioral health screening with validated tools at well-child visits. Use of a screen was to be reported using Current Procedural Terminology (CPT) code 96110 in billing claims for the visit, and providers were to receive payment for the procedure. While the recommendation was to screen at well-child visits, consistent with EPSDT regulations, screens were also reimbursed if used at non-well child visits.
We investigated the impact of the mandate on rates of newly identified behavioral health problems and rates of subsequent behavioral health utilization using logistic regression and interrupted time series analyses. Among continuously enrolled children with evidence of screening, 43 percent with positive screens had no BH history. This ‘newly identified’ group was more likely to be female, younger, minority, and from rural residences Factors predicting positive modifiers included, gender (male), age (older), foster care, BH history, and Hispanic ethnicity.
The mandate was also associated with dramatic increases in the rate of non-physician behavioral health care utilization. However, we observed no measurable impact on the rate of specialty mental health care use or use of psychotropic medications. There was also some indication that Emergency Department visits with a coded mental health diagnosis increased in the post-mandate period.
“Marginal structural modeling to estimate the effect of long-term physical activity on cardiovascular disease and mortality.”
Susan Shortreed, PhD, Assistant Investigator, Biostatistics Unit, GHRI
Abstract: The majority of studies estimating the effect of physical activity on cardiovascular disease (CVD) and mortality assess physical activity at a single time point. The impact of long-term physical activity is likely to differ. In this talk, Dr. Shortreed will
“The development, implementation, and evaluation of the Keele STarT BACK Tool for stratifying back pain patients in terms of clinical complexity.”
Nadine Foster, DPhil, Jonathan Hill, PhD, and Gail Sowden, MSc, Keele University, England
Abstract: Come hear about the creation, implementation, and evaluation of a paradigm-shifting approach to primary care for back pain developed by researchers at Keele University in England. Rather than focusing primarily on the degree of acuity/chronicity of back problems, the Keele model gives greater emphasis to consideration of the psycho-social factors that have consistently been found more predictive of patient outcomes than have clinical measures. In essence, this tool uses patient responses to nine simple questions to determine the level of each patient’s complexity and then uses this information to select a treatment option that is most appropriate for that complexity level. This approach has been found to improve patient outcomes and decrease costs of care in National Health Service general practices. Group Health is preparing to conduct the first evaluation of this risk stratification approach in a U.S. health care system.
“Individualizing prevention in older adults.”
Sei Lee, MD, MAS, Assistant Professor, Geriatrics, Department of Medicine, University of California, San Francisco and Physician, Division of Geriatrics, San Francisco VA Medical Center
Abstract: Preventive interventions, by definition, seek to prevent adverse events in the future. However, preventive interventions often impose risks on patients immediately. The time between the risks of preventive interventions (usually immediate) and the benefits is the “lagtime to benefit” and can be many years. For patients with limited life expectancy, preventive interventions may expose them to the risks, with little chance they would benefit. We will examine how to determine mortality risk in multimorbid older adults and quantify the lagtime to benefit for common preventive interventions to identify which patients are most appropriate for specific preventive interventions.
“Primary care transformation: Lessons from the Safety Net Medical Home Initiative.”
Katie Coleman, MSPH, Research Associate, MacColl Center for Healthcare Innovation, GHRI
Abstract: Interested in reducing health disparities? Improving patient health outcomes? Better coordinating care? So are we! Join us as we share lessons learned from our five-year effort to develop patient-centered medical homes in 65 safety-net practices across the country.
Scientific seminars are held at the Metropolitan Park East Building (MPE), 1730 Minor Avenue, in Seattle. For directions to GHRI and contact information see our Contact Us page.