2012 Research Annual Report

Improving Health Through Community-Based Research

OCHIN RESEARCH2012 ANNUAL REPORT

LETTER FROM JENNIFER DEVOE, MD, DPHIL, EXECUTIVE DIRECTOR OF RESEARCH, OCHIN, INC.

OCHIN RESEARCH ANNUAL REPORT 2012

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The year 2012 was an exciting year for research at OCHIN. We grew not only in staff and the number of research projects and proposals, but also saw increased engagement with our members and research partners. In addition, OCHIN Research realized a greater visibility on the national scene. Highlights from this past year include:

• Participation in 20 research proposals, five of which have been funded at this time• Awarding of two AHRQ P30 grants in July 2012 (“Meta-LARC: Meta-Network

Learning & Research Center”, Fagnan PI; “N2: A Safety Net Research Network”, Tobin PI). Between the two grants, OCHIN will collaborate with eight other practice-based research networks

• The addition of two new research department staff members • Participation by nine members in active research projects and 10 members in submitted

research proposals• A community research summit in May 2012 that brought together over 50 OCHIN

clinicians and community researchers• Publication of 13 new research papers• Hosting internationally-recognized primary care researchers such Dr. Alex Krist, Dr.

Gloria Coronado, Dr. Kurt Stange, and Dr. Warren Newton• Nine or more oral presentations to national audiences, including: the Epic Research

Advisory Council; the AHRQ PBRN Conference; the National Association of Community Health Centers, and the North American Primary Care Research Group

• Creation of a patient engagement panel to advise us from the patients’ perspective• Jennifer DeVoe, OCHIN’s PBRN Director, appeared briefly on CNN to discuss the

implications of the U.S. Supreme Court decision regarding the Patient Protection and Affordable Care Act

By strengthening our partnership with local and national academic health centers and building trust within the OCHIN membership, we are creating the foundation for a research program at OCHIN that will directly benefit over 700,000 established patients currently being seen in the OCHIN safety net clinic network. These efforts are enhancing the capacity of our “community practice-based research laboratory” to support future research activities that will inform changes impacting millions more throughout the national healthcare safety net.

This research program will enable the sustainable engagement of OCHIN’s provider and patient communities in overseeing, formulating, and conducting research, and will facilitate the translation of research results to improve the health of disadvantaged populations. The year 2012 brought us closer to achieving our long-term goal: to advance research directly relevant to the health and well-being of the vulnerable citizens who receive services in our nation’s health care safety net.

OCHIN is a non-profit Health Center Controlled Network (HCCN) and a national leader in quality health information technology (Health IT) software and services focused on community health centers serving low-income individuals. In 2012, the 66-member collaborative had over 300 individual clinics spanning 12 states. OCHIN is also Oregon’s Health Information Technology Extension Center (O-HITEC), designed to support providers as they transition into the world of Health IT. Currently, OCHIN supports over 3,200 individual medical providers.

With a staff of predominately systems software and health care professionals, OCHIN provides high-quality software products and supportive services to health centers, critical access hospitals, and small private practices serving some of the most medically complex patients in their

Overview of the OCHIN Collaborative

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Where We Are

OREGON WASHINGTONNEVADACALIFORNIA ALASKA MONTANA TEXAS MINNESOTA WISCONSIN INDIANA OHIO NORTH CAROLINA

SEX RACE ETHNICITY

VISITSBY

PAYOR

MALE 43% 57% FEMALE

WHITE 72%1% OTHER

12% UNKNOWN

11% BLACK

3% ASIAN1% AMERICAN INDIAN 61% NON-HISPANIC

10% UNKNOWN

29% HISPANIC

FEDERALPOVERTY

LEVEL

UNKNOWN 23%

53% 100% AND BELOWOVER 200% 12%

151%-200% 4%

101%-150% 9%

OTHER 1%

MEDICARE 14%

SELF-PAY 28%10% COMMERCIAL

47% MEDICAID

OCHIN’S MISSION Partnering with communities to create the knowledge and information solutions to promote access, high quality and affordable healthcare for all


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At its core, OCHIN is a collaborative enterprise supporting the individual and collective needs of its member health centers, which include a range of: • Federally Qualified Health Centers (FQHCs) • FQHC look-alikes • Urban and rural community clinics • School-based health centers

OCHIN provides its members economies of scale that enable each clinic to acquire and effectively use certified electronic health record (EHR) and health information technology products and the full range of support services otherwise out of reach for these organizations. OCHIN’s HCCN model provides structure and stability.

OCHIN’s goal is to support members’ effective use of its centrally-hosted Epic ambulatory practice management and EHR systems tailored to meet unique member needs. OCHIN augments these systems with a suite of auxiliary data aggregation, analytical and reporting tools, and a collaborative learning community. These services drive improved care delivery and health outcomes, best practice clinic operations, and effectiveness research toward achieving the explicit goals of the Institute for Health Improvement’s Triple Aim—better health, better care, and lower cost.

Rich diverse patient dataServing over 600,000 patients annually, OCHIN has one of the nation’s most diverse patient databases of Medicaid and uninsured individuals.

The OCHIN Collaborative is one of only a few organizations in the nation current-ly capturing aggregate healthcare data and statistics of low income and uninsured populations. As an Agency for Health Research and Quality (AHRQ) registered PBRN, OCHIN’s research network is focused on improving health care delivery and health outcomes of the medically underserved. With our PBRN partners, we are building the infrastructure to collaborate with research experts on studies that are consistent with evidence-based practices. Since 2002, the OCHIN Collabora-tive has served over 1.3 million individual patients.

The ability to aggregate this patient data to inform and improve health care provides us with many opportunities to participate in local and national research projects. With strong relationships between OCHIN and researchers from major universities, state and federally-funded research programs and institutes, OCHIN Research is fast becoming a positive force in practice transformation at the com-munity-based research level.

OCHIN’s Practice-Based Research Network (PBRN)

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Adults with diabetes who take statins and ACE inhibitors/angiotensin receptor blockers can dramatically reduce their risk of cardiovascular events. Building from a similar study performed five years ago by Kaiser Permanente (KP) on its members, this project aims to put eligible diabetic patients (in 11 of OCHIN member health centers) on these medications.

This study utilizes the electronic health records (EHR) at OCHIN health centers to identify patients not taking the medications, to remind clinicians to start these patients on the medications, and contact eligible patients. The main goal is to see if KP’s program can be successful in other settings.

As of September 1, 2011, the six early clinic sites had fully implemented the EHR Tools. After implementation, OCHIN staff worked in collaboration with Kaiser Permanente to refine the study tools based on feedback from clinic staff. Other major project work involved developing monthly feedback reports for the clinics.

Preliminary data suggests the intervention is having the desired impact on the rates of patients with appropriate diabetes medication. Looking ahead, the project team plans to disseminate key project learnings to the broad research community through published papers.

DISSEMINATION OF CVD RISK FACTOR TREATMENT AMONG DIABETIC PATIENTS IN FQHCS (ALL).

Highlights of 2012 Research Projects

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COMMUNITY HEALTH APPLIED RESEARCH NETWORK (CHARN)

CHARN was established in September 2010 through the Health Resources and Services Administration to create an infrastructure that has the capacity to pool the experiences of patients across different sites and treatments for the purpose of conducting comparative effectiveness research (CER)—observational and interventional studies.

CHARN is comprised of 17 community health centers (CHC) in nine states that served 519,636 individual patients in 2010. CHARN’s most significant accomplishment is its centralized data registry. This data covers calendar years 2008 through 2010, and includes demographic and insurance data on the total CHARN patient population as well as diagnosis, laboratory, and medication data on six patient populations—those with cardiovascular disease, diabetes, dyslipidemia, hypertension, hepatitis A and B, and AIDS and AIDS-related conditions. The CHARN data warehouse currently holds data from visits to the 17 CHARN CHCs from 2008 through 2010. In spring 2013 it will expand to include data from the years 2006 through 2012.

OCHIN, a Research Node Center of CHARN, brings together academic researchers and community clinician researchers to conduct patient-centered outcome research in order to improve patient care at federally-supported community health clinics. In the past year the OCHIN node has published two papers in the Journal of the American Board of Family Medicine and presented at numerous national conferences, including the North American Primary Care Research Group Annual Meeting and the Academy Health Annual Research Meeting. The node also established the Patient Engagement Panel which will incorporate patients’ perspectives in research relating to clinic workflow and patient impact, patient recruitment and dissemination efforts.

OCHIN took the lead on a number of initiatives. John Heintzman, MD, MPH, led the Diabetes writing group and Sonja Likumahuwa, MID, MPH, served as chair of the national Communications and Community Engagement Committee. As the Committee chair, Likumahuwa led the development of a feedback report for CHARN health centers. Jon Puro, OCHIN’s Senior Data Architect, has been part of a core team designing the second version of the CHARN Registry.

During the last year, the OCHIN node steering committee met monthly, bringing together community clinicians, OCHIN executives, and affiliated researchers to discuss and refine research proposals. The OCHIN node’s Research and Data committee (made up of clinician representatives from participating member organizations, OCHIN staff, and our partner data warehouse specialists), also met monthly to share information and get clinician input on CHARN research and data proposals. Looking forward, findings will be shared among the four research nodes to improve the care provided to safety net patients on a national level.

FAMILIES’ ACCESS TO MEDICAL CARE AND IMPACT OF INSURANCE LAPSES ON CHILDREN AND YOUTH (FAMILY)

In 2008, the Oregon Division of Medical Assistance Programs (DMAP) implemented a lottery that offered adults without insurance a chance to enroll in Oregon Health Plan (OHP) coverage. One of the major goals of this study is to understand how this change in OHP coverage for adults may have impacted children’s health insurance stability and utilization of health care services. In addition, the study was designed to demonstrate how electronic health record (EHR) data differ from health insurance claims data when measuring health care utilization. DMAP and OCHIN have worked together to create a linked dataset using OHP administrative data and OCHIN EHR data that is being used for study analyses.

ASSESSING A MEDICAID RANDOMIZED INSURANCE EXPERIMENT WITHIN COMMUNITY CLINICS (CARDIAC)

The CARDIAC study was designed to assess the impact of the OHP lottery on patients in Oregon who receive care at an OCHIN member clinic. The purpose of this study is to understand how obtaining OHP insurance coverage may have affected how often people receive preventive care for cardiovascular disease (CVD). The study will look at EHR data before and after the OHP lottery to assess differences in receipt of CVD disease prevention care. This study also aims to provide a national model for using EHR data to conduct preventive care surveillance.


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OCHIN is working in collaboration with the Kaiser Permanente Center for Health Research (KPCHR) on the MoodHelper project, a blended-efficacy-effectiveness randomized controlled trial (RCT) of high-fidelity, Internet-delivered cognitive behavioral therapy (CBT) for depression. The study is extending previous research done by KPCHR to maximize treatment availability and reduce costs for people seeking help with depression. The OCHIN partner clinics participating in this study include OHSU Richmond, OHSU Scappoose, Winding Waters, Mosaic Medical, La Clinica del Valle, and Benton County.

As of August 2012, 545 Kaiser Permanente Northwest participants and 261 OCHIN partner participants had been recruited to participate in the study. Over the next few months, recruitment of Spanish-speaking patients will begin; aided by the newly participating OCHIN partner clinic, Virginia Garcia Memorial Health Center, which has a large population of Spanish-speaking patients. Over the course of 36 months, MoodHelper aims to enroll 1,800 adults seeking care for depression.

INTERNET CBT FOR DEPRESSION: COMPARING PURE, GUIDED, AND STEPPED CARE (MOODHELPER)

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Research Team Members


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JILL ARKIND, MPH, is a Research Assistant with the OCHIN research team. Prior to joining OCHIN, she worked as a Research Assistant within academic organizations and as a Policy Analyst with a state health department program providing health services to uninsured and underinsured women. Ms. Arkind received an MPH in Health Promotion with a focus in Women’s Health from Portland State University in 2011.

VANCE BAUER, MA, is OCHIN’s Research Operations Director. In his role, he manages budgets for all current projects, assists in the development of new projects and operations, manages the development of the PBRN infrastructure, and manages the conduct of research activities in conjunction with the network. Prior to joining OCHIN in January 2011, Mr. Bauer worked at Kaiser Permanente Center for Health Research (CHR) for over 10 years where he served as both a research associate and project manager. While at CHR, Mr. Bauer played a pivotal role in the formation of the Oregon Clinical and Translational Research Institute(OCTRI), a partnership with Oregon Health & Science University. Mr. Bauer also served as the research coordinator for CHR’s Work, Family, and Health Network. Mr. Bauer obtained an MA in psychology from the University of Pennsylvania.

STUART COWBURN, MS, is a Research Analyst with the OCHIN research team. Mr. Cowburn’s primary expertise is in research design, proposal development, and statistical analysis of healthcare information. Mr. Cowburn’s focus is on data analysis in support of ongoing NIH and AHRQ-funded research studies examining clinical and financial outcomes for healthcare organizations that serve safety net populations. Prior to joining OCHIN in January 2011, Stuart worked in a variety of scientific, research and grant development roles for educational and non-profit organizations, including Portland State University, Washington State University, Portland Community College, and the Oregon Museum of Science and Industry.

JENNIFER (JEN) DEVOE, MD, MCR, DPHIL, FAAFP, is the Executive Director of the OCHIN PBRN. Dr. DeVoe is an Associate Professor of Family Medicine at Oregon Health & Science University (OHSU) in Portland, Oregon and maintains a part-time clinical practice in Portland. She obtained her MD from Harvard Medical School in 1999 and her Master’s of Philosophy and Doctorate of Philosophy (DPhil) from Oxford University in 1998 and 2001, respectively. She completed her residency in family medicine at OHSU in 2004. She received a Master’s in Clinical Research (MCR) from OHSU in 2010. Dr. DeVoe’s work is focused on utilizing OCHIN’s EHR data for research, and refining processes for linking OCHIN data with state Medicaid data to inform practice transformation. As a practicing family physician and a health services researcher, she has been a central member of a statewide team studying access to insurance and health care services for vulnerable families. In addition to leading the collection of primary data from families across Oregon, Dr. DeVoe has expertise in secondary analyses of large data sets, such as Medicaid insurance claims data and the Medical Expenditure Panel Survey.

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JENNIFER LEMBACH, MUS, is a Research Associate with the OCHIN research team. She serves as the project manager for several of OCHIN’s research studies involving the safety net population. Prior to joining OCHIN, she worked for 11 years conducting research and evaluation of educational programs, mental health treatment services, and substance abuse treatment and prevention programs. She also served as an evaluator of the Alliance for a Healthier Generation’s Healthy Schools Program, which aims to reduce childhood obesity by supporting schools in making systemic improvements to their physical education programs and school lunches. Ms. Lembach earned a Master’s in Urban Studies with a focus on research design from Portland State University and is matriculated in the Graduate Certificate in Public Health program at Oregon Health & Science University.

SONJA LIKUMAHUWA, MID, MPH, is the OCHIN PBRN Coordinator and Senior Research Assistant at Oregon Health & Science University’s Department of Family Medicine. She serves as the OHSU project manager for federal grants, on which OHSU is partnering with OCHIN, seeking to empower and support practice-based research in primary health care safety-net clinics. Prior to joining OHSU, Ms. Likumahuwa worked as director of a quality of life study with liver cancer patients and their primary caregivers at the University of Pittsburgh. The study was a randomized control trial testing a psychosocial intervention. She received a Master of Public Health (behavioral and community health sciences) and a Master of International Development (nonprofits and civil society) in 2008 from the University of Pittsburgh.

CHRISTINE NELSON, PHD, RN, is a Senior Research Associate with the OCHIN research team. She manages several studies involving OCHIN’s safety net population and serves as the OCHIN community research engagement liaison, building relationships with OCHIN member clinics, community health researchers, and both current and potential practice-based research partners. Prior to joining OCHIN, Dr. Nelson gained extensive experience as a nurse researcher with the Oregon Health & Science University School of Nursing where she was working on extramurally funded research studies related to family caregiving, bioethics, and end-of-life care. She received her Master’s of Science in Nursing from University of California San Francisco and her PhD in Family Sciences from Oregon State University..

JON PURO, MPA/HA, is the Lead Information Architect with the OCHIN research team. Mr. Puro’s primary expertise is the design, use, and deployment of information systems for the collection and dissemination of data and reports to the consumers of healthcare information, with a specialization in database modeling and data warehouse architecture. Mr. Puro has held a variety of information technology roles, such as an analyst, database administrator, and manager in several healthcare settings in addition to OCHIN, including Multnomah County, CareOregon, and Kaiser Permanente. Mr. Puro is now focusing on clinical research and the development of information systems to collect data for and report on clinical and financial outcomes for healthcare organizations that serve safety net populations.

TRISHA VAKARCS is a Research Analyst with the OCHIN research team. She has eleven years of experience working with OCHIN’s Epic and Clarity systems. In addition, Ms. Vakarcs has thirty years of experience in the accounting and financial analysis fields, twenty years of which were focused on healthcare. Ms. Vakarcs is certified in SQL 2000 Basic Queries, Crystal XI and has Epic Certifications in Resolute, Prelude and Clarity.

2012 Publications

Gold R, DeVoe J, McIntire P, Puro J, Chauvie S, Shah A. (2012). Receipt of Diabetes Preventive Care Among Safety Net Patients Associated with Differing Levels of Insurance Coverage. Journal of the American Board of Family Medicine, 25(1), 42-49.

Gold R, Angier H, Mangione-Smith R, Gallia C, McIntire P, Cowburn S, Tillotson C, DeVoe J. (2012). Feasibility of Evaluating the CHIPRA Care Quality Measures in Electronic Health Record Data. Pediatrics, 130(1), 139-149.

Gold R, Devoe J, Turner A, Hill C, Shah A, Clarke G, Muench J. (2012). Collaborative Development of a Randomized Study to Adapt a Diabetes Quality Improvement Initiative into Federally Qualified Health Centers. Journal of Health Care for the Poor and Underserved 23(2), 236-246.

Hazlehurst B, McBurnie M.A, Mularski R, Puro J, Chauvie S. (2012). Automating Care Quality Measurement With Health Information Technology. American Journal of Managed Care, 18(6), 313-319.

Yamauchi M, Carlson MJ, Wright BJ, Angier H, DeVoe, JE. (2012). Does Health Insurance Continuity Among Low-income Adults Impact Their Children’s Insurance Coverage? Maternal and Child Health Journal. E-pub, February 24 2012.

DeVoe JE, Westfall N, Crocker S, Eigner D, Selph S, Bunce A, Wallace LS . (2012). Why Do Some Eligible Families Forego Public Insurance for Their Children? A Qualitative Analysis. Family Medicine 44(1), 39-46.

DeVoe JE, Tillotson C, Wallace LS, Lesko S, Pandhi N. (2012) Is Health Insurance Enough? A Usual Source of Care May Be More Important to Ensure a Child Receives Preventive Health Counseling. Maternal and Child Health Journal 16(2):306-15.


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DeVoe J, Gold R, Spofford M, Chauvie S, Muench J, Turner A, Likumahuwa S, Nelson C. (2011). Developing a Network of Community Health Centers with Common Electronic Health Record: Description of the Safety Net West Practice-based Research Network (SNW-PBRN). Journal of the American Board of Family Medicine, 24(5), 597-604.

DeVoe JE, Wallace LS, Selph S, Westfall N, Crocker S, Eigner D. (2011). Comparing Type of Health Insurance Among Low-Income Children: A Mixed-Methods Study from Oregon. Maternal and Child Health Journal, 15(8), 1238-1248.

DeVoe JE, Tillotson CJ, Wallace LS, Angier H, Carlson MJ, Gold R. (2011). Parent and Child Usual Source of Care and Children’s Receipt of Health Care Services. Annals of Family Medicine, 9(6), 504-513.

DeVoe JE, Tillotson CJ, Lesko SE, Wallace LS, Angier H. (2011). The Case for Synergy Between a Usual Source of Care and Health Insurance Coverage, 26(9), 1059-1066.

DeVoe JE, Tillotson CJ, Wallace LS, Selph S, Graham A, Angier H. (2011). Comparing Types of Health Insurance for Children A Public Option Versus a Private Option. Medical Care 49(9), 818–827.

Hazlehurst B., Stevens V., McBurnie, MA., Mularski R., Elder C., Bachman K., Puro J., McIntire P., & Chauvie S. (2011). Development of a Measure Set for Routine, Comprehensive, Automated Assessment of Obesity Care Quality. Clinical Medicine and Research, 9(3-4), 161.

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We anticipate that 2013 will be another ground-breaking year for OCHIN Research. We look forward to partnering with OCHIN’s new clinical leadership to explore ways to translate research findings into OCHIN member clinics and to support our members with the implementation of evidence-based and best practices. These new leaders include Scott Fields, Chief Medical Officer; Tim Burdick, Chief Medical Information Officer; Jonathan Merrell, Vice President of Performance Improvement; and D’Angela Merrell, Clinical Improvement Professional.

We will maintain our track record of presenting our research at national conferences and publishing our findings in professional journals. We will continue to build the research infrastructure at OCHIN through participation on relevant OCHIN committees and work groups and to identify opportunities to expand research with OCHIN members across the collaborative. Finally, we will move forward with convening a Patient Engagement Panel to advise us on research questions and methods important to patients served by OCHIN members.

We are pleased that our hard work in 2012 has paid off with the recent award of three new major research grants:

STOP CRC - Strategies and Opportunities to Stop Colon Cancer in Priority Populations. Colorectal cancer (CRC) is the second-leading cause of cancer death in the United States. Rates of CRC screening are extremely low for patients at Federally Qualified Health Centers (FQHCs), which serve nearly 19 million patients annually. We are partnering with Kaiser Permanente Center for Health Research (KPCHR) and Group Health to implement and test an intervention to improve rates of CRC screening in a group of FQHCs. We intend for our program to be a model for other FQHCs and health systems.

Plans for 2013

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PRIME (FORMERLY SMI SCREENING) – Understanding Disparities in Preventive Services for Patients with Mental Illness. The goal of this study is to identify modifiable factors that affect preventive service use among people with serious mental illnesses. The study will seek to understand the underlying factors at the patient, provider and clinic level that may affect the receipt of preventive care and to identify the extent in which people with serious mental illnesses receive age- and gender-appropriate preventive services. The project is led by Carla Green, PhD, a senior investigator at KPCHR. IMPACCT – Innovative Methods for Parents and Clinics to Create Tools (IMPACCT) for Kids’ Care. We will work with families, policy makers, and community health care providers to develop and test new computer tools to help people in community clinics find pediatric patients in need of insurance and communicate with their families about public insurance programs. These tools will be based on technologies currently used to help patients and clinics manage chronic diseases. We will look to see if children in the clinics using the tools are more likely to have health insurance and also more likely to receive certain health care services, compared to children in the clinics without such tools.

These new studies, as well as those already in progress, enable us to accelerate our progress toward the long-term goal of advancing research to improve the lives of those who receive healthcare in our nation’s health care safety net. We look forward to actively participating in the transformation of healthcare through our research.

1881 SW Naito Parkway, Portland, OR 97201-5195503-943-2500 (telephone) 503-943-2501 (fax)www.ochin.org

2012 Research Annual Report

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