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Posts Tagged ‘Population Health Management’


8:00AM 11/13/2014 – 10th Annual Personalized Medicine Conference at the Harvard Medical School, Boston

REAL TIME Coverage of this Conference by Dr. Aviva Lev-Ari, PhD, RN – Director and Founder of LEADERS in PHARMACEUTICAL BUSINESS INTELLIGENCE, Boston http://pharmaceuticalintelligence.com

8:00 A.M. Welcome from Gary Gottlieb, M.D.

Opening Remarks:

Partners HealthCare is the largest healthcare organization in Massachusetts and whose founding members are Brigham and Women’s Hospital and Massachusetts General Hospital. Dr. Gottlieb has long been a supporter of personalized medicine and he will provide his vision on the role of genetics and genomics in healthcare across the many hospitals that are part of Partners HealthCare.

Opening Remarks and Introduction

Scott Weiss, M.D., M.S. @PartnersNews
Scientific Director, Partners HealthCare Personalized Medicine;
Associate Director, Channing Laboratory/
Professor of Medicine, Harvard Medical School 
@harvardmed

Welcome

Engine of innovations

  • lower cost – Accountable care
  • robust IT infrastructure on the Unified Medical Records
  • Lab Molecular Medicine and Biobanks
  • 1. Lab Molecular medicine
  • 2. Biobank
  • 3. Translations Genomics: RNA Sequencing
  • 4. Medical Records integration of coded diagnosis linked to Genomics

BIOBANKS – Samples and contact patients, return actionable procedures

LIFE STYLE SURVEY – supplements the medical record

GENOTYPING and SEQUENCING – less $50 per sequence available to researcher / investigators

RECRUITMENT – subject to biobank, own Consents – e-mail patient – consent online consenting — collects 16,000 patients per month – very successful Online Consent

LAB Molecular Medicine – CLIA — genomics test and clinical care – EGFR identified as a bio-marker to cancer in 3 month a test was available. Best curated medical exon databases Emory Genetics Lab (EMVClass) and CHOP (BioCreative and MitoMAP and MitoMASTER). Labs are renowned in pharmacogenomics and interpretability.

IT – GeneInsight – IT goal Clinicians empowered by a workflow geneticist assign cases, data entered into knowledge base, case history, GENEINSIGHT Lab — geneticists enter info in a codified way will trigger a report for the Geneticist – adding specific knowledge standardized report enters Medical Record. Available in many Clinics of Partners members.

Example: Management of Patient genetic profiles – Relationships built between the lab and the Clinician

Variety of Tools are in development

GenInsight Team –>> Pathology –>> Sunquest Relationship

The Future

Genetic testing –>> other info (Pathology, Exams, Life Style Survey, Meds, Imaging) — Integrated Medical Record

Clinic of the Future-– >> Diagnostics – Genomics data and Variants integrated at the Clinician desk

Gary Gottlieb, M.D. @PartnersNews
President and CEO, Partners HealthCare

Translational Science
Partners 6,000 MDs, MGH – 200 years as Teaching Hospital of HMS, BWH – magnets in HealthCare

2001  – Center for Genomics was started at Partners, 2008 Genomics and Other Omis, Population Health, PM – Innovations at Partners.

Please Click on Link  Video on 20 years of PartnersHealthcare

Video of Dr. Gottlieb at ECRI conference 2012

Why is personalized medicine  important to Partners?

From Healthcare system to the Specific Human Conditions

  • Lab translate results to therapy
  • Biobank +50,000 specimens links to Medical Records of patients – relevant to Clinician, Genomics to Clinical Applications

Questions from the Podium

  • test results are not yet available online for patients
  • clinicians and liability – delays from Lab to decide a variant needs to be reclassified – alert is triggered. Lab needs time to accumulated knowledge before reporting a change in state.
  • Training Clinicians in above type of IT infrastructure: Labs around the Nations deal with VARIANT RECLASSIFICATION- physician education is a must, Clinicians have access to REFERENCE links.
  • All clinicians accessing this IT infrastructure — are trained. Most are not yet trained
  • Coordination within Countries and Across Nations — Platforms are Group specific – PARTNERS vs the US IT Infrastructure — Genomics access to EMR — from 20% to 70% Nationwide during the Years of the Obama Adm.
  • Shakeout in SW linking Genetic Labs to reach Gold Standard

Click to see Advanced Medical Education Partners Offers

 

– See more at: http://personalizedmedicine.partners.org/Education/Personalized-Medicine-Conference/Program.aspx#sthash.qGbGZXXf.dpuf

@HarvardPMConf

#PMConf

@SachsAssociates

@PartnersNews

@MassGeneral

@HarvardHealth

@harvardmed

@BrighamWomens

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Cardiovascular Risk Reduction in Diabetes in Sub-Saharan Africa

Reporter and Curator: Larry H. Bernstein, MD, FCAP 

 

In the immediate preceding article we discussed the problem of small subsistence farming and dependence on crop, and milk as a main source of food. We discussed the dilemma of unavailability of adequate nutrition, that posed a dilemma.  Insects invade and destroy the vegetation.  That can be avoided by either of two choices, crop-treatment with pesticide or by GMO crops resistant to types of destruction, both having unaffordable costs that impose an austere challenge and abject poverty with marginal after sales gains, in no way comparable to farming in Iowa, Wisconsin, Minnesota, or California, U.S.  So the situation could be improved by the introduction of/or development of a practical genome-based synthetic tehnology that might be free of Western dominance, if there were the home-based universities and scientific research.
I also touched on the consequences of the malnutrition in that region because of a diet that imposes either marasmic or kwashiorkor-like feature, the distinction being made based on the body compartment related to loss of fat mass or the loss of lean body mass, the latter being more serious.

Cardiovascular Risk Reduction in Diabetes in Sub-Saharan Africa

The abstract of this discussion is directly taken from an article published in Clinical Medicine Insights: Cardiology; 2008: 2: 25-31,  Libertas Academica, ISSN(s):1178-1165.  Added to DOAJ: 2008-05-01
http://la-press.com/article.php?article_id=529

Cardiovascular Risk Reduction in Diabetes in Sub-Saharan Africa: What should the Priorities be in the Absence of Global Risk Evaluation Tools?

Subjects: Diseases of the circulatory (Cardiovascular) system, Specialties of internal medicine, Internal medicine, Medicine, Cardiovascular, Medicine (General), Health Sciences
Andre Pascal Kengne, Alfred Kongnyu Njamnshi, Jean Claude Mbanya

Keywords: diabetes mellitus, cardiovascular disease, risk factors, prevention, Sub-Saharan Africa

Background

The growing burden of type 2 diabetes in Sub-Saharan Africa (SSA) and related cardiovascular complications call for vigorous actions into prevention. Comprehensive cardiovascular risk evaluation is important for the success of such actions.

Methods

We have reviewed 3 currently existing sets of recommendations for cardiovascular prevention in diabetes in SSA. Distribution of major risk factors and patterns of reported cardiovascular outcomes are used to suggest orientations for cardiovascular prevention in diabetes in this region. Papers and reports published over the period 1990 to 2007 were used.

Results

Existing guidelines share some similarities, but also have areas of inconsistencies. They are generally adaptations of existing guidelines, focused more on individual risk factors, and are not usually backed-up by local evidence.

  • They all have a projection on blood pressure lowering.

This focus is supported by the high prevalence of hypertension among people with diabetes in SSA.

  • Blood pressure and tobacco smoking are the modifiable risk factors accessible to evaluation and interventions on a wide scale in SSA.

Appropriate blood pressure control will have a major impact on stroke (the commonest cardiovascular disease) through

  • a reduction of the cerebrovascular risk, and
  • to a lesser extent on coronary heart disease and
  • total deaths in diabetes in this region.

Conclusions

In the absence of global risk evaluation tools,

  • the use of blood pressure lowering as a primary focus of cardiovascular prevention strategies is relevant for SSA.

However, there is a need to set-up diabetes and stroke registers

  • to monitor outcomes and generate tools for accurate risk prediction and management in diabetes in this region.

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Reporter: Alan F. Kaul, PharmD. MS. MBA, FCCP

As a part of the Accountable Care Act (ACA) added to the Social Security Act, CMS under the Hospital Readmissions Reduction Program (HRRP) is required to reduce payments to Inpatient Prospective Payment System (IPPS) hospitals reporting excess readmissions commencing with discharges on October 1, 2012.

In the FY2012 IPPS final rule, readmission measures for Acute Myocardial Infarction (AMI), Heart Failure (HF), and Pneumonia (PN) and the calculated excess readmission ratio will be used, in part, to calculate the readmission payment adjustment under the HRRP. CMS using risk adjustment endorsed by the National Quality Forum (NQF) and adjustments for clinically relevant factors such as patient comorbidity, frailty, and demographics will use a national dataset to compare to each hospital’s set of patients. CMS will look-back at three years worth of each hospital’s discharges and a minimum of 25 cases to calculate a hospital’s excess readmission rate for each condition. Beginning FY 2013, each excess readmission ratio will look at discharges occurring from July 1, 2008 through June 30, 2011.

In its FY2013 proposed rules making cycle, CMS proposed to continue the process and which hospitals will be subject to the HRRP, the methodologies used in its calculations, and a process for hospitals to review the information and submit proposed corrections before the information is publically released.

While CMS moves forward with its HRRP, hospitals readiness for population-base accountable care is questionable. A national survey of all hospitals was undertaken in 2011 to assess the current state of hospital readiness in the development of Accountable Care Organizations (ACOs). There were 1,672 responses to the survey or a 34% response rate. Several major themes were identified such as:

1. Only a small percentage of hospitals (3%) participate in ACOs and only 10% were preparing to do so.
2. Hospitals expect their revenue sources fro risk-based financial reimbursement to double from 9% to 18% over the next two years.
3. Most hospitals were engaged in numerous care co-ordination methods, though there was variation in specific practices.
4. There are several perceived barriers between hospitals preparing to participate an ACO and hospitals participating in ACOs. Of note, the greatest challenges of those hospitals participating in ACOS were perceived to be reducing clinical variation and reducing costs. Those planning participation, the greatest challenge was perceived to be increasing the size of the covered patient population.
5. ACO hospitals are significantly more involved in population health management services including coordination across the continuum of care.
6. There are significant gaps in care coordination functionalities. For example, there is a low-use of risk stratification and other care coordination activities. As an example, only 38% of hospitals participating in ACOs, 33% planning their participating, and 24% of hospitals not exploring an ACO model assign case managers to patients at risk for hospital readmission for out-patient follow-up. Less than 25% of hospitals in each group have nurse case managers who work with patients with chronic diseases. Similarly, 23%, 21%, and 11% respectively of those hospitals participating, planning participation, or with no plans to participate in an ACO have a post-hospital discharge continuity of care program with scaled intensiveness. Approximately one-third of hospitals participating in or preparing to participate in an ACO have no chronic-care registry. About 20% have a registry for one condition and 40% for two conditions.
7. ACOs are striving to improve the quality of their services by using valid performance measures and making results available to the public and participating providers.

Sources:

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html

Hospital Readiness for Population-based Accountable Care. Health Research and Educational Trust, Chicago:April 2012. Accessed at http://www.hope.org

Accessible at: http://www.hpoe.org/accointable-care

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