David Haggstrom Slides from AHRQ Kick-Off Event

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ShawnHoke

Colorectal cancer screening: overview & background

Health & Medicine Technology

Outline ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Colorectal cancer screening Clinical practice guidelines ,[object Object],[object Object]

Colorectal cancer screening Clinical practice guidelines (USPSTF) Test Interval ,[object Object],[object Object],Annually Flexible sigmoidoscopy Every 5 years Colonoscopy Every 10 years Double-contrast barium enema Every 5 years

Competing clinical demands ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Yarnall et al., AJPH , 2003)

Computer reminders – Regenstrief Institute ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Litzelman, Tierney, JGIM , 1993)

Electronic health record – Partners HealthCare Barriers to use ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Linder, AMIA Annu Symp Proc , 2006)

Computer reminders - VA Facilitators to adherence ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Mayo-Smith, Abha Agrawal, 2004 & 2006)

Computer reminders - VA Barriers to reminders ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Patterson, Doebbeling, Asch et al., J Biomed Inform , 2005)

Colorectal cancer screening Primary care-based interventions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(STEP-UP - Study to Enhance Prevention by Understanding Practice) (Stange, Goodwin, Am J Prev Med , 2001 & 2003)

CRC screening in primary care practices ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Hudson & Crabtree, Can Det Prev , 2007)

Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Systems engineering framework ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],(Kopach-Konrad, Doebbeling et al., JGIM , 2007)

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UCLA CTSI-Los Angeles County Department of Health Services (DHS) Projects Principal Investigators: Lauren Daskivich (DHS), Carol Mangione (UCLA) Diabetic retinopathy (DR) is the leading cause of blindness among working-age Americans, and among Los Angeles Latinos—the ethnic majority of patients in the Los Angeles County (LAC) safety net—the prevalence of DR is ~50%. Despite evidence that early detection and treatment can prevent blindness from DR, a significant number of persons with diabetes in our system fail to receive annual screening examinations and/or sight-saving treatments due to lack of access to specialty care. To date, the effect of a system level intervention on improving access to eye care and definitive treatment for diabetic retinopathy in an urban medically underserved, or safety net, population has not been evaluated. The objective of this project is to evaluate the impact of teleretinal screening on access to specialty ophthalmic care for diabetic patients in LAC who need monitoring or treatment for diabetic retinopathy. We propose a pre-post analysis of the LAC teleretinal screening implementation, and we aim to evaluate the number of patients screened for diabetic retinopathy, the number presenting for timely ophthalmic follow-up care and treatment, and the cost of the program.

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