Conflicts of Interests Disclosure

Transcription

1 Conflicts of Interests Disclosure AAO Foundation Hoskins Center for Quality and Safety American Board of Ophthalmology Centers for Disease Control and Prevention ARVO Foundation for Eye Research American Glaucoma Society American University Professors of Ophthalmology AAMC Council for Faculty and Academic Societies Private investment Merck Pfizer Glaxo Consultant and Research funding NEI Kellogg Foundation University of Michigan Duke University Intellectual property Statins for glaucoma EMR decision support and data entry

2 National Academy of Medicine Report Facilitate public awareness through timely access to accurate and locally relevant information; Generate evidence to guide policy decisions and evidence-based actions; Expand access to appropriate clinical care; Enhance public health capacities to support visionrelated activities; and Promote community actions that encourage eye and vision-healthy environments.

3 Future Directions for Improving Access and Care Delivery What is our Goal? Prevent (and restore) vision loss through a public health systems approach in the US

4 Themes Elements of an integrated care system as embodied in NAM recommendations Progress towards an integrated system

5 1. Continuous Improvement System (s) CQI, Lean, TQM

6 2. Need for Evidence-Based Unified Guidelines to Reduce Variation and Drive Payment Policies example of preoperative testing and office visits for eye surgery. Chen CL et al. N Engl J Med 2015;372:

7 3. Integrate Care Across the Health Delivery System (diagram from Milani RV, Lavie CJ, Am J Med 2014)

8 4. Integrate Health Delivery and Public Health Systems Partners in Work Eye care specialists Primary care providers Schools Public health departments Social welfare departments FQHC s NGO s Others

9 5. Enhance Diversity of Workforce From: Current and Future Status of Diversity in Ophthalmologist Workforce JAMA Ophthalmol. 2016;134(9): doi: /jamaophthalmol Figure Legend: Proportions of Ophthalmology Faculty Members Stratified by Sex, Race, and Ethnicity From 2005 Through 2015The data source is the Association of American Medical Colleges Faculty Roster, (December 31 snapshot). URM indicates underrepresented in medicine. Date of download: 11/6/2016 Copyright 2016 American Medical Association. All rights reserved.

10 Themes Elements of an integrated care system as embodied in NAM recommendations Progress towards an integrated system

11 1. Integrated System with Practitioners Performing Trained Functions (Rao GN, Barrie Jones Lecture, Eye, 2015)

12 Figure 3. Distribution of eye care resources in the pyramid model. April Y. Maa, Barbara Wojciechowski, Kelly J. Hunt, Clara Dismuke, Jason Shyu, Rabeea Janjua, Xiaoqin Lu, Charles M. Medert, Mary G. Lynch Early Experience with Technology-Based Eye Care Services (TECS) : A Novel Ophthalmologic Telemedicine Initiative Ophthalmology, 2017 VA System

13 Management of Glaucoma Suspects Through OCT AAO Poster 87, Kaiser Permanente, 2015 Following suspects (discs or risk factors, but normal VF and RNFL thickness) First 100 at one year results 9 patients with > 10 micron loss in any quadrant Average RNFL loss was 1.1 microns

14 2. Moving Care to the Community and Home and Away from Health Care Facilities Spectrum of care End of life Wellness Source: Paul Lee

15 Expanded Opportunities for Care CDC Efforts Walmart UAB Community Groups with glasses Wilmer Senior Housing / Vans Wills Community Health Centers (Jamaica)

16 A patient Hi doc, I just wanted you to take a look at my transplant. Courtesy of Mia Woodward, MD

17 3. Leverage New Technology / Innovation Aravind Eye Hospital System

18 From: Development and Validation of a Deep Learning Algorithm for Detection of Diabetic Retinopathy in Retinal Fundus Photographs JAMA. 2016;316(22): doi: /jama Date of download: 1/12/2017 Copyright 2017 American Medical Association. All rights reserved.

19 4. Incorporate Social Determinants of Health

20 5. Integrated Data Analytics across Care Stakeholders Digital Knowledge Objects Algorithm Development Real-time Streaming Analytics Machine Learning, AI Data Aggregation Analytics Knowledge Management Knowledge Patient + Family Data PRO, Vitals/Physiology Activity/Sleep, etc. Action Clinical decision support Precision Services Outcome Evaluation Secure Message Virtual Visits Home Visits Connected Home Care Team Doctor Nurse Visiting Nurse Allied Health -Pharm -Dietician Peer -EMT Advisor Network Enterprise analytics roadmap Mobile (Apple, Android), Sensor, Device, IOT Health System Data EMR, RDW, etc. (>300, e.g. Cards) Payer Perspective Patient Perspective Health System Perspective -Quality -Financial

21 Value of IRIS Registry Courtesy of Flora Lum, MD, AAO Evaluate your own data Benchmark your outcomes against your practice colleagues or national averages Manage your patients at a population level Look at a specific group of patients based on conditions, risk factors, demographics or outcomes Identify trends and track interventions Answer specific clinical questions

22 Future Directions for Improving Access and Care Delivery What is our Goal? Prevent (and restore) vision loss through a public health systems approach in the US

23

24 Figure 1. Photographs of on-site glaucoma detection examinations and treatment. Clockwise from top left: intraocular pressure measurement (Goldmann Applanation Tonometry), Wills Eye Van for team and equipment transportation to community sites, laser peripheral surgery and imaging equipment Michael Waisbourd, Noelle L. Pruzan, Deiana Johnson, Angela Ugorets, John E. Crews, Jinan B. Saaddine, Jeffery D. Henderer, Lisa A. Hark, L. Jay Katz The Philadelphia Glaucoma Detection and Treatment Project : Detection Rates and Initial Management Ophthalmology, Vol. 123, 2016:

25 Insurance and Use of Eye Care Zhang X, et al, Arch 2008

26 Figure 1. Flowchart showing cycle time intervals: 1 = documented in VistA for both Technology-Based Eye Care Services (TECS) and the New Comprehensive Clinic (NCC); 2 = time stamp when technician opens Medflow for both TECS and the NCC; 3 = time stamp when tec... April Y. Maa, Barbara Wojciechowski, Kelly J. Hunt, Clara Dismuke, Jason Shyu, Rabeea Janjua, Xiaoqin Lu, Charles M. Medert, Mary G. Lynch Early Experience with Technology-Based Eye Care Services (TECS) : A Novel Ophthalmologic Telemedicine Initiative Ophthalmology, 2017, Available online 9 January

27 Importance of Patient and Family SES Factors: Likelihood of Visit Based on Ocular Diagnosis LL = Low income / Low education, LH = Low income / High education, HL= High income / Low education, HH = High income / High education