Implementing Practice-Based Use of ArcGIS Mapping in VA Home-Based Primary Care. Sarah Tubbesing, MD, MSc Jacqueline Fickel, PhD Michael Ong, MD, PhD

Transcription

1 Implementing Practice-Based Use of ArcGIS Mapping in VA Home-Based Primary Care Sarah Tubbesing, MD, MSc Jacqueline Fickel, PhD Michael Ong, MD, PhD January 26, 2015

2 Purpose and Overview Purpose Describe a project to implement and evaluate the use of ArcGIS for Server by VA Home-Based Primary Care (HBPC) teams, to support their practice management activities. Overview Description & advantages of HBPC Needs that GIS maps could help with The pilot project Implementation & Evaluation Findings & Conclusions 2

3 VA Home-Based Primary Care Home-Based Primary Care (HBPC) --Integrated primary care team provides comprehensive services to Veterans who have complex, chronic conditions, and face barriers to accessing clinic-based primary care. Practice Management Needs --Improved efficiency can help increase the reach of this clinicallyeffective, patient-centered extended care program. --Computer-based map-making software for creation of custom maps, tailored to local practice management needs. 3

4 Problem: Typical Views of a Practice are Limited 1. Excel A flat data file provides a very limited picture of a practice that takes place across geographic distances 2. Push pins in wall maps Not portable/shareable 3. Google maps Not secure 4

5 ArcGIS Computer-Based Mapping Geographic Information Systems (GIS) in Healthcare: Epidemiology Site service locations Identify vulnerable populations GIS at Greater Los Angeles HBPC: Examine practice boundaries Organize assignment of consults Decrease providers potential travel distance Emergency preparedness 5

6 Initial Pilot Experiences VA Greater Los Angeles HBPC piloted the use of GIS mapping in to improve its practice efficiency. --Efficiently bringing new patients into provider panels by avoiding over-distancing of individual providers and strategically determining panel growth locations

7 Initial Pilot Experiences --Decreased potential NP travel distance between patients from 3.7 to 1.4 miles (p<0.05)

8 Initial Pilot Experiences 8

9 Initial Pilot Experiences Use public data on weather & other hazards appropriate for your location NP1 NP4 NP2 NP3 Earthquake Threat Wildfire Threat

10 National Mentored Program VHA Geriatric Extended Care ArcGIS has expanded to a current total of 30 diverse HBPC sites. VHA holds an enterprise license for the ArcGIS for Server software that is housed on its servers and supported by existing VHA technical staff. Access to the software is via an internet portal Interdisciplinary coordinating team includes HBPC clinicians, GIS experts, and experts in implementation and evaluation. Implementation activities: Training map making & use in practice Ongoing technical support (Help Desk & Office Hours) Implementation process facilitation Collaborative learning via a users community (monthly teleconference call) Evaluation to assess implementation progress, and refine tools & processes Data: staffing & census, GIS utilization, stakeholder surveys & interviews 10

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12 Findings and Lessons HBPC Programs can learn and use GIS maps, given adequate staff skills, training, and time. Sites created locally-tailored goals for map use Implementation Tools tailored for HBPC GIS users, and available via regular operational sources. Preliminary evidence of positive impact on patient care activities Travel Efficiency Dashboard Emergency Preparedness 12

13 Implementation Factors GIS map-making can be done by regular HBPC staff members with a moderate level of computer ability who complete self-study training tailored for HBPC. At least 10 hours for initial training 2-5 hours weekly for making and updating maps, including patient database maintenance (the greater amount of time is needed earlier in the implementation process) Competing demands affect ability to adequately train staff, create maps, and keep maps updated; designating time for mapping activities has been helpful. 13

14 Outcomes: How Sites Are Using GIS Maps Facilitating patient assignments to clinical care teams Improving organization and efficiency of staff territories Planning day-to-day travel Managing remote parking of government vehicles Identifying geographic areas for potential HBPC program expansion Developing emergency preparedness plans Demonstrating HBPC program issues to facility administration 14

15 Assigning Patients and Improving Clinical Team Travel Efficiency Vignette An HBPC program in the Eastern US received 20 patients from an adjacent HBPC Program as a result of administrative restructuring by the facilities. During the same time period they sustained significant reductions in total staffing for nurse practitioners (from FTE to 40.5 FTE). To maintain compliance with national guidelines for the number of patients served, the HBPC had to restructure its clinical organization by changing patient assignments among nurse practitioners. GIS maps were used to visualize the most efficient modification of patient assignments. Travel distances between patients for providers, Achieve maximum caseloads with minimal travel distances. Restructuring took three months to complete, but resulted in nurse practitioners traveling less and seeing more patients. 15

16 Assigning Patients and Improving Clinical Team Travel Efficiency 16

17 Travel Efficiency Benefits to HBPC Practices from GIS Use Miles (100s) Caseload Miles/Caseload 17

18 Developing Emergency Preparedness Plans Vignette An HBPC program in the Northwestern US used ArcGIS in developing a comprehensive emergency preparedness plan. Their area is prone to flooding, and the coastal areas are at risk of tsunamis. The lead map-maker, a Medical Support Assistant (MSA), worked with the HBPC-GIS users support team to apply GIS mapping layers relevant to potential natural disasters. A patient database was created that assigns each patient an emergency risk category (from 1-3) based on chart review and level of vulnerability related to natural disasters. For example, patients who require oxygen and electricity are identified to be evacuated if a Tsunami warning was issued. This system helps in notifying local emergency responders which patients may need evacuation assistance, given a specific event. 18

19 Sample Emergency Preparedness Map 19

20 Telling the Story: Responding to a Wildfire Emergency A rapidly burning wildfire began on July 22, 2016, in a rural area served by a Southwestern HBPC Program. The HBPC Program team used their GIS maps of patient locations to identify their patients in the risk areas, They phoned each of them to be sure that they were okay, and to explain the proper procedure if the fire did approach them. Fortunately, no HBPC patient required evacuation. 20

21 Next Steps Continue working with operational partners for ongoing sustainment and spread Development of tools relevant to VHA top priorities: Pilot-testing Travel Efficiency Dashboard Collaboration for Emergency Preparedness 21

22 Acknowledgements Our Veterans Current HBPC-GIS Program sites GEC HBPC Program (Darlene Davis, Dayna Cooper, Tom Edes) GEC NILTC Mentoring Partnership Program (Karen Massey, Ken Shay) Field-Based Analytics (Marguerite Fleming, Amy Sadler, Ron Freyberg) HBPC-GIS Project Team (Diane Cowper-Ripley, Jason Lind, Bridget Cotner, Jacqueline Fickel, Alicia Bergman, Judith Katzburg, Leon Lee, Michael Ong, Sarah Tubbesing) David Glick, VISN 15 Informatics, and St Louis VAMC HBPC Program Richard Leatherman, Asheville NC HBPC Program 22

23 Contact Information Jacqueline Fickel, PhD, Co-investigator/Project Director, (818) , ext Sarah Tubbesing, MD, MSc, Medical Director HBPC, VA Greater Los Angeles Medical Center, Project PI, (310)