Patient-Cen enter ered ed Strateg egies es t to Improve H e - - PowerPoint PPT Presentation

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ANNUAL OCT. 31-NOV. 2, 2017 MEETING ARLINGTON, VA Patient-Cen enter ered ed Strateg egies es t to Improve H e Health h and Health O Outcomes f for V Vulnerable P Populations November 1, 2017 #PCORI2017 ANNUAL MEETING | #PCORI2017

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SLIDE 1

ANNUAL MEETING

  • OCT. 31-NOV. 2, 2017

ARLINGTON, VA

#PCORI2017

Patient-Cen enter ered ed Strateg egies es t to Improve H e Health h and Health O Outcomes f for V Vulnerable P Populations

November 1, 2017

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ANNUAL MEETING | #PCORI2017

November 15, 2017 2

Welcome & Introductions

  • Mod
  • derator:
  • r: C

Cheryl Peg egus us, MD, MPH, Clinical Professor

  • f Population Health, New York University Lagone

Health

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ANNUAL MEETING | #PCORI2017

November 15, 2017 3

Increasing CRC Screening among Hispanic Primary Care Patients

  • Princ

ncipa pal I Inves estigator: R Ron Myers, PhD, Professor and Director of the Division of Population Science, Thomas Jefferson University

  • Patien

ent/Stakeho eholder der P Partner: M Myra P Piña, MD, Executive Director, Fé Foundation of the Hispanic Chamber of Commerce of the Lehigh Valley

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ANNUAL MEETING | #PCORI2017

November 15, 2017 4

Patient-Centered Trauma Treatment for PTSD and Substance Abuse: Is It an Effective Treatment Option

  • Princ

ncipa pal I Inves estigator: A Annette C e Crisanti, PhD, Research Associate Professor of Psychiatry and Behavioral Sciences, University of New Mexico

  • Patien

ent/Stakeho eholder der P Partner: G Gina na J James es, Research Assistant, Division of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, University of New Mexico

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ANNUAL MEETING | #PCORI2017

November 15, 2017 5

Lowering the Risk of Heart Problems for People in Appalachian Kentucky

  • Principal I

Investigator: De

  • r: Debra M

Mos

  • ser, PhD, RN, FAAN,

Professor, University of Kentucky College of Nursing

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ANNUAL MEETING

  • OCT. 31-NOV. 2, 2017

ARLINGTON, VA

#PCORI2017

Incr creasing C Colorect ctal Cance cer ( (CRC) Scr creening among H Hispanic P c Primary C Care Patients

Ronald E. Myers, PhD and Myra D. Piña

Professor Executive Director of the Fé Foundation November 1, 2017

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ANNUAL MEETING | #PCORI2017

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Ronald E. Myers, PhD and Myra D. Piña

  • Have nothing to disclose.

November 15, 2017

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ANNUAL MEETING | #PCORI2017

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Objectives

At the c conclusio ion o

  • f this a

activ ivit ity, t the p part rtic icip ipant s should ld b be able to to:

  • Des

escribe i e inter ervention i impact o

  • n

n over erall s scree eening adher herenc ence

  • Des

escribe i e inter ervention i impact o

  • n

n tes est-spec pecific s screeni ening ng adher herenc ence

  • Des

escribe i e inter ervention i impact o

  • n

n screen ening dec decisi sion stage ge

November 15, 2017

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ANNUAL MEETING | #PCORI2017

9 November 15, 2017

Colorectal C Cance cer a and Scr creening in the US H Hispanic/L c/Latino P Population

Incidenc dence: e: 12,400 400 Deaths: hs: 3,800 00 Localized d ed disea ease: e: 38% 38% Screen eening non

  • n-adher

dherenc ence: 50% 50%

  • 80%

80% by 2018 2018 C Campaign Go Goal:

  • Increase the n

e number a and % % of f non-adher erer ers w who s screen een

Cancer Facts & Figures for Hispanic/Latinos 2015-2017; National Center for Health Statistics. Health, United States, 2015: With Special Feature on Racial and Ethnic Disparities. Hyattsville, MD, 2016

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November 15, 2017 10

Study P Participants

Patien ents f s from 5 Lehigh V h Valley ey H Health N h Net etwork ( (LVHN) Primary Care P e Practices es, S Southea heastern P n PA

  • Hi

Hispanic m men en a and women aged 5 50-75 y yea ears o

  • f a

age ge

  • Visited

ed p practice w e within p previous 2 2 yea ears

  • No f
  • fam

amil ily y histor

  • ry o

y of C CRC o

  • r c

colon

  • lon p

polyp lyps

  • No p
  • personal h

al history o

  • f CRC, c

colon

  • lon p

polyp lyps, o

  • r i

inflam lammatory bow

  • wel

l disea ease

  • Scree

eening n g nonadher erence

  • 80%

80% b by 2018 2018 Campaign Goal i in LVHN VHN:

30% adherers + [70% nonadherers (71%)]

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ANNUAL MEETING | #PCORI2017

November 15, 2017 11

Patien ent t and S Stakeh eholder er Advi dvisory ry Co Committee (PA PASAC)

PASAC Structure

  • 12 members came from community groups,

religious organizations, health support groups, primary care practices, and include LVHN health system primary care provider, specialist, and administrator representatives.

  • Project staff and members met 3 X a year at a

convenient health system location

  • Members included veterans, clergy, patient

support, housewives, nurses, and a diabetes support group president.

  • Meetings were facilitated by a bilingual

moderator and were conducted in both English and Spanish. PASAC Function/Feeling

  • Members provided input on study materials,

intervention methods, and strategies for reaching the population.

  • Members were part of the research team, with

the role of advising the staff on realities of working with the population and the health system.

  • Members felt an additional role was to learn and

educate members of the Hispanic community about cancer screening.

  • Members viewed themselves as an extension of

the community, with a duty to share their knowledge to guide research and to improve the community health.

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ANNUAL MEETING | #PCORI2017

November 15, 2017 12

Standard Intervention (n=203) Decision Support and Navigation Intervention (n=197)

Study D Design gn

Consented, Surveyed, and Randomized (N=400) Endpoint Survey (n = 123) and Chart Audit (n = 203) Endpoint Survey (n = 123) and Chart Audit (n = 197)

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November 15, 2017 13

Dec ecision S Support t and N Navigati tion Inter erven enti tion ( (DSNI) I)

Patient Education

  • Send informational

booklet, FIT kit, and colonoscopy scheduling instructions

Support & Navigation

  • Identify preferred test
  • Determine likelihood of

screening and barriers to adherence

  • Develop screening plan

and navigate through adherence

Patient Reminder

  • Send reminder

Provider Engagement

  • Send patient’s

screening plan to practice

  • Send screening status

report and encourage follow-up as needed

Standard I Inter erven enti tion ( (SI)

Patient Education

  • Send informational

booklet, FIT kit, and colonoscopy scheduling instructions

Patient Reminder

  • Send reminder
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November 15, 2017 14

Hypotheses

  • H1: O

Over erall s screen eening g adher eren ence i e in DSNI Group > SI G Group

  • H2

H2: T Tes est-spec ecific a adher eren ence i e in DSNI Group > > SI G Group

  • H3: S

Screen eening d g decision stage i in DSNI G Group > > SI Group

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November 15, 2017 15

Table 1

  • 1. B

Baseline Survey Data (N (N=400)

Char arac acter eristic N (%) %) Age ge < 60 Y 60 Years 277 277 (69) 69) > 60 Y 60 Years 123 123 (31) 31) Race ce White te 133 133 (33) 33) Black ck 118 118 (30) 30) Other/Unknown 149 149 (37) 37) Gender Fe Female 235 235 (59) 59) Ma Male le 165 165 (41) 41)

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November 15, 2017 16

Table 1

  • 1. B

Baseline Survey y Data ( a (continued)

Char arac acter eristic N (%) %) Ma Marit ital S l Status Ma Marrie ied o

  • r Livin

ing a g as Ma Marrie ied 192 192 (48) 48) Not Ma Marrie ied 208 208 (52) 52) Language Spoken a at H Home Spanis ish 331 331 (83) 83) Both S Spanish a and E Engli glish 41 41 (10) 10) Englis glish 28 28 (7) 7) Insuran ance Sta tatus In Insu sured 281 281 (70) 70) Not Insured o

  • r Unsure

119 119 (30) 30)

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November 15, 2017 17

Table 1

  • 1. Baseline Survey D

y Data ( a (continued)

Te Test Prefer eren ence N N (%) Pr Prefer C Colon

  • nos
  • scop
  • py

39 39 (10) 0) Equa qual P Prefer eren ence 275 275 (69) 69) Prefer er F Fecal I Immun unochem emical Bl Blood T Test ( t (FIT) 86 86 (21) 1) To Total 400 400 (10 100)

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November 15, 2017 18

Findings

  • Over

erall C CRC s scree eening a adh dherence w e was s almost 5 5 times es grea eater er i in n the D he DSNI Gr Group up t tha han i in n the S he SI Gr Group

  • FIT s

screeni ening ng a and c d colonoscopy scree eeni ning a adher herenc ence wer ere m e more t e tha han 4 4 times s greater a and a almost 9 9 times es grea eater er, r resp espec ectively, i , in n the D he DSNI Gr Group up t tha han i in n the S he SI Gro roup

  • Forward c

cha hange i in n CRC s screen ening dec decisi sion s stage w e was almost 5 5 times m more likely i in the D DSNI G Group than i in the S he SI Gr Group up

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November 15, 2017 19

Dissemination a at a LVHN C Community C y Conference

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November 15, 2017 20

Conclusions

  • A p

patient-cen entered C ed CRC s scree eeni ning i interven ention f n for Hi Hisp spanic pr primary c care pa patients i s in n the L he LVH VHN was s suc uccess ssful

  • A dec

ecision s support a and n navigati tion interenti tion ( (DSNI) I) had a substan antial al and s statis istic ically s ly signif ific ican ant p positiv ive i imp mpac act

  • n p

patien ent CRC s screen eening a adher eren ence a e and readines ess to to screen een c compared ed to to a standard inter terven enti tion ( (SI)

  • Inf

nfrastruc uctur ure a e and r d resea earch a ch are n needed t ed to suppo pport the i implemen entation n of the DSNI a and o d other ev evidenc dence- based i ed interven entions i ns in the L LVHN a and o d other h health h sy systems.

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November 15, 2017 21

  • Patient Centered Outcomes Research Institute (EAIN 2471)

and Thomas Jefferson University support

  • Develop a scalable model (the Reducing Cancer Disparities by

Engaging Stakeholders (RCaDES) Initiative) for adapting and implementing evidence-based cancer screening interventions in health systems

  • Apply the model to CRC and lung cancer screening

Intervention A Adaptation a and I Implementation

The RCaDES Initiative

Center for Health Decisions at Jefferson

Cancer Disparities

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ANNUAL MEETING

  • OCT. 31-NOV. 2, 2017

ARLINGTON, VA

#PCORI2017

Cancer Disparities

The RCaDES Initiative

Center for Health Decisions at Jefferson

  • 1. Identify Evidence Based

Intervention (EBI)

  • 2. Define EBI Core Components for

Adaptation

  • 4. Adapt EBI Core Components
  • 3. Train patients and stakeholders

in EBI Adaptation

  • 5. Implement the Adapted EBI
  • 6. Disseminate

Lessons Learned

Cancer Centers - Health Systems - Payers - Employers

The Road Ahead

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ANNUAL MEETING | #PCORI2017

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Learn More

  • www.pcori.org
  • info@pcori.org
  • #PCORI2017
  • www.YourURL.url

November 15, 2017

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ANNUAL MEETING | #PCORI2017

November 15, 2017 24

Thank You!

Ronald E. Myers, PhD and Myra D. Piña Professor Executive Director of the Fé Foundation November 1, 2017

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ANNUAL MEETING

  • OCT. 31-NOV. 2, 2017

ARLINGTON, VA

#PCORI2017

Effectiveness of Peer-Delivered Services in the Provision of Trauma-Specific Treatment

Annette S. Crisanti, Ph.D1. and Regina James2, CPSW

1Associate Professor, Department of Psychiatry and Behavioral Sciences, UNM

acrisanti@salud.unm.edu;

2Research Assistant, Department of Psychiatry and Behavioral Sciences, UNM

rkjames@salud.unm.edu 11/01/2017

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A.S. Crisanti and R. James

  • No disclosures
  • This work was supported through a PCORI

Program Award (CE-12-11-4484)

  • All statements in this report, including its

findings and conclusions, are solely those of the authors and do not necessarily represent the views of PCORI, its Board of Governors or Methodology Committee.

November 15, 2017

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Objectives

At the conclusion of this activity, the participant should be able to:

  • Understand the need for substance abuse

treatment in rural communities

  • Describe the value of peer support workers,

especially in rural communities

  • Describe the effectiveness of peer support

workers in the provision of trauma-specific treatment

November 15, 2017

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Need for Substance Abuse Treatment

November 15, 2017

NEW MEXICO 2010-2014

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Strategies to Address the Behavioral Health Needs of Underserved Communities

  • Increase Peer Support Services
  • A Peer Support
  • rt W

Work rker r is someone who uses his or her lived experience of recovery from mental illness and/or addiction, plus uses skills he or she learned in formal training, to deliver services in behavioral health settings to promote mind-body recovery and

  • resilience. SAMHSA –HRSA Center for Integrated Health Solutions.

Who are Peer Providers?

November 15, 2017

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Peer Support Worker in NM

  • In NM, the peer support worker training

requires 40 hrs. of classroom training over 5- days followed by a certification exam through the NM Credentialing Board for Behavioral Health Professionals.

  • Training topics include professionalism, ethics,

components of recovery and resiliency, mental health and substance use disorders, communication skills and stress management.

November 15, 2017

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Effectiveness of Peer Support Workers

Including peers as part of behavioral health has been associated with:

  • Increased engagement
  • Reduced inpatient hospitalizations
  • Improved relationships with providers
  • Higher levels of empowerment
  • Higher levels of activation
  • Higher levels of hopefulness and recovery

(Chinman et al., 2014)

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Undertaking & Managing the Research

  • Patients were in multiple paid, influential positions,

including:

  • Project Director
  • Group facilitators (delivered intervention)
  • Group support coordinator (helped with

engagement and retention)

  • Researchers (data collection)
  • Steering committee members
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Risk Factors for Substance Abuse

November 15, 2017

  • Family and Community
  • Exposure to substances
  • Abuse
  • Genetic/Family History
  • Stressful/Negative Life

Events

  • Trauma Exposure
  • Peer Pressure
  • Depressed Mood
  • Low Self-Esteem
  • Delinquent Behavior
  • Disrupted Family

Environments

  • Lack of Coping Skills

“The more I use, the more I won’t feel anything. The pain is so bad you just want to die.”

Quote from A Trauma Survivor Seeking Safety Manual, (Najavits, L. 2002)

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35 November 15, 2017

  • Seeking Safety (SS), is an evidence-

based, manualized, present-focused counseling model to help people attain safety from trauma and/or substance

  • abuse. Mostly delivered in group format.
  • Research is based on using trained

clinicians to implement the treatment, including, counselors, social workers, psychologists.

 

Is peer-delivered SS as effective as SS delivered by clinicians?

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Primary Objective & Hypothesis

November 15, 2017

  • Determine the effectiveness of peer-led SS groups

compared to clinical-led SS groups in decreasing substance use and PTSD symptoms and improving coping skills, overall mental health & physical health. Hypo pothes hesis:

  • Peer-led SS groups would be AS E

EFFE FECTIVE VE as clinician- led SS groups in decreasing substance use and PTSD symptoms and improving coping skills, overall mental health & physical health.

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37 November 15, 2017

Project Overview

  • Three years: August 2013 – July 2016
  • Primary Data Collection Peer-Operated CB Setting - N=291
  • Expanded to Residential Treatment Program for SUDs for three months

enrolled 47 individuals into research

  • Target Population:
  • Rio Arriba County;
  • Adults 18+;
  • PTSD and/or Substance Abuse determined by a licensed clinician

using the Mini International Neuropsychiatric Interview (M.I.N.I) for Alcohol Dependence/Abuse, Substance Dependence/Abuse and PTSD

  • 9% met criteria for PTSD only
  • 26% met criteria for SUD only
  • 65% met criteria for both
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Project Overview: Intervention

November 15, 2017

  • RCT, Comparative Effectiveness Study
  • Intervention - SEEKING SAFETY (SS):
  • Groups were gender specific
  • Treatment group – SS Peer-Led Groups
  • Control Group – SS Clinician-Led Groups
  • Male licensed clinical mental health counselor (LPCC) with a M.A. in

counselling

  • Female licensed Alcohol and Drug Abuse Counselor (LADAC) with a

M.S. in Developmental Psychology

  • 12 group sessions, one session per week, open-

enrollment

  • 6 sessions defined as a “completed treatment”
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Relevant Outcomes

November 15, 2017

Baseline 3-Month 6-Month

Face-to-face interviews: $20.00 each

  • PTSD Symptoms
  • Substance use
  • Coping skills
  • Mental health
  • Physical health
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Intakes N = 533 Assessments N = 431 Eligible N = 422 Determined Not Eligible Among Inside Out Only N = 9 Clinician Group N = 145 Peer-Led Group N = 146 Started Treatment and Completed Baseline N = 291

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Demographics

November 15, 2017

N = 291 Clinician-Led Peer-Led Overall Age (range) 35 (18 – 64) 35 (18-60) 35 (18-64) Female 43% 46% 44% Male 57% 54% 56% Hispanic 83% 85% 84% Caucasian 62% 59% 60% Native Amer. 11% 12% 11% Unemployed 80% 75% 77%

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At least Six Sessions

November 15, 2017

52.7% 30.8% 16.4% 57.2% 31.0% 11.7%

0% 20% 40% 60% 80% 100%

Never 3 months 6 months

% Participants Completion Time

Peer-led Clinician-led

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Analysis

November 15, 2017

  • Linear mixed models were fitted to each of the outcome

measures to assess the effect of intervention group

  • Full models included covariates for:
  • treatment arm
  • age
  • gender
  • ethnicity
  • completion of SS
  • any missed follow-up interviews
  • site
  • living status
  • time point
  • Interaction time point by treatment arm
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PTSD Symptoms: Cl vs. PL

November 15, 2017

Measured by the PCL-C Higher scores mean higher severity; Range: 17-85

PTSD Symptoms Decreased over Time

48.2 44.7 43.3 47.2 43.9 42.1

17 27 37 47 57 67 77

Baseline 3 months 6 months Clinician-Led Peer-Led

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Days of Drug Use in Past 30 Days: CL vs. PL, Peer Operated Community-Based

November 15, 2017

25.0 21.3 21.1 24.0 20.3 19.1

5 10 15 20 25 30

Baseline 3 months 6 months Clinician-Led Peer-Led

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Days of Drug Use in Past 30 Days: CL vs. PL, Residential Treatment

November 15, 2017

4.3 3.9 9.5 6.0 6.9 10.0

5 10 15 20 25 30

Baseline 3 months 6 months Clinician-Led Peer-Led

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Coping Skills: CL vs. PL

November 15, 2017

Measured by the Coping Scale Range: 0 - 90 Higher scores mean better coping skills

Coping Skills Increased over Time

46.5 48.3 52.1 45.7 48.6 51.2

10 20 30 40 50 60

Baseline 3 months 6 months Clinician-Led Peer-Led

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Mental Health Functioning: CL vs. PL

Measured by the SF36 range is 0% to 100% Higher scores mean better functioning

November 15, 2017

35.7 40.2 41.8 36.3 41.2 42.9

20 40 60 80 100

Baseline 3 months 6 months Clinician-Led Peer-Led

Mental health Functioning Increased over Time

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Physical Health Functioning: CL vs. PL

Measured by the SF36 range is 0% to 100% Higher scores mean better functioning

November 15, 2017

52.7 51.5 50.9 50.8 50.2 49.8

10 20 30 40 50 60

Baseline 3 months 6 months Clinician-Led Peer-Led

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Dissemination and Implementation (D&I)

November 15, 2017

  • PL-Seeking Safety is covered under group recovery

services (Medicaid)

  • Research on barriers to D&I has identified lack of skilled

personnel as one of the most important to address to improve implementation of evidence-based practices

  • Development of a Peer Guide as a Supplement to the SS

Manual

  • Future research needs to address ways to improve

physical health among those receiving services for mental health and/or substance abuse

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Learn More and Questions

  • www.pcori.org
  • info@pcori.org
  • #PCORI2017

November 15, 2017

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Discussant Dialogue

  • Rober

bert M McNel ellis, MPH, PA, Senior Advisor for Primary Care, Agency for Healthcare Research and Quality

  • Glady

dys L Lundy ndy, MA, Lead Stakeholder, Compass Study

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Moderated Questions & Answers

  • In case we are unable to address all questions during

Q&A, there are sheets around the room to list 1) your contact information 2) your question/comment and 3) who your question/comment is for. PCORI will share this with session participants and either respond to questions and/or connect session attendees and participants.

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November 15, 2017 54

Thank You!