in Alaska 35th Annual Alaska Health Summit January 18, 2018 Meghan Clark and Danielle Reed Thank you to Project Echo and Dr. Kristin Sohl, University of Missouri for sharing their slides.
Today s Agenda Welcome General Announcements o o o Mute when not talking Say your name when speaking No disclosure of personal health information (PHI) Introductions Presentation on in Alaska Mock Case Presentation Questions & Closing Remarks
Presentation Objectives What is Project How is being used for autism screening and management in Alaska - Current topics and lessons learned Alaska Charter Questions
What is Project? Extension for Community Healthcare Outcomes It helps democratize medical knowledge and develops specialty care capacity in underserved communities. It is not Telemedicine. It is a revolutionary model of telementoring, collaborative medical education and care management. It empowers front-line primary care professionals to provide the right care, in the right place, at the right time.
Where it Began Underserved patients have limited access to quality specialist care for common complex conditions. Sanjeev Arora, M.D., a social innovator and liver disease specialist at the University of New Mexico Health Sciences Center in Albuquerque, was frustrated that he could serve only a fraction of the HCV patients in his state who needed treatment. In 2003: Only 5% of New Mexicans infected with hepatitis C were able to access treatment. In 2015: 80% of New Mexicans infected with hepatitis C have access to the right treatment, at the right time, at the right place.
Why? PROBLEM: Providers want to advance their skills, career and professional relationships. Providers lack access to knowledge and training to provide specialty care for their patients. Providers often feel socially and professionally isolated. SOLUTION: Providers engage in a community with like-minded fellow providers and specialists from academic centers. Develop specialized knowledge. Provide specialty care for common complex conditions. Receive free CME/CE credits. Providers participating in in New Mexico: Felt their professional isolation diminish Had increased professional satisfaction and self-efficacy for treating hepatitis C 1. Arora S, Kalishman S, Thornton K, Dion D et al: Hepatology. 2010 Sept;52(3):1124-33
What are the Benefits? 1.Better access for rural and underserved patients 2.Reduced disparities 3.Better quality and safety 4.Rapid dissemination of best practices 5.Reduced variations in care 6.Greater efficiency 7.Reduced wait times
One to Many Hub and Spokes participate in virtual grand rounds, combining patient case presentations with didactic learning and mentoring.
Platform
Moving Knowledge, Not People
Autism Pilot Study 6-Month Pilot Study o Twelve 2-hour Autism clinics o 2 clinics per month o Specific focus on: Screening and Identification of ASD Symptoms Management of Medical and Psychiatric Comorbidities
Improvement in Overall Self-Efficacy
Improvement in Self-Efficacy Subscales
Adherence to Autism Screening Guidelines Percentage of Pediatricians in Compliance with AAP Autism Screening Guidelines* *Using ASD-specific screening tools at 100% of 18-month and 24-month well-child visits conducted over the prior 6 month period.
Autism Alaska GOAL Increase self-efficacy with autism issues, screening and management. OBJECTIVES 1. Increase knowledge of ASD, how to identify it, and how to treat it 2. Increase knowledge about management of common medical issues (e.g., ADHD, irritability, anxiety, sleep, GI, and diet) 3. Increase knowledge of screening for ASD 4. Increase knowledge/ability to monitor psychotropic medication
Survey of Providers Survey of pediatric providers at the All Alaska Pediatric Symposium 2016 (N=55, 74% from Anchorage & Mat-Su) I have the knowledge and comfort to (Scale from 0 to 5) N Mean Refer to early intervention 54 3.889 Children with Autism in Practice Answer parents questions about their child s development Refer to agencies that have information on services available in schools 55 3.564 54 3.218 17 providers identified 1-5 children with autism in their practice Refer to agencies that provide navigation services to families 55 3.055 30 providers responded they suspected autism in over 30 children in their practice Care for families and children experiencing autism 55 2.836 Answer parents questions about autism 55 2.764
Autism Clinic Framework Clinic Flow Introductions Case Presentation o Clarifying Questions o Recommendations Brief Didactic Q & A Wrap Up Adjourn Autism Hub Team Beth Ellen Davis, MD, MPH Developmental Expert Erika Stannard, PhD Clinical Psychologist Lisa Jackson, ANP Population Champion Annette Blanas, LCSW BCBA Resource Expert Christie Reinhardt BS Parent Expert
Autism Curriculum What is Autism? While You Wait Anxiety and Autism ADHD and Autism
Autism Lessons Learned Use experts that practice in Alaska Encourage team participation within a spoke community Allow time for hub team development Foster the relationships between participants (hub and spokes)
TABI Increase confidence in identifying and treating TABI symptoms Expand knowledge about behavioral treatments 90 minute sessions with free CMEs
Why TABI in Alaska? High rates of brain injury in Alaska Primary care providers have limited knowledge for treatment post injury Limited specialists in the state TBI grant with State of Alaska Senior and Disability Services
Survey of Providers Snowball sample of a variety of providers to evaluate TBI training needs (N=367). Provider history of brain injury training and education (N=367) 46% had attended training specific to brain injury 26.6% had some formal education specific to BI 6.3% had professional certifications specific to BI
The TABI Hub Team Amy Kolarova, DO Board Certified in Physical Medicine and Rehabilitation, Brain Injury Medicine Frank Box Peer Advocate and Support, CBIS Heather Wengler Physical Therapist DPT, MPT, CCI Deanna Yoder-Black Speech Language Pathologist MS, CC-SLP/L
TABI Pilot Curriculum Screening and Treatment for Brain Injury Medication Management What Do PTs Do? What Do SLPs Do? Plus two more sessions (topics TBD) this next round
Feedback and Lessons Learned What did you learn in this CME activity that you will apply to your practice? o How helpful PT, OT, and Speech can be. What change(s) will you incorporate into your practice as a result of knowledge acquired at this activity? o More referrals to these people Do you have any comments or suggestions related to TABI o We need more primary providers I think this is an incredibly effective way to encourage community resources being shared and collaborative care
Current s in Alaska Timeline o Palliative Care January 2017 (ANTHC) o Psychiatry and Addiction Medicine October 2017 (Polar Health) o Developmental Disabilities January 2018 (UAA CHD) o Behavior Analysis January 2018 (UAA CHD) o Traumatic and Acquired Brain Injury February 2018 (UAA CHD) More information on o http://echo.unm.edu/ o https://www.uaa.alaska.edu/academics/college-of- health/departments/center-for-human-development/ak- /index.cshtml