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Ogundele OB, Song X, Rao P, Greever-Rice T, Boren SA, Edison K, Burgess D, Becevic M. Claims data analysis of provider-to-provider tele-mentoring program impact on opioid prescribing in Missouri. J Opioid Manag 2024; 20:133-147. [PMID: 38700394 DOI: 10.5055/jom.0825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
OBJECTIVE The objective of this study was to assess opioid prescribing patterns of primary care providers (PCPs) participating in a virtual tele-mentoring program for patients with chronic pain as compared to nonparticipants. DESIGN We utilized Missouri Medicaid claims from 2013 to 2021 to compare opioid prescription dosages and daily supply of opioids prescribed by PCPs. Participants and nonparticipants were matched using propensity score matching. SETTING Missouri Medicaid data were received through partnership with the Center for Health Policy's MO HealthNet Data Project, the state's leading provider of Medicaid data. PARTICIPANTS Missouri-based prescribers. INTERVENTION Show-Me Project Extension for Community Healthcare Outcomes (ECHO), an evidence-based provider-to-provider telehealth intervention that connects PCPs with a team of specialists. MAIN OUTCOME MEASURES We compared the rate of prescription opioid >50 morphine milligram equivalents (MMEs), mean MMEs/day, and mean number of daily supply to understand the impact of the ECHO model on providers' opioid prescribing. RESULTS Patients treated by ECHO providers have 33 percent lower odds of being prescribed opioid dose >50 MME/day (p < 0.001) compared to non-ECHO providers. There is also a 14 percent reduction in the average opioid dose prescribed to patients of ECHO providers (p < 0.001). We observed a 3 percent (p < 0.001) reduction in average daily supply of opioids among patients of ECHO providers compared to the comparison group. CONCLUSIONS Pain Management ECHO supports PCPs with needed education and skills to provide specialty care in the management of pain conditions and safe prescribing of opioid medications.
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Affiliation(s)
- Olabode B Ogundele
- Institute for Data Science and Informatics; Missouri Telehealth Network, University of Missouri, Columbia, Missouri
| | - Xing Song
- Institute for Data Science and Informatics; Biomedical Informatics, Biostatistics and Medical Epidemiology (BBME), Columbia, Missouri
| | - Praveen Rao
- Institute for Data Science and Informatics; Department of Electrical Engineering and Computer Science, University of Missouri, Columbia, Missouri
| | | | - Suzanne A Boren
- Institute for Data Science and Informatics; College of Health Sciences, University of Missouri, Columbia, Missouri
| | - Karen Edison
- Missouri Telehealth Network; Center for Health Policy, Department of Dermatology, University of Missouri, Columbia, Missouri
| | - Douglas Burgess
- Department of Psychiatry, University of Missouri-Kansas City (UMKC), Kansas City, Missouri
| | - Mirna Becevic
- Institute for Data Science and Informatics; Missouri Telehealth Network; Department of Dermatology, University of Missouri, Columbia, Missouri. ORCID: https://orcid.org/0000-0001-6520-1581
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Venkataramanan R, Pradhan A, Kumar A, Alajlani M, Arvanitis TN. Role of digital health in coordinating patient care in a hub-and-spoke hierarchy of cancer care facilities: a scoping review. Ecancermedicalscience 2023; 17:1605. [PMID: 37799945 PMCID: PMC10550326 DOI: 10.3332/ecancer.2023.1605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Indexed: 10/07/2023] Open
Abstract
Background Coordinating cancer care is complicated due to the involvement of multiple service providers which often leads to fragmentation. The evolution of digital health has led to the development of technology-enabled models of healthcare delivery. This scoping review provides a comprehensive summary of the use of digital health in coordinating cancer care via hub-and-spoke models. Methods A scoping review of the literature was undertaken using the framework developed by Arksey and O'Malley. Research articles published between 2010 and 2022 were retrieved from four electronic databases (PubMed/MEDLINE, Web of Sciences, Cochrane Reviews and Global Health Library). The preferred reporting items for systematic reviews and meta-analyses extension for the scoping reviews (PRISMA-ScR) checklist were followed to present the findings. Result In total, 311 articles were found of which 7 studies that met the inclusion criteria were included. The use of videoconferencing was predominant across all the studies. The number of spokes varied across the studies ranging from 1 to 63. Three studies aimed to evaluate the impact on access to cancer care among patients, two studies were related to capacity building of the health care workers at the spoke sites, one study was based on a peer review of radiotherapy plans, and one study was related to risk assessment and patient navigation. The introduction of digital health led to reduced travel time and waiting period for patients, and standardisation of radiotherapy plans at spokes. Tele-mentoring intervention aimed at capacity-building resulted in higher confidence and increased knowledge among the spoke learners. Conclusion There is limited evidence for the role of digital health in the hub-and-spoke design. Although all the studies have highlighted the digital components being used to coordinate care, the bottlenecks, Which were overcome during the implementation of the interventions and the impact on cancer outcomes, need to be rigorously analysed.
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Affiliation(s)
- Ramachandran Venkataramanan
- Institute of Digital Healthcare, WMG, University of Warwick, CV4 7AL Coventry, UK
- Strategy and Research Wing, Karkinos Healthcare, Mumbai 400086, India
| | - Akash Pradhan
- Strategy and Research Wing, Karkinos Healthcare, Mumbai 400086, India
| | - Abhishek Kumar
- Strategy and Research Wing, Karkinos Healthcare, Mumbai 400086, India
| | - Mohannad Alajlani
- Institute of Digital Healthcare, WMG, University of Warwick, CV4 7AL Coventry, UK
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Milgrom ZZ, Severance TS, Scanlon CM, Carson AT, Janota AD, Vik TA, Duwve JM, Dixon BE, Mendonca EA. An evaluation of an Extension for Community Healthcare Outcomes (ECHO) intervention in cancer prevention and survivorship care. BMC Med Inform Decis Mak 2022; 22:135. [PMID: 35581580 PMCID: PMC9112252 DOI: 10.1186/s12911-022-01874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
To improve cancer care in Indiana, a telementoring program using the Extension for Community Healthcare Outcomes (ECHO) model was introduced in September 2019 to promote best-practice cancer prevention, screening, and survivorship care by primary care providers (PCPs). The aim of this study was to evaluate the program’s educational outcomes in its pilot year, using Moore’s Evaluation Framework for Continuing Medical Education and focusing on the program’s impact on participants’ knowledge, confidence, and professional practice. We collected data in 22 semi-structured interviews (13 PCPs and 9 non-PCPs) and 30 anonymous one-time surveys (14 PCPs and 16 non-PCPs) from the program participants (hub and spoke site members), as well as from members of the target audience who did not participate. In the first year, average attendance at each session was 2.5 PCPs and 12 non-PCP professionals. In spite of a relatively low PCP participation, the program received very positive satisfaction scores, and participants reported improvements in knowledge, confidence, and practice. Both program participants and target audience respondents particularly valued three features of the program: its conversational format, the real-life experiences gained, and the support received from a professional interdisciplinary community. PCPs reported preferring case discussions over didactics. Our results suggest that the Cancer ECHO program has benefits over other PCP-targetted cancer control interventions and could be an effective educational means of improving cancer control capacity among PCPs and others. Further study is warranted to explain the discrepancies among study participants’ perceptions of the program’s strengths and the relatively low PCP participation before undertaking a full-scale effectiveness study.
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Affiliation(s)
- Zheng Z Milgrom
- Center for Biomedical Informatics, Regenstrief Institute, 1101 West Tenth Street, Indianapolis, IN, 46202, USA.,Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Indianapolis, IN, 46202, USA
| | - Tyler S Severance
- Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA.,Indiana University School of Medicine, 340 West Tenth Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202, USA
| | - Caitlin M Scanlon
- Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA
| | - Anyé T Carson
- Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Indianapolis, IN, 46202, USA
| | - Andrea D Janota
- Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Indianapolis, IN, 46202, USA
| | - Terry A Vik
- Riley Hospital for Children, 705 Riley Hospital Drive, Indianapolis, IN, 46202, USA.,Indiana University School of Medicine, 340 West Tenth Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202, USA
| | - Joan M Duwve
- Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Indianapolis, IN, 46202, USA.,Kansas Department of Health and Environment, Curtis State Office Building, 1000 SW Jackson St, Topeka, KS, 66612, USA
| | - Brian E Dixon
- Center for Biomedical Informatics, Regenstrief Institute, 1101 West Tenth Street, Indianapolis, IN, 46202, USA.,Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Indianapolis, IN, 46202, USA
| | - Eneida A Mendonca
- Center for Biomedical Informatics, Regenstrief Institute, 1101 West Tenth Street, Indianapolis, IN, 46202, USA. .,Indiana University School of Medicine, 340 West Tenth Street, Fairbanks Hall, Suite 6200, Indianapolis, IN, 46202, USA.
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