Transcript Slides - cceHUB

Cancer Care Engineering: A
Collaborative Transformational
Project
Indiana University School of Medicine
Purdue University
Cancer Care Engineering
Project Leaders:
Stephen Williams, MD
HH Gregg Professor of Oncology
Director, IU Cancer Center
Associate Dean of Cancer Research
Indiana University School of Medicine
VA/IU Center for Implementing
Evidence Based Practice, RI/IU
Center for Health Services &
Outcomes Research
Bradley Doebbeling, MD
Director VA CIEBP
IU Cancer Center
Director (RI, RCHE)
Indiana University School of Medicine
Joseph Pekny, PhD
Professor of Chemical Engineering
Director, e-Enterprise Center
Founder, Regenstrief Center for Healthcare Engineering
Purdue University
Marietta Harrison, PhD
Professor of Medicinal Chemistry
Director, Oncological Sciences Center
Associate Director Purdue Cancer Center
Purdue University
Cancer Care Engineering
Vision: Goal-oriented cancer research
Approach: “Systems Analysis” for cancer
prevention, detection, treatment and care
delivery & project management
Team: Over seventy physicians, caregivers,
engineers, scientists and staff drive the
CCE vision
CCE Strategy
Understand
Model,
Analyze,
Communicate
Animal
Models
System
Awareness
Decision
Support Tools
Indiana Cancer Care
CCE Hub
Goal Oriented
Improvement
CCE Pillars & Hierarchy
The Integrated Pillars
The Integrated Hierarchy
Cancer Care System Projects
Mathematical
Models
Cancer Care Best
Practice Projects
Physician Tools
Projects
Patient OMIC
Analysis
Health Services
Research
OMICS
Projects
Cancer as a Managed Disease
CCE Enablers
Modeling the Indiana Cancer Care System:
A What-If Tool for the Big Picture
CRC Care System
validate
Organizational
& Regulatory
Agents
Regulatory Agents
data
Caregiver
Agents
Indiana Cancer Care System
Patient
Agents
Indiana Cancer Care Model
What is the impact of
screening rate
improvement?
What is the best strategy
for using OMICS
advances?
What is the best strategy
for colonoscopy
screening?
How can all patients with
colonoscopy orders to
follow-up get them? What
resources are required?
What If Questions
Indianapolis CRC Quality Improvement
Initiative
• Implementing evidence-based practices, including psychosocial services, and guidelines to deliver high quality care and
outcomes – last step in translational research
• Within CRC care, screening, treatment, and surveillance tests
after treatment are studied within primary and specialty care
• Interventions within two healthcare systems with wellintegrated EMRs: Wishard / IUMG and VA (links to VA national
initiative)
• Main project components and outcomes:
– Cancer prevention and care process maps
– Quality reports for Indianapolis clinics
– Application of implementation research methods
– Building a Cancer Care – Technical Assistance Program (CCTAP), patterned after RCHE Healthcare TAP, to help
implement best practices in one or more clinics
– Understanding the barriers to best practice care
Connecting Research to Practice: Mechanistic modeling
of polyp & CRC development
Total IN CRC incidence
• Methods
– Mutation network
– Stochastic cell growth
• Predictions
CRC incidence / 100,000 people
400
– Likely incidence with age
data
1 model
350
300
250
200
150
100
50
0
0
20
• Growth characteristics
• Transformation rates
• Applications
– Adaptive modeling to individual patients
• Connection to “omics” measurements
– Decision tree hypothesis testing
– Identification of heterogeneous sub-populations
40
60
Age (yrs)
80
100
Personalizing Cancer Care: Data Driven
Prevention/Treatment, “Omics”, & Measurement Driven
Medicine
Genetic Information
What markers indicate risk?
Develop markers based on all information – integrated omics, clinical data
What markers presage cancer?
Normal
On which patient groups
does Drug X work?
Trajectory
What markers are present with
cancer?
Patient
groups are indistinguishable with respect to
Proteomics and
metabolomics
What
markers differentiate people?
malignancy
What resolution is possible?
treatment
What dosage is best?
Cancer
Trajectory
CCE Predictive Molecular
Signatures
Patient Blood
• Genomic Analysis
• Lipidomic
• Metabolomic
• Glycoproteomic
Personalizing Cancer Care: Data Driven
Prevention/Treatment, “Omics”, & The Role of Dog Models
Genetic Information
Well understood & controlled lineage
What markers indicate risk?
What markers presage cancer?
Companion animals get care & study
registration typical
Normal
Trajectory
IT
What markers are present with cancer?
Proteomics and
metabolomics
What
markers differentiate dogs?
malignancy
What resolution is possible?
infrastructure prototype usable for humans
Rapid knowledge acquisition cycle
Insight to more genetically
Cancerdiverse humans, established
animal model
Trajectory
6/08
DOD IRB
4/08
Initial DCCE Results
3/08
IU IRB SRC-2
7/07
WCCE-1
6/07
IU IRB SRC-1
5/07
Regenstrief CCE Funded
11/06
WCCE Proposal
9/06
Regenstrief CCE Proposal
3/06
Washington WCCE Presentation
9/05
Indy Foundations Presentation
First NIH Proposal
CCE is “Born” in Lebanon, IN
CCE Milestones
10/08
11/08
Cancer Care Engineering
Current Funding Initiatives
Engineering the Cancer
System (R-CCE)
Warfighter
CCE (W-CCE)
Walther Cancer
Institute Foundation
Funded: $1.35M
Regenstrief Institute
7/1/07-2009
Funded: $2.4M
DOD, 12/1/07-2011
Funded: $0.2M
2007-2009
Focused on Health
Services Research
Focused on Prevention,
Molecular Signatures
• Cancer Care Delivery,
Modeling & Data
Visualization, CCEHub
•Sample Acquisition, OMIC
Analysis, Data Modeling,
Data Visualization,
Literature Mining
Dog-CCE (D-CCE)
Funded: $0.2M
2007-2009
Regenstrief, PCC, DP,
Engineering, Vet
School
CCE Future
• Harvest CCE Seed Projects
– First Wave of Results Papers & Proposals
• Present Status & Plans to Indy Foundations
– Presentation Proposal (August 14)
– Presentation (Fall 2008)
• Take Results to Foundations & Expand
Partnerships
• Iterative Refinement
• Evolve According to Results & Funding
• Realize Results in Care System