Transcript Training Presentation

Site Training
Adult Emergency Department Patients
with Acute Asthma
and Survey of Local Asthma Centers:
36th Multicenter Airway Research
Collaboration (MARC-36) Study
1
Web & Audio Meeting
• Webinar has no audio function
• For audio function:
– Please dial 800-501-8979
– Then enter the access code (7265276)
2
Study Leadership
Carlos Camargo, MD, DrPH (Principal Investigator)
Kohei Hasegawa, MD, MPH (Co-investigator)
Project Coordination: Dr Hasegawa & Ms Sullivan.
Funded by a grant from Novartis to MGH (Camargo).
Emergency Medicine Network (www.emnet-usa.org),
Dept. of Emergency Medicine, MGH, Boston, MA
3
Outline of Presentation
1. Overview
2. Chart review
3. Survey
4. REDCap
4
Outline of Presentation
1. Overview
2. Chart review
3. Survey
4. REDCap
5
Aims
1. To describe adult ED patients with acute
asthma, with a focus on the characteristics of
patients with a high number of ED asthma
visits in the 12 months before their index visit
Aims
(continued)
2. To evaluate the concordance of current ED
management of acute asthma with the 2007
National Asthma Education and Prevention
Program (NAEPP) guideline.
3. To determine the characteristics of local
hospital-affiliated asthma centers and the
services they provide.
7
Significance
 Acute asthma accounts for almost 2 million ED
visits/yr, representing a high-risk population.
 Our survey of 177 US asthma centers in 2004
demonstrated suboptimal care in the asthma centers
 Current data are scarce on the epidemiology of this
patient population, asthma care in ED, and the status
of asthma centers.
 MARC-36 will address these knowledge gaps.
8
Study Design
The MARC-36 study consists of two parts:
1. Chart review of 2,000 ED asthma patients in
50 EDs across the USA
2. Online survey about asthma centers affiliated
with participating hospitals
– Conducted by EMNet Coordinating Center
9
Outline of Presentation
1. Overview
2. Chart review
3. Survey
4. REDCAP
10
Identification of Visits
• Use ICD-9-CM codes 493.xx to identify all visits
with a principal ED or hospital discharge
diagnosis of asthma during a 12-month period
– Identify 12-month period from January 1, 2011 to
December 31, 2012 (i.e., 24-month window)
– We encourage all sites to start with calendar year
2012 (i.e., January 2012 to December 2012)
• The ED visit chosen for chart review will be
selected at random from all asthma-related ED
visits over the 12-month period
11
Inclusion Criteria
1) Asthma ED visit made by adult patient aged
18 to 54 years
AND
2) a history of asthma before the index visit
12
Exclusion Criteria
1) History of COPD, emphysema, or chronic
bronchitis
2) Transfer visits
3) Repeat visit by the same subject
-- the visit that was randomly chosen first will be
retained for chart review
4) Visits not prompted, in large part, by an
asthma exacerbation, per judgment of the
chart reviewer
13
Random Sampling
1. Create a list of eligible ED visits during a 12month period
2. Send the number of eligible visits to EMNet
Coordinating Center
3. EMNet will assign randomly-generated Study
IDs to the visits, and send a list of them to the
site
4. Sites review the charts in order (ie, ID 1, 2, 3,
….) until they have reviewed 40 eligible cases
14
Random Sampling
1. Creating a list at the site
Name
Visit Date
Running Visit #
Carlos
Jan 1
1
Carlos
May 1
2
Debbie
May 1
3
…
…
…
Kohei
Dec 1
70
15
Random Sampling
2. Sending running # to EMNet
Name
Visit Date
Running #
Carlos
Jan 1
1
Carlos
May 1
2
Debbie
May 1
3
…
…
…
Kohei
Dec 1
70
16
Random Sampling
3. Random ID assigned by EMNet
Running #
Study ID
1
23
2
1
3
70
…
…
70
2
17
Random Sampling
4. Reviewing charts in order
Name
MRN
Running #
Study ID
Carlos
Jan 1
1
23
Carlos
May 1
2
1
Debbie
May 1
3
70
…
…
…
…
Kohei
Dec 1
70
2
18
Repeated visits?
the visit that was randomly chosen first will be retained for
chart review
Name
Visit date
Running #
Study ID
Carlos
Jan 1
1
23
Carlos
May 1
2
1
Debbie
May 1
3
70
…
…
…
…
Kohei
Dec 1
70
2
19
Study ID#
Patient
number
1 11 0 01
Site-specific 3
digit number
20
Data Entry: REDCap
 All data to be entered into Research Electronic
Data Capture (REDCap)
 We will review basics of REDCap in the final
section of this presentation.
21
General information
ED records vs. Non-ED records
• Most of the information should be available in
the ED records
• Some variables may require review of non-ED
records, such as primary care physicians,
specialists, and hospitalizations
Examples  age of first asthma diagnosis,
number of hospitalizations, medication nonadherence, laboratory tests, and weight
22
Decision rules for conflicting
results
Among the patient’s records
• Inpatient > specialist > PCP > ED record
Between providers within the same visit
• Attending > resident > PA/NP > student
23
No vs. Not Documented/Unknown
• “NO” -- if, after review of all charts, the treatment
was not consistently documented
– eg, there is the patient medication list and an
inhaled corticosteroid is not listed
• “Not documented/Unknown” -- if insufficient
documentation was available to inform the
variable
– eg, if the medication list is missing, do not
assume “No”
24
Variables
•
•
•
•
•
•
•
Demographics
Past asthma history
Chronic asthma medications
ED presentation
ED treatments
ED disposition
Laboratory testing over 12 mo
25
Excel Log - Site Use Only
• Using the Excel sheet (Chart Review Log), enter
patient PHI (eg, name, date of birth, medical
record number, home ZIP code, visit date)
• Maintain the tracking form locally; do NOT send it
to the EMNet Coordinating Center.
26
Season of ED visit
• Date of ED visit is PHI
– Collected on Chart Review Log
• Enter the season of ED visit based on the month
of ED visit (triage) date
– Fall: Sep, Oct, Nov
– Winter: Dec, Jan, Feb
– Spring: Mar, Apr, May
– Summer: June, July, Aug
27
Median Household Income
• Estimated by ZIP code (=PHI)
– ZIP code will be collected on the Chart
Review Log
• Conversion table (ZIP code – Income) will be
posted online
www.emnet-usa.org/Marc_36/M36_resources.htm
• Please call EMNet Coordinating Center if the
patient’s ZIP code is not on the table.
28
Ethnicity and Race
• Consider ethnicity a separate concept from race
• Hispanic Ethnicity
– Enter “Yes” if Hispanic, Latino, Spanish origin
– Persons of Hispanic origin may be of any race
• Race (check all that apply)
– eg, white, black, Asian, other
29
Standard Treatment
• Calculate the number of “standard treatments” of
inhaled beta-agonist given.
• “Standard treatment” is equal to
– 2.5 mg albuterol neb
– 4-6 puffs from MDI
• e.g., 10 mg albuterol neb = 4 standard
treatments
30
Practice Charts
• Abstractors will complete 2 practice charts
– assessed vs. ‘‘criterion standard’’
• If an abstractor’s accuracy is less than 80% per
chart, the individual will be retrained
• After confirming the accuracy >=80%, 40 chart
review can be started.
• Online tools will be available
– eg, Manual of Procedures, ZIP-income table,
FAQ
31
Practice Charts (continued)
• Practice charts will be posted online
(password-secured).
– www.emnet-usa.org/Marc_36/login.cfm
• Enter the data to REDCap (PRACTICE
DATABASE)
32
Practice Chart ID #
Patient number
(P1 and P2)
1 11 XP1
Site-specific 3
digit number
Reviewer initial or #
at the study site
(you can decide)
33
Outline of Presentation
1. Overview
2. Chart review
3. Survey
4. REDCap
34
34
Surveys
1. Site survey
2. Asthma center survey (conducted by EMNet
Coordinating Center)
35
1) Site Survey
Online survey of each site will collect data on ED
and hospital characteristics, including:
– Annual ED visits for acute asthma
– Order sets, clinical pathways
– Whether or not the hospital has an asthma
center
– Contact information of asthma center
director
36
Asthma center
• A stand-alone clinic focusing on asthma
OR
• A usual allergy or pulmonary clinic that has time
set aside for preferential scheduling of
individuals with asthma.
37
Surveys
1. Site survey
2. Asthma center survey (conducted by EMNet
Coordinating Center)
38
2) Asthma center survey
• Background: Our survey in 2004 and 2006
showed suboptimal coordination of care w/I
asthma centers
• Objective: To determine the characteristics of
local hospital-affiliated asthma centers
• Methods: Online survey to asthma center
directors, collecting the characteristics (eg,
staffing, services available, allergy testing)
• Conducted by EMNet Coordinating Center
39
Outline of Presentation
1. Overview
2. Chart review
3. Survey
4. REDCap
40
41
Background
• REDCap (Research Electronic Data Capture) is
a secure, web-based application designed
exclusively to support data capture for research
studies
• Initiated at Vanderbilt University and includes
>600 active institutional partners
(http://project-redcap.org/)
42
Features
• Validation/pop-up alerts to minimize data-entry
errors
• Save forms as PDF and print as needed
• No need to transmit data to EMNet Coordinating
Center
43
Getting Started
1. Sign User Agreement
2. Send to EMNet
3. Access granted by Partners (MGH)
4. Log in at https://redcap.partners.org
44
Getting Started (continued)
45
Data Entry
• Select database from “My Projects”
• Use the left-hand toolbar to initiate data entry
(Chart Review Form)
46
Data Entry (continued)
47
Data Entry (continued)
 Use your mouse to move from field to field
(Note: pressing “Enter” will save and kick you
out of the form)
 Do not use the browser arrows to move back
and forth between screens/forms
48
Data Entry (continued)
49
Changing Responses
• “reset value”
• Response changes to questions with branching
logic result in a pop-up box asking for
confirmation of the change
50
Changing Responses (continued)
51
Databases
1. Practice Database
2. Participant Database
Practice databases are available for use and are
designated by “PRACTICE” in title
52
Saving Records
• After saving a form, a pop-up box will appear if
a response is missing in a required field
• Return to that field and enter a response
53
Saving Records (continued)
• After completing blank fields, you are ready
to save form as “complete”
54
Tips
• Save your work frequently!
– Before you leave a form
– Times out
• REDCap is case sensitive
• Use the comment section to record anything
that does not fit into form
55
REDCap Downtime
 Partners or EMNet will communicate scheduled
downtimes (e.g., for system upgrades)
 May be unanticipated downtime or other factors
that prevent use of REDCap (e.g., problem with
local internet connection)
56
REDCap Questions?
 Problems logging in?
Contact Partners HealthCare EDC Support
[email protected]
 New user requests, other issues, or questions?
Kohei Hasegawa, MD, MPH
[email protected]
617-643-5276
57
MARC-36 Timelines
June 2013
July-August 2013
(September at latest!)
September-October
2013
November 2013
IRB application
Training
Site survey
Chart review
Asthma center survey
Data management
Site queries
Close database
Primary data analysis
SAEM abstracts
58
Questions?
Kohei Hasegawa, MD, MPH
[email protected]
617-726-5276
Carlos A. Camargo, MD, DrPH
[email protected]
617-726-5276
59