A Simulated Diabetes Learning Intervention Improves Provider Knowledge and Confidence in Managing Diabetes JoAnn Sperl-Hillen, MD Co-director of Center for Chronic Care Innovation HealthPartners Research Foundation, Minneapolis, MN Wednesday May 2, 2012 8-9:30am 18 th Annual HMO Research Network Conference Seattle, WA Accelerating excellence in health performance through education, advocacy, and collaboration
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A Simulated Diabetes Learning Intervention Improves Provider Knowledge and Confidence in Managing Diabetes HILLEN
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A Simulated Diabetes Learning Intervention
Improves Provider Knowledge and Confidence in Managing
DiabetesJoAnn Sperl-Hillen, MD
Co-director of Center for Chronic Care Innovation
HealthPartners Research Foundation, Minneapolis, MN
Wednesday May 2, 2012 8-9:30am
18th Annual HMO Research Network Conference
Seattle, WA
Accelerating excellence in health performance through education, advocacy, and collaboration
Team Members
JoAnn Sperl-Hillen Patrick O’Connor Heidi Ekstrom William Rush Omar Fernandes Jerry Amundson Deepika Appana
Steve Asche George Biltz* Deb Curran Paul Johnson* Andrew Rudge Todd Gilmer**
HealthPartners Research Foundation and HealthPartners
Institute for Medical Education, Minneapolis, MN;
* Carlson School of Management, University of Minnesota,
Minneapolis MN;
** Department of Family and Preventive Medicine, University of
California, San Diego, La Jolla, CA
Presenter Disclosures
NIH research support Listed inventor on a U.S. patent application filed
related to simulation technology HPRF has recently entered into a royalty-bearing
license agreement with a third party to commercialize the simulated learning technology for the purpose of broader dissemination.
Non-paid director on the board of directors for that licensee (SimCare Health)
Why is provider training needed?
Provider performance varies, even within the same clinic populations
Clinical inertia is common, particularly for insulin treatment
Provider knowledge varies The cognitive processes and tasks
related to diabetes are complex
Barriers to Provider Training
Time constraints Lack of continuity experiences Relatively limited ambulatory
experience in residency training Complicated diseases with need for
personalization of care Experts & opinion leaders are often not
available or affordable, and teaching is difficult to standardize
What is simulation?
“Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner.” Gaba (2004)
AviationNASAMilitaryMedical
1960s First Mannequin: Resusci-Annie1960s-70s Computer-assisted learning program in medicine 1990 High fidelity mannequins become available
History of Simulation
What are the advantages to simulation?
Efficient & cost effective Sustainable & standardized In line with adult learning principles Personalized (case-based). Case-based
simulations provide a context for learning People are more likely to remember learning
and replicate in real-world situations. Capture the importance of continuity of care Proven satisfaction & effectiveness
Elements needed to create a simulated learning program
1. Identify the learning needs and create a library of case scenarios
2. Create an interactive web-interface
3. Model and program the physiology
4. Program the feedback – to critique action the provider takes between encounters
Patient “snapshot” screen shot
Demo of SimCare available at www.simcarediabetes.org
Visit navigator screen shot
Feedback between every encounter
Early SimCare Study
57 consented PCP’s and their 2,020 patients. Randomized to one of 3 groups:
(A) no intervention (B) learning intervention (SimCare) consisting
metformin in patients with renal impairment (p=0.03).
Group B (SimCare alone) achieved slightly better glycemic control than A or C (p=.04)
Funding through R01HS10639, Physician Intervention to Improve Diabetes Care
2001-03
SimCare Version 2
Eleven clinics with 41 consenting PCP’s
Randomized to receive or not receive an improved version of SimCare (12 cases assigned based on profiled “needs”, 3 hrs)
Results: Patients of intervention providers with baseline A1c > 7% had significantly greater A1c reduction (-.19%) relative to patients of non-intervention providers.
Funding through R01DK068314, Reducing Clinical Inertia in Diabetes
2006
SimCare Version 3
19 eligible residency programs linked to 723 residents
gift card promotion to achieve acceptable learning and assessment case completion rates
Baseline characteristics of residentsIntervention
(n=92)Control(n=128)
P-value
% female 48% 57% 0.31
% white 48% 58% 0.41
Age (median) 29 29 0.69
Specialty Family Medicine Internal Medicine Med-Peds Other
34%54%8%4%
49%42%7%2%
0.15
Post graduate year 1 2 3 4
35%36%28%1%
34%34%28%4%
0.70
2. A 77 year old black man is seeing you for follow up. He has a 13 year history of type 2 diabetes, coronary heart disease (CABG at age 58), chronic stable angina, and dyslipidemia. He has been eating out a lot and gaining weight. His current medications are metformin 1000 mg bid, atenolol 50 mg qd, and simvastatin 40 mg qd. His BMI is 37, BP is 165/86, A1c 9.3%, Cr 2. 2 mg/dl, eGFR 28, LDL 94 mg/dl, HDL 36 mg/dl, and TG 278 mg/dl. Which of the following would be your MOST likely recommended action? A. Start basal insulin and treat to an A1c goal of < 7%. No change in other glycemia medications.B. Discontinue metformin and start basal insulin. Follow up with patient for insulin adjustments with an A1c goal of < 7%.C. Start basal insulin and follow up with the patient for insulin adjustments with an A1c goal of < 8%. No change in other glycemia medications.D. Discontinue metformin and start basal insulin. Follow up with patient for insulin adjustments with an A1c goal of < 8%.E. No change now because I would address other patient problems
Simulated Physician Learning Intervention to Improve Safety and Quality of Diabetes Care: A Randomized Trial
O’Connor PJ, Sperl-Hillen JM, et al. Simulated physician learning intervention to improve safety and quality of diabetes care: A Randomized Trial. Diabetes Care. 2009;32(4): 585-590.
Simulated Physician Learning Program Improves Glucose Control in Adults with Diabetes
Sperl-Hillen JM, O’Connor PJ, Rush WA, Johnson PE, Gilmer TP, Biltz G, Asche SE, Ekstrom HL. Simulated Physician Learning Program Improves Glucose Control in Adults with Diabetes. Diabetes Care. 2010;33(8): 1727-1733.