Transcript The Omaha System in Minnesota: Innovations in Research

The Omaha System in Minnesota:
Innovations in Research
Karen A. Monsen, Oladimeji Farri,
Carolyn Garcia, Elaine M. Darst,
Madeleine J. Kerr,
David M. Radosevich
[email protected]
omahasystempartnership.org
Presenter Disclosure
K. A. Monsen
The following personal financial relationships with
commercial interests relevant to this presentation existed
during the past 12 months:
No relationships to disclose
Omaha System
• Used in public health information systems and
clinical documentation in the US and
internationally.
– Omaha System data fill a void in existing
population data sources
– Activities of public health clinicians:
• Problems assessed
• Interventions delivered
• Outcomes observed
Omaha System Partership
• Invited by Dean Delaney
– Center of Nursing Informatics, University of
Minnesota School of Nursing
• Practice-based Research Network
– Building scientific inquiry methods
– Generating new knowledge
• Over 50 studies in progress or completed
Omaha System Partnership
• multidisciplinary scientific teams of
researchers with experience in advanced data
analysis and data mining techniques
– University of Minnesota
– University of Pennsylvania
– Istanbul University
Omaha System Partnership
• affiliate members from many countries who
contribute clinical Omaha System data,
suggest important clinical questions, and work
together with the scientific team on research
and evaluation projects
Omaha System Partnership
• a warehouse of de-identified clinical Omaha
System data including client problems,
signs/symptoms, interventions, and
knowledge, behavior, and status outcomes
Three Recent Studies
• descriptive study of problems experienced by
community dwelling adults with schizophrenia
• comparative study of public health nursing
services and outcomes for adult and
adolescent Latina mothers
• analysis of hearing assessments for
firefighters
Community Dwelling Adults with
Schizophrenia
PI Elaine Darst
Team: Students and Community Partners
Data source: Interview
Purpose: To evaluate the use of the Omaha
System for assessment of community
dwelling older adults with schizophrenia
Method: Case Study
Results
Description of complex client
problems was facilitated by use of the
Omaha System
Comprehensive
Holistic
Standardized
Problems identified
Income
Neighborhood/workplace safety
Abuse
Physical activity
Mental health
Cognition
Nutrition
Substance use
Areas of Greatest Concern
Mental health
Cognition
Nutrition
Substance use
Mental health assessment
K 2
Some knowledge of symptoms of
his mental illness; poor knowledge of
impact of illness symptoms on life; minimal
understanding of positive coping skills.
B 4
Med-compliant due to supportive
environment. Regularly accesses mental
health care under supervision of staff.
S 2
Symptoms of mental illness
severe enough to warrant a 24-hour care
setting; vacillating levels of anxiety,
depression, agitation and psychosis.
Structured Living Situation
Contributes to Patient Stability
KBS ratings show differences in
dimensions of functioning
Differences may indicate level of
probable patient functioning without
support
Future research: develop algorithm to
assess risk of decompensation using
KBS ratings
Comparison of PHN outcomes for
adolescent and adult mothers with and
without the Mental health problem
• PI: Carolyn Garcia
• Team: U of M, Rush University
• Data source: Large metropolitan public health
nursing agency
• Purpose: to determine effectiveness of PHN
visits for improving outcomes in Latina
adolescents with mental health problems
Background
• Health Literacy study
– Knowledge scores across problems by race/ethnicity
– Optimal response to PHN interventions among Latinas
– Mental health is a concern for all
Benchmark = 3
Method
• Design: Nested-block, pre-test and post-test.
• Blocking factors include age of the client and
mental health problem.
• General linear mixed models adjusted for
number of problems, length of service and the
number of visits.
• Outcomes were expressed as a change in
Knowledge, Behavior and Status scores.
Knowledge
• KBS scores improved after PHN services (p <
0.001).
• Knowledge improved equally for all groups.
4
No MH Teen
No MH Adult
3
MH Teen
MH Adult
2
Baseline
Final
Behavior
• Behavior improved most for adult clients with
mental health problems (p = 0.013).
4
No MH Teen
No MH Adult
MH Teen
MH Adult
3
Baseline
Final
Status
• Status showed the greatest statistical
improvement for adolescents with mental
health problems (p = 0.012).
5
No MH Teen
No MH Adult
4
MH Teen
MH Adult
3
Baseline
Final
Status
• An increase in the number of PHN visits was
related to an increased status change in
adolescents with mental health problems (p =
0.011).
• Status change was attenuated for clients with
increasing number of problems (p < 0.001).
Firefighter Hearing
PI: OiSaeng Hong
Team: UCSF, UofM
Data source: Large research data set
Purpose: to model hearing health
outcomes of a health promotion
intervention using Knowledge, Behavior,
and Status scores
 Method: correlation following data
transformation




Background
 Occupational noise-induced hearing loss is
one of the most prevalent occupational
injuries in the U.S. yet there are limited
data on hearing ability of workers. Data
are needed to describe the extent of NIHL
and to measure outcomes of hearing loss
prevention programs.
 New data standards and electronic health
record (EHR) systems offer technology
solutions to inform the information gap.
Knowledge
 Knowledge: the ability of the client to
remember and interpret information.
(1=no knowledge - 5=superior knowledge)
 Knowledge algorithm
 responses to four noise-induced hearing loss
questions
 1=0 correct; 2=1 correct; 3=2 correct; 4=3
correct; and 5=4 correct responses
 The mean score was close to adequate
for knowledge (3.72).
 About 75% of participants correctly answered all
four items of knowledge.
Behavior
 Behavior: observable responses, actions, or activities of
the client fitting the occasion or purpose. (1=not
appropriate 5=consistently appropriate)
 Behavior algorithm
 frequency of self-reported percentage of time of HPD
use during loud noise exposure
 1= 0-20%; 2=21-40%; 3=41-60%; 4=61-80%; and
5=81-100%
 The mean score was close to minimally acceptable
for behavior (2.22)
 Only 12% consistently used appropriate hearing
protection devices more than 80% of the time that
they were needed.
Status
 Status: the Condition of the client in
relation to objective and subjective defining
characteristics (1=extreme signs &
symptoms 5=no signs & symptoms)
 Status algorithm
 grading system proposed by the World Health
Organization (1986)
 1>80dB; 2=61-80dB; 3=41-60dB; 4=25-40dB;
and 5<25dB
 The mean score for status was minimal
signs and symptoms (4.39)
Bivariate correlations among three
KBS variables
 Significant positive relationship
between knowledge and behavior
(Spearman’s rho=.13, p=.01), and
Behavior and status (Spearman’s
rho=.12, p=.02).
 There was no significant relationship
between knowledge and status.
Realizing the Goal
• Use of a shared interface terminology enables
large-scale population health research across
settings, populations, practices, languages,
and countries
Working Together in Partnership
• Practice-based research partnerships are an
optimal environment in which to enhance
practice, evaluate programs, measure
outcomes, and improve population health.
Questions?
• Thank you!
• [email protected]