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The Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions was a two-day workshop with the purpose of convening experts from diverse domains to:

  • Understand the data elements important to the care of people with MCC, including CKD, T2DM, CVD, chronic pain and/or OUD, across settings of care
  • Identify, discuss and facilitate collaboration across ongoing work relevant to the development of e-care plans for people with MCC
  • Discuss challenges and potential solutions relating to the electronic exchange of care plan data with regard to privacy, security, patient preferences, and interoperability, among other issues

The table below includes the meeting materials from that day. To see a full workshop event details and agenda click the link here.

DateMeeting NameDescriptionMeeting Materials 

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Background reading: 

The TEP Meeting White Paper is an environmental landscape review of AHRQ/NIDDK e-care plan related projects

The Altarum Care Plan Report is a report on the variety and merits of care plan templates and regulations in use, including implications for information technology 

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Putting the Project in Context: Building Data Capacity to Conduct Pragmatic PCOR by Developing an Interoperable Electronic (e-) Care Plan

Arlene Bierman, MD Agency for Healthcare Research and Quality (AHRQ) 


View file
name01 - E-care planning -TEP Bierman (1).pptx
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Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Putting the Project in Context: Building Data Capacity to Conduct Pragmatic PCOR by Developing an Interoperable Electronic (e-) Care Plan

Jenna Norton, M.P.H.  National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

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name02-Norton-PCOR-Intro (1).pptx
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Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Defining Care Planning

Malaz Boustani, M.D., Indiana University

View file
name03-Boustani - Minimum Specs eCare Plan_9.30 mb.19_formatted (1).pptx
height150

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Primary Care

David Dorr, M.D., M.S., Oregon Health & Science University 

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name05-Dorr - PrimaryCare_MCC.pptx
height150

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Social Work

Nicole Ruggiano Ph.D., The University of Alabama

View file
name06- Ruggiano - NIH e_CarePlanning.pptx
height150

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions


Long-term Services and Supports

Nancy Kusmaul Ph.D., LMSW, University of Maryland, Baltimore County

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name07-Kusmaul - Long term services and supports (LTSS).pptx
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Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Shared Care Plans: Nurses, Physicians, Patients

Patricia C. Dykes D.N. Sc., R.N., FACMI, Brigham and Women's Hospital/Harvard University 

View file
name08-Dykes-DDK-AHRQ TEP_Shared Care Plans.pptx
height150

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Background on Key Data and Knowledge Standards

Clem McDonalds, M.D., National Library of Medicine

View file
name09 - McDonald - 2019 10 02 NIDDK-AHRQ Standards MCDONALD.pptx
height150

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Data and Knowledge Standards for eCare Plans 

Evelyn Gallego, M.B.A., M.P.H., CPHIMS, EMI Advisors LLC

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name10-Gallego - eCare Plan TEP 20191002.pptx
height150

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Data Standards for Social Determinants

Sarah DeSilvey, APRN-C, Northwestern Medical Center

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name11 - Desilvey - SDH Data SCD.3.pptx
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Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Data Standards for Chronic Kidney Disease 

Theresa Cullen, M.D., M.S., FAMIA, Regenstrief Institute, Inc

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name12 - Cullen - NIH_AHRQ_Cullen 10_2_19 .pptx
height150

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Data Standards for eLTSS

Elizabeth Palena Hall, MIS, M.B.A., R.N., Health Resources and Services Administration

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name13- Palena Hall - eLTSSInitiative_eCarePlanTEP.pptx
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Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

HL7 FHIR Care Plan Connect-a-thons

Dave Carlson, Ph.D., M.B.A. 

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name14 - Carlson - TEP e-Care Plans on FHIR - Carlson.pptx
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Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Pharmacy Care Plan

Shelly Spiro, R.Ph., FASCP, Clinical Cloud Solutions, LLC

View file
name15 -SPIRO - NIDDK- AHRQ eCare Plan Technical Expert Panelv2 .pptx
height150

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Nursing Care Plans 

Laura Heerman Langford Ph.D., R.N., Healthcare Services Platform Consortium

View file
name16 - Heermann PCOR Nursing Care Plans 20191001.pptx
height150

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Managing Diabetes: Clinical Perspective 

Neda Laiteerapong, M.D., M.S., University of Chicago 

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nameLaiteerapong - Diabetes Breakout - Management.pptx
height150

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Managing Cardiovascular Disease (CVDs): Clinical Perspective 

David Schopfer, M.D., University of California, San  Francisco

View file
nameCVD Breakout - Schopfer - PCOR eCare CVD.pptx
height150

 

Data Capacity for Patient-Centered Outcomes Research for People with Multiple Chronic Conditions

Managing Pain and Opioid Use: Clinical Perspective 

David Thomas, Ph.D., Office of Research on Women's Health

View file
namePain Breakout - Thomas-NIDDK final.pptx
height150

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