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The PAC Tweets #ICNCC15s

A record seven gutsy patient advocates in ICN's Patient Advisory Council - PAC, "pack" - attended the Community Conference. We tweeted live at #ICNCC15s all the way through - so please check out our feed!!

The Patient Voice is already strong on Twitter. For a week leading up to the conference, Alex, Bianca, Christian, Isabelle, Jennie, Randa, and I tweeted once a day to provide a glimpse into how IBD factors (or does not factor, in some cases) into our days. We made special reference to the key drivers of remission took center stage at the Community Conference and form the foundation of ImproveCareNow's work:

7 Key Drivers of Remission



Jennie described challenges that impede her access to and communication with her doctor.

Screen Shot 2015-03-26 at 11.30.29 AMRanda described how proactive care allowed her to take better control of her ulcerative colitis.

Screen Shot 2015-03-26 at 11.18.23 AM Alex questioned why it can be so hard to find the right medication - and shared his optimism that more accurate diagnoses and research can change the game!

Screen Shot 2015-03-26 at 11.17.49 AM

Bianca shared how less-than-optimal nutritional intake has impacted her - and made it difficult for her to grow at the same rate as her peers.

Screen Shot 2015-03-26 at 11.27.27 AM Isabelle emphasized the relevance of compassionate care to psychosocial health.

Screen Shot 2015-03-26 at 11.31.39 AMFinally, Christian described how a food journal has improved his ability to self-manage his IBD.

Screen Shot 2015-03-26 at 11.11.38 AMAnd, I shared how my pill case makes it easier for me to stay adherent at college and on-the-go!

Screen Shot 2015-03-26 at 11.34.53 AM We hope you'll join the conversation on Twitter now and in the future!

 


Interview with Laura Mackner


Laura, can you give us a professional snapshot of who you are?


I have several roles and titles etc., as you can see by my signature. I primarily conduct research as an Investigator in the Center for Biobehavioral Health at Nationwide Children's (NCH). That's about 85% of my job.  I also do some clinical work, primarily with children with IBD, as a child psychologist working with the IBD team and in the Division of Pediatric Psychology at NCH.  This is primarily outpatient psychotherapy, although in the past I have also done inpatient consults and work in the GI Clinic.  Finally, I have an academic appointment at Ohio State University, in the College of Medicine in the Department of Pediatrics, providing training and supervision to psychology and GI interns, residents and fellows. What will you be sharing at the Community Conference?



I'll be leading a breakout session on peer mentoring and giving a presentation on psychosocial issues in pediatric IBD.


For the session on peer mentoring, I'll (1) discuss some of the research on mentoring programs and some of the "best practices" that have been developed from this research, (2) identify some practical resources for developing a mentoring program that exist, and (3) we'll spend most of the session discussing challenges specific to developing a peer mentoring program for youth with IBD.  I'll discuss the peer mentoring program I've been running at NCH, and I hope to brainstorm with the participants in the session about some of the challenges that all mentoring programs face (e.g., recruiting male mentors) as well as some of the challenges specific to IBD mentoring programs (e.g., confidentiality, mentor-mentee matching issues).  Jennie David and Isabelle Linguiti will be joining me to sharing their experiences with formal and informal mentoring and help with brainstorming as well.


For the presentation on psychosocial issues, I'll be discussing psychosocial issues that affect patients and families living with IBD, and how psychosocial issues can also affect health outcomes in IBD.   We know that IBD can affect pretty much any area of life, so I'll be reviewing the research on overall quality of life, emotions, social life, school, and family.  I'll also review research on the risk factors that have been identified that suggest which children are more likely to experience problems in these areas.  Then I'll discuss how psychosocial factors can affect IBD, and things we can do to address psychosocial issues that may also affect IBD. How does this session/focus pertain to parents?  Or how can parents use the information as part of our mission to help improve care.


For peer mentoring, we initially ran focus groups to develop our program, and our NCH parents had a lot of great ideas.  I'd love to hear from the ICN parents, and I hope the information provided in the session will be useful for any parents who are interested in developing a mentoring program.


For the presentation on psychosocial issues, parents certainly play a role in the psychosocial health of their children, and I'll specifically be discussing ways we might be able to improve psychosocial and physical health.




An update from the Patient Priorities team

ImproveCareNow has partnered with Patient PrioritiesThe IBD Learning Priorities project was designed to give young adults, parents and clinicians in the IBD community a chance to ask the questions they felt were most important in the treatment of IBD. Using an online survey, families and clinicians submitted over 200 questions - or 'learning objectives'. Common themes included diet, diagnosis and individual care needs.

 

 

 

These questions will help us further understand what information those who are impacted by IBD really need. We expect to find some of these questions already have answers. And where there there is good research to answer these common questions, ImproveCareNow will work to develop and share this knowledge through family-centered tools and resources. Those questions that do not have complete answers will help prioritize future pediatric IBD research.

 

Below are a few examples of the learning objectives received from families and clinicians like you!




    • Beyond enteral therapy, what is the role of diet in the maintenance of remission in IBD?

 

    • Is 6mp safe? Will it hurt her liver anymore than it already is?

 

    • We need more data on dual therapy with thiopurines and methotrexate. Specifically, will patients do better if these agents are started before starting biologics rather than starting them at the same time?



Stay connected with ImproveCareNow by joining our CIRCLE so we can send you updates on the continued progress of these important community-developed learning objectives and ensure you have access to the family-centered tools and information that are developed in response to some of these questions.


Buzzy: A small tool to help in a big way

Three years ago my son started on Humira in an attempt to get his Ulcerative Colitis into remission. Although it quickly became apparent that Humira was controlling his UC, my husband and I were struggling to successfully administer the drug. Our process consisted of 30 to 40 minutes of negotiation along with bribes and other unsuccessful attempts at minimizing the injection pain. We tried our best to allow our son to have some control over the situation by waiting for him to tell us when he was ready.  In the end, we were just getting frustrated.  That is when we found Buzzy.

 

Buzzy was developed by a physician and pain researcher (www.buzzy4shots.com).  It works on the Gate Control Theory of Pain. Its design confuses the nerves with both temperature and vibration. The theory is that this distracts from the injection pain and interrupts the neural pain pathways. Using Buzzy has reduced our shot time to 2-3 minutes and has greatly reduced the family stress and anxiety associated with this experience. I knew that we needed to make Buzzy accessible to all of our patients who receive injections or infusions to help with injection pain and needle phobia.  With a price tag of $40, our care team recognized that this purchase could be a burden on families already dealing with high medical costs.

 

Our Parent Mentoring Group at Riley Hospital for Children did research using the ICN database to determine the number of our patients that were using injections and infusions as their primary therapy.  We collected data from the infusion nurses and Child Life specialists that had been successfully using Buzzy in the hospital.  Armed with this data and personal experience, we prepared a grant that we submitted to the Women for Riley, a philanthropic group of women that support the Riley Hospital and Foundation.  Our group was then selected to present our grant to the review board.  In late February, we received word that we were awarded the grant to purchase 150 Deluxe Buzzy Kits to distribute to our patients.

 

Over the next year, we will be distributing these kits to this target group of patients and any new patients that start on infusions or injections.  We plan on surveying the recipients to gauge the effectiveness of this device. Our hope is that Buzzy will improve the time spent administering injections, lower family frustration, and reduce the overall pain of the injection. These kids go through so many procedures and experience so much pain with their diseases.  It is wonderful to have a small tool to help in a big way.

 

[Editor’s Note: This story was shared by Liz D - a mom of a three boys.  Her youngest son was diagnosed with Ulcerative Colitis at age 5.  She volunteers her time as a parent representative on the Riley Hospital for Children Parent Mentor Group, where she is an advocate for all families with IBD receiving care at Riley.  A mechanical engineer by trade, Liz has “retired” and loves her role as a full-time wife and mother.  This has also allowed her to pursue her love of all that is artistic and creative.  Over the past 12 years, she has taught both photography and memory preservation classes to both adults and kids.]


My Interview with Melida from the ICN Exchange Team



Melida, can you give us a professional snapshot of who you are?

I have an elevator speech, “My name is Melida, I am passionate about Information and Knowledge Management & Knowledge Creation within research communities.  I believe good data makes all the difference.”  I also have a professional identity:  Melida Busch, MLIS, and Director of Cincinnati Children’s Edward L. Pratt Research Library, of which I am proud. I work with the @ICNExchange team which provides me the pleasure of being connected to the ImproveCareNow community.



What will you be sharing at the Community Conference?
My colleague Sheryl Sheldon and I will be presenting on the use of the ICN Exchange as an empowering tool for all members of ICN to “share seamlessly and steal shamelessly”. The ICN community produces a lot of tools and resources, but until we use them, share them and improve them, they really aren’t very meaningful. We’re hoping to make our break-out session very practical, i.e. “This is how you use the ICN Exchange”, while reminding folks that it’s them and not the tools that make the ICN Exchange powerful. Hence the name for the session:  “You are How Data Becomes Knowledge”…

How does this session/focus pertain to parents?  Or how can parents use the information as part of our mission to help improve care.
Obviously partnering with patients and parents is a key tenant within the ImproveCareNow community. I think increasing both the amount and the diversity of the tools, resources and stories that patients and parents share on the ICN Exchange will have a direct impact on the improvement of care in the treatment of children with chronic IBD throughout the network.

Also, sharing in the commons increases your sphere of influence, not only in the potential number of people reached, but also in the ability of those whom you do not currently know to find your contributions later. You have the ability to make a big difference in your community long term, with what feels like such a small action.



 


Lessons from the Field: Making the Pitch

[Editor's note: This update was shared by engagement team member Elizabeth Monti Sullivan]


Having the opportunity to represent ImproveCareNow at the recent Cincinnati Children’s Hospital Medical Center IBD Education Day gave me a firsthand view of the challenges and opportunities associated with communicating about our Network. While my ImproveCareNow Engagement and Leadership campaign team partners and I had a plan for our time at the information fair, we learned that you can never come too prepared to tell the story of this dynamic community!

We learned that building awareness and pitching involvement in ImproveCareNow to potential partners can be challenging at first, even for those of us who know a lot about the Network. And if we struggle with telling the ICN story, it must be even more challenging for our colleagues in the Network's 70+ care centers. How well can they explain ICN and its objectives? Are we sending a clear and consistent message? And why can it be so tricky to give a clear picture of ICN?

We know that ImproveCareNow is an intricate web of people, activities, and platforms. We are staff & leaders, volunteers, families, patients, sponsors, partners, clinicians, and researchers. We are many people working on many projects. You might find us talking about social media platforms and forums, quality improvement, awareness campaigns, research studies, work groups, goals and metrics, and many other things. With all of this constant activity taking place, how can we be sure we are effectively articulating who we are in ways that resonate with all of our partners?

Here is where I like to start: What we know is that ImproveCareNow centers have together increased the remission rate for registered kids with IBD from 55% to nearly 80% without using new medications. Their success is rooted in the application of quality improvement methodologies, seamless sharing of lessons learned, and a relentless focus on data that tell the story of the patients’ disease course. We know that we want to elevate and even more closely incorporate patient and family voices into the process of improving care. We are bringing together many people who focus on many different things, but all our activities share one common goal: we want to continue to be the cure for waiting for the cure. We want to outsmart IBD together!

We have heard the voices of parents and patients who see the value of collaborative improvement and are pushing us further, faster as we pursue this goal together.

Tell us what ICN means to you and how you want to be involved.

ICN Engagement Campaign

Recently, ImproveCareNow has been training participating care centers to develop and empower leaders at the center level. With this training, ImproveCareNow will have an opportunity to deepen its impact and extend its reach by focusing on equipping the whole community with the skills, knowledge and tools they need to take ownership of ImproveCareNow’s work at the local level. We are happy to announce that the first round of centers have almost completed a five-module training series and that we are about to begin rolling out training to the next group of centers!


Christian joins the Patient Advisory Council

PAC Member Christian HansenMy name is Christian Hanson and I am a sophomore at Brown University. I was diagnosed with Crohn’s disease at age ten and receive Remicade infusions at Boys Town Medical Center in Omaha, Nebraska. While Crohn’s so often feels like a heavy burden, there have been fleeting moments where my condition feels more like a blessing: Through this disease I have discovered a network of heroes who have overcome the trials of IBD and have been surrounded by a caring and compassionate network that spans the United States. I am joining the Patient Advocacy Council because I believe in their mission to magnify the voices of patients and advocate for those who cannot. I will be helping share, via CIRCLE eNewsletter, updates about the PAC and various projects related to patient engagement active throughout the ImproveCareNow Network. Feel free to contact me at pac@improvecarenow.org if you would like to learn more about the PAC or would like to speak with me regarding my personal experiences.


All the best,
Christian Hanson


What is Smart Patients? And why are we partnering?

Smart Patients logoThe team at Smart Patients has impressed us here at ImproveCareNow. They have proven themselves as experts in creating a culture and a space for generous, information-rich sharing which gives people living with chronic illnesses like Crohn's disease and ulcerative colitis (Inflammatory Bowel Disease or IBD) a safe place to learn and share.

There are many social networks and online communities for IBD, but we have chosen to partner with the Smart Patients team because their custom-built, disease-specific forums offer a truly safe, warm and engaging experience for users. Smart Patients also offers conversation tagging, and clearly defined community norms, which means community members are highly likely to find the answers they need and highly unlikely to be trolled. And because the conversations are arranged using tags and completely searchable, you can always find what you’re looking for.

The Smart Patients team and ImproveCareNow have partnered to create an online IBD community that is supportive and also powerful. The Smart Patients IBD community has the power to improve health and health care systems through patient and family peer-to-peer learning.

Join the Smart Patients community for IBD today. Together, we can outsmart IBD!


Using ICN Data to Investigate Health Disparities in Children and Teens with Crohn's Disease

[Editor's note: One of the unique aspects of research in a large network such as ImproveCareNow (ICN) is the opportunity for collaboration.  Jennifer Dotson and Michele Cho both submitted protocols to the ICN Research Committee to study racial disparities in pediatric patients with IBD.  Both are young eager investigators.  The Research Committee helped make a connection, and the result has been the start of important collaborative research utilizing the ICN2 registry.  This work exemplifies the power of the ICN network: the power of people and the power of data.  I hope you enjoy reading about the outcomes of their work.  Steve Steiner, Co-Chair, ICN Research Committee]




Kids in a circle on the grassUsing ICN Data to Investigate Health Disparities in Children and Teens with Crohn's Disease

 

By Jennifer L. Dotson, MD, MPH and Michele Cho, MD

 

Health care differences due to race have been shown to contribute to suboptimal healthcare outcomes for minorities and low-income groups. Identifying differences among those at-risk is an essential step to improve healthcare delivery and ultimately outcomes, and to reduce costs for all patients. For our study, we wanted to look at racial differences during the initial presentation and medical management of children and teens with Crohn's disease. Specifically, we wanted to determine if there were differences in disease severity and treatment with medications between Black and White children at time of diagnosis. The ImproveCareNow (ICN) network gave us the opportunity to look at a large group of patients from across the country and was a valuable tool in facilitating this work. ICN contains data collected at the time of outpatient clinic visits and is able to track patients over time. Data was pulled from the ICN database for all patients under 21 years of age with clinic visit between September 2006 and October 2014. We then narrowed the list of patients by including only those that had a visit within 90 days of their initial Crohn’s diagnosis.

 

We are in the early stage of this study and would like to share some of our preliminary results.

 

There were 1728 patients (Black=222 (13%), White=1506 (87%)) from 46 sites included. The average age was 13 years and 62% were male. Black children had more Medicaid insurance (39% vs. 10%) than White children. There were no differences by nutritional status, body mass index, or growth status. There was no difference in disease activity based on the short Pediatric Crohn’s Disease Activity Index, however Black children had more severe disease based on Physician Global Assessment. 0.9% of Black children had perianal disease as compared to 0.5% of White children. Anti-TNFα therapy (medications such as Remicade or Humira) was more commonly prescribed for Black children (17% vs. 11%).

 

Racial and socioeconomic disparities have the potential to impact healthcare delivery and Crohn’s disease outcomes. This study identified several differences among newly diagnosed children and teens with Crohn’s within an outpatient quality improvement network. Specifically, Black children were more likely to receive treatment with anti-TNFα therapy than White children. This difference does not appear to be explained by differences in age, growth, nutrition, perianal disease or standardized disease severity scores, but rather by subjective assessment of disease severity and/or consideration of additional information such as endoscopic appearance that is not accounted for by the short Pediatric Crohn’s Disease Activity Index.

 

ICN helped make this research project a reality by providing a rich data set and facilitating a successful collaboration of two young physician scientists. Realizing we had similar research interests in health disparities, we decided to combine our efforts and focus on a single, large project together. We are delighted to be working together on this, along with our mentor team, and are thankful for the encouragement by the ICN network.

 

Jennifer L. Dotson, MD, MPH is a pediatric gastroenterologist and research studying racial disaprities in IBD care using the ImproveCareNow registry.Jennifer Dotson, MD, MPH, is a pediatric gastroenterologist and principal investigator in the Center for Innovation in Pediatric Practice at The Research Institute at Nationwide Children's Hospital, Columbus, Ohio. She conducts clinical research focusing on improving healthcare delivery and reducing healthcare disparities, and outcomes-based research in children with inflammatory bowel disease (IBD). Her interests are studying hardships and barriers to care, and assessing potential health system solutions from the patient/caregiver perspective that impact clinical outcomes for children with IBD. When she is not taking care of patients and conducting research, she loves traveling with her family and spending time doing activities outdoors (hiking, kayaking, etc.).

 

Michele Cho, MD is a pediatric gastroenterology and research studying racial disaprities in pediatric IBD care using the ImproveCareNow registry.Michele Cho, MD, is a pediatric gastroenterologist working in the greater Chicago area. She is part of the Center for Children’s Digestive Health and is the physician lead for ICN at her site at the Advocate Children’s Hospital in Park Ridge, IL. Outside of work, she enjoys running and participating in other outdoor activities. She is looking forward to summertime in Chicago.


Michael Seid #myICN

Michael Seid supports ICN for his daughter.If you're a parent, you know. You know what you'd do for your kids. If your child is diagnosed with a chronic illness, you discover that you'd do even more.  Until a cure is found, part of what you'll have to do is work closely with your child's doctor and care team. This can be hard and intimidating but everyone knows the best care comes from everyone partnering together – communicating honestly, sharing the work, pushing each other towards the goal.

 

Have you seen our health care system? It doesn't always work that way. But imagine if every interaction with your child's care team felt exactly like that – like you were part of the best team in the world. And your team had access to knowledge and wisdom from other best teams in the world. World class teams networked together to make things better for your child and all kids who suffer? That's what ICN is building. And you know what's even better? Having the opportunity to work with ICN to make this happen. That's why I'm part of ICN – we're the cure for waiting for the cure.


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