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2008 Q1 - QUARTERLY UDPATE
1. Lewis J. Rubin (chair)
2. Richard Channick
3. Philip Clements
4. Anatoly Langer
5. Vallerie V. McLaughlin
6. Ron Ourdiz
7. Vic Tapson
What is it?
QuERI represents an innovative integration of guidelines and clinical care delivery, to identify and implement evidence based practices in routine health care setting.
What it is NOT: Clinical trial
Care Gap and the Model for Improved Care
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Link guidelines and risk based management with actual patient care |
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Monitor outcome and provide feedback |
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Ensure dynamic (over a period of time) and interactive environment (allowing for changes) |
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Use data for future research direction and guidelines development |
PAH QuERI: Background
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To facilitate access to published PAH guidelines and to allow an opportunity of evaluating the applicability of the guidelines to their practice and ability to adhere to the guidelines as part of their patient management. |
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The electronic case report form will provide a platform for diagnostic and therapeutic work up of PAH patients, prompting participating physicians to follow the guidelines. |
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Integration of this approach into physician's work environment will provide opportunities to apply the standard of care. |
QuERI Approach
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Define existing practice patterns and outcomes and current variations from best practice |
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Identify and implement interventions to promote best practice |
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Document that best practice improves outcome |
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Document that outcomes are associated with improved health-related quality of life |
| 1. |
To optimize patient care through provision of guidelines at bedside |
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Develop insight into care gap |
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Provide long term (3 years) follow up |
PAH QuERI: update
| PAH: |
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Enrolling sites: 44 across US |
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Patients enrolled: 291 |
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| Scleroderma: |
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Enrolling sites: 3 |
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Patients enrolled: 8 |
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| All Updates are at: www.mdprimer.com |
(Western IRB)
Applicable for the sites where the local IRB approval is not required (e.g., group/private practice)
Approval Date: 07/29/2005
Approval letter and approved consent form sent to the sites who already signed the memorandum of understanding (MOU).
New sites: Please review, sign and fax the MoU to MD Primer Inc. You will be sent the WIRB approval letter and approved consent form.
Applicable for the sites where local IRB approval is required (e.g., university hospitals)
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The protocol and template of consent form sent to the sites (who already signed the MoU) for local IRB submission. |
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These are also available on our website in PDF format. |
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Once the site receive the local IRB approval, a copy of approval letter and approved consent form to be sent to the MD Primer Inc |
Please contact the Project leader (Alina Dragomir) at: Toll Free Tel: 1-800-659-3734 (Ext. 251)
OR (416) 930-9164
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Provides clear guidelines for patient management (evidence-based approach) |
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Helps physicians optimize diagnostic and therapeutic approach to PAH |
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Helps physicians to manage their patients according to guidelines (case-based intervention) using patient management algorithm |
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Asks physicians to send information (case report form) on how they manage their patients |
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Provides feedback to physicians in comparison to national and regional standings |
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Patient follow-up (ethics approved) provides opportunity to assess benefit |
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Provides database for future research |
Step 1: Current guidelines are provided re: diagnostic work up after inclusion criteria are satisfied.
Step 2:
a. Practical steps towards confirming diagnosis: essential testing - all patients
b. Contingent tests - selected patients.
Step 3: Collect data on current patient management while providing guidelines and evidence-based approach.
Step 4: Interactive continuing professional development as part of QuERI: implementation of learned principles into practice, i.e. enhancement of care and closure of care gap through physician feedback.
| 1. |
Symptoms consistent with PAH such as
(any of the below): |
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a. |
Exertional dyspnea |
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b. |
Fatigue or weakness |
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c. |
Syncope or exertional presyncope |
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d. |
Angina |
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e. |
Peripheral edema |
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f. |
Abdominal distension |
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At risk for PAH
(any of the below and not limited to any specific one): |
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a. |
First degree relative with idiopathic PAH |
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b. |
Known genetic mutation |
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c. |
Scleroderma spectrum of disease |
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d. |
Congenital systemic-to-pulmonary shunt |
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e. |
Portal hypertension |
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f. |
Other with high risk of suspicion |
RIFAI
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Pulmonary arterial hypertension |
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Idiopathic PAH |
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Familial PAH |
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Related to: |
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Connective tissue diseases |
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HIV |
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Portal hypertension |
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Anorexigens |
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Congenital heart diseases |
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PPHN |
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PAH with venule/cap inv (PVOD) |
| 2. |
PH with left heart disease |
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Atrial or ventricular |
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Valvular |
| 3. |
PH with Lung Diseases/Hypoxemia |
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COPD |
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Interstitial lung diseases |
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Sleep-disordered breathing |
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Developmental abnormalities |
| 4. |
PH due to chronic thrombotic and/or embolic disease |
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TE obstruction of proximal PA |
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TE obstruction of distal PA |
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Non thrombotic Pulm embolism |
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| 5. |
Miscellaneous |
+ Click to enlarge
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PAH Steering Commitee
Needs Assessment Survey