The Omaha System in Minnesota: Innovations in Research

Karen A. Monsen, Oladimeji Farri, Carolyn Garcia, Elaine M. Darst,

Madeleine J. Kerr, David M. Radosevich

mons0122@umn.eduomahasystempartnership.org

Presenter DisclosureK. 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 DarstTeam: Students and Community PartnersData source: InterviewPurpose: To evaluate the use of the Omaha System for assessment of community dwelling older adults with schizophreniaMethod: Case Study

Results

Description of complex client problems was facilitated by use of the Omaha System

ComprehensiveHolisticStandardized

Problems identified

IncomeNeighborhood/workplace safetyAbusePhysical activityMental healthCognitionNutritionSubstance use

Areas of Greatest Concern

Mental healthCognitionNutritionSubstance 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 functioningDifferences may indicate level of probable patient functioning without supportFuture 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.

2

3

4

Baseline Final

No MH Teen

No MH AdultMH Teen

MH Adult

Behavior

• Behavior improved most for adult clients with mental health problems (p = 0.013).

3

4

Baseline Final

No MH Teen

No MH AdultMH TeenMH Adult

Status

• Status showed the greatest statistical improvement for adolescents with mental health problems (p = 0.012).

3

4

5

Baseline Final

No MH Teen

No MH AdultMH Teen

MH Adult

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!

• mons0122@umn.edu