ABFI 2004 Chronic Disease Management

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ABFI 2004 Chronic Disease Management
Colonel Ronald Poropatich,MD Robert Read, LTC
(Ret) USA

• Medical Research Materiel Command
• Telemedicine Advanced Technology Research
  Center
• Ft Detrick, MD

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The Portfolio

• Chronic disease management (CDM) is an approach
  to health care that emphasizes helping
  individuals maintain independence and keep as
  healthy as possible through prevention, early
  detection, and management of chronic conditions,
  such as congestive heart failure, asthma,
  diabetes, and other debilitating illnesses.
• Chronic conditions impose challenges for those
  affected, their families and care providers. A
  patient's ability to follow medical advice,
  accommodate lifestyle changes, and access
  resources are all factors that influence
  successful management of an ongoing illness.

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The Portfolio

• In 2004, TATRC managed nearly 10.5M in Diabetes
  research alone.
• Joslin Diabetes Center, Childrens Hospital of
  Pittsburgh and Marshall Island Diabetes Wellness
  and Reversal Program.

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Schematic of Joslin Vision Network System
Architecture
Remote Imaging Work Station EMRS and Education
Remote Imaging Work Station EMRS and Education
Remote Imaging Work Station EMRS and Education
Data Storage (50Gb)
Remote Hub Site
Central JVN Imaging Workstations EMRS
and Education Modules
Remote Reading Center Diagnosis and Treatment
JVN Hub Site, FDDI Ring, Intranet
INTERNET ACCESS
Diabetes Management and Education on
WWW
Central JVN Reading Center EMRS and Automated
Diagnosis and Treatment Plans
Central JVN Server and Data Store (1Terabyte)
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Comprehensive Diabetes Management Program (CDMP)
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Development of an Inexpensive Portable Retinal
Imaging Device

• Current commercially available non-mydriatic
  retinal imaging systems are limited by high cost,
  lack of portability, high flash intensities for
  exposure, and pupil diameter less than 4 mm
  impacting image quality and ability to grade
  images. Diabetic patients and older non-diabetic
  subjects characteristically present with smaller
  pupils
• Developed a JVN retinal imaging prototype that
  will be portable, inexpensive, will image through
  a 2.8 mm pupil providing a 37 degree field of the
  retina, and will perform at lower light levels
  using a novel light diode strobing technique for
  retinal exposures.
• An SBIR application in collaboration with Kestrel
  Corporation is in preparation with the aim of
  developing a production model of this retinal
  imaging system
• A patent for this system was filed in August 2003

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Childrens Hospital of Pittsburgh

• Genetics Evaluation of inheritance patterns of
  specific loci and risk of developing diabetes or
  diabetic-complications.
• Biomarkers Identification of molecular biomarkers
  in the proteome and transcriptome associated with
  islet function and microvasculature disease.
• Education Telemedicine-based programs increasing
  patient and provider understanding of diabetes.

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Diabetic and Diabetic-Nephropathy Pedigrees
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Genetic Information for TestingType 1 Diabetes
GIFT-D

• Developing and Evaluating a theory-based web
  education and counseling program

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Marshall Islands Diabetes

• PI proposes to adapt the NEWSTART wellness
  program (commercial program from the Weimar
  Institute) to a subset population in the Marshall
  Islands.
• This program utilizes Diabetes Reversal and
  Wellness thru lifestyle change reflected in a
  more healthy diet and increased physical activity
  (felt more effective than medication) in the
  hopes of decreasing the incidence of type II
  diabetes.
• Success of the intervention will be based on
  achieving a clinically and statistically
  significant improvement in diabetes
  self-management, evidenced as reduction in
  fasting glucose and HA1C levels.
• Also included will be a dental component that
  will assess baseline and dental health status
  after intervention in the wellness program.

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Future of the Portfolio

• Good Chronic Disease Management offers real
  opportunities for improvement in patient care,
  service quality and reduction on costs.
• Good Chronic Disease Management can make a real
  difference, helping to prevent crises and
  deterioration, and enable people living with
  chronic conditions to attain the best quality of
  life.
• It is anticipated that this portfolio will
  continue to increase to 12M in 2005 and include
  other chronic diseases .

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Questions See Mr. Read or feel free to email or
call Colonel Poropatich at 301-619-2829 or
poropatich_at_tatrc.org