Impact of Funding

A Closer Look at the Video Grand Rounds Program

Given the rarity of bleeding disorders and the limited number of medical professionals who specialize in their management, Hemophilia Treatment Center (HTC) staff members rarely have an opportunity to interact with colleagues outside of their facilities. However, an innovative program funded through a grant from the Aventis Behring Foundation and initiated by the Yale Hemophilia Treatment Center has helped to address this situation.

The Video Grand Rounds program began in June of 2002. The initial goal of the program was to increase opportunities for healthcare professionals at HTCs in New England to interact with one another and share expertise. With the exception of an annual regional meeting or an executive committee meeting, these professionals did not have a dedicated setting for formal, ongoing learning and discussion.

Eight HTCs participated in the initial Video Grand Rounds, with the Yale Hemophilia Treatment Center acting as the program's facilitator. The other participating centers included:

• Boston Hemophilia Center
• Dartmouth-Hitchcock Hemophilia Center
• Maine Hemophilia Treatment Center
• New England Hemophilia Center
• Hemophilia Center of Rhode Island
• University of Connecticut Health
• Center Hemophilia Treatment Center
• Vermont Regional Hemophilia Center

How the Program Was Implemented

Achieving consensus from the participating HTCs at an early stage was critical to the success of the Video Grand Rounds program. To help ensure maximum participation, the medical or surgical director from each Center was asked to lead a presentation, and all professional staff members, including nurses, nurse coordinators, the surgical team, physical therapists, and social workers, were encouraged to attend the sessions.

The initial Video Grand Rounds program consisted of seven sessions, which were held monthly during 2002 and 2003 with the exception of December and during the summer. Each session focused on a specific topic related to the management of the care of people with bleeding disorders. The topics for the sessions (see box) were selected at the annual executive committee meeting. Representatives from the HTCs volunteered to present the topics that were of greatest interest to them.

At the scheduled time (usually 8:00 a.m.), participants "met" in front of their computers, logged on to a password-protected Web site, and viewed a half-hour presentation through streaming video technology. Following the presentation, Yale Hemophilia Treatment Center facilitated a half-hour conference call in which the topic was explored in more detail, and applications in the HTC setting were discussed.

Video Grand Rounds Presentations 2002-2003

• Clinical Management of Hemorrhage in Hemophilia
  Dr. Diana Beardsley
• Orthopedic Issues in Hemophilia Patients
  Dr. Philip Bernini
• Acquired von Willebrand Disease
  Dr. Robert Bona
• Inhibitors
  Dr. Peter Marks
• Hemophilia Patient and HIV: Conflict Between Duty to Warn and Privacy
  Dr. Anita Kestin
• Hepatitis C
  Dr. Doreen Brettler
• Rare Coagulation Disorders
  Dr. Marjorie Boyd

All participants were asked to fill out evaluation forms at the end of each session. To encourage people to share their feedback, continuing education credits were offered through Yale University to those who completed the forms.

An outside vendor was contracted to develop and maintain the Web site. The presenters were videotaped several weeks before each session, and the presentation slides were collected in advance, then digitized and synchronized with the speaker. With the exception of some minor technical problems, the implementation of the program went smoothly.

The Program's Impact in New England and Beyond

"The Video Grand Rounds program has been a resounding success," explains Diana Beardsley, M.D., Ph.D., Yale Hemophilia Treatment Center. "We had excellent participation, and the program was really appreciated by the eight centers in our region."

Participants reported that the sessions were valuable and relevant to their practices. Equally important, participants felt the program could help enhance the care they provide to their patients. In general, participants felt that the presentations were organized and well planned, the slides were of good quality, the presenters were knowledgeable in the field, and the streaming video technology used was effective. In fact, because of the technology used, people could take part in the sessions from home or if they were out of town. One person even participated from an international location.

While the initial funding was only for its first year of operation, the Centers were determined to find ways to continue to offer the Video Grand Rounds program. The Yale Hemophilia Treatment Center plans to offer a second series of Video Grand Rounds during 2004. To help manage some of the costs associated with the program, Yale videotaped six of the presenters in advance at the December 2003 American Society of Hematology annual meeting.

Furthermore, some HTCs outside of New England have learned of the program and expressed interest. Yale is currently exploring cost-effective ways in which these Centers can participate in the Video Grand Rounds.

"I am happy that the program is being offered again," comments Dr. Beardsley. "The talks that have been featured were excellent. I'm so pleased with what people have brought to and received from this project."