Dissemination and Implementation: Putting Evidence into Practice - - PowerPoint PPT Presentation

▶
dissemination and implementation putting evidence into
SMART_READER_LITE
LIVE PREVIEW

Dissemination and Implementation: Putting Evidence into Practice - - PowerPoint PPT Presentation

Feb 19, 2024 255 likes •514 views

Dissemination and Implementation: Putting Evidence into Practice Implementing Peer-Driven Care to Patients with Sleep Apnea Sairam Parthasarathy, MD Chief, Division of Pulmonary, Allergy, Critical Care & Sleep Medicine @sai_sparthamd

slide-1
SLIDE 1

Dissemination and Implementation: Putting Evidence into Practice Implementing Peer-Driven Care to Patients with Sleep Apnea

Sairam Parthasarathy, MD

Chief, Division of Pulmonary, Allergy, Critical Care & Sleep Medicine @sai_sparthamd Friday, September 20th, 2019

slide-2
SLIDE 2

2

Sairam Parthasarathy, MD

Disclosures

Rela latio ionship ip Company ny(ies es) Speakers Bureau Advisory Committee Board Membership Special Advisor to NIH-NHLBI Consultancy Review Panel PCORI Funding DI-2018C2-13161; IHS-1306-02505; PPRND-1507-31666; PCS-1504-30430 Honorarium Ownership Interests

slide-3
SLIDE 3

3

Patient Experience

“Sleepy” - Median of 10 years before diagnosis

PCORI-EAIN #3394-UoA

slide-4
SLIDE 4

4

Patient Experience

Sleepy

Physician’s office – Don’t ask, don’t tell No sleep question in Review of Systems (ROS)

PCORI-EAIN #3394-UoA

slide-5
SLIDE 5

5

Patient Experience

Sleepy

Sleep ROS Find sleep laboratory at night and overnight stay

slide-6
SLIDE 6

6

Patient Experience

Sleepy Sleep ROS Sleep Lab

Sleep study

slide-7
SLIDE 7

7

Patient Experience

Sleepy Sleep ROS Sleep Lab Sleep study

Results not provided on morning of study CMS / Accreditation rule Await sleep study results

slide-8
SLIDE 8

8

Patient Experience

Durable Medical Equipment Company “drops off” CPAP machine “Stark Laws”

slide-9
SLIDE 9

9

Patient Experience

Sleepy Sleep ROS Sleep Lab Sleep study Delayed Results DME Stark Laws

slide-10
SLIDE 10

10

CPAP machine, buttons, accessories and supplies, SD chips, masks, etc. etc. Complex external device-based therapy that requires daily wear and behavior change

slide-11
SLIDE 11

11

Patient Experience

Sleepy Sleep ROS Sleep Lab Sleep study Delayed Results DME Stark Laws Complex Device

slide-12
SLIDE 12

12

Non-adherence to CPAP Therapy – “31- 90 day” Period

slide-13
SLIDE 13

13

Patient Experience

Sleep ROS Sleepy Sleep Lab Sleep study Delayed Results DME Stark Laws Complex Device Removed!

Delayed Diagnosis Fragmented Care Silos of care-delivery Complex device-based therapy Requiring Behavior Change

slide-14
SLIDE 14

14

slide-15
SLIDE 15

15

Outcomes

Patient-ratings of satisfaction with care delivery [PRIMARY] CPAP adherence Care Coordination Patient-assessment of Chronic Illness Care

slide-16
SLIDE 16

16

slide-17
SLIDE 17

17

slide-18
SLIDE 18

ANNUAL MEETING | #PCORI2017

BACKGROUND

Adherent to PAP therapy by CMS criteria Non-adherent to PAP therapy by CMS criteria

170,641 (63.7% of database) 16 years of data

November 15, 2019

18

slide-19
SLIDE 19

ANNUAL MEETING | #PCORI2017

Socioeconomic inequity in Adherence to Positive Airway Pressure Therapy in Population Level Analysis

Adherent to PAP therapy by CMS criteria Non-adherent to PAP therapy by CMS criteria 170,641 (63.7% of database) 16 years of data

November 15, 2019

19

slide-20
SLIDE 20

ANNUAL MEETING | #PCORI2017

The goal of the current implementation proposal is to implement a cheap, effective and scalable and exportable system of patient-centered care aimed at promoting CPAP adherence in patients with OSA, reducing blood pressure, improving patient satisfaction and reducing healthcare utilization.

11 sleep centers and clinics Stepped-wedge manner.

November 15, 2019

20

slide-21
SLIDE 21

ANNUAL MEETING | #PCORI2017

Adaptations

November 15, 2019

21

slide-22
SLIDE 22

ANNUAL MEETING | #PCORI2017

Context and Environment’s Readiness for Change and Maintenance

  • 210,000 Medicaid and dual-eligible Medicare beneficiaries (Low SES = poor

adherence)

  • Study team’s experience
  • CMS
  • Pulmonary CCG
  • Implementing telemedicine ICU care across 21 hospitals
  • 8 stakeholder groups and their priorities and early engagement
  • Medicaid Plan – Innovation for Value-based care bundle
  • Sustainability of change beyond the life of implementation project
  • Passive collection of outcomes = Accreditation requirement

November 15, 2019

22

slide-23
SLIDE 23

ANNUAL MEETING | #PCORI2017

Biggest challenges/successes

Challenges

  • NEW Healthcare System contract with different IVR system

Successes

  • Support from Healthcare System
  • Approval by Systemwide Clinical Consensus Group
  • Payment bundle for Value-based care
  • Patients on CPAP therapy; before sleep study

November 15, 2019

23

slide-24
SLIDE 24

24

Questions?

slide-25
SLIDE 25

25

Thank You!

Sairam Parthasarathy, MD

Chief, Division of Pulmonary, Allergy, Critical Care & Sleep Medicine @sai_sparthamd Friday, September 20th, 2019