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 20 th , 2019
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 2
Patient Experience PCORI-EAIN #3394-UoA “Sleepy” - Median of 10 years before diagnosis 3
Patient Experience PCORI-EAIN #3394-UoA Sleepy Physician’s office – Don’t ask, don’t tell No sleep question in Review of Systems (ROS) 4
Patient Experience Find sleep laboratory at night and overnight stay Sleepy Sleep ROS 5
Patient Experience Sleep Sleep Sleepy Sleep study ROS Lab 6
Patient Experience Results not provided on morning of study Sleep Sleep Sleepy Sleep CMS / Accreditation rule ROS Lab study Await sleep study results 7
Patient Experience Durable Medical Equipment Company “drops off” CPAP machine “Stark Laws” 8
Patient Experience DME Sleep Sleep Sleepy Sleep Delayed Stark ROS Lab study Results Laws 9
CPAP machine, buttons, accessories and supplies, SD chips, masks, etc. etc. Complex external device-based therapy that requires daily wear and behavior change 10
Patient Experience DME Sleep Sleep Sleepy Complex Sleep Delayed Stark ROS Lab Device study Results Laws 11
Non-adherence to CPAP Therapy – “31- 90 day” Period 12
Patient Experience DME Delayed Diagnosis Fragmented Care Silos of care-delivery Complex device-based therapy Removed! Sleep Sleep Sleepy Complex Sleep Delayed Stark Requiring Behavior Change ROS Lab Device study Results Laws 13
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Outcomes Patient-ratings of satisfaction with care delivery [PRIMARY] CPAP adherence Care Coordination Patient-assessment of Chronic Illness Care 15
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ANNUAL MEETING | #PCORI2017 BACKGROUND 170,641 (63.7% of database) Adherent to PAP therapy by CMS criteria 16 years of data Non-adherent to PAP therapy by CMS criteria 18 November 15, 2019
ANNUAL MEETING | #PCORI2017 Socioeconomic inequity in Adherence to Positive Airway Pressure Therapy in Population Level Analysis 170,641 (63.7% of database) Adherent to PAP therapy by CMS criteria 16 years of data Non-adherent to PAP therapy by CMS criteria 19 November 15, 2019
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. 20 November 15, 2019
ANNUAL MEETING | #PCORI2017 Adaptations 21 November 15, 2019
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 22 November 15, 2019
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 23 November 15, 2019
Questions? 24
Thank You! Sairam Parthasarathy, MD Chief, Division of Pulmonary, Allergy, Critical Care & Sleep Medicine @sai_sparthamd Friday, September 20 th , 2019 25
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