Multiple Sc le ro sis At Ho me Ac c e ss (MAHA): Ca re I nto - - PDF document

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Multiple Sc le ro sis At Ho me Ac c e ss (MAHA): Ca re I nto - - PDF document

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Multiple Sc le ro sis At Ho me Ac c e ss (MAHA): Ca re I nto Co mmunity K AT HL E E N HE AL E Y ARNP, PHD ASSI ST ANT PROF E SSOR, MUL T I PL E SCL E ROSI S PROGRAM DE PART ME NT OF NE UROL OGI CAL SCI E NCE

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SLIDE 1

Multiple Sc le ro sis At Ho me Ac c e ss (MAHA): Ca re I nto Co mmunity

K AT HL E E N HE AL E Y ARNP, PHD ASSI ST ANT PROF E SSOR, MUL T I PL E SCL E ROSI S PROGRAM DE PART ME NT OF NE UROL OGI CAL SCI E NCE S UNI VE RSI T Y OF NE BRASK A ME DI CAL CE NT E R

Disc lo sure s

 Spe a ke r unb ra nde d c o nte nt

Bio g e n I de c , a nd T e va Ne uro sc ie nc e s

 Suppo rt thro ug h a g ra nt fro m the

Multiple Sc le ro sis F

  • unda tio n
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SLIDE 2

MS With Se ve re Disa b ility

 Hig hly c o mple x, c hro nic , dyna mic , disa b ling  I

nc re a sing numb e rs re la te d to a g ing / dura tio n o f dise a se 1,2

 I

ndividua ls a nd fa milie s fa c e e no rmo us c ha lle ng e s in a c c e ssing , c o o rdina ting , ma na g ing a nd fina nc ing c a re 3

 F

re q ue nt c o mplic a tio ns a nd ho spita liza tio ns

 2nd mo st c o stly dise a se pe r individua l, hig he r c o st

with inc re a sing disa b ility 4,5,6

  • 1. Co nfa vre ux C.,Re v Pra t. 2006;56(12):1313-1320.
  • 2. T

utunc u M., Mult Sc le r. 2013;19(2):188-198.

  • 3. Na tio na l Multiple Sc le ro sis So c ie ty. Stra te g ic re spo nse white pa pe r
  • 4. Ade lma n G., J

Me d E c o n. 2013;16:639–647.

  • 5. K
  • b e lt G, J

Ne uro lNe uro surg Psyc hiatr

  • y. 2006;77(8)
  • 6. .Na c i H, Pharmac o e c o no mic s. 2010;28(5)

T he So nya Slifka L

  • ng itudina l

Multiple Sc le ro sis Study (N=2000)

N %

R equires cane to walk 25 feet 308 14.3 R equires bilateral support to walk 25 feet 123 6.8 R equires wheelchair or scooter 270 15.1 Bedridden 7 0.4 T

  • tal

708 36%

Minde n, S.L ., Multiple Sc le ro sis, 2006

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SLIDE 3

Pro b le ms, Ne e ds a nd Critic a l Ba rrie rs

Ca re g ive r b urde n Co mplic a tio ns UT I s, Re spira to ry F a lls a nd Pre ssure Ulc e rs Pa in, c o g nitio n, mo o d diso rde rs, Psyc ho so c ia l F ina nc ia l I mmo b ility, we a kne ss, b la dde r, b o we l, spe e c h, swa llo w, re spira to ry ,visio n L a c k o f e xpe rts g a ps in se rvic e L a c k o f c o mmunic a tio n, c o o rdina tio n a nd c o ntinuity o f c a re Struc ture o f c urre nt pa yme nt syste ms L a c k o f I nfra struc ture Diffic ult Ac c e ss to c a re due to se ve re disa b ility Ne e d multiple disc ipline s Assistive de vic e s, the ra pie s,dura b le me d Ho using T ra nspo rta tio n Po lic y/ Pa yo rs

Disabling Chronic Hig hly Comple x Dyna mic

Ca re I nto Co mmunity- MS AT HOME ACCE SS MAHA

 T

he te rm MAHA is de rive d fro m its c ity o f

  • rig in Oma ha , Ne b ra ska , whic h wa s

se ttle d b y Na tive Ame ric a ns o f the Oma ha trib e .

 I

n the ir la ng ua g e , Oma ha me a ns: “against the wind, against the cur r e nt”

 F

a ll 2013…. first pa tie nt Ma rc h 2014

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SLIDE 4

Yo ung , L ., He a le y, K ., Sc hmid, K ., Cha rlto n, M., Za b a d, R.,We ste r, R., F 1000Re se a rc h, 2015 Yo ung , L ., He a le y, K ., Sc hmid, K ., Cha rlto n, M., Za b a d, R.,We ste r, R., F 1000Re se a rc h, 2015

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SLIDE 5

E le me nts Guiding Ca re Pro c e ss : The 10 C’s

  • Cooperation
  • Competency
  • Continuity
  • Caring and

compassion

  • Comprehensive
  • Credibility and

consistency

  • Coordination
  • Communication
  • Continuous quality

improvement

  • Cost aware

Yo ung , L ., He a le y, K ., Sc hmid, K ., Cha rlto n, M., Za b a d , R.,We ste r, R., F 1000Re se a rc h, 2015 F S K C SR CK SM DS AG DW DA DI L W CP JS CG K N JK K S JW MC MH JC L G MJ CF MP L C K W K W AO Mw

MAHA

  • 2y -1y 0 +1y +2y

Hospita liza tion E R Infe c tion F a ll Pre ssure ulc e r De ath

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SLIDE 6

Re a so ns fo r Ho spita liza tio n o r E R

Re asons for hospitalizations or E R visits

26% UT I 8% F a lls, injury 23% Re spira to ry 8% Re la pse 13% Skin de c ub / c e llulitis 5% E le c tive 16% Othe r suic ide atte mpt, Stro ke , b e lls pa lsy, pa in

70% pote ntially avoidable

Cha ra c te ristic s o f Pa tie nts

Numbe r % MS E DSS >7.5

  • E

DSS 7.5

  • E

DSS 8

  • E

DSS 8.5

  • E

DSS 9

  • E

DSS 9.5

  • E

DSS 10 30 6 10 7 7 20% 33% 23% 23% ***

Ge nde r F / M

23/ 7 77%/ 23%

Age 35- 54/ > 55

12/ 18 40%/ 60%

L iving Situa tion

With o the rs 20 67% Alo ne 8 27% F a c ility 2 6%

Rac e

Ca uc a sia n 28 94% Afric a n-Ame ric a n 2 6%

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SLIDE 7

Othe r Cha ra c te ristic s o f Pa tie nts

Othe r Numbe r %

I ndwe lling c a the te rs 11/ 30 37% G tub e s 5/ 30 17% Re spira to ry 4/ 30 13% Po we r c ha irs 20/ 30 67% Pre ssure Ulc e rs 6/ 30 20% Dise a se Mo dula to rs 20/ 30 67% Adva nc e d Dire c tive s 3/ 30 10%

I nsura nc e Co ve ra g e

Insur anc e Numbe r %

Me dic a re / c o mme rc ia l 10/ 30 33% Me dic a re / full Me dic a id 10/ 30 33% Me dic a re / sha re o f c o st 10/ 30 33%

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SLIDE 8

Ho spita liza tio ns

Numbe r % L OS Ave r age L OS

  • 1 y

Numb e r o f individua ls ho spita lize d

13/ 29 45% 106

106/ 13=8.0 da ys

(US a ve ra g e 9.0)

106/ 29=3.7 da ys

+1 y Numb e r o f individua ls ho spita lize d

5/ 11 45% 16

16/ 5=3.2 da ys 16/ 11=1.5 da ys

Diffe re nc e is 2.2 da ys x 4000.00$ hospita l da y= 8,800.00 x

500 pa tie nts = $ 4,400,000.00 e stima te d c o sts a vo ide d

Bha rg a va P, 65th Annua l Me e ting o f the Ame ric a n Ac a de my o f Ne uro lo g y; Ma rc h 16-23, 2013; Sa n Die g o , Ca lifo rnia . Ab stra c t PO3-203.

Skille d Nursing Da ys

Numbe r % L OS Ave r age L OS

  • 1 y Numb e r o f individua ls

with skille d nursing sta ys 10/ 29 34% 439

44 da ys 439/ 10=44 da ys 15 da ys 439/ 29=15 da ys

+1y Numb e r o f individua ls skille d nursing 0/ 11 0%

Diffe re nc e is 15 days x 500.00$ skille d day= 7,500.00 x

500 pa tie nts = $ 3,750,000.00 e stima te d c o sts a vo ide d

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SLIDE 9

T

  • ta l Annua l E

stima te d Sa ving s in Re duc ing Ho spita liza tio ns, Skille d F a c ility

N Hospita l Skille d T

  • ta l

500 4,400,000.00 3,750,000.00

8,150,000.00

E stimate s for US population

I f we wo uld g e ne ra lize the se sa ving s to U.S. c o uld po te ntia lly sa ve mo re tha n 1 b illio n do lla rs in re duc tio n o f ho spita l da ys a nd skille d nursing fa c ility c o sts o n a nnua l b a sis 80,000 (c o nse rva tive e stima te 20% MS po pula tio n) x 16,300$ (a nnua l sa ving s in re duc e d ho spita l a nd skille d fa c ilitie s =1,304,000,000

Pa tie nt Sa tisfa c tio n

10 of 12 sur ve ys r e tur ne d

Qua lity o f se rvic e E xc e lle nt 10/ 12 Go o d F a ir Po o r Me e t ne e ds Almo st a ll 10/ 12 Mo st F e w No ne He lp yo u de a l with yo ur pro b le ms Ye s he lpe d g re a t de a l 9/ 12 Ye s so me wha t 3/ 12 No No ma de wo rse “I t wa s a “Go dse nd” the y he lpe d us so muc h” “I t he lps tre me ndo usly, I do n’ t ha ve to wo rry so muc h, I ’ ve re c o mme nde d it to o the rs” “T he y g e t it do ne , it’ s a ma zing I ha ve the e q uipme nt I ne e d no w to b e mo re inde pe nde nt” “the y he lpe d me g e t fina nc ia l a ssista nc e ”

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SLIDE 10

Co nc lusio n

 Mo re issue s tha n e xpe c te d  T

re nds in de c re a se d c o mplic a tio ns

 T

re nds in de c re a se d ho spita l a nd skille d nursing fa c ility da ys

 Ve ry hig h pa tie nt a nd c a re g ive r

sa tisfa c tio n

 Suppo rt fo r c o ntinuing pro g ra m a nd

furthe r study is wa rra nte d

F uture Dire c tive s

 Co ntinue to ra ise a wa re ne ss o f pro b le m  I

nc re a se vo lume a nd c o ntinue to de ve lo p infra struc ture , e xpa nd te le -visits

 T

ra in pro vide rs

 Ob ta in a dditio na l da ta o n inc ide nc e a nd o utc o me s in

sta te (Me dic a re )

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SLIDE 11

MAHA T E AM

  • Ne uro lo g ist: Ra na Za b a d MD, Dire c to r MS Clinic
  • So c ia l Wo rke r: Nic o le Ridde r
  • Nurse pra c titio ne r “Co mpre he nsivist”: K

a thle e n He a le y NP

  • Physic a l the ra pist: T

a mmy Ro e hrs PT

  • Prima ry c a re physic ia n: Re b e c c a We ste r MD

T ha nk yo u MS F

  • unda tio n

fo r suppo rting o ur c linic a l wo rk +Aub rie L inde r MA Ne il Jo uve na t Ma c Mc la ug hlin Do nna Mruz Do ttie No rg a rd Dia ne Va c e k Ang e la F re nc h Me la nie L

  • ze no

Me lissa Ro b inso n