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AARCs 2015

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COPD. Prevalent yet treatable disease. Affects 12-24 million. 4th ... Mortality After Hospitalization for COPD. P Almagro et al, Chest 2002; 121:1441-1448. ... – PowerPoint PPT presentation

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Title: AARCs 2015


1
AARCs 2015 Beyond InitiativeWhat Does it
Mean?
  • Patrick J. Dunne, MEd, RRT, FAARC
  • HealthCare Productions, Inc.
  • Fullerton, CA 92838

2
Disclosure
  • This presentation is sponsored by Monaghan
    Medical.

3
Beleaguered US Healthcare SystemCost Drivers
  • Aging population
  • Smoking, obesity
  • Uncoordinated care
  • Prevalence of chronic disease
  • Non-participating patients/caregivers
  • Archaic financial foundation
  • Workforce fatigue, apathy

4
Cost Drivers
  • Aging population
  • Population 60 yrs. Fastest growing
  • Smoking, obesity
  • Diabetes
  • Hypertension
  • Heart disease
  • Significantly higher than European countries
  • CDC ? 80 preventable!
  • Poor attention to health wellness

5
Cost Drivers
  • Chronic disease prevalence
  • 2/3 of annual expenditures
  • Only 50 receive recommended care
  • Evidence-based standards of care
  • Non-participating patients/caregivers
  • Episodic care vs. continuing care
  • Exacerbations vs. disease management
  • January 1, 2010 (MIPPA 2008)

6
Cost Drivers
  • Uncoordinated care
  • Duplicative
  • Delayed
  • Sicker, less stable
  • Fragmented
  • Medical errors, misadventures
  • Lack of continuity
  • Not a seamless transition

7
Cost Drivers
  • Archaic hospital financial model
  • Clipboard/pen vs. digital
  • Unforgiving credit markets
  • ? ability to raise capital
  • ? municipal/state credit worthiness
  • ? indigent care
  • Un-insured, under-insured
  • Impact of global economic crisis
  • Closures, layoffs

8
Other Cost Drivers
  • Task oriented practitioners
  • Maintain the status quo
  • Provincial view
  • Profound change a threat
  • Fatigued
  • Inefficient practices
  • Inane orders v/s protocol directed care
  • Wasted teachable moments

9
Other Cost Drivers
  • Anachronistic hospital structure
  • Silo mentality
  • Department v/s Service
  • Traditional metrics of limited value
  • Inconsistent leadership
  • Professional malaise
  • Lack of vision
  • Limited vision w/ lacking skill set

10
2015 BeyondTime Lines
  • Spring 2007
  • Task force formed
  • Health care reform inevitable!
  • Envision the RT of the future
  • 3 invitation-only conference
  • March 2008
  • Spring 2009
  • Fall 2009

11
Creating a Vision for Respiratory Care in 2015
and Beyond Charles G. Durbin Jr. MD, FCCM,
FAARC John Walton, MBA RRT, FAARC Conference
Co-chairs March 3-5, 2008 Hilton DFW Lakes
Executive Conference Center 1800 Highway 26 East,
Grapevine, Texas
Presented by the AMERICAN ASSOCIATION FOR
RESPIRATORY CARE 9425 N. MacArthur Blvd., Suite
100 Irving, TX 75063, U.S.A.
12
2015 Initiative QuestionsMarch 2008 Conference
  • How will the new system respond to health care
    needs of patients with acute and chronic
    respiratory disorders?
  • What current and new capabilities will
    respiratory therapists need to effectively
    participate?

13
2015 Initiative Questions
  • What additional responsibilities can RTs assume
    to improve heath care outcomes for patients with
    chronic respiratory diseases?

14
2nd ConferenceSpring 2009
  • Build on proceedings of 1st conference
  • Define knowledge, skills attributes required to
    competently provide future respiratory services
  • Define the education and credentialing systems
    required to support future RTs

15
3rd ConferenceFall 2009
  • Determine how we prepare RTs (existing and
    entry-level) for new roles and responsibilities
    with minimal impact on the RT workforce
  • Getting from here to there

16
Creating a Vision for Respiratory Care in 2015
and Beyond Charles G. Durbin Jr. MD, FCCM,
FAARC John Walton, MBA RRT, FAARC Conference
Co-chairs March 3-5, 2008 Hilton DFW Lakes
Executive Conference Center 1800 Highway 26 East,
Grapevine, Texas
Presented by the AMERICAN ASSOCIATION FOR
RESPIRATORY CARE 9425 N. MacArthur Blvd., Suite
100 Irving, TX 75063, U.S.A.
17
Post- Acute Conditions
  • COPD
  • Asthma
  • Obstructive sleep apnea
  • Lung cancer
  • Cystic fibrosis
  • IPF

18
COPD
  • Prevalent yet treatable disease
  • Affects 12-24 million
  • 4th leading cause of death
  • The 3rd by 2020 (if not sooner!)
  • More women than men
  • 64,000 v/s 59,000 deaths in 2003
  • Huge economic impact
  • 37 billion in 2004 21 billion for hospital care

19
COPD
  • 1993 2002 ?
  • Hospitalizations 461,000 619,000 ? 34
  • Length of stay 7.2 days 5.1 days ? 30
  • Cost per stay 10,500 15,400 ? 47
  • Recidivism the primary driver of repeat
    hospitalizations
  • Inability and/or unwillingness to adhere to
    prescribed maintenance medications for symptom
    control
  • Agency for Healthcare Research and Quality

20
Mortality After Hospitalization for COPD
Kaplan-Meier survival curves in 135 patients
hospitalized for acute exacerbation of COPD (DRG
088)
P Almagro et al, Chest 2002 1211441-1448.
21
Asthma
  • 22 million affected
  • gt 6 million children
  • 497,000 admissions
  • Failure to control symptoms
  • Since 1998, deaths are down
  • lt 4,000/yr
  • 19 billion annual expenditures
  • gt 75 for direct medical costs
  • 12 mm lost school days 14 mm lost work days

22
Cost Impact of Asthma
  • Influenced by degree of individual control
    exacerbation avoidance
  • Emergent care more costly than scheduled
    out-patient care
  • Non-medical, indirect costs substantial
  • Guideline driven care cost-effective

23
Obstructive Sleep Apnea
  • 18 million affected
  • ? 6 mm with moderate to severe
  • 10 diagnosed treated
  • Morbidity-mortality data lacking
  • 38,000 deaths due to cardio-vascular issues
  • Direct health costs ? 2 of total
  • Drowsy driving
  • 100,000 MVA per year
  • ? 40,000 injuries 1,550 deaths
  • ? Work-related injuries, productivity

24
Respiratory Diseases
  • Affect millions
  • Millions more yet to be diagnosed
  • Cost billions
  • Recidivism driven
  • Usually a critical care component
  • Are predominantly chronic
  • Usually diagnosed later rather than sooner
  • Hospital has limited impact after discharge
  • Chronic care different than acute care

25
Crossing the Quality ChasmA New Health System
for the 21st Century
  • Chronic conditions
  • Illness lasting gt 3 months but not self-limiting
  • Leading cause of illness, disability and death
  • 100 million Americans, two-thirds under age 65
  • gt 60 of annual expenditures
  • Care differs from acute (episodic)
  • 15 top priority conditions
  • Emphysema/COPD
  • Asthma

26
Workforce Study
  • 2007 by CA Respiratory Care Board
  • Identify trends in workplace
  • Provide input for scope of practice purposes
  • Evaluate supply-demand status
  • Gauge perceptions/attitudes of licensed RTs
  • Establish data base for future decisions
  • www.rcb.ca.gov (key word workforce study)

27
Concurrent Therapy
28
Protocol Care
29
How Widespread is Protocol Care?
30
Key Findings
  • Workplace policies - specifically the use of
    protocols, concurrent therapy and triage -
    influenced how RTs felt about their job and the
    quality of care they provided to their patients.
  • RTs using protocols were significantly more
    satisfied with the quality of patient care.
  • The use of concurrent therapy and triage was
    associated with lower levels of satisfaction with
    the quality of patient care.
  • Additionally, use of both was also associated
    with lower levels of overall job satisfaction,
    satisfaction with workload, and involvement in
    decisions.

31
Health Promotion Disease Prevention
  • AARC Position Statement (2005)
  • RT as a health educator a collaborator
  • To instill the ability to improve a patients
    quality and longevity of life
  • Not hi-tech, but huge cost impact!
  • Collaborative health care
  • Those afflicted assume self-care responsibilities
  • Activated consumers an ally

32
Health Promotion Disease Prevention
  • Chronic disease state management
  • Risk factors, triggers, medication management,
    symptom control, exacerbation avoidance
  • Pulmonary function screening
  • At risk population smokers 45 yrs or older
  • Tobacco control
  • Cessation abstinence
  • Community preparedness

33
What About Respiratory Care?
  • Patient demand to increase
  • Transformation of traditional roles
  • From single tasks to bundles
  • From task doer to decision-maker
  • Performance expectations to increase
  • Educational preparation challenges
  • Continuing competency issues
  • Novel strategic planning essential!

34

The Health Care Environment
  • Tomorrow
  • Chronic disease prevention and management
  • Price competitive
  • Consumer responsive
  • Ambulatory Home and Community
  • Team
  • Evidence based practice
  • Consumer engagement
  • Today
  • Acute treatment
  • Cost unaware
  • Professional prerogative
  • In-patient
  • Individual profession
  • Traditional practice
  • Patient passivity

Edward O'Neil, Ph.D., M.P.A., Center for the
Health Professions, San Francisco, CA
35
Disease Management
  • A system of coordinated healthcare interventions
    and communications for populations with chronic
    medical conditions in which patient self-care
    efforts are significant to control symptoms
  • Disease Management Association of America

36
Goals of Disease Management
  • Reduce rate of disease progression
  • Eliminate/reduce risk factors
  • Control symptoms
  • Reduce recidivism
  • Facilitate activities of daily living
  • Enhance quality/duration of life
  • Provide a positive cost-benefit

37
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38
AARCs 2015 Beyond InitiativeWhat Does it
Mean?
  • Patrick J. Dunne, MEd, RRT, FAARC
  • HealthCare Productions, Inc.
  • Fullerton, CA 92838
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