Transcript Aerosol Therapy Update: New Devices, Agents and Applications

AARC’s 2015 & Beyond Initiative:
What Does it Mean?
Patrick J. Dunne, MEd, RRT, FAARC
HealthCare Productions, Inc.
Fullerton, CA 92838
Disclosure
This presentation is sponsored by
Monaghan Medical.
Beleaguered US Healthcare System
Cost Drivers

Aging population

Smoking, obesity

Uncoordinated care

Prevalence of chronic disease

Non-participating patients/caregivers

Archaic financial foundation

Workforce fatigue, apathy
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
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)
Cost Drivers
• Uncoordinated care
– Duplicative
– Delayed
• Sicker, less stable
– Fragmented
• Medical errors, misadventures
– Lack of continuity
• Not a seamless transition
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
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
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
2015 & Beyond
Time 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
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.
2015 Initiative Questions
March 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?
2015 Initiative Questions
 What additional responsibilities can RTs
assume to improve heath care outcomes
for patients with chronic respiratory
diseases?
2nd Conference
Spring 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
3rd Conference
Fall 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
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.
Post- Acute Conditions

COPD

Asthma

Obstructive sleep apnea

Lung cancer

Cystic fibrosis

IPF
COPD

Prevalent yet treatable disease


4th leading cause of death


The 3rd by 2020 (if not sooner!)
More women than men


Affects 12-24 million
64,000 v/s 59,000 deaths in 2003
Huge economic impact

$37 billion in 2004; $21 billion for hospital care
COPD
1993
Hospitalizations
Length of stay
Cost per stay
2002
461,000 619,000
 34%
7.2 days 5.1 days
 30%
$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
Mortality After Hospitalization for COPD
Kaplan-Meier survival curves in 135
patients hospitalized for acute
exacerbation of COPD (DRG 088)
Percentage Surviving
1.0
114(84%)
0.8
105(78%)
94(70%)
86(64%)
0.6
75(56%)
0.4
0
180
360
540
Survival Days
P Almagro et al, Chest 2002; 121:1441-1448.
720
900
Asthma

22 million affected
>

6 million children
497,000 admissions
 Failure

Since 1998, deaths are down
<

to control symptoms
4,000/yr
$19 billion annual expenditures
>
75% for direct medical costs
 12
mm lost school days; 14 mm lost work days
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
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
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
Crossing the Quality Chasm
A New Health System for the 21st Century
 Chronic conditions
 Illness lasting > 3 months but not self-limiting
 Leading cause of illness, disability and death
 100 million Americans, two-thirds under age 65
 > 60% of annual expenditures
 Care differs from acute (episodic)
 15 “top priority” conditions
 Emphysema/COPD
 Asthma
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)
Concurrent Therapy
Protocol Care
How Widespread is Protocol Care?
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.
Health Promotion & Disease Prevention

AARC Position Statement (2005)


RT as a health educator; a collaborator
To instill the ability to improve a patient’s 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
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
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!
The Health Care Environment
Tomorrow
• Acute treatment
• Chronic disease
prevention and
management
• Cost unaware
• Price competitive
• Professional prerogative
• Consumer responsive
• In-patient
• Ambulatory – Home
and Community
Today
• Individual profession
• Traditional practice
• Patient passivity
• Team
• Evidence based
practice
• Consumer engagement
Edward O'Neil, Ph.D., M.P.A., Center
for the Health Professions, San
Francisco, CA
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
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
AARC’s 2015 & Beyond Initiative:
What Does it Mean?
Patrick J. Dunne, MEd, RRT, FAARC
HealthCare Productions, Inc.
Fullerton, CA 92838