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Are you Making A Difference? Prove It with ANDHII
Are You Making a Difference? Prove It with William Murphy, MS, RDN, LD Senior Manager, Outcomes Research ANDHII Project Leader 3/5/2016 Disclosure: Mr. Murphy is an employee of the Academy of Nutrition and Dietetics, an organization that may have a commercial interest in the ANDHII technology discussed in this presentation. 2 About Me • • • • Completed Dietetic Internship at Louis Stokes VA Hospital / Case Western Reserve University Certificate of Specialization in Data Science Former Spinal Cord Injury Unit RDN at Memphis VA Hospital Sr. Manager, Outcomes Research at the Academy of Nutrition and Dietetics for 3 years • • • • Conduct comparative effectiveness and outcomes research Develop health informatics software to facilitate outcomes management and research Provide scientific commentary to Academy legislative and public policy efforts Develop computerized simulation-based dietetics education content 3 Objectives After this presentation, learners will: 1. Name three reasons for collecting outcomes and quality data 2. Describe the methodology of comparative effectiveness research 3. Have experience collecting outcomes data using ANDHII 4 Reasons to track outcomes: Prove my worth 5 Patients need nutrition care My clients get better RDNs make a difference 6 https://youtu.be/6xMaR8au-YU 7 Patients need nutrition care My clients get better RDNs make a difference PROVE IT with ANDHII 8 Reasons to track outcomes: Prove my worth Advance the profession 9 Evidence Based Practice 1996 •EBP Defined •Medical Nutrition Therapy Across the Continuum of Care 2001 •MNT Evidencebased practice guidelines 2004 •Evidence Analysis Library The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients 10 Evidence Based Practice 1996 •EBP Defined •Medical Nutrition Therapy Across the Continuum of Care 2005 •Nutrition Care Process Model and Diagnostic Terminology 2001 •MNT Evidencebased practice guidelines 2007 •International Dietetics & nutrition Terminology Reference Manual 1st Edition 2004 •Evidence Analysis Library 2014 •eNCPT 11 12 Evidence Based Practice 1996 •EBP Defined •Medical Nutrition Therapy Across the Continuum of Care 2005 •Nutrition Care Process Model and Diagnostic Terminology 2001 •MNT Evidencebased practice guidelines 2007 •International Dietetics & nutrition Terminology Reference Manual 1st Edition 2004 •Evidence Analysis Library 2014 •eNCPT •Academy of Nutrition and Dietetics Health Informatics Infrastructure 13 The Evidence Based Practice Cycle Clinical and Translational Research Evidence Based Practice Guidelines Clinical Practice The Evidence Based Practice Cycle EAL Clinical and Translational Research Evidence Based Practice Guidelines Clinical Practice Assessment Outcomes Diagnosis Intervention Monitoring & Evaluation NCP EAL: Evidence Analysis Library, NCP: Nutrition Care Process, NCPT: Nutrition Care Process Terminology (formerly IDNT) ANDHII: Academy of Nutrition and Dietetics Health Informatics Infrastructure, DPBRN: Dietetics Practice Based Research Network 16 Class I recommendations: Addition of an aldosterone antagonist is reasonable in selected patients with moderately severe to severe symptoms of HF and reduced LVEF who can be carefully monitored for preserved renal function and normal potassium concentration... risk of death was reduced from 46% to 35% (30% relative risk reduction) over 2 years, with a 35% reduction in HF hospitalization and an improvement in functional class. 17 Class I recommendations: Addition of an aldosterone antagonist is reasonable in selected patients with moderately severe to severe symptoms of HF and reduced LVEF who can be carefully monitored for preserved renal function and normal potassium concentration... risk of death was reduced from 46% to 35% (30% relative risk reduction) over 2 years, with a 35% reduction in HF hospitalization and an improvement in functional class. 18 The Evidence Based Practice Cycle EAL Clinical and Translational Research Evidence Based Practice Guidelines Clinical Practice Assessment Outcomes Diagnosis Intervention Monitoring & Evaluation NCP EAL: Evidence Analysis Library, NCP: Nutrition Care Process, NCPT: Nutrition Care Process Terminology (formerly IDNT) ANDHII: Academy of Nutrition and Dietetics Health Informatics Infrastructure, DPBRN: Dietetics Practice Based Research Network 20 Comparative Effectiveness Research The generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition or to improve the delivery of care. The purpose of CER is to assist consumers, clinicians, purchasers, and policy makers to make informed decisions that will improve health care at both the individual and population levels. Institute of Medicine. Initial National Priorities for Comparative Effectiveness Research. 2009. National Academies Press 21 CER Toolbox Pragmatic Clinical Trial • Is an intervention effective in real-world practice? • Tests a specific intervention against control • Similar to a Randomized Controlled Trial with less strict control Surveillance Research • What is happening in real-world practice? • Discover which interventions are being used and how they compare 22 Pragmatic Trial v. RCT • • • • • • • Fewer eligibility restrictions Usual care control Less control over intervention implementation Variety of practitioner skill levels Realistic follow-up schedules Practical, patient-centered outcomes Expected noncompliance by both patient and practitioner Patsopoulos, N. A. (2011). A pragmatic view on pragmatic trials. Dialogues in clinical neuroscience, 13(2), 217. 23 CER Considerations • Noisy Data • Missing data • Variable follow up periods • Confounding factors • Clinical Equipoise • What control can be used when evaluating current practice guidelines? 24 CER Example Preventing Diabetes Guideline Usage and Impact on Care 1. Define what care based on the guideline should look like Thompson KL, Davidson P, Swan WI, Hand RK, Rising C, Dunn AV, Lewis N, Murphy WJ. Nutrition care process chains: the "missing link" between research and evidence-based practice. J Acad Nutr Diet. 2015 Sep;115(9):1491-8. 25 26 27 CER Example Preventing Diabetes Guideline Usage and Impact on Care 1. Define what care based on the guideline should look like 2. Assess current practices for similarity to guidelines and patient outcomes 28 Evaluating Care Adherence to Evidence-Based Nutrition Practice Guideline for the Prevention of Diabetes Unpublished Research Data Redacted 29 CER Example Preventing Diabetes Guideline Usage and Impact on Care 1. Define what care based on the guideline should look like 2. Assess current practices for similarity to guidelines and patient outcomes 3. Provide training on new guidelines 4. Assess practice and patient outcomes after training 30 Malnutrition Validation Malnutrition Clinical Characteristics Morbidity & Mortality Inadequate Energy Intake Physical function Weight Loss Fat Loss Malnutrition Quality of Life Muscle Loss Readmissions & Length of Stay Fluid Accumulation Healthcare Costs Diminished Grip Strength 31 Malnutrition Validation Unpublished Research Data Redacted 32 The Evidence Based Practice Cycle EAL Clinical and Translational Research Evidence Based Practice Guidelines Clinical Practice Assessment Outcomes Research NCPT Diagnosis Intervention Monitoring & Evaluation ANDHII/DPBRN Positions and Public Policy NCP EAL: Evidence Analysis Library, NCP: Nutrition Care Process, NCPT: Nutrition Care Process Terminology (formerly IDNT) ANDHII: Academy of Nutrition and Dietetics Health Informatics Infrastructure, DPBRN: Dietetics Practice Based Research Network 34 Reasons to track outcomes: Prove my worth Advance the profession Get paid 35 Quality and Value Outpatient • Physician Quality Reporting System (PQRS) • 2015 Participation: Avoid 2017 payment adjustment penalty Inpatient • Hospital ValueBased Purchasing (VBP) • 2015 Participation: Incentive Payments 36 Quality and Value Outpatient • Physician Quality Reporting System (PQRS) • 2015 Participation: Avoid 2017 payment adjustment penalty PQRS Requirements • Medicare Practitioner • Registered Dietitian • Paid under Medicare Physician Fee Schedule (PFS) • Bill by National Provider Identifier (NPI) 37 PQRS Participation 38 PQRS Participation 39 PQRS Participation 40 PQRS Participation 41 Reasons to track outcomes: Prove my worth Advance the profession Get paid How to track outcomes? ANDHII 42 http://www.andhii.org/info 43 ANDHII Use 44 Popular Assessments 45 Popular Diagnoses 46 Popular Interventions 47 Case Study 48 49 50 51 52 53 Thank you and Questions Feel free to contact me: [email protected] [email protected] 54 ANDHII’s impact on Time Unpublished Research Data Redacted 55 Time vs. Benefit Perceptions Unpublished Research Data Redacted 56
