FINAL OUTCOMES REPORT

Transcription

1 OVERVIEW FINAL OUTCOMES REPORT The annual Endovascular Advances: A Hands On Preceptorship Program is a continuing medical education series designed to provide physicians with hands on training in all aspects of managing peripheral, arterial, and venous disease, including diagnosis and treatment. Approved attendees were trained during 1 of 16 two day programs under the direct supervision of faculty at each participating program site. Attendees gained exposure to procedures for atherectomy, AV access, crossing strategies, CTO, and stent placement. This report encompasses outcomes for the year 2016, continuing into the first quarter of Total Activities: 16 Certified by the Academy for Continued Healthcare Learning (ACHL) for up to 16.5 AMA PRA Category 1 Credits (amount of credit varied by site) Supported by an educational grant from Boston Scientific Corporation (Grant ID: CV_20677_0908) Total Participants: 36 / CME/CE Certificates Generated: 27 ACTIVITIES Date Faculty Hospital Location # of Credits April 13 14, 2016 John Ross, MD, PA Regional Medical Center Orangeburg, SC 16 Heart Hospital of New Mexico at April 28 29, 2016 Steve Henao, MD Lovelace Medical Center Albuquerque, NM 16.5 May 23 24, 2016 Jim Joye, MD Silicon Valley Interventional Center Mountain View, CA 15.5 June 27 28, 2016 John Ross, MD, PA Regional Medical Center Orangeburg, SC 16 August 8 9, 2016 John Ross, MD, PA Regional Medical Center Orangeburg, SC 16 April 21 22, 2016 Michael Silva Jr., MD University of Texas Medical Branch Galveston, TX 15 September 8 9, 2016 Steve Henao, MD Heart Hospital of New Mexico at Lovelace Medical Center Albuquerque, NM 16.5 September 11 12, 2016 Rajesh Dave, MD Holy Spirit Hospital Camp Hill, PA 12 September 15 16, 2016 Michael Silva Jr., MD University of Texas Medical Branch Galveston, TX 15 September 12 13, 2016 Jim Joye, MD Silicon Valley Interventional Center Mountain View, CA 15.5 October 3 4, 2016 John Ross, MD, PA Regional Medical Center Orangeburg, SC 16 November 2 3, 2016 John Ross, MD, PA Regional Medical Center Orangeburg, SC 16 Heart Hospital of New Mexico at November 3 4, 2016 Steve Henao, MD Lovelace Medical Center Albuquerque, NM 16.5 January 26 27, 2017 Michael Silva Jr., MD University of Texas Medical Branch Galveston, TX 15 March 22 23, 2017 Jim Joye, MD Silicon Valley Interventional Center Mountain View, CA 15.5 March 30 31, 2017 Michael Silva Jr., MD University of Texas Medical Branch Galveston, TX 15 1

2 LEARNING OBJECTIVES Peripheral Arterial Disease Analyze risk assessment and diagnostic methods in peripheral arterial disease Compare and contrast medical, surgical, and endovascular treatment options for peripheral arterial disease Formulate strategies to manage potential complications AV Access Evaluate devices for maintaining access in patients with renal disease Perform arteriovenous fistula and graft surgeries and ensure maintenance Demonstrate endovascular thrombectomy techniques Evaluate and create proper dialysis access and patient management Carotid Analyze risk assessment and diagnostic methods in carotid artery disease Compare and contrast medical, surgical, and endovascular treatment options for carotid artery disease Formulate strategies to manage potential complications EXECUTIVE SUMMARY Level 1 & 2: Faculty were highly rated, with an overall average rating of 4.57 (out of 5.00) Quality of educational content was highly rated as well (4.70 out of 5.0) Learners strongly felt they were able to achieve the learning objectives of the course (average rating of 4.75 out of 5.0) 100% of learners would recommend this activity to a colleague 100% of learners felt the activity was fair and balanced, and did not perceive any bias or commercialism towards any product or drug in this activity Level 3 & 4: 100% of learners felt this activity improved their knowledge, while 96% felt it improved (or would improve) their competence 96% of participants anticipate this activity will improve their performance, noting greater confidence in performing procedures as a result of this experience. 81% of participants anticipate this activity will improve their patient outcomes, based on increased knowledge, experience, and the array of treatment options to choose from. 100% of learners plan to change their practice after participating in the activity o 59% plan to update management approaches for complications o 48% plan to secure new equipment and/or devices for their facilities o 37% indicated they would utilize a different imaging technique Up to 342 patients will be impacted monthly by these changes. Considerations for Future Education: Cases in other areas such as subclavian, mesenteric, aortic, and carotid stenting Advances in PAD 2

3 Hands on training with EVAR and TAVR Educational Impact: Participants are better able to perform dialysis access procedures and endovascular interventions, particularly carotid artery stenting. Participants report that they plan to update their current management approaches to complications, acquire new equipment/technology, and increase performance of procedures based on their improved confidence and experience in this course. Pre/Post Comparison/Intent to Change 1 5 Point Scale: 5=Excellent; 3=Fair; 1=Poor Peripheral Artery Disease and/or Carotid Artery Disease: How would you rate your ability to perform the following? Utilization of risk assessment tools (CVD Risk calculator, ABI, or other) Selection of appropriate diagnostic methods and treatment options Technical execution of endovascular procedures Development of management strategies for complications with endovascular revascularization Pre Post N=21 pre/18 post 3

4 1 5 Point Scale: 5=Always; 3=Sometimes; 1=Never 5 4 Renal Disease: I CURRENTLY/NOW PLAN TO perform the following for patients with renal disease who require dialysis access: Catheter placement Arteriovenous fistula surgery Arteriovenous graft surgery Pre Post N=9 pre/8 post 1 5 Point Scale: 5=Excellent; 3=Fair; 1=Poor 5 Dialysis Access: How would you rate your ability to perform the following? Selection of appropriate access types and locations Technical execution of catheter placement Arteriovenous fistula and graft surgeries Pre Post N=9 pre/8 post 4

5 1 5 Point Scale: 5=Always; 3=Sometimes; 1=Never 5 Selection of Therapy: I now plan to use endovascular therapies as first line treatment in patients with the following conditions: Peripheral artery disease Carotid artery disease Post N=18 post 1 5 Point Scale: 5=Always; 3=Sometimes; 1=Never 5 Guidance on Diagnostic and Treatment Options: I now plan to apply the following information in my selection of diagnostic and treatment options for patients with peripheral artery disease or carotid artery disease: Evidence based clinical guidelines Recent clinical trial findings Case studies Post N=18 post 5

6 Faculty Evaluation Scale: 5= Excellent; 4=Good; 3=Satisfactory; 2=Fair; 1=Poor Faculty Name Ability to effectively convey the subject matter Ability to deliver an objective and balanced presentation Ability to present scientifically rigorous information Ability to adjust to the knowledge and experience level of the audience Expertise on the subject matter James Joye, DO, FACC John Ross, MD, FACS Michael B. Silva, Jr., MD, FACS Rajesh Dave, MD Steve Henao, MD, FACC No. of Respondents 26 Activity Evaluation 1. Learning Objectives Scale: 5=Excellent; 4=Good; 3=Satisfactory; 2=Fair; 1=Poor Rating Peripheral Arterial Disease A. Analyze risk assessment and diagnostic methods in peripheral arterial disease B. Compare and contrast medical, surgical, and endovascular treatment options for peripheral arterial disease C. Formulate strategies to manage potential complications

7 AV Access D. Evaluate devices for maintaining access in patients with renal disease E. Perform arteriovenous fistula and graft surgeries and ensure maintenance F. Demonstrate endovascular thrombectomy techniques 5.00 Carotid A. Analyze risk assessment and diagnostic methods in carotid artery disease B. Compare and contrast medical, surgical, and endovascular treatment options for carotid artery disease I. Formulate strategies to manage potential complications Objectivity and balance A. Excellent 81% B. Good 15% C. Satisfactory 4% D. Fair 0% E. Poor 0% 3. Did you perceive any bias or commercialism towards any product or drug in this activity? A. No 100% B. Yes. If yes, please explain 0% 7

8 4. Please evaluate by marking the Appropriate Response Scale: 5=Excellent; 4=Good; 3=Satisfactory; 2=Fair; 1=Poor Rating A. Quality of educational content 4.77 B. Scientific rigor 4.62 C. Level of instruction 4.69 D. Effectiveness of teaching method used 4.77 E. Appropriateness of active learning strategies (questions, cases, discussion, etc) 4.77 F. Time allotted for presentation of information 4.69 G. Time allotted for question and answer session(s) 4.73 H. Facilities, technical arrangements, efficiently supported this activity 4.88 No. of Respondents Please rate the importance of your reasons for attending this educational activity Rating A. Topics 4.73 B. Faculty reputations 4.74 C. Interaction with colleagues 4.27 D. CME/CE credit Please rate the projected impact of this activity on your knowledge, competence, performance and patients outcomes: This activity increased my knowledge. A. Yes. If yes, please describe: 100% Comments: 8

9 I hope to eventually be the second person in our community to offer and perform carotid stenting Below the knee interventional approaches I have a better understanding of risks and benefits of endovascular repair More interventional options to treat PVD Help in treatment of patients Increased my comfort level to perform these procedures Use of atherectomy Potential complications Observation of new technology Treatments and available option Performing carotid stenting (2) Learned much about carotid stenting Latest concepts PAD. Latest technology for intervention. Current understanding of PAD and Rx B. No 0% C. No Change 0% 7. This activity increased my competence. A. Yes. If yes, please describe: 96% Comments: I have deployed many stents throughout many different vascular beds, but never before in the carotid system The skills and exercises greatly raised my abilities More skills for peripheral access 9

10 Evaluate and treat peripheral vascular disease More aware of possible complications Indications for atherectomy and cryoplasty for INS More experience with filter Technical Skill set Perform carotid stent Technical competence increased B. No 0% C. No Change 4% 8. This activity will improve my performance. A. Yes. If yes, please describe: 96% Comments: I hope to start with diagnostic carotid studies and then build up to stenting It made me feel much stronger and more capable Newer techniques (2) Increase experience with multiple treatment modalities By changing my strategy Managing restenosis More experience Efficiency Perform carotid stent Increases performance in carotid stent procedures 10

11 Planning on O/P based PAD lab B. No 0% C. No Change 4% 9. This activity will improve my patient outcomes. A. Yes. If yes, please describe: 81% Comments: I will employ alternative treatments to surgery By applying new knowledge, techniques By knowing complications and procedural techniques and equipment More experience Treatment options Satisfaction Increase patient care with regards to carotid disease B. No 0% C. No Change 19% 10. Please identify how you will change your practice as a result of attending this activity (select all that apply) A. Utilize a different imaging technique 37% B. Secure new equipment or devices for my facility 48% C. Update management approaches for complications 59% D. This activity validated my current practice; no changes will be made 22% 11

12 E. Other. Please specify: 4% Comments: Increase experience in different treatment modalities 11. Number of patients affected by these changes each month A. 0 8% B % C % D % E. > 50 8% No. of Respondents Effect of changes on patient care A. Significant effect 46% B. Some effect 46% C. Minimal effect 4% D. No effect 4% No. of Respondents Please indicate any barriers you perceive in implementing these changes. (select all that apply) A. Lack of experience 27% B. Lack of opportunity (patients) 27% C. Lack of resources (equipment) 12% 12

13 D. Lack of administrative support 23% E. Lack of time to assess/counsel patients 4% F. Reimbursement/insurance issues 23% G. Patient compliance issues 0% H. Lack of consensus or professional guidelines 8% I. Cost 15% J. No barriers 23% K. Other, please specify: 8% Comments: Peer barriers No. of Respondents Will you attempt to address these barriers in order to implement changes in your competence, performance, and/or patients outcomes? A. Yes? How? 60% Comments: I will try to arrange for equipment purchases with my hospital Committee Meetings Further training ACC policy Will search for cases Management Continue online education Appropriate patient selection B. No? Why Not? 0% C. N/A 40% 13

14 No. of Respondents How many years have you been in practice? A % B % C % D. >16 37% 16. Would you recommend this activity to a colleague? A. Yes 100% B. No 0% 17. How did you first hear about this activity? (Choose only 1) A. Institution Calendar 4% B. Flyer 4% C. Colleague 56% D. E mail 18% E. Other: 18% Comments: Boston Scientific rep (2) Scientific meeting 14

15 18. EDUCATIONAL NEEDS What topic areas would you like to see in future activities? More on the diagnostic imaging issues of cerebrovascular disease, specifically carotid diagnostic angios... and complications and their management More of the same TAVR More cases, involving other areas such as subclavian, mesenteric, aortic and carotid stenting Brief discussion of anatomy/veins Leg procedures Pedal access CLI Which devices to use and why Pain management, US guided MSK interventions, EVAR Abdominal aorta stents Central line placement Techniques for opening chronic total occlusions EVAR Advances in PAD General comments: This was a truly unique course in its design with the allowance of only two participants and the hands on very closely monitored style of the course... this makes the course the best possible learning tool conceivable. Excellent course I had a great experience those 2 days! Really good cases and Dr. Ross is amazing. Thank you for arranging this and looking forward to more To gather suitable clinical cases and to run the sessions in a very timely fashion Outstanding educational opportunity Excellent program 15

16 Excellent experience Would like specific technical instruction on opening chronic total occlusions Excellent course. Cases chosen were varying levels of complexity: Simple to Complex. Teaching was high intensity. Special emphasis on treating complications. No. of Respondents 15 16