Data Management of the Sleep Disordered Breathing Patient

Transcription

1 Data Management of the Sleep Disordered Breathing Patient 1 AARC or AAST CEU credit As Allies in Better Sleep and Breathing, we make it our #1 priority to work in harmony with caregivers and patients to establish: healthier patients by accelerating adoption, maximizing therapy effectiveness and promoting long-term compliance healthier practices by enabling care team collaboration and creating easy access to critical information healthier businesses by streamlining patient management and increasing efficiency 2 Objectives Provide overview of PAP compliance Understand that compliance leads to positive health outcomes Provide an overview of compliance technologies in healthcare Explore tools and technologies to facilitate PAP compliance 3 1

2 Medical definition of compliance Compliance Degree to which a patient follows medical advice Usually refers to medication compliance Can also refer to the use of: Medical appliances Advice on lifestyle management Attending counseling Medicare compliance physician follow-up Continued coverage of a PAP device (CPAP or BiPAP) beyond the first three months of therapy requires that, no sooner than the 31st day but no later than the 91st day after initiating therapy, the treating physician must conduct a clinical re-evaluation and document that the beneficiary is benefiting from PAP therapy. Documentation of clinical benefit is demonstrated by: 1. Face-to-face clinical re-evaluation by the treating physician with documentation that symptoms of obstructive sleep apnea are improved; and, * Reference LCD 2. for Objective Positive Airway Pressure evidence (PAP) Devices of adherence for the Treatment of to Obstructive use of Sleep the Apnea PAP (L11528) device, 5 reviewed by the treating physician.* CPAP therapy adherence Compliance Meter How is OSA treatment adherence defined? > 4 hours of use, >70% of time (Kribbs 1 ) Studies show patient adherence to therapy is not ideal but similar to maintenance medications 2 Kribbs found that 54% could be inconsistent users 1 1 Kribbs, et al., Objective Measurement of Patterns of Nasal CPAP Use by Patients with OSA. American Review of Respiratory Disease 1997:147 No. 4 2 Weaver, et al., Night-to-Night Variability in CPAP Use Over the First Three Months of Treatment. Sleep 1993:20(4):

3 Consequences of non-adherence to CPAP therapy for the OSA patient Aggravates: High blood pressure Heart disease Blood sugar problems Significantly increases risk of stroke Stroke Diabetes OSA HTN Cardiovascular Disease Atrial Fibrillation Hui et al, Prevalence of Sleep Disordered Breathing and Continuous Positive airway Pressure Compliance, Chest, Sept CPAP non-adherence Hindrance to CPAP compliance Poor patient education Poor understanding of the disease management process Supportive interventions enhance the use of CPAP therapy by 0.59 hours/night 1 1. Donepudi et al., Touch Point Care and Advanced Monitoring Technologies Improves Compliance Rate of CPAP Usage, Abstract 1300, APSS Non-adherence to long-term therapies Noncompliance compromises treatment outcomes 1 Decreases quality of life Increases financial burden on society. Patient non-adherence studies 90% do not follow physician s orders % with chronic illness do not take prescribed medications 70 80% will comply to lifestyle change 3 1. FirstWord Intelligence Report, Digital Technologies to Boost Patient Compliance, September Moriskey, Donald E. Adherence or Compliance Behavior, enotes.com 3. Jin et al, Factors Affecting Therapeutic Compliance: A Review from the Patient s Perspective, Therapeutic Clinical Risk Management, February

4 Sleep Therapy Compliance Engaging the clinician and the patient with new technologies and motivation Show of hands How did you get here? 4

5 Could you imagine? Changes in CPAP What does this all mean? That over the past 30 some years the Sleep industry has changed with great new inventions and technology to help patients become compliant both short term and long term 5

6 Technology of Today Just like things have changed in our everyday lives we need to make changes to the way we treat patients and how we can help patients become compliant to PAP therapy Data Management with Encore 1. Select date range for report 2. Select report type desired 3. Create report 18 6

7 Encore report structure: summary report CPAP Auto CPAP Encore report structure: full report Demographics Hours of Use Pressure Trend Patterns of Use (One or more pages) Long-Term Trends Full report structure Daily Details (at least 7 sessions) Summary of All Data 7

8 Waveform report icon 22 Flow waveform report 1 hour per page up to 8 hours of sleep session Fixed CPAP reports:patient demographics Dates for Reports Humidifier setting C-Flex setting Mode Usage Pattern Pressure 8

9 Dates for reports Details Report Remstar Auto DS550 Device time Therapy time Black bars indicate device on breathing not detected Gaps indicate device was turned off Time spent in device on breathing not detected is difference in times 26 Long Term Trend Avg % of night in Periodic Breathing Avg Central Apnea Index Avg Obstructive Apnea Index Avg Hypopnea Index Avg RERA Index Avg Flow Limitation Index Avg Snore Index Avg % night in large leak Avg time in Large Leak 9

10 What is a large mask leak? Large Leak Levels > 2 times the average mask exhalation port leak Considered to be in Large leak if threshold exceeded for greater than 1.5 minutes. A light green hash mark on Mask Leak graph indicates a large leak has occurred Summary of compliance Cumulative Usage Total Patient Compliance 90% Pressure Advanced event detection Identification of complicated and changing conditions that may indicate alternative therapy No Algorithm Response (CA) Clear Airway Apnea (OA) Obstructed Airway Apnea Periodic Breathing RERA Hypopnea Flow Limitation Vibratory Snore Mask Fit Indicator 10

11 Auto CPAP reports: patient demographics Dates for Reports Humidifier setting A-Flex setting Mode Usage Pattern Max pressure setting 90% pressure- Min. pressure setting Daily details Max pressure setting 90% Pressure Average Pressure Pressure Profile Min. pressure setting % Periodic Breathing Event Flags: Central apnea Obstructed Hypopnea Flow limitation Snore RERA AHI Daily details Normal Mask Fit Blower on but no breathing detected Large Leak Detected Total leak profile in LPM Time in large leak % time in large leak Ave Leak in night Minutes at Pressure 90% Pressure 11

12 What is 90% Pressure? The pressure the unit operated at or below for 90% of the time. Offered as a suggestion for traditional cpap therapy if desired. 34 AHI at specific pressures -Be sure to consider MaP -Position and sleep stage unknown 35 Summary of daily details Table contains indexes for all pressure settings and flags the 90% pressure for titration Cumulative graph which can be used to evaluate pressure requirements for titration 12

13 Advanced event detection Identification of complicated and changing conditions that may indicate alternative therapy Periodic Breathing such as Cheyne-Stokes Respiration Flow Waxing and waning breathing pattern repeating itself between 30 and 100 sec The nadir is characterized by at least a 40% reduction in airflow from baseline The pattern must be present for several minutes Encore reports: Waveforms CSR 38 Encore reports: Waveforms CA detection 39 13

14 AutoSV Advanced: Encore Reports Daily Use Compliance Check Avg. Pressure Support Avg. EPAP Trended AHI Encore Reports: Long Term Trends Assess PS Range Sleep Events Leak: Nightly variability Data Management with SleepMapper 14

15 The digital age has changed the way we live, communicate and conduct business 70% of Americans play online computer or video games 33% of Americans use social media and online sites to research health issues 40% of physicians believe that mobile health technologies 88% of physicians support patients monitoring their own health at home 74% of physicians already own a tablet or Smartphone 1,2 1. FirstWord Intelligence Report, Digital Technologies to Boost Patient Compliance, September Dolan, Brian, Survey:45 percent of doctors have ipads, Mobihealthnews.com, April 2012 Patient involvement Physicians effectively communicate with patients through mobile technology Reminding patients to go for tests Reminding patients of appointments Collection/transmission of data from home care clinician 1 via tablet Via Smartphone 1. FirstWord Intelligence Report, Digital Technologies to Boost Patient Compliance, September 2010 Patient involvement Internet-based social networks 36% value other consumer s knowledge prior to making healthcare decisions Social networks can: Enable communication and collaborations Maintain the flow of information in the healthcare space Increase compliance to therapies Environment to offer support and encouragement 1. FirstWord Intelligence Report, Digital Technologies to Boost Patient Compliance, September

16 Mobile applications for compliance Power of the mobile application in healthcare Not only reminder tools Increase communication Increase education Centered around disease management Medication tracking Drug recalls Healthcare costs Record management 1. Donepudi et al., Touch Point Care and Advanced Monitoring Technologies Improves Compliance Rate of CPAP Usage, Abstract 1300, APSS Compliance and technology Compliance rate study Touch point care and advanced monitoring technologies 626 patients using Medicare compliance criteria 88.5% compliance rate Conclusion Engaging patients in their own disease management process and utilizing the newest technologies to monitor therapy greatly improves CPAP adherence 1. Donepudi et al., Touch Point Care and Advanced Monitoring Technologies Improves Compliance Rate of CPAP Usage, Abstract 1300, APSS SleepMapper self-management system SleepMapper s value Reinforces PAP usage with immediate feedback Develops PAP usage goals Answers questions/troubleshooting Coaches for therapy guidance Motivates enhancement therapy Offers positive reinforcement Supports community Offers reminders 16

17 Feedback AHI Leak Therapy Hours Goal Aided Adherence Compete against their best Set goals Share achievements 17

18 Goal Aided Adherence Education OSA Equipment Mask and Device Troubleshooting Mask and Device Motivational Enhancement Therapy Motivational Enhancement Therapy (MET) is a counseling approach that helps individuals resolve their ambivalence about engaging in treatment. This approach aims to evoke rapid and internally motivated change, rather than guide the patient stepwise through the recovery process. Motivation Heart Risk Understanding an Apnea Event 18

19 Provider Access Name Logo Phone Number Address SleepMapper self-management system SleepMapper s value Reinforces PAP usage with immediate feedback Develops PAP usage goals Answers questions/troubleshooting Coaches for therapy guidance Motivates enhancement therapy Offers positive reinforcement Supports community Offers reminders 19

20 CEU certificate To obtain your CEU certificate log on to the Philips Respironics Partners in Training website at: Log in to the website Click on CEU Online Management System on the left side 20