Healthcare in Transition: An Opportunity for Sleep Technologists

Transcription

1 Healthcare in Transition: An Opportunity for Sleep Technologists Robyn Woidtke MSN,RN,RPSGT,CCP,CSE Director, Education Florida International Sleep School Principal, CPAPCoach.com

2 Objectives At the completion of this session the attendee will Explain the proposed role of the CSE Describe core competencies of the CSE Formulate and propose a role within their organization 2

3 Opportunity Quality Satisfaction Models ACO Chronic Care Medical Home 3

4 What is a clinical Sleep Educator? Background Role originated from the ACCP Sleep Apnea Aftercare Consensus Conference, 2006; First Sleep Apnea Educator conference held in 2009 Possible Definition of the role Creates a individualized needs assessments Uses established principles of adult teaching and learning to create and optimize treatment Employs concepts of health behavioral change models to enhance individualized patient instruction Provides sleep and sleep disorder specific information to aid the patient in successful self management; considers co-morbidity in all patient interactions Works collaboratively with other HCP to address barriers and strive for successful outcomes 4

5 Scope of Practice A clinical sleep educator does NOT diagnose, treat, or provide any such services prohibited by law or scope of practice Scope of practice is dependent on licensure and other regulatory oversight Licensure and regulations vary by state and profession Work collaboratively with a sleep team 5 Courtesy, C.Altman, President, BRPT

6 Evidence Based Care 6

7 2006 AASM Practice Parameters Recommendations for OSA Patients CPAP usage should be objectively monitored to help assure utilization (standard) Close follow-up for PAP usage and problems in patients with OSA by appropriately trained health care providers is indicated to establish effective utilization patterns and remediate problems, if needed. This is especially important during the first few weeks (standard) The addition of a systematic educational program is indicated to improve PAP utilization (standard) After initial CPAP setup, long-term follow-up for CPAP treated patients with OSA by appropriately trained health care providers is indicated yearly and as needed to troubleshoot PAP mask, machine or usage problems (option) Kushida C et al Sleep 2006;

8 Adult OSA Task Force: AASM Patient education should optimally be delivered as part of a multidisciplinary chronic disease management team including the sleep physician, the referring provider, and allied health care providers 8

9 So, where does this role fit and why is it needed? At minimum, there are 13 different health care specialties and subspecialties that are involved in diagnosis and treatment anesthesiology, cardiology, dentistry, endocrinology, immunology, neurology, nursing, nutrition, otolaryngology, pediatrics, psychiatry, psychology, and pulmonology IOM,

10 So, where does this role fit and why is it needed? There are numerous reasons for a paradigm shift to chronic disease management. Proper treatment for most sleep disorders as for other chronic diseases such as congestive heart failure, diabetes, asthma, and depression requires a period of time for fine-tuning, extended follow-up, and lifestyle changes. Sleep disorders cannot be adequately treated in a single visit IOM Report on Sleep and Sleep Deprivation

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12 So, where does this role fit and why is it needed? Sleep disorders are chronic conditions necessitating complex treatments. They are frequently co-morbid with other sleep disorders and other conditions, which, by themselves, are complex to treat. Despite the importance of early recognition and treatment, the primary focus of most existing sleep centers is on diagnosis, rather than on comprehensive care of sleep loss and sleep disorders as chronic conditions 12 IOM Report on Sleep and Sleep Deprivation 2006

13 Silo 13

14 Creation of a role: Look to other specialties 14

15 Are there benefits to providing patient education/support? Healthy People 2010 objective regarding diabetes education 60 percent of persons with diabetes should receive formal diabetes education Data shows that diabetes education saves money and decreases healthcare utilization Robbins et al. found that hospitalization rates for patients who had no educational visits during follow-up was 38.1 per person per 100 years; the hospitalization rate was 34 percent lower (25.0 per person per 100 years) for patients who had at least one educational visit 15

16 The role of the Diabetic Educator Facilitate behavior change by counseling patients and families on how to adopt informed lifestyle decisions and incorporate healthier choices into their self-management. Diabetes educators focus on seven key behaviors that promote successful self-management. Called the AADE7 Self-Care Behaviors, they are: Healthy eating, being active, monitoring, taking medication, problem solving, healthy coping and reducing risks. 16

17 Provide self-management training/education, and Diabetes Self-Management Support (DSMS) and other interventions to prevent the development of diabetes. An important part of sustaining outcomes (or continual improvement) is to ensure that ongoing support and reinforcement is provided (by a variety of different professionals and non-professionals including diabetes educators). Are the key to coordination of the interdisciplinary diabetes team and development of the plan of care for the individual patient. 17

18 Domains 18

19 Diabetic Educator Certification Objectives of the certification program are to provide a mechanism to demonstrate professional accomplishment and growth Provide formal recognition of specialty practice and knowledge at a mastery level Provide validation of demonstrated dedication to diabetes education to consumers and employers Promote continuing commitment to best practices, current standards and knowledge 19

20 Diabetic Educator Practice Requirements (Certification) A minimum of two years (to the day) of professional practice experience in diabetes selfmanagement training AND A minimum of 1,000 hours of diabetes selfmanagement training experience AND Current employment in a defined role as a diabetes educator a minimum of four hours per week, or its equivalent, at the time of application. 20

21 Asthma Educators certification ELIGIBILITY REQUIREMENTS Individuals may be admitted to the examination based on either of the two following qualifications: 1. The following U.S. * currently licensed or credentialed health care professionals may be admitted to the examination: Physicians (MD, DO) Physician Assistants (PA-C) Nurses (RN, LPN, NP) Respiratory Therapists (RRT, CRT) Pulmonary Function Technologists (CPFT, RPFT ) Pharmacists (RPh) Social Workers (CS W) Health Educators (CHES ) Physical Therapist (PT) Occupational Therapist (OT ) 2.Individuals providing direct patient asthma education, counseling or coordinating services with a minimum of 1000 hours experience in these activities 21

22 Opening the door to a new specialty 22

23 The Time Is Right Focus on the value of sleep and healthy life Chronic nature of OSA and sleep disorders Decreasing physician reimbursement Move toward OCST diagnosis and management Outcomes-based medicine CHF, asthma, diabetes education-improved outcomes, quality of life, and reduced costs Interdisciplinary coordination and care 23 Courtesy, C.Altman, President, BRPT

24 CSE Certificate Program BRPT CSE programs May & Sept 2012, May & Sept 2013 Currently around 1000 individuals with CSE certificate, Sept 2013 group not in totals yet--in process Interest is high and climbing Identity and authentication to something new DIFFERENT from RPSGT Current limitations Certificate is NOT a credential Focus on OSA One day is not enough No minimum education requirement 24 Courtesy, C.Altman, President, BRPT

25 Developing a CSE Credential New credential from BRPT Community driven Job Task Analysis early June 2013 Expert Panel Meeting July 2013 Examination blueprint Board approval in August 2013 Press release mid September 2013 New exam delivery Spring/Summer 2014 For experienced health care worker 25 Courtesy, C.Altman, President, BRPT

26 Description of a CSE Healthcare worker Deep understanding of sleep disorders, treatments, and the importance of good sleep Review and analyze test results, treatments, and compliance data Use a variety of communication and teaching techniques to optimize patient education, self-management, and community interactions Consider co-morbidity issues in all interactions Work collaboratively with other healthcare providers 26 Courtesy, C.Altman, President, BRPT

27 CSE Fund of Knowledge Sleep physiology Respiratory/cardiac/neurophysiology Sleep disorders and diagnostic criteria Sleep related comorbidities Intervention/treatment/therapy modalities Clinical guidelines Adherence/compliance techniques Testing options 27 Courtesy, C.Altman, President, BRPT

28 CSE Fund of Knowledge Sleep and related test results Human growth and development Cultural competency Behavioral health models Health literacy Written care plans Learning theories Outcomes data and measures 28 Courtesy, C.Altman, President, BRPT

29 CSE Fund of Knowledge Verbal and written communication skills Medical terminology Patient assessment techniques Chart review and documentation Medications and over-the-counter products Patient confidentiality and ethics Emergency procedures and safety Basic knowledge of computers Math skills/calculations Courtesy, C.Altman, President, BRPT 29

30 CSE Exam Blueprint Developed by a job analysis of individuals currently working as CSE s JTA represents current role of CSE, not individual or future expectations Blueprint is based on JTA results Sleep Over the Lifespan 20% Clinical Evaluation and Management 40% Patient/Family Communication and Education 30% Program Maintenance and Administration 10% 30 Courtesy, C.Altman, President, BRPT

31 Domain 1: Sleep Over the Lifespan Describe normal sleep architecture, quantity, quality Identify factors contributing to variations in normal sleep Identify and recognize pathophysiology, epidemiology, and clinical presentation of abnormal sleep 31 Courtesy, C.Altman, President, BRPT

32 Domain 2: Clinical Evaluation/Management Correlate and document sleep and medical history Identify comorbid conditions and impact on patient Assess and explain evaluation and management tools Evaluate treatment and therapy 32 Courtesy, C.Altman, President, BRPT

33 Domain 3: Patient and Family Communication and Education Provide education to patient and family Understand and explain the importance of sleep hygiene Encourage and promote patient selfassessment and self-management 33 Courtesy, C.Altman, President, BRPT

34 Domain 4: Program Maintenance and Administration Develop multidisciplinary programs Manage performance improvement and quality Promote sleep disorders as a public health issue 34 Courtesy, C.Altman, President, BRPT

35 Current/Future Training CSE Role Current/Future Education

36 Things to Consider in practice Age Co-Morbidity Sleep Disorder Family Support Health Literacy 36

37 Needs Assessment What do you need to know to provide appropriate education, self-care information and follow-up? Co-morbidity Psychosocial Physical limitations Assess what do they know and what do they need to know Elicit-Provide-Elicit Determine levels of readiness and motivation towards self-care Determine barriers 37

38 Sleep Apnea Numbers don t add up Deadline is now take work home perform! insurance mortgage debt Wasted! Daughter back at home 2 beautiful girls CPAP Machine Sleep Specialist Get a ride Dietitian Take off work 108 kg Endocrinologist Obese High cholesterol Avoid salt, fats, carbs LDL high Metformin A1c 8.2% Diabetes GlipizideCheck sugars Hypertension HCTZ Dizzy 55 Take pills Beta-blocker Exercise Depression Can t sleep Bad back Neuropathy Pain Podiatrist Check his feet Adapted and Used with Permission Dr. Victor Montori, Mayo Clinic ; minimally disruptedmedicine.com

39 The workload of being a chronic patient Self-reported: 48 min/d Desirable (ADA): 122 min/d + admin: 143 min/day Russell LB et al. JFP 2005; 54: Bohlen et al. Diabetes Care 2011 Used with Permission Dr. Victor Montori, Mayo Clinic ; 39 minimally disruptedmedicine.com

40 The Work of being a patient with chronic illness is almost the equivalent of a part time job. The Burden triggers a spiral of negative consequences (Eton, et al., 2012)

41 Framework of Burden of Treatment 41

42 Sleep health is a particular concern for individuals with chronic disabilities and disorders such as arthritis, kidney disease, pain, human immunodeficiency virus (HIV), epilepsy, Parkinson s disease, and depression. Among older adults, the cognitive and medical consequences of untreated sleep disorders decrease health-related quality of life, contribute to functional limitations and loss of independence, and are associated with an increased risk of death from any cause. 42

43 Concept Mapping Causes Sleep Apnea Hypertension Difficulty Sleeping Medication Anxiety 43

44 Patient Education The process of influencing patient behavior and producing changes in knowledge, attitudes and skills necessary to maintain or improve health Behar-Horenstein, et al. (2005) 44

45 Your Scenario You are working as a CSE; you are referred the following patient; your allotted time is 30 minutes 57 year old female, BMI 27, reports insomnia, waking up with anxiety, cognitive difficulties at work, separated and lives alone, no children or siblings, parents deceased, has hypertension, is a college graduate Had a sleep study, AHI 20, SE 92%; will require therapy for SDB What are your next steps? 45

46 Create an individualized plan: Audience Participation What are things that stand out? What would you be concerned about? What is her affect? How will you integrate teaching? What will be your follow-up plan? 46

47 The Value Proposition val ue [val-yoo] Show IPA noun, verb, val ued, val u ing. noun 1. relative worth, merit, or importance: the value of a college education; the 47

48 Opportunities Where What Knowledge Pediatrics/Schools OSA, behavioral sleep challenges Childhood growth and development; what is normal; physiology; parent-child interaction OB/GYN Occupational Health OSA, menopause, polycystic ovarian syndrome Preventative; OSA ; shift work Normal reproductive physiology, changes to sleep in menopause; understanding PCOS Circadian rhythm; phase shift, sleep promoting guidance Nursing Homes Cognitive decline, sleep deprivation Normal changes; abnormal neurodegenerative changes; impact to family and QoL Community/Society Poor knowledge 48 in general Health promotion including sleep, diet, exercise

49 Another Reason: Do Not assume While knowledge of findings like these (referring to sleep apnea) have raised my awareness of the dangers of untreated sleep apnea, I can tell you that a majority of the nurses at my hospital, and even those within my own critical care unit still do not aggressively address the issue of having the MD order studies to diagnose and/or treat OSA which has been diagnosed (Anonymous Critical Care RN, MSN student) 49

50 Some value questions to think about As it is currently delivered, does sleep medicine (aggregate), provide patient centric, value driven health care? How would the CSE role improve or not the delivery of care Home sleep testing: Where/How How can the role of the CSE be utilized? Demonstrate improved outcomes Where else can a CSE have impact? Chronic care models, ACO s, Hospitals 50

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52 Knowledge Skills Activation and Engagement CSE Role

53 The Challenge Be Proactive/Demonstrate the Need and Value Validate your worth to your medical community Be a part of the interdisciplinary team Be a patient advocate Continue to learn new skills Collect data, demonstrate that what you do MATTERS! Continue to be a life long learner! Write to your elected representatives Conduct Community Events Local schools and libraries Walking group let by the CSE Go to your local nursing program and offer to give a lecture 53

54 Summary Sleep disorders are chronic conditions with complex treatments. They are frequently comorbid with other sleep disorders, as well as other complex conditions (e.g., cardiovascular disease, depression, and diabetes) sleep disorders also are dynamic, meaning that the underlying condition or its treatment changes with age and onset of new comorbidities 54

55 Summary The role may encompass all sleep disorders, sleep promotion and provide for continuity of care Must be knowledgeable regarding bi-directionality nature of sleep, sleep disorders and other medical conditions Has the ability to apply affective communication techniques, understand behavioral theories and integrate patientcentered principles. There is much work to be done regarding this role and development of a certification 55

56 Next Steps Recognition Professional scope of practice Education and eligibility pathways Outcomes research critical Evidence-based practices Reimbursement Acceptance 56 Courtesy, C.Altman, President, BRPT

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58 Contact Information home office (If ing, please put CSE-KASP in subject line)