Download
how to get clinicians to use your project n.
Skip this Video
Loading SlideShow in 5 Seconds..
How to Get Clinicians to Use Your Project PowerPoint Presentation
Download Presentation
How to Get Clinicians to Use Your Project

How to Get Clinicians to Use Your Project

103 Views Download Presentation
Download Presentation

How to Get Clinicians to Use Your Project

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. How to Get Clinicians to Use Your Project Sue Palsbo, PhD Associate Director NRH-CHDR

  2. Diffusion of New Technologies • Translating research into practice • Early adopters • Opinion leaders • Volume leads to assignment of a CPT code by the American Medical Association • “Evidence based practice”

  3. Get It Covered • Definition of “covered” benefits • experimental • medical necessity (restorative) • Medicaid; DoD and VA • Private sector (Technology Assessment Centers) • Medicare • a “leader” or “follower”?

  4. Clinical Trials • Safe • Effective • Timing • Modality • Intensity

  5. Building a Research Team • Track record and experience • “New” investigators • Team skill set • What they want to see from you • Advisors

  6. Agree on the Study Stage • Innovation • Pilot study • Feasibility study • Large scale clinical trial

  7. Agree on the Methods • Define characteristics of the study population • Randomization • Blinding • of treatments • of analysis • Control group

  8. Agree on the Outcome Measures and Statistical Tests • Clinical, Satisfaction, Financial • Significance • Statistical • Clinical • Locus of control; patient empowerment • Valid, reliable assessment tools

  9. Research Designs • Single-Subject • N=1 Randomized Trial • Sequential Medical Trial (SMT)

  10. Single Subject Designs • Repeated measures • AB • Withdrawal (ABAB, etc). • Multiple Baseline (subjects, settings) • Alternating Treatments • Statistics for repeated measures • Withdrawing treatments (ABA) • Natural recovery; maturation multiple baseline

  11. Measures You Might See • FIM=Functional Improvement Measure • GMFM=Gross Motor Function Measure • ROM=range of motion • Ashworth Scale = spasticity • COPM=Canadian Occupational Performance Measure • MRFA=Medical Rehabilitation Follow Along • SIP=Sickness Impact Profile • ADL=Activities of Daily Living

  12. Ethical Questions • Is an N=1 trial indicated for this patient? • Is the effectiveness really in doubt? • If Tx is effective, will it be continued in long term? • Is patient eager to collaborate?

  13. Ethical Questions • Is an N=1 trial feasible in this patient? • Rapid onset? • Does Tx cease to act soon after it is discontinued? • Is an optimal Tx duration feasible? • Can clinically relevant targets be measured? • Are the criteria for stopping the trial, sensible? • Should an unblinded run-in period be conducted?

  14. Practical Questions • Is an N=1 trial feasible in the clinician’s practice? • Will you be available to help the clinician? • Are strategies in place for interpreting the data? • Has the study been approved by the IRB? • What will happen to the device after the test? • Where will the results be published?

  15. Funding Sources • Public • Private

  16. Huzzah, My Device is Covered -- Now What? • Retrospective, fee-for-service • Prospective, Medicare • Inpatient • Outpatient • SNF & Nursing homes • Home health

  17. Prospective Payment System (PPS) (National base rate) x (local cost of inputs factor) x (national case or procedure index) = reimbursement per case or procedure • Incentive on facility is to find and use tools that will maximize clinical outcomes while still living within the reimbursement per case