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

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how to get clinicians to use your project

How to Get Clinicians to Use Your Project

Sue Palsbo, PhD

Associate Director

NRH-CHDR

diffusion of new technologies
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”
get it covered
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”?
clinical trials
Clinical Trials
  • Safe
  • Effective
  • Timing
  • Modality
  • Intensity
building a research team
Building a Research Team
  • Track record and experience
  • “New” investigators
  • Team skill set
  • What they want to see from you
  • Advisors
agree on the study stage
Agree on the Study Stage
  • Innovation
  • Pilot study
  • Feasibility study
  • Large scale clinical trial
agree on the methods
Agree on the Methods
  • Define characteristics of the study population
  • Randomization
  • Blinding
    • of treatments
    • of analysis
  • Control group
agree on the outcome measures and statistical tests
Agree on the Outcome Measures and Statistical Tests
  • Clinical, Satisfaction, Financial
  • Significance
    • Statistical
    • Clinical
  • Locus of control; patient empowerment
  • Valid, reliable assessment tools
research designs
Research Designs
  • Single-Subject
  • N=1 Randomized Trial
  • Sequential Medical Trial (SMT)
single subject designs
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

measures you might see
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
ethical questions
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?
ethical questions1
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?
practical questions
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?

funding sources
Funding Sources
  • Public
  • Private
huzzah my device is covered now what
Huzzah, My Device is Covered -- Now What?
  • Retrospective, fee-for-service
  • Prospective, Medicare
    • Inpatient
    • Outpatient
    • SNF & Nursing homes
    • Home health
prospective payment system pps
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