PLENARY I: WED, 2 NOV 2016
Preparing Rehabilitation Clinicians and Researchers for Transformative Health Care and Pragmatic Research
Pamela W. Duncan, PhD, PT, Professor of Neurology and Senior Policy Advisor for Transitional Outcomes, Wake Forest Baptist Health, Winston-Salem, NC
The Centers for Medicare and Medicaid (CMS) is setting new directions for management of patients with complex conditions. For these patients, CMS has established both payment and care delivery models. These new directions of care require the engagement of rehabilitation providers and the endorsement of functional status as the primary currency for value based care. The transformation journey for impactful clinical practice and clinical research will require integrated care across the continuum with patient- centered care plans agnostic to site of care, and assessment of long term outcomes.
This presentation will:
- Discuss the drivers of health care transformation
- Discuss key changes in structures and processes of care which rehabilitation providers must implement to be effective clinical and research partners in the transformation of healthcare
- Provide an overview of pragmatic research paradigms that could provide evidence for the new models of care
Pamela Duncan is a nationally and internationally renowned expert in health policy, outcomes research and clinical epidemiology. Her expertise is in post-acute management of the elderly and individuals with stroke and falls management and prevention. She is Professor of Neurology and Senior Policy Advisor for Transitional Outcomes for Wake Forest Baptist Health. Her secondary appointments are in the Division of Geriatrics and Gerontology, Division of Public Health Sciences, and the Translational Sciences Institute. Dr. Duncan has led or co-led multiple studies related to falls in the elderly and stroke survivors, she has developed measures of balance and stroke outcomes, analyzed the physical determinants for falls in the elderly, evaluated the benefits of strength training to reduce falls, and developed international trials to evaluate home based exercise for those who suffered an injurious fall. She is an investigator for the PCORI Falls Prevention Grant (STRIDE). Her role in the STRIDE project is to support implementation of best practices for physical interventions to reduce falls as well as collaborate with home health agencies to implement evidence based falls prevention programs in collaboration with primary care.
Dr. Duncan is the principle investigator of a 2015 PCORI funded large pragmatic trial to implement and evaluate an evidenced-based COMprehensive Post-Acute Stroke Services (COMPASS) model. This model of care combines CMS transitional care services provided by advanced practice providers (APP) and early supported discharge services coordinated by the APPs to develop with patients and families actionable care plans. Care plans will be individualized to manage blood pressure and diabetes, manage medications, increase physical activity, reduce falls risk, optimize functional recovery and optimize access to primary care and community based services. The cluster randomized trial will include over 50 North Carolina Hospitals and over 6000 patients.
PLENARY II: THU, 3 NOV 2016
Health, Health Care & Participation Disparities Experienced by People with Chronic Disabilities
Lisa I. Iezzoni, MD, MSc, Professor of Medicine, Harvard Medical School and Director, Mongan Institute Health Policy Center, Massachusetts General Hospital, Boston, MA
Joy Hammel, PhD, OTR/L, Professor & Endowed Chair, University of Illinois at Chicago, Departments of Occupational Therapy and Disability & Human Development Joint Doctoral Programs in Disability Studies and in Rehabilitation Sciences, Chicago, IL
Despite 26 years since the Americans with Disabilities Act, a growing body of research has documented disparities experienced by people with disabilities in everyday life and societal participation. Dr. Iezzoni will present national evidence on disparities in health and health care, and insights from qualitative research that highlights the perspectives of people with disabilities. Dr. Hammel will follow with evidence on disparities related to community living, social participation and work from national participatory action research. Both will point to promising practices and recommendations for rehabilitation professionals and research to recognize client-centeredness and collaboratively strategize environmental barriers to health and participation.
Dr. Lisa I. Iezzoni is professor of medicine at Harvard Medical School and director of the Mongan Institute Health Policy Center at Massachusetts General Hospital in Boston. Dr. Iezzoni has conducted numerous studies for the Agency for Healthcare Research and Quality, National Institutes of Health, the Medicare agency, and private foundations on evaluating methods for predicting costs and clinical outcomes and assessing quality of care. She has published extensively on risk adjustment and has edited Risk Adjustment for Measuring Health Care Outcomes, now in its fourth edition.Her current research focus is health care quality and health policy issues relating to persons with disability. Her book, When Walking Fails was published in 2003, and More Than Ramps: A Guide to Improving Health Care Quality and Access for People with Disabilities, co-authored with Bonnie L. O’Day, appeared in 2006.
Dr. Iezzoni has served on the editorial boards of numerous medical and health services research journals, study sections, and on many national advisory committees. She also spends considerable volunteer time as an advocate for persons with disability. Dr. Iezzoni is a member of the National Academy of Medicine in the National Academy of Sciences.
Dr. Joy Hammel is a professor and endowed chair at the University of Illinois at Chicago. Her scholarship focuses on participatory action research with disability and aging communities to identify and assess barriers and supports people with disabilities experience to full participation in society; to document national, state and community level participation disparities and opportunities that can be used to effect systems change; and to design and evaluate innovative participation-focused interventions and programming that support long term community living, social participation and economic/work participation.
She is a co-principal investigator of the Americans with Disabilities Act Participation Action Research Consortium (ADA-PARC), a national center focused on documenting participation disparities and opportunities that is sponsored by the National Institute on Disability, Independent Living and Rehabilitation Research.
PLENARY III: FRI, 4 NOV 2016
2016 John Stanley Coulter Award Lecture: How Rehabilitation Can Thrive in a Challenging Healthcare Environment
Alan Jette, PT, PhD, MPH, professor of health law, policy and management, Boston University School of Public Health; professor of rehabilitation sciences at the MGH Institute of Health Professions; and editor-in-chief of Physical Therapy
While evidence-based practice is firmly entrenched in rehabilitation, how to translate evidence into clinical practice is unsettled. While major gaps in scientific knowledge exist, an enormous amount of scientific knowledge remains unused in practice. The transfer of evidence into patient care is unpredictable, highly variable, and needs to be accelerated. Dr. Jette will discuss strategies for moving rehabilitation from innovation dissemination to actual implementation and will review several considerations guiding the choice of implementation strategy.
"If we are serious about speeding up the rate of adoption of evidence-based practices in rehabilitation," he said. "We need to direct resources to designing and applying active implementation strategies to consistently deliver what is known to work into practice."
ACRM is pleased to honor Alan Jette, PT, PhD, MPH with the 2016 John Stanley Coulter Award for his significant contributions to the field of rehabilitation. Dr. Jette’s research interests include late-life exercise, evaluation of rehabilitation treatment outcomes, and the measurement, epidemiology, and prevention of disability. He is an international expert in the development of contemporary outcome measurement instruments to evaluate health care quality and outcomes and has published over 240 peer reviewed articles on these topics.
From 1996-2004 Dr. Jette served as dean of Boston University’s Sargent College of Health & Rehabilitation Sciences. He chaired the Institute of Medicine’s 2007 study, The Future of Disability in America. From 2010-2011, he served on the NIH Blue Ribbon Panel that evaluated NIH research in rehabilitation. From 2011-2014, he co-chaired the IOM Forum on Aging, Disability, and Independence and was elected as a member of the IOM in 2013.