Value of a Credential: The Certificate in Clinical Sleep Health

Focus Fall-Pittsburgh PA

September 28, 2017

Robyn Woidtke MSN, RN, RPSGT, CCSH

1

What is Somnology and Sleep Medicine? • The branch of science devoted to the study and the physiology

of sleep, the behavioral dimensions of sleep and the consequences of sleep loss and sleep disorders on an individuals and the general populations health, performance, safety and quality of life.

• Sleep Medicine is a branch of clinical medicine devoted to the diagnosis and treatment of individuals suffering from chronic sleep loss or sleep disorders

IOM Report on Sleep and Sleep Deprivation 2006 2

Shifting>>>>>>>

“a shift from today’s siloed organization by specialty department and discrete

service to organizing around the patient’s medical

condition”

https://hbr.org/2013/10/the-strategy-that-will-fix-health-care

3

Everybody……SLEEPS!

4

BRFSS The Behavioral Risk Factor Surveillance System (BRFSS) is the nation's premier system of health-related telephone surveys that collect state data about U.S. residents regarding their health-related risk behaviors, chronic health conditions, and use of preventive services

http://www.cdc.gov/brfss/about/index.htm

5

•444,306 respondents (BRFSS) • 11.8% reported a sleep duration ≤5 hours • 23.0% reported 6 hours • 29.5% reported 7 hours (highest in age ≥

65) • 27.7% reported 8 hours • 4.4% reported 9 hours • 3.6% reported ≥10 hours.

~34% with less than

recommended sleep duration

6

• The age-adjusted prevalence of healthy sleep duration was lower among

• Native Hawaiians/Pacific Islanders (53.7%),

• Non-Hispanic blacks (54.2%)

• Multiracial non-Hispanics (53.6%),

• and American Indians/Alaska Natives (59.6%) compared with non-Hispanic whites (66.8%), Hispanics (65.5%), and Asians (62.5%).

• Unemployed or unable to work

• The prevalence of healthy sleep duration was highest among respondents with a college degree or higher (71.5%). The prevalence was higher among married respondents (67.4%) compared with those who were divorced, widowed, or separated (55.7%), or never married (62.3%).

7

Social Determinants of Health • Economic and Social Conditions and their distribution

among populations

• Influence individual and group differences in health status

Various definitions of inclusion

• CDC

"life-enhancing resources, such as food supply, housing, economic and social relationships, transportation, education, and health care, whose distribution across populations effectively determines length and quality of life"

http://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/SDOH-workbook.pdf

8

Sleep Health- Always Event

• Evaluation of sleep health

• Promotion of sleep health

• Life Style Management

• Education

• Person-Centered Care

• Identification, treatment and follow-on care for patients with sleep disorders

9

Sleep Disorders are Chronic Conditions “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.

IOM Report on Sleep and Sleep Deprivation 2006 10

Components of the CCSH Role

• Patient intake/follow on care

• Assess health literacy

• Provide appropriate education and use communication tools

• Critically evaluates patients needs

• Applies tenets of patient centered care

• Applies health behavior models 11

Components of the CCSH Role

• Care Coordination

• Assess co-morbid conditions; addresses them in the context of sleep health

• Practices health promotion activities

• Develops and provides individualized sleep health education

• Motivational Enhancement Therapy/Motivational Interviewing

12

Why is Certification Important • Individual:

• Certification plays a vital role in making sure care providers critically evaluate their practices, acquire new skills, and adapt their practices to changing patient health needs

• Patients benefit: • Better communicative relationships built on listening and sharing

• Improved sensitivity to their needs and concerns

• Demonstrated clinical knowledge concerning their medical condition

• Coordinated care from inter-professional teams and integrated systems of care

• Employers • certification and the continuing education required to maintain certification

contribute to the creation of an environment of professionalism and a culture of retention. Certification is also a vehicle for facilities to differentiate themselves from competitors and demonstrate to consumers that they have attracted the most skilled and experienced professionals

http://www.abms.org/board-certification/value-of-board-certification-to-health-care/

http://www.aacn.org/wd/certifications/content/benefitstoptempnrs.pcms?menu=certification

13

Certification in Clinical Sleep Health

• The CCSH is validation of a specialized knowledge base

• Standardizes the knowledge and skills required for this emerging specialty of clinical sleep health professionals

• The outcome is enhanced patient care and employer recognition

• Insurance and technology are changing the field of sleep medicine

14

Certification in Clinical Sleep Health

CCSH provides professional designation to healthcare workers who

• focus on patient care and outcomes in sleep health

• function as the liaison and point of contact for patient issues, problems, and treatments regarding sleep

15

Are core competencies important to our field? • The National Academy of Medicine (NAM), established

in 1970 under the name Institute of Medicine (IOM), is an independent organization of eminent professionals from diverse fields including health and medicine; the natural, social, and behavioral sciences; and beyond.

• Works outside of government to provide unbiased and authoritative advice to decision makers and the public.

• Synch with other specialties

• Provides a framework

16

NAM (IOM) Core Competencies (2003) •Provide Patient Centered Care

•Work in Interdisciplinary Teams

•Practice Evidence Based Care

•Apply Quality Improvement

•Use Informatics

17

18

Value Based Healthcare

Change from episodic to care coordination

“In health care, the overarching goal for providers, as well as for every other stakeholder, must be improving value for patients, where value is defined as the health outcomes achieved that matter to patients relative to the cost of achieving those outcomes.

Improving value requires either improving one or more outcomes without raising costs or lowering costs without compromising outcomes, or both”

https://hbr.org/2013/10/the-strategy-that-will-fix-health-care

19

Sleep Health Fragmentation

PCP>>>>>>>> Referral to Cardiology • Staff knowledge • Patient Education • Patient follow through • EMR/EHS

DME Referral <<<<<<<<

Sleep Center • Sleep Center Staff

Knowledge • PSG • HST

• Patient Education • Patient Follow Through • EMR/EHS

Cardiology >>>>>>>> Referral to Sleep Specialist • Staff knowledge • Patient Education • Patient follow through • EMR/EHS

Patient Outcomes

20

Value Based Agenda

https://hbr.org/2013/10/the-strategy-that-will-fix-health-care

21

Integrated Practice Units

• IPUs treat not only a disease but also the related conditions, complications, and circumstances that commonly occur along with it—such as kidney and eye disorders for patients with diabetes, or palliative care for those with metastatic cancer.

• IPUs not only provide treatment but also assume responsibility for engaging patients and their families in care—for instance, by providing education and counseling, encouraging adherence to treatment and prevention protocols, and supporting needed behavioral changes such as smoking cessation or weight loss

https://hbr.org/2013/10/the-strategy-that-will-fix-health-care

22

The Integration of the CCSH Role

Patient

MD/NP/PA

Care Coordination/Targeted

Education

Administration

23

What if…….?

Falling asleep at

work

Sleep Health Assessment

Dx with Type II

Diabetes

Sleep Health Assessment

MVA due to falling asleep

Sleep Health Assessment

24

Interprofessional collaborative practice • “When multiple health workers from different professional

backgrounds work together with patients, families, carers [sic], and communities to deliver the highest quality of care” (WHO, 2010)

25

• Principles of Effective Team Based Care

• Effective Communication

• Shared Goals

• Clear Roles

• Mutual Trust

• Measureable Process and Outcomes

What is a team-based approach?

26

Be an Active Team Member! (IOM, 2003)

• Learn about other team members expertise, background, knowledge, and values.

• Learn individual roles and processes required to work collaboratively.

• Demonstrate basic group skills, including communication, negotiation, delegation, time management, and assessment of group dynamics.

• Ensure that accurate and timely information reaches those who need it at the appropriate time.

27

• Customize care and manage smooth transitions across settings and over time, even when the team members are in entirely different physical locations.

• Coordinate and integrate care processes to ensure excellence, continuity, and reliability of the care provided.

• Resolve conflicts with other members of the team.

• Communicate with other members of the team in a shared language, even when the members are in entirely different physical locations.

Be an Active Team Member! (IOM, 2003)

28

Interprofessional team-based care • Care delivered by intentionally created, usually relatively small

work groups in health care, who are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients, e.g., rapid response team, palliative care team, primary care team, operating room team.

• How about the “sleep team” ?

29 https://www.uth.edu/ipc/about/what-is-ipe.htm

PCP HST

Established collaborative

agreement with the Sleep Lab

Peds Screening

Established collaborative

agreement with the Sleep Lab

Cardiology HST

Established collaborative

agreement with the Sleep Lab

Pain Clinic HST

Established collaborative

agreement with the Sleep Lab

2 way stream of information

“Community” CCSH acts as a liaison between all groups; rotates through the network 1 day per week; paid by the consortium

Sleep Laboratory

Specialists lending their knowledge

about sleep to the medical and lay

community

Consortium members bill accordingly for all home sleep tests, test that are positive funnel to the sleep laboratory for full night titration *not peds*

Sleep Center/DME provides centralized web based reports for the consortium members; improves communication and knowledge between members, improves and consolidates patient care, reduces redundancy, improves efficiencies

All Rights Reserved © 2011 Updated 2016 RVW Clinical Consulting

Community Sleep Health Consortia

Model

A potential for collaboration

The “SLEEP TEAM”

30

Opportunity

• Quality • Satisfaction • Models

– ACO – Chronic Care – Medical Home – Sleep Clinic

• Integration of Sleep Health – Reduction in hospital readmission rates – Risk mitigation: Perioperative 31

Opportunities Where What Knowledge

Pediatrics/Schools OSA, behavioral sleep challenges

Childhood growth and development; what is normal; physiology; parent-child interaction

OB/GYN OSA, menopause, polycystic ovarian syndrome

Normal reproductive physiology, changes to sleep in menopause; understanding PCOS

Occupational Health Preventative; OSA ; shift work

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 in general Health promotion including sleep, diet, exercise

32

Obesity Guidelines (2016)

33

Obesity Guidelines (2016)

34

More Opportunities

35

Moving toward the Future

36

The changing nature of health care makes some practices and practitioners obsolete at the same time it opens up opportunities for the formation of new groups

Sleep as a focal point for intra professional collaboration…, the binding factor

37

Attributes of Successful Programs

38

http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/care-high-need-high-cost-patients

Is This Credential Needed?

39

The changing role of the sleep technologist

• Background • Role originated from the ACCP Sleep Apnea Aftercare Consensus Conference,

2006; First Sleep Apnea Educator conference held in 2009

• Job tasks/skills 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

40

The Emerging Role of the Clinical Sleep Health Allied Health Professional

• Broader context

• Integration of sleep health across the lifespan

• Bi-directionality between sleep health and illness

• Plays an active role on the interdisciplinary/interprofessional team

• Preventative

• Promotion

“The Certification in Clinical Sleep Health (CCSH) examination is for healthcare providers and educators who work directly with sleep medicine patients, families, and practitioners to coordinate and manage patient care, improve outcomes, educate patients and the community, and advocate for the importance of good sleep” BRPT, 2014

Educational Trends

• AAST Summit Meeting

• Educational level must move to a minimum of an associates degree

• Most PSG programs at associates degree

• Bachelors program are basically non-existent • B.S. in Neurodiagnostics and Sleep Science UNC Charlotte Department of

Kinesiology, in collaboration with the UNC Chapel Hill Department of Allied Health Sciences

AASM Task Force Report 2011

•Role of telemedicine

• Impact of health care reform

•Development of disease management programs

• Strategic Research

•Partnership with Industry

43

AAST Future of Sleep Technology

• Core Competencies

• A&P; Pathophysiology

• Interpersonal communication skills

• Research skills

• Disease Management

• Co-morbidities

• PAP follow-up

• Patient Education

• Individual and Group Sessions

• Sleep Center Management

Brooks & Trimble, 2014, JCSM

Roles and Opportunity-AAST • Pre-Test Evaluation

• Glucose monitoring

• Pulmonary Function

• Diagnostic Testing

• Out of Center Testing

• Provision of Treatment

• Mask fitting

• Patient Education

• Follow-up

• Monitoring Adherence

• Long-term Care

• Adherence and outcomes tracking

Brooks & Trimble, 2014 JCSM

So, where does this Credential/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, 2006 46

A good place for CCSH • Sleep health education and promotion strategies are needed

to address disparities in sleep health across age, race, education, and socioeconomic groups.

• Health education and promotion programs can increase awareness of common sleep disorders, such as insomnia, restless leg syndrome, and SDB.

• Sleep health education programs in workplaces can promote better work schedule patterns and motivate managers and workers to adopt strategies that reduce risks to health and safety. Without sleep health education, individuals often prioritize other activities over sleep and accept constant sleepiness and sleep disruption as inevitable

Healthy People, 2020

47

Episodic Care

Many # of MD visits; lack of interoperability, repeat tests, increase waste of healthcare

resources, pt confusion

Care Coordination

Improved outcomes, reduced cost, improved

patient and clinician satisfaction 48

CCSH Care Coordination and Management

• High Risk Population

• Frequent Patient Follow up

• Review laboratory results/data downloads

• Provide Self-management support

• Coaching, life-style management, supportive

• Has established patient rolls

• Establishes a relationship

• Provides a single point of contact

Adapted from Talani, et al., Am J Manag Care. 2013;19(12):957-964

49

Putting it Together

• Why

• Sleep health is imperative to quality of life, health and well-being

• What

• Sleep health should be an Always Event!

• Who

• The clinical sleep health professional has the skills and knowledge

• How

• Planning, Advocacy, Activism, Data and Value

50

51

Contact Info: robyn.woidtke@gmail.com

510-728-0828