VHA INNOVATION PROGRAM Innovation #554 Insulin Pen Project VHA ISB Business Case September 25, 2013.
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Transcript of VHA INNOVATION PROGRAM Innovation #554 Insulin Pen Project VHA ISB Business Case September 25, 2013.
VETERANS HEALTH ADMINISTRATION
Project Background
• Problem Statement – The traditional vial and syringe method of administering insulin is complex, involving over 15 separate steps. Many patients find the process daunting and are reluctant to start insulin therapy, increasing their risk for diabetes-related complications. Insulin pens offer an easier method for patients to administer insulin injections. Previous research has shown that patients prefer insulin pens and report significantly less fear of self-injecting. They also report improved ease of use/handling with insulin pens, a factor that is particularly important for patients with poor manual dexterity or vision. As a result, many studies have shown improved adherence to recommended insulin regimens with insulin pens as compared to traditional vial and syringe (1,2). The goal of this project is to offer insulin pens in lieu of insulin vials and syringes to Veterans at the VA Montana Health Care System. The anticipated benefits include improvements in clinical outcomes as measured by hemoglobin A1c (HbA1c) levels, reductions in the amount of time clinicians spend training patients to administer insulin therapy, decreased adverse events related to insulin misuse and improvements in patient satisfaction.
• Description of Proposed Solution – Begin offering insulin pens in lieu of vial and syringes in inpatient settings– Expand use of insulin pen in outpatient settings in select patient populations– Provide training to nursing staff, physicians, pharmacists, and diabetes educators on
insulin pen use– Collect outcomes data to evaluate the impact of providing insulin pens as opposed to
traditional vial and syringe 2
VETERANS HEALTH ADMINISTRATION
Execution Status
• Local deployment in the VA Montana Healthcare System• Pharmacy staff was not supportive due to cost concerns
– The pharmacy staff was not supportive because cost-effectiveness data are lacking– Previous studies highlight that the overall health care costs are similar or lower with
insulin pen as compared to vial and syringe (1-2)• The modest increase in the cost of pens versus syringe and vials is usually more than
compensated for in cost-savings from reduced utilization of inpatient and outpatient services as a result of better medication adherence and disease management
• High level, project specific, tasks required for enterprise deployment:– In depth data gathering completed to identify specific number of Veterans currently receiving syringe
and vial treatment– Six (6) month pilot at approximately six (6) sites and Class III to Class I verification performed prior to
national release
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VETERANS HEALTH ADMINISTRATION
ISB Selection Criteria
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Criteria See… Self-Assigned Score
Compliance Slide 4 1
Five-Year Net Operational Cost Change Slide 5 0
Implementation Cost Slide 6 -6
Clinical Impact (Broadness) Slide 7 10
Clinical Impact (Degree) Slide 7 10
Business Impact (Broadness) Slide 8 10
Business Impact (Degree) Slide 8 10
Patient Safety Slide 9 7
Patient Value Slide 10 10
Healthcare Disparity Slide 11 1
Summary Value = 1 * (14+38) = 52
Business Value = 0 + (-6) + 10 + 10 = 14
Clinical Value = 10 + 10 + 10 + 1 + 7 = 38
VETERANS HEALTH ADMINISTRATION
Business Case – Compliance
• The solution is compliant with regulations, including patient safety
5
Self Assigned Score: 1
VETERANS HEALTH ADMINISTRATION
Business Case – 5 Year Net Operational Cost Change
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Self Assigned Score: 0
While the pharmacy costs associated with the insulin pen are greater than with a vial & syringe, reviews of the literature suggesting that replacing traditional vial and syringes with insulin pens is cost-neutral due to reduced utilization of inpatient, outpatient, and ER resources (improved adherence)
Cost Element Cost Difference
Pharmacy cost differences between insulin pen vs. vial & syringe (anti-hyperglycemic therapy HTs and self –monitoring blood glucose supplies)
+ $293
Total diabetes-related costs (pharmacy, outpatient, inpatient, and ER)
- $296
Cost Element Cost Difference
Annual diabetes-related healthcare costs with vial and syringe vs. insulin pens
$3970 vs. $4838
Total annual healthcare related costs with vial and syringe vs. insulin pends $13,214 vs. $13212
Authors reported there were no significant changes in health care costs
Authors reported there were no significant changes in health care costs
Lee et al., 2011 Baser et al., 2010
VETERANS HEALTH ADMINISTRATION
Business Case - Implementation Costs
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Year 1 Year 2 Year 3 Year 4 Year 5
Pilot Phase $250,000 $0 $0 $0 $0
Deployment Phase $0 $125,000 $125,000 $125,000 $125,000
Annual Total $250,000 $125,000 $125,000 $125,000 $125,000
Cumulative Costs $250,000 $375,000 $500,000 $625,000 $750,000
Self Assigned Score: -6
• Identified cost based on oversight of deployment at facilities• Initiating insulin therapy with a pen device was associated with
comparable medication adherence and significant reductions in health care resource utilization and associated costs compared with vial/syringe insulin(3).
VETERANS HEALTH ADMINISTRATION
Business Case – Clinical Impact
• Broadness: This solution positively impacts three clinical performance metrics
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Self Assigned Score, Broadness: 10Self Assigned Score, Degree: 10
Clinical Performance Metric Degree of Impact
Communication about medications 20% improvement
Discharge information 15% improvement
DM, HbA1 GT9 or not done, poor control (OP)
• Degree: This solution positively impacts these metrics in the following ways
- Improves communication of staff by simplifying process for educating patients- Improves quality of care by preventing medication errors- Improves accuracy of medication profiles - Eliminates Veteran confusion associated with administration of new medication- Limits adverse drug events and decreases patient misuse- Improves hospital admission/discharge communication on medications
VETERANS HEALTH ADMINISTRATION
Business Case – Business Impact
• Broadness: This solution positively impacts five business performance metrics
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Self Assigned Score, Broadness: 10Self Assigned Score, Degree: 10
• Degree: This solution positively impacts these metrics in the following ways- Improves accuracy of medication profiles (medication reconciliation) for clinical decision making- Standardizes and streamlines process for patient instruction- Reduces amount of time clinicians spend providing training to patients on administering self-
injections- Reduces Patient confusion/intimidation of new prescription
Business Performance Metric Degree of Impact
Improved accuracy of decision making (quality of work) 25% improvement
Standardization of best practices (quality of work) 10% improvement
Reduces program or organizational risk (quality of work) 25% improvement
Reduces costs (VA staff efficiency or workflow) 5% improvement
Improves the environment of care (Veteran/beneficiary’s experience) 15% improvement
VETERANS HEALTH ADMINISTRATION
Business Case - Patient Safety
• This solution demonstratively improves patient safety
- Improves accuracy of medication administered by patients due to visual impairment
- Improves quality of care by preventing medication errors
- Limits adverse drug events and decreases patient misuse
- Eliminates Veteran confusion due to ease of use of pens vs. vial and syringe and dosage requirements
Evaluation CriteriaScored -10 to 10 where -10 is severe decrease in patient safety, 0 is no change in patient safety and +10 is very strong impact in patient safety
1. Demonstratively reduces preventative harm in this population: 62. Reduces mortality and morbidity in this population: 53. Improves patient safety by demonstratively reducing the chance of human error: 9
10
Self Assigned Score: 7
VETERANS HEALTH ADMINISTRATION
Business Case – Patient Value
• This solution significantly increases patient satisfaction
– Decreases Veterans risk of needle stick injuries with the pens as compared to vial and syringe creates a safer environment for clinicians and patients
– Improves patient satisfaction with ease of use of pens
– Improves training for patients by simplifying process to administer medication
– Improves availability/portability of prescriptions
– Improves Veteran Satisfaction by reducing needs of refrigeration of vial
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Self Assigned Score: 10
VETERANS HEALTH ADMINISTRATION
Business Case – Healthcare Disparity
• This solution does not address a healthcare disparity
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Self Assigned Score: 1
VETERANS HEALTH ADMINISTRATION
References
1. Baser, O., Bouchard, J., DeLuzio, T., Henk, H., & Aagren, M. (2010). Assessment of adherence and healthcare costs of insulin device (FlexPen) versus conventional vial/syringe. Advances in therapy, 27(2), 94–104.
2. Lee, L. J., Li, Q., Reynolds, M. W., Pawaskar, M. D., & Corrigan, S. M. (2011). Comparison of utilization, cost, adherence, and hypoglycemia in patients with type 2 diabetes initiating rapid-acting insulin analog with prefilled pen versus vial/syringe. Journal of medical economics, 14(1), 75–86.
3. Pawaskar MD, Camacho FT, Anderson RT, Cobden D, Joshi AV, Balkrishnan R. (2007)Health care costs and medication adherence associated with initiation of insulin pen therapy in medicaid-enrolled patients with type 2 diabetes: a retrospective database analysis.
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VETERANS HEALTH ADMINISTRATION
Other Considerations – Environmental Impact
• Insulin Pen Project will:
- Reduce hazardous waste reaching landfills and major water sources- Discarded syringes- Unusable/expired vials on insulin
- Decrease availability and misuse of insulin therapy syringes for illegal drug use
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