Successfully reported this slideshow.
Your SlideShare is downloading. ×

How Regional Anesthesia Can Improve Outcomes that Matter

Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad
Ad

Check these out next

1 of 42 Ad

How Regional Anesthesia Can Improve Outcomes that Matter

Download to read offline

The clinical practice of regional anesthesia has evolved over time into a true medical subspecialty incorporating acute pain medicine. Advancing the science of regional anesthesiology and acute pain medicine will require identifying research priorities and meaningful outcomes. There are tremendous opportunities to develop new applications of regional anesthesiology and acute pain medicine that may improve patient experience, public health, and healthcare value.

By the end of this lecture, learners will be able to:
1. Discuss current problems related to perioperative pain medicine and access to regional anesthesia;
2. Apply strategies to provide consistent high quality pain management for postsurgical patients; and
3. Identify opportunities to improve outcomes that matter to patients.

The clinical practice of regional anesthesia has evolved over time into a true medical subspecialty incorporating acute pain medicine. Advancing the science of regional anesthesiology and acute pain medicine will require identifying research priorities and meaningful outcomes. There are tremendous opportunities to develop new applications of regional anesthesiology and acute pain medicine that may improve patient experience, public health, and healthcare value.

By the end of this lecture, learners will be able to:
1. Discuss current problems related to perioperative pain medicine and access to regional anesthesia;
2. Apply strategies to provide consistent high quality pain management for postsurgical patients; and
3. Identify opportunities to improve outcomes that matter to patients.

Advertisement
Advertisement

More Related Content

Slideshows for you (13)

Similar to How Regional Anesthesia Can Improve Outcomes that Matter (20)

Advertisement

More from Edward R. Mariano, MD (20)

Recently uploaded (20)

Advertisement

How Regional Anesthesia Can Improve Outcomes that Matter

  1. 1. @EMARIANOMD How Regional Anesthesia Can Improve Outcomes that Matter Edward R. Mariano, M.D., M.A.S. Professor of Anesthesiology, Perioperative & Pain Medicine Stanford University School of Medicine Chief, Anesthesiology and Perioperative Care Veterans Affairs Palo Alto Health Care System
  2. 2. @EMARIANOMD Disclosures  None financial.  Other disclosures: – FDA public workshop on regional anesthesia – CMS quality and cost measures – The Joint Commission hospital-based pain management standards – ACGME accreditation of regional anesthesiology and acute pain medicine – National Academy of Medicine action collaborative countering the opioid epidemic
  3. 3. @EMARIANOMD Society Healthcare System Patient
  4. 4. @EMARIANOMD Society Healthcare System Patient
  5. 5. @EMARIANOMD Start with the Patient
  6. 6. @EMARIANOMD “Personalize” Pain Medicine
  7. 7. @EMARIANOMD What Do Patients Know?
  8. 8. @EMARIANOMD What Do Patients Want?
  9. 9. @EMARIANOMD Which Functional Outcomes?  Range of motion (degrees)  Timed ambulation distance (meters) – 6-MWT – 2-MWT  Muscle strength (force)  Timed performance (min) – TUG  Western Ontario and McMaster Univ Osteoarthritis Index (WOMAC)  Knee Society Score  Lower Extremity Functional Scale  Health-Related Quality of Life Choi S, et al. RAPM 2013;38:340 Bernucci & Carli. Curr Op Anaes 2012;25:621 Performance-Based Self-Reported &
  10. 10. @EMARIANOMD For regional anesthesia to improve outcomes, it has to be accessible to ALL.
  11. 11. @EMARIANOMD 2017;42:368 http://www.edmariano.com/archives/1196 27%! J Arthroplasty 2016
  12. 12. @EMARIANOMD 2017;42:368 http://www.edmariano.com/archives/1196 27%! J Arthroplasty 2016 100% at VA Palo Alto
  13. 13. @EMARIANOMD So Many Options Kandarian, Elkassabany, Tamboli, Mariano. Best Pract, in press
  14. 14. @EMARIANOMD So Many Options Kandarian, Elkassabany, Tamboli, Mariano. Best Pract, in press
  15. 15. @EMARIANOMD Society Healthcare System Patient
  16. 16. @EMARIANOMD Regional Anesthesia is One Part Anesthesiology 2012;116:248
  17. 17. @EMARIANOMD We Love Regional Anesthesia
  18. 18. @EMARIANOMD
  19. 19. @EMARIANOMD Have We Made Regional Anesthesia Too Difficult?
  20. 20. @EMARIANOMD Evaluate New Blocks/Protocols Mudumbai & Mariano, et al. Pain Manag 2018;8:475
  21. 21. @EMARIANOMD Evaluate New Blocks/Protocols Mudumbai & Mariano, et al. Pain Manag 2018;8:475 Point system = 100 total 25 50 15 10 Practice- dependent
  22. 22. @EMARIANOMD Protocol = Checklist, Not a Recipe Hebl JR, et al. JBJS 2005;87 Suppl 2:63
  23. 23. @EMARIANOMD VALUE = Quality Cost
  24. 24. @EMARIANOMD CMS Fee-for-Service to MIPS 2017 https://qpp.cms.gov/ Promoting Interoperability Updated in 2019
  25. 25. @EMARIANOMD CMS Fee-for-Service (MIPS) 60%25% 15% 2017 Quality Advancing Care Information Improvement Activities 45% 25% 15% 15% 2019 Quality Promoting Interoperability Improvement Activities Cost https://qpp.cms.gov/
  26. 26. @EMARIANOMD Pain Quality Measures https://www.asra.com/news/185/four-new-quality-pain-measures-approved Under Consideration for MIPS
  27. 27. @EMARIANOMD CMS Fee-for-Service (MIPS) 60%25% 15% 2017 Quality Advancing Care Information Improvement Activities 45% 25% 15% 15% 2019 Quality Promoting Interoperability Improvement Activities Cost https://qpp.cms.gov/
  28. 28. @EMARIANOMD Episode-Based Cost Measures 30 days before to 90 days after
  29. 29. @EMARIANOMD Role of Acute Pain Service Hernandez-Boussard, et al. Ann Surg 2017;266:516 Postoperative pain trajectories identify populations at risk for 30-day readmissions and ED visits
  30. 30. @EMARIANOMD Resource Utilization  >1 million patients  PNB associated with: – Lower rates of complications – Decrease length of stay – Lower rates of transfusion – Lower rate of ICU admission (THA only) Memtsoudis SG, et al. Anesth 2013;118:1046
  31. 31. @EMARIANOMD Society Healthcare System Patient
  32. 32. @EMARIANOMD Death?  30-day mortality was lower for neuraxial and neuraxial/GA vs. GA alone for TKA  Most in-hospital complications were lower for neuraxial and neuraxial/GA vs. GA alone  Transfusion requirements lowest for neuraxial Memtsoudis SG, et al. Anesth 2013;118:1046
  33. 33. @EMARIANOMD Chronic Pain?
  34. 34. @EMARIANOMD Cost of Chronic Pain https://www.sciencedaily.com/releases/2012/09/120911091100.htm
  35. 35. @EMARIANOMD Cancer Recurrence?  14 studies met criteria EA±GA vs. GA (including Cummings study, n=42,151)  Improved overall survival with EA  No difference in cancer recurrence Chen & Miao. PLOS ONE 2013;8:e56540 Cummings KC, et al. Anesth 2012;116:797 Does the intervention match the trajectory of recovery?
  36. 36. @EMARIANOMD Opioid Abuse?
  37. 37. @EMARIANOMD Mudumbai & Mariano, et al. Pain Med 2016;17:1732 The Opioid Crisis is Complex
  38. 38. @EMARIANOMD
  39. 39. @EMARIANOMD How Long Does Pain Last? Lavand’homme, et al. CORR 2014;472:1409 TKA Patients at 3 months 42% Pain Free 47% Persistent Pain 11% Neuropathic Pain
  40. 40. @EMARIANOMD Opportunities for Pain Medicine Mariano, Walters, Kim, Kain. A&A 2015;120:1163 Walters, Mariano, Clark. Pain Med 2015;16:1666.
  41. 41. @EMARIANOMD Transitional Pain Katz, et al. J Pain Res 2015;8:695 Huang, et al. Pain Manag 2016;6:435
  42. 42. @EMARIANOMD Summary  We discussed how regional anesthesia can improve outcomes that matter to: – Our patients – Healthcare systems – Society

×