This document discusses marketing strategies for less invasive cardiac surgery techniques like robotic CABG. It notes that patients generally prefer less invasive procedures due to quicker recovery times. The document outlines tactics for marketing robotic CABG such as developing websites, publications, presentations and advertising. It acknowledges both benefits like improved cosmesis but also challenges like higher costs and learning curves. Data on early ad campaigns for robotic CABG show they increased elective case volume and reduced length of stay. The document emphasizes integrating marketing messages and reassessing based on the local environment.
Presentation given in March 2014 as an invited speaker at the PIMA Medical Society (http://www.pimamedicalsociety.org/schedule/). These society presentations are widely attended by physicians in the Tucson area. The topic was innovation in CT surgery at UA.
Presentation given in March 2014 as an invited speaker at the PIMA Medical Society (http://www.pimamedicalsociety.org/schedule/). These society presentations are widely attended by physicians in the Tucson area. The topic was innovation in CT surgery at UA.
Force TJR Annual Report 2014Force TJR Annual Report 2014
Force TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) Registry
UMass Medical School
Department of Orthopedics and Physical Rehabilitation
Using the Bigtown Simulation Model to Predict the Impact of Enhanced Seven Day Services on Hospital Performance and Patient Outcomes
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
TexRAD is a software application that analyses the textures in existing radiological scans to assist the clinician in assessing the prognosis of patients with cancer. Currently applicable to colorectal, breast, lung, prostate and renal cancers.
An inclusive presentation of all the above applications and benefits can be viewed here
What is the place of CT coronary angiography in ED chest pain?kellyam18
CT coronary angiography is a relatively new modality for identifying coronary artery disease. What is its place in ED chest pain assessment. See the evidence -and the evidence gaps- and judge for yourself where it might fit!
ICNC 2019 (poster) More normal scans but comparable post-test referral after ...Joris van Dijk
Background: Myocardial perfusion imaging (MPI) using Rubidium-82 (Rb-82) PET is more accurate than using SPECT. However, downstream clinical treatment strategies have not been compared.
Purpose: Our aim was to compare MPI scan outcomes and post-scan referral for invasive coronary angiography (ICA) between patients undergoing MPI with cadmium-zinc -telluride (CZT)-SPECT or PET in perfectly comparable groups generated by propensity score matching.
Method: 1188 patients who underwent MPI CZT-SPECT (Discovery 570, GE Healthcare) with attenuation correction and 487 patients who underwent Rb-82 PET (D690, GE Healthcare) were retrospectively analyzed. Propensity score-based matching was performed using calcium score category (0, 1-100, 101-400, >400), gender, age, body weight, current smoker, diabetes mellitus, hypercholesterolemia, hypertension and family history as variables. The frequency of normal scans, post scan ICA, and percutaneous coronary intervention (PCI) or coronary bypass surgery (CABG) within six months, were compared between SPECT and PET patients.
Results: After matching, no significant differences were found between the PET (n=487) and SPECT group (n=487) except for weight (91 vs. 87kg, respectively, p<0.001). PET scans were more often interpreted as normal (84% vs. 74%, p<0.001). The number of scans showing ischemia or possible ischemia was lower for PET (10.8%) than for SPECT (21.2%, p<0.001). The percentage of ICA (9.7 vs. 11.3%, p=0.41), PCI (1.9% vs. 2.5%, p=0.51) or CABG (1.4% vs. 1.6%,p=0.80) did not differ between the PET and SPECT, respectively.
Conclusion: As compared to CZT-SPECT, Rb-82 PET MPI results in more normal scans and fewer diagnoses of ischemia and doubtful ischemia. However, this did not translate to fewer ICA and PCI procedures within 6 months, but this may require more experience among referring cardiologists.
Νικόλαος Κουρεντζής, Country Head Radiology-Ελλάδα, Κύπρος, Ισραήλ, Ρουμανία, Βουλγαρία, Μάλτα και Μολδαβία, Bayer
«Οι νέες προκλήσεις στην ιατρική απεικόνιση»
Force TJR Annual Report 2014Force TJR Annual Report 2014
Force TJR (Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement) Registry
UMass Medical School
Department of Orthopedics and Physical Rehabilitation
Using the Bigtown Simulation Model to Predict the Impact of Enhanced Seven Day Services on Hospital Performance and Patient Outcomes
Poster from the 'Delivering NHS services, seven days a week' event held in Birmingham on 16 November 2013
More information about this event can be found at
http://www.nhsiq.nhs.uk/news-events/events/nhs-services-seven-days-a-week.aspx
TexRAD is a software application that analyses the textures in existing radiological scans to assist the clinician in assessing the prognosis of patients with cancer. Currently applicable to colorectal, breast, lung, prostate and renal cancers.
An inclusive presentation of all the above applications and benefits can be viewed here
What is the place of CT coronary angiography in ED chest pain?kellyam18
CT coronary angiography is a relatively new modality for identifying coronary artery disease. What is its place in ED chest pain assessment. See the evidence -and the evidence gaps- and judge for yourself where it might fit!
ICNC 2019 (poster) More normal scans but comparable post-test referral after ...Joris van Dijk
Background: Myocardial perfusion imaging (MPI) using Rubidium-82 (Rb-82) PET is more accurate than using SPECT. However, downstream clinical treatment strategies have not been compared.
Purpose: Our aim was to compare MPI scan outcomes and post-scan referral for invasive coronary angiography (ICA) between patients undergoing MPI with cadmium-zinc -telluride (CZT)-SPECT or PET in perfectly comparable groups generated by propensity score matching.
Method: 1188 patients who underwent MPI CZT-SPECT (Discovery 570, GE Healthcare) with attenuation correction and 487 patients who underwent Rb-82 PET (D690, GE Healthcare) were retrospectively analyzed. Propensity score-based matching was performed using calcium score category (0, 1-100, 101-400, >400), gender, age, body weight, current smoker, diabetes mellitus, hypercholesterolemia, hypertension and family history as variables. The frequency of normal scans, post scan ICA, and percutaneous coronary intervention (PCI) or coronary bypass surgery (CABG) within six months, were compared between SPECT and PET patients.
Results: After matching, no significant differences were found between the PET (n=487) and SPECT group (n=487) except for weight (91 vs. 87kg, respectively, p<0.001). PET scans were more often interpreted as normal (84% vs. 74%, p<0.001). The number of scans showing ischemia or possible ischemia was lower for PET (10.8%) than for SPECT (21.2%, p<0.001). The percentage of ICA (9.7 vs. 11.3%, p=0.41), PCI (1.9% vs. 2.5%, p=0.51) or CABG (1.4% vs. 1.6%,p=0.80) did not differ between the PET and SPECT, respectively.
Conclusion: As compared to CZT-SPECT, Rb-82 PET MPI results in more normal scans and fewer diagnoses of ischemia and doubtful ischemia. However, this did not translate to fewer ICA and PCI procedures within 6 months, but this may require more experience among referring cardiologists.
Νικόλαος Κουρεντζής, Country Head Radiology-Ελλάδα, Κύπρος, Ισραήλ, Ρουμανία, Βουλγαρία, Μάλτα και Μολδαβία, Bayer
«Οι νέες προκλήσεις στην ιατρική απεικόνιση»
Presentation given to health-care management class discussing how military research impacts medical innovations eventually benefiting the civilian population
Morphologomics - Challenges for Surgical Pathology in the Genomic Age by Dr. ...Cirdan
This presentation introduces and discussesthe concept of ‘morphologomics’ that is omics approaches critically reimagined and reappraised from the viewpoint of classic morphology.
It was delivered by Dr. Anthony Gill at the Pathology Horizons 2017 conference in Cairns, Australia.
introduce and discuss the concept of ‘morphologomics’ that is omics approaches critically reimagined and reappraised from the viewpoint of classic morphology.
I gave this talk in the "Presidential Symposium" at the annual meeting of the American Association of Physicists in Medicine, in Annaheim, California. The President of AAPM, Dr. Maryellen Giger, wanted some people to give some visionary talks. She invited (I kid you not) Foster, Gates, and Obama. Fortunately Bill and Barack had other commitments, so I did not need to share the time with them.
Outcomes of patients undergoing cardiac surgery at SUNY-Downstate between Aug '18 and Aug '19. Includes 148 patients that underwent cases that are risk adjustable according to STS definitions.
Invited Presentation at the Eastern Cardiothoracic Surgical Society 2018Robert Poston
The classic focus of cardiac surgeons attempting to implement robotics programs is on the technical tasks. This presentation focuses on the managerial and political challenges that can strongly influence the chances of success with these high profile programs.
Outcomes for cardiac surgery at Mt. View 2017Robert Poston
Dr. Poston arrived at Mt View in 2017 as their director of cardiothoracic surgery. The most comprehensive way to understand the performance of his program is to review the quarterly report from STS national cardiac surgery database. This provides risk adjusted outcomes. It shows that compared to the year prior to his arrival, both outcomes and total surgical volume increased.
Team training for robotic heart surgery at DownstateRobert Poston
Downstate University had not done robotic heart surgery in the past. In order to train the surgical team, we performed a series of "dry runs". This involved setting up the OR as close as possible to a live case and then rehearsing the normal course of events as well as emergency scenarios.
Dr. Poston underwent training and started his robotic practice in Aug 2006. One year later, he submitted for publication the outcomes of his first 100 robotic cardiac cases (see: Ann Surg 2008; 248(4):638-46). He has maintained a steady practice of >100 robotic cases per year since that time.
National database analysis completed 11/16 regarding the results for cardiac surgery performed at St Francis Medical Center, Trenton, NJ. from 2015-16.
Invited presentation at the major robotic cardiac surgery meeting at a society called ISMICS. This presentation described the use of less invasive cardiac surgery as a way to accelerate the recovery so this patient could under go chemotherapy for metastatic breast cancer.
Abstract presentation - Bleeding and patient satisfactionRobert Poston
Abstract presentation given at a national surgical society about the influence of surgical bleeding on patient satisfaction and willingness to recommend the hospital.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
2. “Let no physician teach the people about medicines
or even tell them the names of the medicines, particularly
the more potent ones. . . . For the people may be harmed
by their improper use.”
Royal College of Physicians, circa 1550.
11. Repeating Story…
Arthroscopic surgery
Laparoscopic surgery
Robotic prostatectomy
Robotic hysterectomy
Breast lumpectomy/XRT
12. Pain resolves
quicker
↓ Blood loss
↓ Intubation time
↓ LOS
↓ Complications
CABG Mitral valve Descending aorta
Less Invasive Cardiac Surgery
13. Pain resolves
quicker
↓ Blood loss
↓ Intubation time
↓ LOS
↓ Complications
CABG Mitral valve Descending aorta
Less Invasive Cardiac Surgery
HOW STAKEHOLDERS DEFINE VALUE
PATIENT = ↓invasiveness, ↑information
HOSPITAL = profitability
PAYOR = return to work
TRAINING = learn the “cutting-edge”
NIH = comparative effectiveness research
NQF = shared decision making
14. Pain resolves
quicker
↓ Blood loss
↓ Intubation time
↓ LOS
↓ Complications
CABG Mitral valve Descending aorta
Less Invasive Cardiac Surgery
16. Hybrid Procedure:
PCI 1st, then CABG
Surgery 1st, then PCI
Simultaneous
hybrid OR
Hybrid Cath Lab - OR
17. Advantages of Robotic CABG
Improved cosmesis
Quicker recovery
Less chronic pain
Avoid sternal infection1
1. Press Release, 10/1/08 “CMS Improves Patient Safety
for Medicare and Medicaid by Addressing Never Events”
(http://www.cms.hhs.gov/apps/media/fact_sheets.asp).
Case #1
Case #2
18. Representative Case #1
52 year old man, chronic angina secondary to
proximal LAD (calcified CTO) and mid-RCA
disease (class A lesion).
Self-employed (no paid leave) and very
interested in quick recovery time
Consulted with local cardiologist and cardiac
surgeon who recommended sternotomy CABG
Sought out alternative options using the internet
19. RCA – after stenting
RCA – before stenting
LIMA
LAD
focal
blockage
Webcast 2/28/07: http://www.or-live.com/umm/1713
1. Reicher, Poston, et al. Am Heart J. 2008;155(4):661-7
MULTIVESSEL REVASCULARIZATION
VIA SIMULTANEOUS
HYBRID APPROACH1
Intraoperative angiography
20. Patient Decision Making in Life
Threatening Situations1
1. Pierce. Human Factors 1996; 38(2):278-88
21. Patient Decision Making in Life
Threatening Situations1
1. Pierce. Human Factors 1996; 38(2):278-88
Seek more
information
22. Nallamothu, B. K. et al. JAMA 2007;297:962-968.
Geographic Variations in Referral for CABG
29. Marketing Environment for Robotic CABG at UC
Strengths
Easy to articulate value proposition
Substantial barriers to entry
Platform for derivative procedures
Weaknesses
Learning curve
Fierce competition
Susceptible to retaliation
Opportunities
Large market size
Motivated buyers
Unmet needs
Threats
Declining demand/saturated supply
Advances in PCI technology
Declining reimbursement/higher costs of robotics
Conservative field
30. Marketing Tactics
Public relations
Website development
Outreach
Scientific publications/presentations
Advertising
31. Media Relations
Single vessel
robotic CABG
Starting 6/03
Hybrid revasc
Starting 12/04
Multivessel robotic
CABG
Starting 9/06
1st simultaneous hybrid procedure in US (12/29/04)1
1st robotic-assisted CABG in Maryland (9/26/06)2
400 CASES
~7 years
1st robotic-assisted CABG in Boston (3/4/08)3
1. Am Heart J. 2008;155:661-7.
2. Ann Surg 2008;248:638-46.
3. Am J Card 2010, in press
32. CAD patient
referred for CABG
(n=403)
Candidate for minimally
invasive (n=201)
Hybrid CABG (n=75) Robotic assisted CABG (n=120)
Staged hybrid:
CABG 1st (n=39)
Staged hybrid:
PCI 1st (n=36)
Sternotomy CABG (n=202)
Suitable anatomy
Able to tolerate single
lung ventilation
Stable hemodynamics
Conversions
(n=6)
No
Yes
Culprit lesion stentable?
No Yes
CABG at Boston Medical Center: 3/08 to present
Data Source:
STS National Database 2008-9
University HealthSystem Consortium
39. Effect of Advertising
Mass Media Ad Consumer response
•102 inquiries (68 candidates)
•56 new cases – 12 months
40. Effect of Advertising
Mass Media Ad Consumer response
•102 inquiries (68 candidates)
•56 new cases – 12 months
Meet
(emotional)
needs of the
consumer
•Empowered with new alternatives
•Promise of patient-centered care
•Avoid the long recovery/sternotomy
41. Map of Patient Locations
This map depicts all patients that had a robotic assisted cardiac procedure at BMC FY08-09.
42. Eastern
United States
FY09 – 39% outside Mass.
FY07 – 3% outside Mass.
Map of Patient Locations
This map depicts all patients from outside Massachusetts that had a robotic assisted cardiac procedure at BMC FY08-09.
43. DRAFT August 31, 2007
Heart Marketing Plan
Tactics/Activities Jul Aug Sept Oct Nov Dec
Jan
Yr08
Feb
Yr08
Mar
Yr08
Apr
Yr08
May
Yr08
Jun
Yr08
Jul
Yr08
Aug
Yr08
Sept
Yr08
Srivastava Intro News Release
Major Breakthrough News Stories Begin (3)*
Shop Newsworthy Items/Human Interest Stories (Qty TBD)
Physician Robost Bios on UCMC Site
Enhanced Program Content on UCMC Site
Edited Srivastava Web Videos Posted to UCMC Site
Google Key Words Purchased/ Executed for Enhanced Search
MIS Heart Web Display Ads (2-3 Rounds)
Patient Stories Begin Appearing on UCMC Site
MIS Heart Radio in Market (4 flights per year)**
MIS Heart Print Ads in Market (4 drops per year)**
NOTE: MIS Heart Ad Rotations are Part of Main Heart Campaign
Use Internal Vehicles to Increase Awareness of Expanded UCMC Heart Expertise
Srivastava Story in The Forefront Internal Newsletter
Srivastava Intranet Announcement
* Minimum number of events recommended
** Targeted timing, timing subject to change
Increase UCMC Internal Awareness
Use Print & Radio Advertising to Increase Awareness of UCMC Advanced Heart Expertise
Increase Consumer Awareness of UCMC Heart Expertise
Utilize Web & UCMC Site to Enhance Awareness
Public Relations
44. Map of Patient Locations by Procedure
This map depicts all patients that had a robotic assisted cardiac procedure at UCMC FY07-08.
Across the U.S. Chicagoland Area
Robotic, nonCABG
Robotic CABG
7% robotic cases in UCMC
primary service area.
34% all other cases in PSA
45. Define the Customer
Who they are:
Need CABG, actively
seeking alternatives
(patient #1)
Need CABG, suitable
for robotics but
unaware
Interventionalists
interested in hybrid
Who they aren’t:
Referring cardiologists
(long term relationships
with other surgeons)
Not a candidate for
robotics
Unstable
Need 4-5 grafts
46. Consequences of Ads
Characteristics AD (n=56) Non-Ad(n=46) P-value
Elective case 74.1 41.5 0.0003
Age* (years) 61.7 68.5 0.001
Sex (Male) 88.9 68.8 0.011
BMI>30 42.5 33.7 0.36
DM 43.1 46.7 0.728
Active Smoking 10.3 16.8 0.325
HTN 86.2 93.5 0.238
MI 42.5 54.5 0.225
CHF 22.2 32.4 0.239
PAD 9.2 11.6 0.777
Renal Failure 3.4 5.1 0.6995
Chronic Lung Disease (%) 5.6 19.4 0.0367
47. Length of hospital stay (days) 4.4 6.6 0.0018
Activity score at 3 weeks (% of baseline)* 74.5 72.2 0.89
Satisfaction at 2 weeks (% that would
recommend)** 89.5 84.7 0.54
Unmet expectations at 6 mo. (total #)
“length of incision”
“time required for recovery”
“expertise of Dr. Poston”
10
6
4
0
2
1
1
0
0.04
Consequences of Ads
Postoperative Outcome
AD
(n=56)
Non-Ad
(n=46)
P-value
*Duke Activity Status Index
**Press-Ganey survey
48. Adverse Effects of Advertising
Mass Media Ad
Consumer
response
Patient
Unrealistic expectations
Robotic surgeon
Conflict of interest
Referring physician
Patient relationship1,2
Colleagues
Emphasis on individual
1. J Clin Oncol 2009; 27: 4182-4187
2. Clin Orthop Relat Res 2007;458:202-19.
49. Robotic CABG: Issues That Go Either Way
Safety
Costs
Team morale
Ethics
Autonomy
Vulnerability
Doctor-patient relationship
Differencein
costroboticvs.
sternotomy($/case)
50. Robotic CABG: Issues That Go Either Way
Safety
Costs
Team morale
Ethics
Autonomy
Vulnerability
Doctor-patient relationship
Differencein
costroboticvs.
sternotomy($/case)
learning curve
52. Question Items
1st
survey
2nd
survey
p
Teamwork Climate 2.9 ± 0.6 3.3 ± 1.0 0.05
Disagreements in this ICU are resolved appropriately (i.e., not
who is right, but what is best for the patient) (Q32)
2.0 ± 1.0 3.4 ± 1.1 0.0010
Safety Climate 2.9 ± 0.6 3.2 ± 0.8 0.04
Medical errors are handled appropriately in this ICU. (Q5) 2.9 ± 0.9 3.6 ± 1.3 0.0394
In this ICU, it is easy to discuss errors. (Q12) 2.3 ± 1.0 4.3 ± 0.8 <0.001
Robotic CABG and the Culture of Safety
http://www.ahrq.gov/qual/patientsafetyculture/
Likert Scale 1-5: 1 = strongly disagree, 5 = strongly agree
53. Integrated Marketing
Communications
Planned messages
External – ads, PR campaign
Internal – newsletter, intranet stories, grand rounds,
presentations to stakeholders
Inferred messages - Public impression
How our product is perceived
Customer service
Teamwork, learning curve
Response to retaliation
54. Map of Potential Patients Who Did Not Have a MICS Procedure
Across the U.S. Chicagoland
Insurance problems
Inquired, did not proceed
Not a candidate
Boston – 12 ad responders were candidates and did not have robotic CABG
55. 1. Establish
marketing plan
2. Refine the plan
3. Implement the
message
4. Measure
outcomes
5. Reassess local
environmentFocus group testing
3rd party review for clarity
56. Improved Clinical Outcomes
Shared Decision Making
“the greatest potential to eradicate disparities, reduce
harm, and remove waste from the American healthcare
system.’’1
Create greater symmetry of information
Only the individual
1. knows their values and preferences
2. faces the consequences of the decision.
1. http://www.qualityforum.org/Setting_Priorities/Addressing_National_Priorities.aspx
57. Robotic CABG is a “preference sensitive” choice – dependent on the
context of the patient’s social circumstances and willingness to accept a
new option – not solely the preferences of the surgeon and referring
provider.
“Shared decision making” is valuable because merely having a choice
improves patient satisfaction and outcome.
Having experience with both robotic and open techniques lends credibility
to our center as a place that can engage in shared decision making in a
meaningful way.
The Message
58. “Shared Decision Making” Answers the Problems
Cardiology referrals – distinctive service
marketed direct to patients
Doctor-patient relationship – ads emphasize the
relationship is evolving
Team morale – easier to accept patient’s right to
decide
Potential for retaliation – risk is less unless all
regional surgeons are discussing robotic CABG