WEBVTT 1 00:00:15.880 --> 00:00:24.850 Quality Insights: All right. Well, good good afternoon and welcome to today's Webinar, which is going to focus on the Co. Pd. National Action Plan. 2 00:00:24.940 --> 00:00:30.050 Quality Insights: We're going to get started in just a few minutes. But first I want to go over a couple of housekeeping items. 3 00:00:30.610 --> 00:00:45.440 Quality Insights: First of all, today's participants entered the Webinar in. Listen only mode. If you have a question or a comment during today's call, we just ask that you please type that into either the Q. A feature or the chat box which are located at the bottom of your zoom window. 4 00:00:45.440 --> 00:00:51.350 Dr. Daniel Doyle: You may need to hover your mouse around the bottom of the window to get the icons to appear. Sometimes they disappear on us 5 00:00:51.800 --> 00:01:04.209 Quality Insights: at the end of the program. You'll be directed to an evaluation with some reflective questions. Once completed, you'll be presented with a certificate that you can then fill out and print out as your proof of Webinar of Webinar completion. 6 00:01:04.540 --> 00:01:14.290 Quality Insights: even if you Don't need continuing education credits. We hope that you will still complete the evaluation because it helps. Tell us how we did, and it can help shape our future programming. 7 00:01:17.180 --> 00:01:21.310 Quality Insights: Just wanted to go over a little bit of information about continuing education 8 00:01:21.510 --> 00:01:34.660 Quality Insights: to complete the course learners. We'll need to watch either this live webinar this live 60 min, Webinar, or they can watch the recording, and you'll need to complete the evaluation and reflective questions at the end. 9 00:01:35.080 --> 00:01:40.260 This Webinar has been approved for 1.2 5 contact hours for nursing 10 00:01:40.380 --> 00:01:53.450 Quality Insights: quality insights is accredited as a provider of nursing, continuing professional development by the American nurses. Credentialing centers Commission on Accreditation and Quality insights, and Dr. Doyle have no further disclosures 11 00:01:56.110 --> 00:02:06.630 Quality Insights: just to go over a couple of the learning objectives. After today's Webinar, all learners should be able to identify the need to address primary prevention of Co. Pd. For your patients 12 00:02:06.760 --> 00:02:11.970 explain the need for expanded access to quality assurance for entry and rural areas 13 00:02:12.090 --> 00:02:20.920 Quality Insights: describe the need and value of pulmonary rehabilitation in rural areas and identify the need for care management for persons with chronic lung diseases. 14 00:02:21.280 --> 00:02:21.860 Yeah. 15 00:02:22.830 --> 00:02:37.320 Quality Insights: so we have a lot of great information to deliver today. So without further ado, i'm going to turn things over to Natalie Tapy. She's one of our quality improvement specialists here, quality on sites, and she is going to introduce our guest speaker today. Natalie. 16 00:02:37.390 --> 00:02:46.540 Natalie Tappe: Thank you, Betsy. Welcome. Everyone. I just wanted to give a little history of Dr. Doyle and his background. 17 00:02:46.580 --> 00:03:03.380 Natalie Tappe: Dr. Dan Doyle is the clinical director for the Appalachian Pulmonary Health Project. He formally served as a family physician at New River Health Center, in Fayette County and at Cabin Creek Health Center in Canal County. He helped to fat, found 18 00:03:03.810 --> 00:03:10.950 Natalie Tappe: the New River Health Association of federally qualified Health Center in 1,978, and practice there until 20, 19 00:03:10.950 --> 00:03:29.450 Natalie Tappe: 22 Dr. Doyle graduated from the University of Notre Dame in 1,969 Harvard Medical School, in 1,974 and completed a family medicine residency at the University of Massachusetts, Worcester in 1,977. His teaching and research has focused on 20 00:03:30.140 --> 00:03:48.420 Natalie Tappe: medical education for community health evidence based practice communication skills and pulmonary rehabilitation he is currently the pi for the Palantine Foundation Grant to empower Middle School and High school students with accurate information about the dangers of E. Cigarette use. 21 00:03:48.420 --> 00:03:51.190 Doctor Doyle, I will turn it over to you. 22 00:03:53.470 --> 00:04:05.700 Dr. Daniel Doyle: Thank you, Natalie, and good afternoon, everyone. It's great to be here with you. I want to thank Natalie for inviting me to give this presentation and giving me the opportunity to talk about 23 00:04:06.010 --> 00:04:08.960 Dr. Daniel Doyle: activities that are really important to me. 24 00:04:10.270 --> 00:04:21.740 Dr. Daniel Doyle: I can see that there's about that there are 35 people on this Webinar right now, but I can't see who all you who you all are. So if you want to just 25 00:04:21.829 --> 00:04:29.060 Dr. Daniel Doyle: put in your your name, and kind of where you are. What your organization is. That would be great. Don't have to do it, but it would be nice to see. 26 00:04:30.520 --> 00:04:36.550 Dr. Daniel Doyle: As you can see, the topic today is improving. Copd outcomes starting with prevention. 27 00:04:37.230 --> 00:04:38.310 Dr. Daniel Doyle: And. 28 00:04:38.350 --> 00:04:41.230 Dr. Daniel Doyle: as Natalie said, I 29 00:04:41.270 --> 00:04:46.510 Dr. Daniel Doyle: practice as a family physician for many years in Fayette County and Kanach County. 30 00:04:48.020 --> 00:05:04.450 Dr. Daniel Doyle: and in in most of that time I was taking care of Copd patients. And then for the last 10 years I have really focused a lot on C. O. Pd. And especially making pulmonary rehabilitation more available to our patients in rural areas. 31 00:05:05.210 --> 00:05:11.810 Dr. Daniel Doyle: As I see you putting in your names. I I recognize some names. Hello, everybody. and 32 00:05:12.230 --> 00:05:20.140 Dr. Daniel Doyle: I guess I want to start out by apologizing for telling some of you what you already know. I I know that 33 00:05:20.230 --> 00:05:26.900 Dr. Daniel Doyle: many, many of you are experts about care coordination, and it's part of your daily work. I know that some of you are probably 34 00:05:26.980 --> 00:05:32.280 Dr. Daniel Doyle: nursing home direct nursing directors and nursing homes. 35 00:05:32.360 --> 00:05:41.100 Dr. Daniel Doyle: So again I apologize for telling you things that you already know. But but there will be people hopefully, for whom some of this will be new 36 00:05:41.670 --> 00:05:56.310 Dr. Daniel Doyle: also. I want to apologize for a little bit of alphabet soup, but I think with the the Q. I. N. And the Q. I/O. Probably you guys are kind of used to alphabet soup already. So but i'll try to keep it clear. 37 00:05:56.960 --> 00:06:04.070 Dr. Daniel Doyle: and and especially I want some of you to know that there is such a thing as a Copd National Action plan. 38 00:06:04.090 --> 00:06:10.090 Dr. Daniel Doyle: because, unfortunately, some people have never, never heard of it, and I think it's just important to know about it. 39 00:06:11.500 --> 00:06:20.020 Dr. Daniel Doyle: So, as this Slide says, I want to tell you about 2 programs related to improving C. O. Pd. Outcomes. 40 00:06:20.300 --> 00:06:22.750 Dr. Daniel Doyle: One of them is a national program. 41 00:06:22.950 --> 00:06:27.630 Dr. Daniel Doyle: and it and it's really it's program in the sense of being a plan. 42 00:06:27.950 --> 00:06:40.150 Dr. Daniel Doyle: The Copd National Action plan and kind of the first half of this we'll be talking about that. and then the other one is something here in West Virginia. the Appalachian pulmonary health project. 43 00:06:40.270 --> 00:06:51.160 Dr. Daniel Doyle: although we have had, we have worked with Pennsylvania, and I see Diana carpenter of the Rural Health Redesign project is on on this great. 44 00:06:51.290 --> 00:06:57.770 Dr. Daniel Doyle: and we've also worked some with Kentucky so, but but primarily we're here in West Virginia. 45 00:06:58.550 --> 00:06:59.480 Dr. Daniel Doyle: Next. 46 00:07:02.620 --> 00:07:18.670 Dr. Daniel Doyle: Want to acknowledge these. 123-45-6780rganizations that have been really important in our work. I'm not going to read all the names. except that, speaking of alphabet soup the last one is the coalition for a tobacco-free West Virginia. 47 00:07:18.800 --> 00:07:31.890 Dr. Daniel Doyle: Probably there's people on this call who are part of that and who attend the monthly meetings. and it's a great networking group for trying to have more 48 00:07:32.230 --> 00:07:36.190 Dr. Daniel Doyle: tobacco-free public spaces in our State next 49 00:07:40.730 --> 00:07:41.850 Dr. Daniel Doyle: next. 50 00:07:44.420 --> 00:08:01.530 Dr. Daniel Doyle: So here again, as some of you already know, that there is a very high prevalence of Copd in Appalachia and the South Central Us. Especially here in West Virginia, or or including here in West Virginia, and then we have our own special situation 51 00:08:01.590 --> 00:08:06.370 Dr. Daniel Doyle: of a coal mine. Dust disease, also known as Black Lung 52 00:08:06.380 --> 00:08:10.640 Dr. Daniel Doyle: throughout West Virginia, Southeast, Ohio, and Eastern Kentucky, that 53 00:08:10.650 --> 00:08:23.310 Dr. Daniel Doyle: often overlaps with Copd and and i'm just going to do a little aside here. We've talked about Copd so much for all these years my whole career. But what we're finding more and more is that 54 00:08:23.350 --> 00:08:30.940 Dr. Daniel Doyle: in some ways a lot of people who have the diagnostic label of Copd Don't actually meet the diagnostic criteria. 55 00:08:30.970 --> 00:08:39.169 Dr. Daniel Doyle: And late in my career. We're learning more and more about the importance of interstitial lung disease, which could be a topic for another day. 56 00:08:39.190 --> 00:08:49.280 Dr. Daniel Doyle: The other thing about this slide is, it looks like so many other chronic disease slides that we know about whether it be cardiovascular disease diabetes 57 00:08:49.380 --> 00:08:52.930 Dr. Daniel Doyle: the opiate epidemic Teen pregnancy. 58 00:08:53.020 --> 00:08:58.790 Dr. Daniel Doyle: So we know that we're in an area, and it has to do with social determinants of health 59 00:08:58.820 --> 00:09:09.750 Dr. Daniel Doyle: that has a high prevalence of a number of of diseases, chronic diseases, which is one of the focuses for quality insights 60 00:09:09.850 --> 00:09:17.530 Dr. Daniel Doyle: and for risk factors for chronic disease. And a lot of our work is trying to intervene earlier and earlier 61 00:09:17.610 --> 00:09:23.570 Dr. Daniel Doyle: and not just at end stages of disease, like when people are in the hospital and getting readmitted next. 62 00:09:26.270 --> 00:09:33.460 Dr. Daniel Doyle: So, as I said, the first thing I want to tell you about is that there is such a thing as the Copd National Action plan. 63 00:09:33.740 --> 00:09:45.100 Dr. Daniel Doyle: and we don't really have the setup for people to raise hands because we don't have the gallery view, but I assume i'm I'm pretty sure some of you have heard of it. But my bet is 64 00:09:45.150 --> 00:09:47.820 Dr. Daniel Doyle: that less than a quarter of you have heard of it. 65 00:09:48.100 --> 00:09:57.390 Dr. Daniel Doyle: And the so pediat National Action plan was developed by the National Heart Lung Blood Institute, which is one of the Institutes of the National Institutes of Health. 66 00:09:57.630 --> 00:10:08.110 Dr. Daniel Doyle: It was published in May, 2,017. You can see it has 5. It has, and had 5 main goals. It was developed with a lot of input 67 00:10:08.200 --> 00:10:19.320 Dr. Daniel Doyle: from many different organizations and individuals, and we have with us today somebody who worked on developing that plan, and i'm going to ask her to comment in a minute 68 00:10:19.420 --> 00:10:28.620 Dr. Daniel Doyle: when I get done with this section of the talk. But, as you can see. when it was finally published there were 5 main goals. 69 00:10:28.720 --> 00:10:39.800 Dr. Daniel Doyle: Number one to empower patients. Sounds a lot like some of the Qi, N. Q. I. O. Goals improve, care exactly what you you work to do. 70 00:10:39.960 --> 00:10:43.360 Dr. Daniel Doyle: collect and use public health data. You do some of that 71 00:10:43.610 --> 00:10:56.770 Dr. Daniel Doyle: increase in sustained research, and and probably it's fair To say that Nhlbi's main mission is to is to fund research into heart and lung diseases. 72 00:10:57.040 --> 00:11:05.690 Dr. Daniel Doyle: and they make policy decisions all the time about where to put their focus. and then finally to translate policy into action. 73 00:11:06.200 --> 00:11:15.480 Dr. Daniel Doyle: So there are many ways that these general goals overlap with the mission of quality, insights and other quality improvement organizations around the country. 74 00:11:15.790 --> 00:11:24.410 Dr. Daniel Doyle: It's kind of long. It has 68 pages and 92 sub goals. But when we learned about this in 2,018, 75 00:11:24.560 --> 00:11:34.770 Dr. Daniel Doyle: and when we looked at it and said, Where do we fit in? It was obvious that we fit in primarily in goal 2 to improve care like you. 76 00:11:35.340 --> 00:11:41.240 Dr. Daniel Doyle: And so what I'm going to do in the next couple slides is kind of 0 in on goal 2. 77 00:11:41.260 --> 00:11:48.750 Dr. Daniel Doyle: But remember that overall it has 92 different goals. Some of them are very detailed under these different headings next. 78 00:11:52.530 --> 00:11:55.680 Dr. Daniel Doyle: So what I need there you go. 79 00:11:55.960 --> 00:12:03.890 Dr. Daniel Doyle: So what goal 2 of the Copd National Action plan is is improving diagnosis, treatment and management. 80 00:12:04.090 --> 00:12:18.700 Dr. Daniel Doyle: and you can see they broke it down into 5 sub goals to develop a national guideline. To my knowledge that Hasn't happened. The closest thing we have is the gold guideline, which is an international guideline, gets updated every year. 81 00:12:18.750 --> 00:12:29.830 Dr. Daniel Doyle: and the gold is the global initiative for obstructive lung disease, and my bet is more than half of you are familiar with that. But if you aren't and you're dealing with. C Opd. A lot. Look it up. 82 00:12:30.230 --> 00:12:39.820 Dr. Daniel Doyle: develop a curriculum for health care professionals, and these numbers in parentheses are how many of those 92 sub goals or 92 specific 83 00:12:39.970 --> 00:12:43.560 Dr. Daniel Doyle: action goals fall under this particular subheading. 84 00:12:43.940 --> 00:12:54.840 Dr. Daniel Doyle: Develop a curriculum for health care professionals. There's lots of curricula, but to my knowledge, no central curriculum or none that has been developed specifically out of this plan. 85 00:12:54.940 --> 00:12:57.710 Dr. Daniel Doyle: Develop a clinical decision tree. 86 00:12:59.240 --> 00:13:20.820 Dr. Daniel Doyle: To my knowledge, we don't have that product develop a. A. C. O. Pd. Management plan tool. There are a number of those. Well, a good one is a pocket tool developed by this Copd foundation. That would be something to look for. And also there's a pocket tool that is that you can get from the gold guideline. You can download it, and all those things are free. 87 00:13:21.150 --> 00:13:37.270 Dr. Daniel Doyle: and then finally was improve access and hard to reach areas. And and when we looked at this set it seemed like that's where we especially fit in, and i'll talk more about that in the second. In our second topic, the Appalachian Pulmonary Health Project next. 88 00:13:39.460 --> 00:13:42.290 Dr. Daniel Doyle: So here's here. It gets real detailed. 89 00:13:42.340 --> 00:13:52.660 Dr. Daniel Doyle: So under goal to Section 5. Item B improve access to care with for people with C. O. Pd. Particularly for those in hard to reach areas. And 90 00:13:52.740 --> 00:13:58.290 Dr. Daniel Doyle: and this is something that we've really worked on because we have so many people living in rural areas. 91 00:13:58.380 --> 00:14:09.780 Dr. Daniel Doyle: They can be hours from the closest pulmonary rehab program, and sometimes hours from their primary care, provider or an hour or more. So you you all know about that. 92 00:14:10.230 --> 00:14:21.790 Dr. Daniel Doyle: And so this was something that we thought we should focus on. And then, as you look at the a couple of goals underneath this improving awareness of pulmonary rehab 93 00:14:21.840 --> 00:14:24.230 Dr. Daniel Doyle: that it's covered by insurance. 94 00:14:25.610 --> 00:14:43.160 Dr. Daniel Doyle: trying to get regulation, to facilitate broader access to pulmonary rehab programs outside the hospital setting, and an example of that is right is at least until recently, and and and Grace Anne may be more up on this than I am, at least until recently 95 00:14:43.160 --> 00:14:53.400 Dr. Daniel Doyle: only doctors could order good sign, orders for pulmonary rehab 96 00:14:53.470 --> 00:15:05.940 Dr. Daniel Doyle: and trying to get that change to include nurse position, assistance. because, as you know, in many primary care, sites in our state, they are the main providers, and in some cases they are the only providers. 97 00:15:08.950 --> 00:15:25.290 Dr. Daniel Doyle: and then consider opportunities to identify novel ways, to help health care providers, help health care providers start and maintain pulmonary rehab programs and actually get their patients to pulmonary rehab programs. An example of a novel form is what's called tele rehabilitation. 98 00:15:25.490 --> 00:15:31.960 Dr. Daniel Doyle: And you'll hear a little more about that which is basically telemedicine home based pulmonary rehab next. 99 00:15:34.960 --> 00:15:41.150 Dr. Daniel Doyle: So what has happened in the 5 years or 6 years since this 100 00:15:41.560 --> 00:15:44.340 Dr. Daniel Doyle: C. O. Pd. National Action plan came out 101 00:15:44.530 --> 00:15:55.050 Dr. Daniel Doyle: well in March, 2,018, 5 years ago, and Nhlb. I hosted a national meeting at Nih, in Bethesda to launch the plan and get input from 102 00:15:55.080 --> 00:15:57.750 people all around the country on how to implement it. 103 00:15:57.920 --> 00:16:08.990 Dr. Daniel Doyle: We were there. We actually were invited to present at that conference on our rural pulmonary rehabilitation network here, because we were already 5 years into it. 104 00:16:09.290 --> 00:16:22.440 Dr. Daniel Doyle: December 2021 Nhlb. I hosted an international webinar, on what they call pulmonary tele rehabilitation, or tele-rehab we call it a home-based pulmonary rehab. 105 00:16:22.640 --> 00:16:29.370 Dr. Daniel Doyle: We've we've experimented with and and done home based pulmonary rehab here at a couple of our sites. 106 00:16:29.790 --> 00:16:40.830 Dr. Daniel Doyle: and this particular Webinar had people from all over the world talking about how they use home-based rehab. It's especially used in Australia, where people are 107 00:16:41.060 --> 00:16:55.440 Dr. Daniel Doyle: days from pulmonary rehab. Not just, not just ours. It's been used in Japan. This is something that's been going on around the world for some time last year here in Charleston the Copd Foundation sponsored a 108 00:16:55.460 --> 00:17:02.240 Dr. Daniel Doyle: a forum on Copd readmissions, and i'm almost positive some of you were at that unfortunately I wasn't 109 00:17:02.650 --> 00:17:03.940 Dr. Daniel Doyle: next slide 110 00:17:08.960 --> 00:17:18.460 Dr. Daniel Doyle: and and preparation for this talk, I actually reached out to Nhl. B. I. And got their communications office and got Niall Emory Rich who 111 00:17:18.540 --> 00:17:21.290 Dr. Daniel Doyle: heads their communications office, Mitzi 112 00:17:21.589 --> 00:17:32.160 Dr. Daniel Doyle: and she and and so I asked her, you know. Is there any other things I should tell people about that have come from the Copd National Action plan 113 00:17:32.230 --> 00:17:44.040 Dr. Daniel Doyle: since it was launched, and she suggested that I tell you about these 3 things. and I might ask Natalie to send this slide deck out, because it's a little different from the one you already received. 114 00:17:44.240 --> 00:17:46.900 This slide was added in. 115 00:17:48.140 --> 00:18:07.800 Dr. Daniel Doyle: but they mentioned that they now that they have launched the Copd National Action National Action Plan, community action, tool, and essentially what that is, is a website where you can create an account, and you can actually post activities that you or your organization are carrying out that advance the goals of the Co. Pd. National Action plan. 116 00:18:07.800 --> 00:18:11.300 Dr. Daniel Doyle: and I hadn't seen it before, and so I signed us up today. 117 00:18:11.490 --> 00:18:23.150 Dr. Daniel Doyle: us being partners in Health Network and the Appalachian Pulmonary Health Project. and we should also sign up the Grace and Dorney pulmonary rehabilitation centers? 118 00:18:23.890 --> 00:18:35.940 Dr. Daniel Doyle: She asked. Did I tell you about Nhlbi's? Learn more? Breathe better program? Has a lot of excellent copd education tools in English and Spanish and other languages. 119 00:18:36.080 --> 00:18:44.870 Dr. Daniel Doyle: a lot for patient education and some for provider education. They have a small community subcontract program, 3 grantees last year. 120 00:18:45.660 --> 00:18:54.440 Dr. Daniel Doyle: And then also to mention that the learn more, breathe better program has a number of other resources which are listed here. Next slide. 121 00:18:57.790 --> 00:19:13.410 Dr. Daniel Doyle: One other thing, and and Grace and I will probably comment on this in a minute. Is that partly because of frustration, that the progress on the Copd National Action plan had been so slow, particularly in the area of research. 122 00:19:13.640 --> 00:19:26.000 Dr. Daniel Doyle: Gray-san and her husband, Ted Koppel and their foundation the Dornicopo foundation, organized this national outreach effort sos to get the word out 123 00:19:26.170 --> 00:19:30.080 Dr. Daniel Doyle: that a lot of Copd was under diagnosed. 124 00:19:30.090 --> 00:19:41.210 Dr. Daniel Doyle: What were the experiences of patients, and i'll stop there because i'm hoping Grace Anne will say more, and this is my last slide for part 1 one Copd National Action plan. 125 00:19:41.260 --> 00:19:45.560 Dr. Daniel Doyle: So, grace, and if you're I know you're on, and 126 00:19:45.740 --> 00:19:50.490 Mitzi's going to mute you and give you a chance to comment on what you've heard so far. 127 00:19:51.200 --> 00:20:01.420 Grace Anne Dorney Koppel: Well, Dan, first of all, I applaud your efforts always. and want you to know that I certainly support this this kind of Webinar 128 00:20:01.460 --> 00:20:13.180 Grace Anne Dorney Koppel: broadcast in West Virginia, which. as we all know, has the highest rate of Clpd. In the United States, and over 12% of the population diagnosed. 129 00:20:13.600 --> 00:20:16.330 Grace Anne Dorney Koppel: And if you consider that only half 130 00:20:16.700 --> 00:20:24.850 Grace Anne Dorney Koppel: of those diagnosed with Clp day are represented, the undiagnosed, would bring a quarter of the population 131 00:20:24.920 --> 00:20:26.140 Grace Anne Dorney Koppel: of 132 00:20:26.250 --> 00:20:39.360 Grace Anne Dorney Koppel: West Virginia into the Clp. D. Orbit it's not a great orbit to be in. But I I will comment on first the National Action Plan, which has kind of stalled. 133 00:20:41.630 --> 00:20:52.660 Grace Anne Dorney Koppel: In fact, there was a recent Webinar with the head of of Nhl, Bi Dr. Gary Gibbons and the head of each of the parts 134 00:20:52.800 --> 00:20:56.690 Grace Anne Dorney Koppel: of Nhlb. I. But which is a 135 00:20:57.230 --> 00:21:00.050 Grace Anne Dorney Koppel: lung and sleep and heart. 136 00:21:01.680 --> 00:21:02.550 Grace Anne Dorney Koppel: And 137 00:21:04.080 --> 00:21:08.120 Grace Anne Dorney Koppel: when we got to research plans for 138 00:21:09.210 --> 00:21:14.670 Grace Anne Dorney Koppel: for clpd specifically and for lung disease. 139 00:21:15.720 --> 00:21:18.820 Grace Anne Dorney Koppel: Dr. Kylie, who was head of the Lung division. 140 00:21:19.010 --> 00:21:22.000 Grace Anne Dorney Koppel: says it for the moment it's on pause 141 00:21:22.560 --> 00:21:23.700 Grace Anne Dorney Koppel: and end. 142 00:21:25.300 --> 00:21:37.240 Grace Anne Dorney Koppel: I, who was an attendee, and others from the Clpd Foundation, with whom I'm. Still affiliated. What kind of shock to hear that because we are still the third 143 00:21:37.300 --> 00:21:38.260 Grace Anne Dorney Koppel: killer 144 00:21:38.500 --> 00:21:46.000 Grace Anne Dorney Koppel: of Americans for chronic diseases. It's still heart disease. cancer, clp day. 145 00:21:46.580 --> 00:21:51.500 Grace Anne Dorney Koppel: So i'm hoping that that will change. I know that 146 00:21:51.780 --> 00:22:02.060 Grace Anne Dorney Koppel: Dr. Kylie's artist in the right place, and I use that deliberately. I just hope that the lungs will be in the right place soon, too. 147 00:22:02.200 --> 00:22:06.290 Grace Anne Dorney Koppel: and i'll just make a mention about C. O. P. D. Sos. 148 00:22:06.570 --> 00:22:09.790 Grace Anne Dorney Koppel: I did also refer to 149 00:22:09.960 --> 00:22:14.870 Grace Anne Dorney Koppel: 16 million diagnosed in the United States, and we believe another 150 00:22:15.140 --> 00:22:16.700 Grace Anne Dorney Koppel: 16 million 151 00:22:17.090 --> 00:22:23.290 Grace Anne Dorney Koppel: have Copd and are not diagnosed, and clearly, if we could catch them earlier 152 00:22:23.450 --> 00:22:25.910 Grace Anne Dorney Koppel: in the disease process. 153 00:22:26.470 --> 00:22:37.970 Grace Anne Dorney Koppel: we could achieve much more. and I hope that this campaign, which was joined in by about 18 other organizations as partners 154 00:22:39.410 --> 00:22:47.780 Grace Anne Dorney Koppel: was a success. and I hope soon to reinvigorate it. because I've had some health challenges myself. 155 00:22:47.890 --> 00:22:54.120 Grace Anne Dorney Koppel: so this has not been at the very top of my agenda, but it is moving to that space now. 156 00:22:54.640 --> 00:22:59.490 Grace Anne Dorney Koppel: and I am very proud of what Dr. Doyle and others 157 00:22:59.970 --> 00:23:07.880 Grace Anne Dorney Koppel: have been able to achieve an Appalachia in terms of not only awareness of clpd, but putting boots on the ground 158 00:23:08.010 --> 00:23:13.410 Grace Anne Dorney Koppel: and graduating patients from pulmonary rehab, which actually makes 159 00:23:13.560 --> 00:23:18.180 Grace Anne Dorney Koppel: the greatest difference in their lives, and improves breathlessness. 160 00:23:18.310 --> 00:23:19.830 Grace Anne Dorney Koppel: physical function. 161 00:23:20.260 --> 00:23:27.380 Grace Anne Dorney Koppel: quality of life Better better. I repeat that that any other therapy 162 00:23:27.690 --> 00:23:33.440 Grace Anne Dorney Koppel: and that's from this is national pulmonary rehab week from March the twelfth to the eighteenth. 163 00:23:33.740 --> 00:23:44.640 Grace Anne Dorney Koppel: What I just stated was a direct quote from the Ats pulmonary Rehab assembly that I'm a member of in the National. I hope you have a slide on that, Dan. 164 00:23:44.760 --> 00:23:52.590 Grace Anne Dorney Koppel: to show the benefits of pulmonary rehab included a mortality benefit which is something extraordinary. 165 00:23:52.860 --> 00:23:55.480 Grace Anne Dorney Koppel: So with that I turn it back to you. 166 00:23:57.660 --> 00:23:58.950 Dr. Daniel Doyle: Thanks, Grace, Anne. 167 00:23:58.980 --> 00:24:09.000 Dr. Daniel Doyle: and we're going to talk about Gracie and doorny pulmonary rehab centers and the a Php now. And so I'm. Definitely going to ask you to to chime in again 168 00:24:09.920 --> 00:24:10.950 Dr. Daniel Doyle: next slide. 169 00:24:18.330 --> 00:24:24.400 Dr. Daniel Doyle: So now we're turning from the National action plan, a national effort, an initiative. 170 00:24:24.940 --> 00:24:27.970 Dr. Daniel Doyle: and even if it's stalled, it's good to have a plan. 171 00:24:28.350 --> 00:24:43.140 Dr. Daniel Doyle: We know what we, what we will do and what we can do when we're given the resources to do it. So here in West Virginia we have something called the Appalachian Pulmonary Health Project, and and I have been part of that 172 00:24:43.390 --> 00:24:51.970 Dr. Daniel Doyle: from the beginning, and really the beginning was before there was any Appalachian pulmonary health project. We coined that name in 2,018, 173 00:24:52.040 --> 00:24:58.620 Dr. Daniel Doyle: but 5 years before that were the Gracie and Dorny, pulmonary rehab centers. And really 174 00:24:58.980 --> 00:25:05.410 Dr. Daniel Doyle: she and and Ted were the ones that got this whole ball rolling and got me involved 175 00:25:05.540 --> 00:25:06.580 Dr. Daniel Doyle: next slide. 176 00:25:15.640 --> 00:25:21.480 So so this shows a little bit of that timeline partners in health. And so here comes the alphabet. So 177 00:25:21.570 --> 00:25:33.950 Dr. Daniel Doyle: partners in Health network which some of you are familiar with is based here in Charleston, West Virginia. It's a nonprofit rural health network made up of something like 35 different rural hospitals, Fqh. Cs. 178 00:25:34.120 --> 00:25:52.710 Dr. Daniel Doyle: Ems. Organizations. Cmc. Itself. It has an independent board of Cmc. But it is affiliated with. and it it it's it's mainly health care providers in Central and Southern West Virginia, and they've been around since 1,995 179 00:25:52.820 --> 00:26:05.810 Dr. Daniel Doyle: trying to support all these different rural health providers and link them together in 2,013. We were approached by Grace and Dorney and her husband, Ted Koppel. 180 00:26:05.880 --> 00:26:21.920 Dr. Daniel Doyle: who had a family foundation whose goal was to spread availability to pulmonary rehab. They live in Maryland so, and they knew about, as you just heard Gracie, and talk about the high prevalence of copd morbidity and mortality in this State. 181 00:26:22.020 --> 00:26:34.490 Dr. Daniel Doyle: and they decided that they wanted to reach out and try to make pulmonary rehab more available in West Virginia. They talked to their friend Senator J. Rockefeller, and asked him for some connections, and 182 00:26:34.570 --> 00:26:42.280 Dr. Daniel Doyle: he recommended that they talked to Craig Robinson, administrator of Cabin Creek health Center and in some ways the rest is history. 183 00:26:44.990 --> 00:26:56.470 Dr. Daniel Doyle: and and we start, and that's when the Grace and Dorny pulmonary rehab center started it wasn't until 5 years later, when the the different respiratory therapists who had been needing and I was meeting with them. 184 00:26:56.470 --> 00:27:12.300 Dr. Daniel Doyle: decided that we would expand a bit beyond continue with our pulmonary rehab continue to identify ourselves as gracieand or pulmonary rehab centers, but expand to a a project that included prevention and also care coordination and we named that 185 00:27:12.300 --> 00:27:26.150 Dr. Daniel Doyle: the Appalachian pulmonary health project, and we affiliated ourselves with partners in health Health network largely, so that we would have a a fiscal agent, since we weren't incorporated ourselves 186 00:27:26.290 --> 00:27:27.320 Dr. Daniel Doyle: next slide. 187 00:27:32.030 --> 00:27:41.140 Dr. Daniel Doyle: I think. Click again, Mitzi, because I think I animated this slide. Keep going, so I get all 4 goals. One more great. Well innovation works. 188 00:27:41.170 --> 00:27:59.050 Dr. Daniel Doyle: So we have. So the Appalachian Pulmonary Health Projection plan has 5 main goals. The Appalachian Pulmonary health project of partners in Health Network has 4 main goals to work for the primary prevention of yeah. So we we had spent 189 00:27:59.050 --> 00:28:02.450 our whole careers mostly, and most of our time treating 190 00:28:02.480 --> 00:28:13.250 Dr. Daniel Doyle: the end stages of, but we felt like we wanted to do something for prevention and and intervene at the very root of the problem. And you'll hear about that 191 00:28:13.400 --> 00:28:18.080 to expand access to quality, assured spirometry in rural areas that had been an issue. 192 00:28:18.250 --> 00:28:29.330 Dr. Daniel Doyle: Many doctors off offices, even health centers had no good spirometry. Perhaps a medical assistant had a little handheld spirometer 193 00:28:29.380 --> 00:28:39.440 Dr. Daniel Doyle: that that sheer he could use if the doctor ordered it. But everybody's in a hurry, and so we knew that if we ordered that it would slow her down, and so generally 194 00:28:39.610 --> 00:28:48.800 Dr. Daniel Doyle: any spirometry tended to not be available, and frequently, if it was available, people hadn't really had adequate training and the equipment wasn't that good 195 00:28:49.150 --> 00:28:59.380 Dr. Daniel Doyle: to expand access to pulmonary rehab to our rural areas, and then to provide more care management and better cure management for our patients with chronic lung diseases. 196 00:28:59.880 --> 00:29:03.320 Dr. Daniel Doyle: So i'm going to go through each of these 197 00:29:03.400 --> 00:29:04.770 Dr. Daniel Doyle: next slide. 198 00:29:10.670 --> 00:29:17.050 Dr. Daniel Doyle: Okay. So number one working for primary prevention. How did we do that next slide? 199 00:29:21.210 --> 00:29:29.920 Dr. Daniel Doyle: How did we? And how do we do that? I want to mention that tobacco use is the leading cause of of preventable disease and death in the United States 200 00:29:29.970 --> 00:29:32.570 Dr. Daniel Doyle: I were very aware of lung disease. 201 00:29:33.730 --> 00:29:50.850 Dr. Daniel Doyle: Tobacco uses associated is the cause of not all copd around 70%. There are other causes, especially occupational causes. But tobacco use is the leading cause of preventable disease, and not just for the for lung diseases. But, as you know, for cardiovascular disease for a number of cancers. 202 00:29:51.280 --> 00:30:00.640 Dr. Daniel Doyle: peripheral, peripheral, vascular disease, very important, and nearly all tobacco product use begins during youth and young adulthood. 203 00:30:00.710 --> 00:30:11.420 Dr. Daniel Doyle: so that, knowing that told us that we needed to intervene with the young People, and the logical place to go was school 204 00:30:12.050 --> 00:30:18.100 Dr. Daniel Doyle: to prevent c. Opd. Prevent first use and prevent it in youth and young adults. Next slide 205 00:30:25.220 --> 00:30:27.990 We're going to work with schools 206 00:30:30.840 --> 00:30:47.200 Dr. Daniel Doyle: when we and when we looked at schools and talked to at that point in 2,017 or 2,018, I still was of the mindset that it was about cigarette smoking, but we very quickly learned that we were right on the edge of a vaping epidemic which all of you know about. Because you have kids. They tell you about it. 207 00:30:47.580 --> 00:30:53.170 Dr. Daniel Doyle: Some of you might be school school health nurses. This has been a huge problem. 208 00:30:53.440 --> 00:31:05.610 Dr. Daniel Doyle: and you can see just from 2,018 to 2,019 nationally vaping use in middle schools went from 5% to over 10% more than doubled just in a year. 209 00:31:05.840 --> 00:31:17.060 Dr. Daniel Doyle: and at that time in 2,019 and high schools. It was 27, so we knew that if we wanted to intervene it it was going to be about vaping 210 00:31:17.220 --> 00:31:23.340 Dr. Daniel Doyle: next slide. So our next step was to look for a program or a curriculum 211 00:31:23.560 --> 00:31:36.750 Dr. Daniel Doyle: that worked, and we pretty quickly came to this catch. My breath. Vaping prevention program developed by the University of Texas School of Public Health in Houston 212 00:31:36.940 --> 00:31:42.220 Dr. Daniel Doyle: has 4 forty-minute sessions it's once a week for 4 weeks. It's interactive and hands-on. 213 00:31:42.280 --> 00:31:52.990 Dr. Daniel Doyle: Once we got our our hands on this I actually went and delivered this curriculum myself with health teachers at Eastbank Middle School in Uppercana Valley. 214 00:31:53.130 --> 00:31:59.450 Dr. Daniel Doyle: and and learned about it. It's free to schools with funding from the Cvs Foundation 215 00:32:00.230 --> 00:32:01.510 Dr. Daniel Doyle: next slide 216 00:32:07.800 --> 00:32:10.910 Dr. Daniel Doyle: researchers at the 217 00:32:11.000 --> 00:32:18.660 Dr. Daniel Doyle: University of Texas School of Public Health, and this is primarily Dr. Steven Kelder, but he has a whole team working on this. 218 00:32:18.760 --> 00:32:23.450 I did research on this, and they came up with this interesting infographic which 219 00:32:23.500 --> 00:32:34.060 Dr. Daniel Doyle: the average seventh grade class size in the Us. Is 192 students. And, by the way, there are 18,000 seventh graders in West Virginia, and 220 00:32:34.100 --> 00:32:42.650 Dr. Daniel Doyle: because we have rural areas, I'm. Sure that many seventh grade classes I know that many are less than 192. But in some of our 221 00:32:42.830 --> 00:32:47.250 Dr. Daniel Doyle: bigger schools in our cities. It it could be this or more 222 00:32:47.400 --> 00:32:59.570 Dr. Daniel Doyle: so. 192 students average. If we do nothing 17, we'll start vaping with the catch of my breath program. They found that half of those 223 00:32:59.580 --> 00:33:10.360 Dr. Daniel Doyle: 8 would be prevented, and when they projected that onto the total seventh grade population in the country. That would mean that 152,000 students didn't start. 224 00:33:10.360 --> 00:33:20.740 Dr. Daniel Doyle: and we know that vaping often leads to cigarette use as well, and perhaps other drugs. So some people consider nicotine a gateway. 225 00:33:21.720 --> 00:33:27.060 Dr. Daniel Doyle: and if some of you on the call no, it's a gateway drug. Speak up in in our discussion next slide. 226 00:33:32.320 --> 00:33:45.140 Dr. Daniel Doyle: This is how it has moved to reach many parts of the country since it was developed in Texas. It's not surprising that that this public health measure has been widely applied in Texas. 227 00:33:45.420 --> 00:33:49.790 Dr. Daniel Doyle: so their colors on the left are are where there's greater use. 228 00:33:49.830 --> 00:34:00.630 and a lighter color is less use; but as of 2,019 it had been, it was being used in 49 states, 1,100 schools, and over 300,000 students 229 00:34:00.720 --> 00:34:07.350 Dr. Daniel Doyle: by last year. It was in all 50 states, 5,500 schools, 1.8 million students. 230 00:34:07.470 --> 00:34:19.130 Dr. Daniel Doyle: You can see that there's a little bit of not a red spot, but an orange spot kind of in West Virginia. So this this slide, you know. The very red is where it's being used a lot. 231 00:34:19.170 --> 00:34:30.460 Dr. Daniel Doyle: And then the orange last pink lesson blew. Not at all. And so I think, in a small way we contributed to this reach of the program in our State next slide. 232 00:34:33.460 --> 00:34:41.830 Dr. Daniel Doyle: So then we looked for funding for how to do this, and we we got help from the Palatine foundation of Huntington 233 00:34:42.010 --> 00:34:53.840 Dr. Daniel Doyle: we applied, and we received funding in 2,019, and in the our grain application. Our commitment was to provide this to 4 counties, 10 schools, and 2,400 students. 234 00:34:54.040 --> 00:35:00.300 Dr. Daniel Doyle: It was a two-year grant because of the pandemic and school being stopped in 2,020, 235 00:35:00.310 --> 00:35:05.670 Dr. Daniel Doyle: they allowed us to. They allowed us an extra year, and at the end of that year 236 00:35:06.000 --> 00:35:14.660 Dr. Daniel Doyle: so we would have finished up in 2,021. But Instead, we're actually this is our our final semester right now. We're finishing up this after this spring semester. 237 00:35:14.820 --> 00:35:25.990 Dr. Daniel Doyle: So we we wound up, going for 4 years, and as of December completing 7 of our 8 semesters, we were serving 9 counties, 25 schools, and 7,000 students. 238 00:35:26.210 --> 00:35:44.400 Dr. Daniel Doyle: So, after being sort of stopped in our tracks. We recovered and and feel good about this reach, and are are right now seeking funding to expand the program, and I can say that the West Virginia Bureau of Health is also really interested in expanding this program, and our new commissioner, Matt Christensen. 239 00:35:44.990 --> 00:35:51.990 Dr. Daniel Doyle: I've heard him quoted secondhand a saying that he would like to bring this to all 55 counties next slide. 240 00:35:56.710 --> 00:36:05.890 Dr. Daniel Doyle: So that was that's goal number one of the a Php primary prevention, and I I feel good that we be able, but and actually able to walk our talk on that 241 00:36:05.990 --> 00:36:24.880 Dr. Daniel Doyle: our next 2 goals, expanding access to quality, assert spirometry and expanding access to pulmonary rehab. Really, that's what we started with the gray Sand Dorny pulmonary rehab centers in 2,013. So we've been doing this now for 10 years. That program is going strong. I'll tell you a little bit about it next slide. 242 00:36:28.040 --> 00:36:35.270 Dr. Daniel Doyle: so many of you know. But just to review improving access to quality. 243 00:36:35.370 --> 00:36:40.620 culinary function tests and pulmonary rehabilitation in rural areas. The reason this is important. 244 00:36:40.740 --> 00:36:49.680 Dr. Daniel Doyle: as Grace Anne, already mentioned is pulmonary rehab is it has important benefits. For a long time we've known from 245 00:36:49.800 --> 00:36:50.710 Dr. Daniel Doyle: from 246 00:36:51.080 --> 00:36:54.790 really randomized studies or or control studies. 247 00:36:54.860 --> 00:37:06.200 Dr. Daniel Doyle: that it reduces dysmia. Shortness of breath improves exercise tolerance, and improves quality of life. We also know that it reduces 30 day readmissions after Copd exacerbations. 248 00:37:06.460 --> 00:37:11.260 Dr. Daniel Doyle: That alphabet, soup, acronym is acute exacerbation of 249 00:37:11.720 --> 00:37:23.840 Dr. Daniel Doyle: and as gray Sand mentioned, and she'll scold me for not having that bullet on this slide that it has been now shown to have a mortality benefit, as well to actually reduce mortality with yeah. 250 00:37:23.910 --> 00:37:24.860 Dr. Daniel Doyle: next slide. 251 00:37:27.270 --> 00:37:45.820 Dr. Daniel Doyle: She mentioned how how the great cost effectiveness of pulmonary rehabilitation, and this is the Copd value pyramid developed as a joint project of the London School of Economics and the London Respiratory Team in 2,013, 252 00:37:45.920 --> 00:37:55.750 Dr. Daniel Doyle: and they studied the different Co. Pd. Treatments. the greatest and the measure they used was quality adjusted life, years. 253 00:37:55.870 --> 00:37:58.390 an epidemiologist measure. 254 00:37:58.590 --> 00:38:12.640 Dr. Daniel Doyle: and what they found was that this the single greatest thing for for getting more quality adjusted life years per At that point your British pound 255 00:38:12.740 --> 00:38:30.170 Dr. Daniel Doyle: was actually flu vaccine, and then the next one was smoking cessation support, including nicotine replacement for that. and then came, and then pulmonary rehabilitation came next, and before any of the medications we use, all the inhalers we use, and and 256 00:38:30.340 --> 00:38:32.790 the expensive inhalers that we use. 257 00:38:32.830 --> 00:38:48.170 Dr. Daniel Doyle: And then finally at the top, was telemedicine. So all of these treatments are important and and are cost-effective, but the most cost the right down there near the base of the pyramid, is pulmonary rehabilitation, so the clinical benefits, and also the cost benefits 258 00:38:48.890 --> 00:38:54.870 Dr. Daniel Doyle: of pulmonary rehab are great, and and tend to be underappreciated by my colleagues and 259 00:38:54.890 --> 00:39:03.130 Dr. Daniel Doyle: frontline medical care providers in general. So part of our job is to educate primary care providers about this. 260 00:39:07.660 --> 00:39:11.190 Dr. Daniel Doyle: So in 2,013. I told you about 261 00:39:11.570 --> 00:39:21.410 Dr. Daniel Doyle: Grace Anne and Ted and the Doorney Koppel Foundation, with the help of Senator Rockefeller coming to us and saying, we want to do this? Are Are you up for it? Are you game? And we said, Yes. 262 00:39:22.000 --> 00:39:32.040 Dr. Daniel Doyle: you all know it's hard to say no to a funder. But this was already something we were dealing with, and we knew it was important. 263 00:39:32.170 --> 00:39:40.670 Dr. Daniel Doyle: Honestly, I knew almost nothing about pulmonary rehab. At that point Selimer never referred my patients for it. 264 00:39:41.070 --> 00:39:45.640 Dr. Daniel Doyle: but came and learned about the Cochrane reviews, showing its effectiveness. 265 00:39:45.980 --> 00:39:53.300 Dr. Daniel Doyle: and was enthusiastic to be to learn about this, and to be able to bring it to our patients at New River, in Cabin Creek. 266 00:39:53.550 --> 00:40:04.680 Dr. Daniel Doyle: and so in in the autumn of 2,013, we started with our first 3 sites. With the help of the Dorne Koppel foundation and their funding partners. they definitely had a big 267 00:40:04.780 --> 00:40:10.720 Dr. Daniel Doyle: wanted skin in the game from the local communities. And so 268 00:40:10.820 --> 00:40:19.110 Dr. Daniel Doyle: Craig Robinson wrote the original grant. The grantee was Cabin Creek, but he got additional matching funding from Cmc. 269 00:40:19.470 --> 00:40:26.420 Dr. Daniel Doyle: From the Benetham Foundation. and from the United Mine Workers of America actually Union next slide. 270 00:40:29.710 --> 00:40:47.320 Dr. Daniel Doyle: This was our grand opening at Cabinet Creek, Health Center in Dos. right off the share and exit on I. 77 in November, in November, 2,013. The picture is a little dark, but left to right are Craig Robinson, the CEO of Cabin Creek House Center then, and now 271 00:40:47.430 --> 00:40:56.940 Dr. Daniel Doyle: Kim Tamman, of the Benedham Foundation. That's Cecil Roberts there the President of the United Mine Workers then, and now 272 00:40:57.330 --> 00:41:02.960 Dr. Daniel Doyle: standing to us under Rockefeller, then Grace an then Ted Koppel. So that was 273 00:41:03.170 --> 00:41:06.380 Dr. Daniel Doyle: a big day that was launching the ship next slide. 274 00:41:11.710 --> 00:41:15.340 Dr. Daniel Doyle: This shows the 10 different 275 00:41:15.670 --> 00:41:33.030 Dr. Daniel Doyle: pulmonary rehab sites that are the Grace and dorny pulmonary rehab sites around the State a week. There is one in Eastern Kentucky, and they actually they stopped doing pulmonary rehab for a while, because both our site in Kentucky and in North Carolina 276 00:41:33.040 --> 00:41:40.680 Dr. Daniel Doyle: found that they were having trouble recruiting patients, and it might have been because their sites were kind of out of the way, even even for their patients. 277 00:41:40.910 --> 00:41:56.520 Dr. Daniel Doyle: But then Big Sandy healthcare started again. Recently the other sites I Won't read off all the names, but you can see where they're located around the site. I. We should probably add, C. Amc. To this map, because 278 00:41:56.650 --> 00:42:14.730 Dr. Daniel Doyle: they. They are a central hospital based site, but they are an important partner with us, including in training the original respiratory therapists. At these sites many of these sites did not have respiratory therapists until the great, the dornecopal funding, and that was one of the conditions for the funding was that they hire a respiratory therapist. 279 00:42:14.730 --> 00:42:29.110 Dr. Daniel Doyle: and and that's what allowed us to bring quality pulmonary function testing to those sites because all of them were niosh-certified in doing valid high quality pulmonary function testing, I added, 3 that have just recently joined us. 280 00:42:29.110 --> 00:42:36.810 Dr. Daniel Doyle: Minnie Hamilton, in Calhoun County, Pocahontas memorial in Marlington, and Charles Kennison from there is is on the Webinar with us 281 00:42:36.860 --> 00:42:41.120 Dr. Daniel Doyle: and Montgomery, General Hospital, Montgomery, and Fayette County, next slide 282 00:42:44.880 --> 00:42:58.220 Dr. Daniel Doyle: one of the great things about the great S. And Dority pulmonary rehab centers in West Virginia is that as these new respiratory therapists found new jobs in the Fqhcs, and sometimes in the in the rural hospitals. 283 00:42:58.240 --> 00:43:01.010 Dr. Daniel Doyle: doing education which they loved. 284 00:43:02.720 --> 00:43:10.360 Dr. Daniel Doyle: They kind of created a community among each other. And actually, since the very beginning we have been meeting quarterly 285 00:43:10.650 --> 00:43:22.160 Dr. Daniel Doyle: for them, and primarily those quarterly meetings are a chance for them to talk with each other, share share things that they've learned about supplies, about equipment. 286 00:43:22.170 --> 00:43:35.930 Dr. Daniel Doyle: and it's it's really you know how hard it is to get people to come keep coming to meetings. And and these guys have regularly showed up at meetings, and it's mainly because they love talking to each other. So it's been. This network has 287 00:43:35.950 --> 00:43:39.880 Dr. Daniel Doyle: has been really exciting, and I've been at all the meetings I've been with them all the way 288 00:43:41.130 --> 00:43:55.930 Dr. Daniel Doyle: for them to have the support they need that that peer support that we talk about with doctors that keeps you going in rural areas, and not surprisingly, most of them are from the rural areas. We've got people here from Jackson, General Hospital. 289 00:43:55.980 --> 00:43:58.510 Dr. Daniel Doyle: Boone Memorial Hospital 290 00:43:58.780 --> 00:44:07.220 Dr. Daniel Doyle: from Man Hospital in Logan County, from New River, in Fett County, from Cabin Creek, from Lincoln County. 291 00:44:07.230 --> 00:44:17.940 Dr. Daniel Doyle: from Fake and and and and, as I said, from Pad County, and also from Eastern Kentucky, Big Sandy healthcare. This was their meeting in 2,017 next slide. Since since the pandemic. 292 00:44:18.000 --> 00:44:25.060 Dr. Daniel Doyle: like so many things, we've been meeting virtually. So here's what we've accomplished over these 10 years. 293 00:44:25.190 --> 00:44:31.900 Dr. Daniel Doyle: We've done over a 1,000 pulmonary Rehab intakes since 2,013. 294 00:44:32.040 --> 00:44:38.050 Dr. Daniel Doyle: We've looked at pulmonary rehab is 12 weeks 24 sessions. It takes a lot of commitment 295 00:44:38.060 --> 00:44:44.500 Dr. Daniel Doyle: to be able to finish the whole thing, and what we found is the graduation rate is around 50%. 296 00:44:44.710 --> 00:44:46.650 Dr. Daniel Doyle: So 297 00:44:47.090 --> 00:44:55.820 Dr. Daniel Doyle: a 1,000 intakes. We just were looking at our data this past week. Dr. Mary Emmett, who is also on this call, has been summarizing this and 298 00:44:55.890 --> 00:45:05.510 Dr. Daniel Doyle: Mary. We should probably try to get you to comment as well. But basically what you see here is the steady growth from from 2,013 299 00:45:05.650 --> 00:45:09.400 Dr. Daniel Doyle: up until 2,01819 300 00:45:09.490 --> 00:45:22.460 Dr. Daniel Doyle: peaking around 200 intakes a year for the network, and then the pandemic came and crash. Mostly we stopped doing pulmonary rehab for a few months during this time. 301 00:45:22.470 --> 00:45:31.140 Dr. Daniel Doyle: But then, since then you can see how things have built back up again. We've really worked hard on that, and and are happy to see the recovery of this network next slide. 302 00:45:35.690 --> 00:45:46.010 Dr. Daniel Doyle: And last, but not least, we have a goal that is near and dear to all of your hearts or most of you. which is to provide care management for persons with chronic lung disease. 303 00:45:46.190 --> 00:45:50.490 Dr. Daniel Doyle: and I have one more slide. That shows how we've been doing this 304 00:45:50.890 --> 00:45:51.920 next slide. 305 00:45:55.880 --> 00:46:00.540 Dr. Daniel Doyle: So a lot has happened just in the past year with this. 306 00:46:00.850 --> 00:46:07.190 Dr. Daniel Doyle: and and a lot of that has to do with us, getting a full time coordinator 307 00:46:07.770 --> 00:46:16.700 Dr. Daniel Doyle: for the Appalachian Pulmonary Health Project and Health Network, and was finishing up another project. The accountable health care Communities Project 308 00:46:16.850 --> 00:46:18.350 Dr. Daniel Doyle: of Cms. 309 00:46:18.650 --> 00:46:23.790 Dr. Daniel Doyle: And her name is Hillary Payne, and she might be on this call. 310 00:46:24.150 --> 00:46:40.860 Dr. Daniel Doyle: I know that she and Tom Kuhn, from partners in health, are actually down visiting the Grace and Dorny Pulmonary Rehab center in Mayan, in Logan County today, because one of the things we try to do is get out and visit these sites at least once a year, and sometimes twice a year. But on the care management side 311 00:46:40.860 --> 00:46:47.070 Dr. Daniel Doyle: we've worked Hillary and Tom and I, all, but especially Hillary, have worked a lot with Camc 312 00:46:47.110 --> 00:46:55.040 Dr. Daniel Doyle: Morgan Meeks from division of pulmonary medicine at Cmc. Is on this call. She's been really important in this Dr. Mary Emmett 313 00:46:55.170 --> 00:47:04.580 Dr. Daniel Doyle: and Adam Johnstone is on the call, and he's the one who is responsible for Bullet Number 3 there. The daily Copd Admissions report 314 00:47:04.610 --> 00:47:06.680 Dr. Daniel Doyle: which tells, so we've. 315 00:47:06.930 --> 00:47:19.910 Dr. Daniel Doyle: So a Php. Has worked with Camc to get this report to look at the report we asked Adam to add the Zip code and town where people live so we could look and see where the patients live. 316 00:47:19.910 --> 00:47:36.710 Dr. Daniel Doyle: and then identify which one of our rural sites they would be closest to if they are out from rural areas, our main sites, which which tend to have our patients submitted to Cmc. Or Cap on Creek Boone Memorial, New River Health. 317 00:47:36.710 --> 00:47:41.860 Dr. Daniel Doyle: but we get some patients also from Marone, General from Jackson, General 318 00:47:43.500 --> 00:47:53.280 Dr. Daniel Doyle: So and and and from Lincoln County as well. But so we've been working together a lot over the past year to kind of close the loop between the patients who are admitted 319 00:47:53.340 --> 00:48:10.130 Dr. Daniel Doyle: discharged, and then to get them in touch with their local pulmonary rehab. So it reminds many of you know who Dr. Don Berwick is, and it reminds me of a talk he gave back in 2,019 when he said that hospitals say they're discharging patients. They really mean it. 320 00:48:11.340 --> 00:48:22.520 Dr. Daniel Doyle: A lot of work has been done since then. Many of you are involved in it to make to make sure that discharge is not just dumping people out off the cliff, but that there is follow-up and good transitional care. 321 00:48:24.240 --> 00:48:33.410 Dr. Daniel Doyle: And next slide, which I think says end. Okay. So we have a little over 10 min. 322 00:48:33.640 --> 00:48:35.300 Dr. Daniel Doyle: and 323 00:48:35.350 --> 00:48:40.050 Dr. Daniel Doyle: i'm gonna I'm going to ask Gray Sand to go ahead and comment on 324 00:48:40.380 --> 00:48:52.880 Dr. Daniel Doyle: whatever you would like the the second part, Grayson, and then ask Dr. Mary Emmett to comment as well. And if you don't mind, Nitzi, go back when Dr. Emmett speaks, Go back to that slide that showed 325 00:48:52.950 --> 00:48:57.710 Dr. Daniel Doyle: the the bar graph of all the intakes. But Gracie and go ahead. 326 00:48:58.710 --> 00:49:10.790 Grace Anne Dorney Koppel: Well, first of all. I want to thank you, Dan, because what has been achieved. much of it under your leadership in West Virginia is is is quite amazing and 327 00:49:10.980 --> 00:49:22.840 Grace Anne Dorney Koppel: and very, very gratifying, because. in terms of the 1,000 intakes over this period of time. you have been able to improve the quality of life and functionality 328 00:49:22.970 --> 00:49:25.510 Grace Anne Dorney Koppel: of people living with lung disease. 329 00:49:25.520 --> 00:49:30.090 Grace Anne Dorney Koppel: particularly those with Clpd, and I applaud your efforts. 330 00:49:30.240 --> 00:49:45.120 Grace Anne Dorney Koppel: I do. If you're not going to show the infographic that the Ats Assembly and I worked on for pulmonary Re-head week this week. I will draw one thing to the attention of of those listening. 331 00:49:45.380 --> 00:49:47.850 Grace Anne Dorney Koppel: and that is, we have some new data. 332 00:49:48.700 --> 00:49:55.090 Grace Anne Dorney Koppel: Dr. Marshall, who was published in Jama Open Network. 333 00:49:55.120 --> 00:49:57.360 Grace Anne Dorney Koppel: has completed a study 334 00:49:57.820 --> 00:50:04.270 Grace Anne Dorney Koppel: that $5,721 would be saved per patient 335 00:50:04.330 --> 00:50:08.080 Grace Anne Dorney Koppel: by undertaking timely pulmonary rehab 336 00:50:08.140 --> 00:50:11.290 Grace Anne Dorney Koppel: following a Copd hospitalization. 337 00:50:11.500 --> 00:50:16.960 Grace Anne Dorney Koppel: This would result in a 1 billiondollars saved by medicare annually. 338 00:50:17.760 --> 00:50:18.730 Grace Anne Dorney Koppel: Now. 339 00:50:19.050 --> 00:50:22.300 Grace Anne Dorney Koppel: we we did not have really great cost data. 340 00:50:22.330 --> 00:50:23.750 Grace Anne Dorney Koppel: and that's why you're 341 00:50:23.760 --> 00:50:28.580 Dr. Daniel Doyle: still using the pyramid showing the pulmonary rehab gets more bang for the buck. 342 00:50:29.190 --> 00:50:29.950 Grace Anne Dorney Koppel: But 343 00:50:30.180 --> 00:50:30.770 yeah. 344 00:50:31.190 --> 00:50:35.820 Grace Anne Dorney Koppel: I believe that what You've started with Cmu. 345 00:50:35.890 --> 00:50:45.080 Grace Anne Dorney Koppel: and that is looking at who is being discharged, who has been in a hospital for a copd Exacerbation 346 00:50:45.350 --> 00:50:49.610 Grace Anne Dorney Koppel: is really the way to capture these people. And if you do. 347 00:50:49.890 --> 00:51:09.050 Grace Anne Dorney Koppel: using the leverage of the study that we now have of what the cost savings would be, should be something that everyone in the community is interested in, because it not only does all those wonderful things like help with breathlessness and physical function and quality of life better 348 00:51:09.050 --> 00:51:12.850 Grace Anne Dorney Koppel: than any other therapy, but it also would save money. 349 00:51:12.990 --> 00:51:20.140 Grace Anne Dorney Koppel: So I really do want to underscore that. And again thank you for all your efforts. Thank you. Very soon 350 00:51:20.690 --> 00:51:24.540 Dr. Daniel Doyle: we wouldn't be here without you. Dr. Emmett. 351 00:51:25.160 --> 00:51:31.340 Dr. Daniel Doyle: And hey, could you go back to the Bar Graph slide, please, Mitzi, sure that that's about 3 back 352 00:51:31.620 --> 00:51:32.670 Quality Insights: this one. 353 00:51:32.780 --> 00:51:36.690 Dr. Daniel Doyle: No next next. Yeah. 354 00:51:36.940 --> 00:51:37.590 Quality Insights: Well. 355 00:51:37.840 --> 00:51:45.500 Dr. Daniel Doyle: I think I might be ahead of you. Here is it this one? I'll wait for it to come back toward the end. There, right there. 356 00:51:48.950 --> 00:51:57.130 Mary Emmett: Thank you. Thank you very much for the opportunity to to jump in and just say this documents a great legacy. 357 00:51:57.290 --> 00:52:11.440 Mary Emmett: and this presentation out of papers preserved for po austerity's sake. because it really shows the work that has been done by multiple people across 358 00:52:11.830 --> 00:52:14.690 Mary Emmett: from one company to another continent 359 00:52:15.160 --> 00:52:19.910 Mary Emmett: and across the whole United States. I just want to say that 360 00:52:20.080 --> 00:52:32.540 Mary Emmett: we are in the process of really looking at our data seriously once again. and as you can see from this slide that's up there the Bar graphs the number of intakes that have occurred 361 00:52:32.590 --> 00:52:35.850 Mary Emmett: from 2,013, through 2,022. 362 00:52:36.090 --> 00:52:39.600 Mary Emmett: This bar graph is a result of 363 00:52:39.840 --> 00:52:43.950 Mary Emmett: at each site. When the person comes in and 364 00:52:44.130 --> 00:52:46.800 Mary Emmett: registers for pulmonary we have. 365 00:52:46.870 --> 00:53:01.790 Mary Emmett: and then begins the process that that is what we call it intake. and this represents individual intakes. There may be a few duplicates in it, but we'll eventually get that 366 00:53:02.100 --> 00:53:05.210 Mary Emmett: address as we look more carefully at 367 00:53:05.340 --> 00:53:07.120 Mary Emmett: individual site Data 368 00:53:07.590 --> 00:53:11.070 Mary Emmett: overall. This represents the number of persons 369 00:53:11.140 --> 00:53:15.200 Mary Emmett: that not been touched by the 370 00:53:15.730 --> 00:53:29.710 Mary Emmett: and looking at the clinical indicators that we are considering everyone that we've looked at where a person started the program and completed it has been statistics 371 00:53:29.820 --> 00:53:30.410 Mary Emmett: significant. 372 00:53:30.960 --> 00:53:34.300 Mary Emmett: So it shows a positive impact. 373 00:53:34.530 --> 00:53:35.770 Mary Emmett: I don't know 374 00:53:35.930 --> 00:53:40.000 Mary Emmett: people who are in this program and graduate from 375 00:53:40.570 --> 00:53:44.160 Mary Emmett: any of which they are all right. 376 00:53:44.780 --> 00:53:47.940 Mary Emmett: The the individual pulmonary. We have 377 00:53:48.420 --> 00:53:52.480 Mary Emmett: the other point that I would like to make is that 378 00:53:53.220 --> 00:54:01.110 Mary Emmett: this is again an opportunity that we need to strengthen. The one area is the Ph. Q. 9, which is a 379 00:54:01.210 --> 00:54:03.320 Mary Emmett: on social and 380 00:54:03.540 --> 00:54:06.590 Mary Emmett: psychological indicator of depression. 381 00:54:06.890 --> 00:54:15.270 Mary Emmett: whether it's social related to social activities, unable to get out to them. Engagement with the community engagement with others 382 00:54:15.320 --> 00:54:17.240 Mary Emmett: just being able to move about. 383 00:54:18.280 --> 00:54:27.280 Mary Emmett: We did not have enough free and post assessments in that area to show a statistically significant difference. 384 00:54:27.350 --> 00:54:32.100 Mary Emmett: But the clinical direction is positive. 385 00:54:32.200 --> 00:54:37.570 Mary Emmett: So, in other words, people social life is improving 386 00:54:37.620 --> 00:54:39.660 Mary Emmett: because of. 387 00:54:39.690 --> 00:54:49.540 Mary Emmett: And I really think we need to do a better job of capturing that. So we can focus on the overall them as well as social. 388 00:54:49.960 --> 00:54:52.350 Mary Emmett: and then raise. That makes a great point. 389 00:54:54.110 --> 00:54:55.540 Mary Emmett: Tracking people 390 00:54:56.360 --> 00:55:04.470 Mary Emmett: keep them from being readmitted. The huge cost savings not only to the health care system overall, but 391 00:55:04.530 --> 00:55:09.500 Mary Emmett: many people also pay for a tremendous amount of their care out of their pocket. 392 00:55:09.840 --> 00:55:13.740 Mary Emmett: and so it's a benefit to them as well personally. 393 00:55:15.690 --> 00:55:16.970 Mary Emmett: And Dan made up. 394 00:55:21.860 --> 00:55:25.580 Mary Emmett: We do. We have some duplicates in here, and if we can remove those. 395 00:55:25.960 --> 00:55:29.410 Mary Emmett: it's probably close to about 800 396 00:55:29.890 --> 00:55:35.260 Mary Emmett: total anti experiences overall period of time. 397 00:55:40.020 --> 00:55:50.260 Dr. Daniel Doyle: Thank you, Mary, and we have. We have a couple of minutes left. I'm sorry we don't have more, but there's still some people on, and and 398 00:55:50.430 --> 00:55:56.230 Dr. Daniel Doyle: we'd like to just open it up for other people to comment or ask questions. 399 00:55:56.960 --> 00:56:09.130 Quality Insights: Yes, and i'd like to remind everyone that you can enter questions into either the Q. A. Feature or the chat window, and it looks like we do have a question right. Now, Dr. Doyle. 400 00:56:09.450 --> 00:56:18.690 Quality Insights: this is from Pan-metor, she asks, is cardiac rehab something that those in the late phases of C opd should look into as an intervention. 401 00:56:22.860 --> 00:56:42.380 Dr. Daniel Doyle: Pulmonary rehab is is similar to, but not exactly the same as cardiac. We have cardiac rehab Medicare reimbursees cardiac rehab at about twice the rate, that it reimburses pulmonary rehab, which is one of the reasons why cardiac rehab is more available than pulmonary rehab. 402 00:56:42.600 --> 00:56:47.740 Dr. Daniel Doyle: I would say that people in the late stages of Gopd should start with pulmonary rehab 403 00:56:47.930 --> 00:57:01.320 Dr. Daniel Doyle: they would you? You're not medicare eligible for cardiac rehab, unless you have a qualifying condition. And there could be people on the line in this call who actually know the exact criteria, and if so, speak up. 404 00:57:01.520 --> 00:57:10.790 Dr. Daniel Doyle: But you have to have had some sort of recent either cardiac event or cardiac intervention like you just had bypass surgery. You're just in the hospital with Chf. 405 00:57:10.940 --> 00:57:14.850 Dr. Daniel Doyle: You just you had a recent stent placement, or mi. 406 00:57:14.970 --> 00:57:22.550 Dr. Daniel Doyle: So, pam. I hope that answers your question to to recap what they should look into as pulmonary rehab 407 00:57:22.590 --> 00:57:27.680 Dr. Daniel Doyle: and cardiac rehab. If they have a qualifying condition. 408 00:57:29.360 --> 00:57:30.360 Dr. Daniel Doyle: That's it. 409 00:57:35.680 --> 00:57:47.580 Quality Insights: Okay, it looks like we have another question. This is from Tim Ritz. He says, we know about the blue marble program. What other Mobile or at home services are available for pulmonary rehab, if any 410 00:57:48.750 --> 00:57:59.530 Dr. Daniel Doyle: Hi, Tim! So Tim Ritz is the leader of one of our Grace and Dorny pulmonary rehab centers. He's been he's a respiratory therapist. He's at Jackson, General Hospital. 411 00:57:59.570 --> 00:58:05.290 Dr. Daniel Doyle: He's been with it the project since something like 2,015, 412 00:58:06.210 --> 00:58:10.120 Dr. Daniel Doyle: and tim I don't there are others 413 00:58:10.570 --> 00:58:16.960 Dr. Daniel Doyle: I don't know. I have not had any experience with others. but 414 00:58:17.250 --> 00:58:36.570 Dr. Daniel Doyle: you know, if I were, if I were trying to figure that out. I I I'd go to my Google search, and and if you do the work, please present it at one of our quarterly meetings that's a great topic for one of our on what we call Rt. Quarterly meetings of a Php. But simple answer is, the blue marble 415 00:58:36.570 --> 00:58:41.020 Dr. Daniel Doyle: program is the only one I know of. But there are others. 416 00:58:59.480 --> 00:59:00.230 Quality Insights: Okay. 417 00:59:00.470 --> 00:59:06.950 Quality Insights: I am not seeing any other questions at this time. A couple of comments in the chat 418 00:59:08.640 --> 00:59:12.780 Quality Insights: related to the question if I didn't know if you wanted to speak to those Dr. Doyle. 419 00:59:13.000 --> 00:59:22.980 Dr. Daniel Doyle: Let's see. I'm going to the end here. Nice. Let's see, Gracie, and says important to note anyone who has respiratory symptoms 420 00:59:23.120 --> 00:59:33.700 Dr. Daniel Doyle: is eligible for pulmonary rehab. Oh, Grace, An, said Tim, several pr virtual trials are in progress. I am part of nih monitoring of the trial. So 421 00:59:33.810 --> 00:59:34.850 Dr. Daniel Doyle: so 422 00:59:35.060 --> 00:59:42.370 Dr. Daniel Doyle: after that after that conflict that international conference in 22 December 2,021, 423 00:59:42.410 --> 00:59:50.510 Dr. Daniel Doyle: I guess in hlb I and I did fund some trials of home-based pulmonary rehab what they call tele-rehab 424 00:59:50.850 --> 01:00:07.820 Dr. Daniel Doyle: and a good way to figure that out to see what's going on around the world is to go to Google Scholar or to pubmed. I've I've been familiar with projects in in Australia, in France, in Japan. 425 01:00:08.020 --> 01:00:09.550 Dr. Daniel Doyle: in Canada. 426 01:00:09.760 --> 01:00:14.600 Dr. Daniel Doyle: But those aren't things, Tim, that are available to us right here. 427 01:00:16.590 --> 01:00:21.020 Dr. Daniel Doyle: Gracie, and mentions that there's one going on at University of Alabama. 428 01:00:21.220 --> 01:00:30.100 Dr. Daniel Doyle: Pam Meter says it does. Okay, Great: yeah. Recent: Chf: Event: Thank you for the presentation. 429 01:00:30.270 --> 01:00:33.350 Dr. Daniel Doyle: Thank you. Luanne and Christopher for being with us. 430 01:00:33.970 --> 01:00:42.970 Dr. Daniel Doyle: and that's all I see, you see. And I'd i'd love to go on, but I know that you meant that you try to be done it, too. So 431 01:00:43.060 --> 01:00:51.870 Quality Insights: we did, and I. I want to Thank you, Dr. Doyle, for your time today. This has been excellent information, and I wanted to also remind everyone 432 01:00:51.920 --> 01:01:08.580 Quality Insights: to please fill out the evaluation that will pop up when you exit this Webinar today there will be a recording of today's Webinar that will be shared on our website. I'll put the specific page that that will be on in the chat right now 433 01:01:09.580 --> 01:01:11.360 Quality Insights: for everyone to see. 434 01:01:11.660 --> 01:01:25.360 Quality Insights: And there we go. You should be able to see that now. So I wanna again. Just thank everyone for attending today, Dr. Doyle. Thank you, Grace, and thank you, Dr. Emma. Thank you. 435 01:01:25.390 --> 01:01:29.420 Quality Insights: And everyone have a wonderful afternoon.