JUNE 28 - JULY 2, 2020  
30 years of Care Transitions Across the Full Continuum

PP304 – Optimizing Outcomes Through a Holistic Approach: Re-evaluation of a Care Coordination Model Focused on Intrathecal Targeted Drug Delivery

PP304 – Optimizing Outcomes Through a Holistic Approach: Re-evaluation of a Care Coordination Model Focused on Intrathecal Targeted Drug Delivery

Introduction:
Intrathecal Targeted Drug Delivery is a therapeutic tool for managing intractable pain and spasticity. With this therapy, there is a need for a care coordination program to engage patients and caregivers in order to optimize therapeutic outcomes. Initially the intent of the telephonic nationwide program was a focused approach to management. However, through re-evaluation of the program and best practices in telephonic case management, gaps were identified. Quality initiatives were successfully adopted in order to provide a holistic approach to maximizing outcomes.
Methods:
Patients with intrathecal-implanted pumps were offered an improved program model; encompassing proactive nursing assessments, implementation of evidence based clinical decision support tools, financial support services, health education, and community resources. A retrospective analysis of patients participating in the program was conducted after the implementation of the new model. Through case review, outcomes analysis, and patient engagement trends, the case management nurse team determined the unmet needs could be addressed through the incorporation of additional patient support and nursing interventions.
Results:
Review of six months of program data demonstrates this holistic approach proved beneficial. The engaged patient census grew 170%. Clinical outcomes analyses demonstrated 76% of patients had a positive perception of therapy effectiveness and quality of life. The improved care coordination model provides patients with multidimensional care to optimize outcomes.
Conclusion:
The care coordination program implemented successful initiatives to collaboratively improve patient outcomes through implementation of telephonic case management best practices. The program has incorporated a comprehensive approach utilizing the biopsychosocial model.  It has been confirmed the service is a value-added program that is making a meaningful impact on patient quality of life and outcomes.