7 Highlights & Homework
by Karen Sheffler, MS, CCC-SLP, BCS-S
As soon as the Dysphagia Research Society’s 2016 Annual Meeting and Post-Graduate Course brochure was delivered to my home, I poured over the tantalizing session titles. Let’s all get ready for invigorating warmth from February 24-27th.
Here are 7 highlights (of course there will be more than seven), and I included some comments from DRS members. I will then share the homework I did when I saw the terms of “quality metrics” and “PCORI.”
At the end of the blog, see the social media tips for staying connected, whether you are able to be in Tucson in the flesh or in cyberspace!
- Before I get in too deep, I want to highlight the fun Friday afternoon planned. What do wigs, costumes, singing, and strutting your stuff across the stage have to do with dysphagia? Nothing? Well, I’m not so sure about that. Check out the DRS Lip Sync Battle Fund-Raiser on Friday, February, 26th from 3-5pm. This is hosted by the The Website Communications and Public Relations Committee (WCPRC). See the fabulous video created by the multi-talented Dr Ianessa Humbert to wet your whistle!
- Something You Can Chew On! I am glad I can go to the post-graduate course again this year. Yvette McCoy, MS, CCC-SLP, BCS-S shared with me how excited she is “to attend the post-graduate course for the first time,” as “it looks like there will be a lot of valuable, clinically relevant information.” The presentations promote evidence-based dysphagia evaluations and clinical care in adults and pediatrics. Our Tucson adventure will start early Wednesday morning with Stephanie Daniels, Giselle Carnaby, Susan Langmore and Julie Barkmeier-Kraemer, covering the state of the evidence and standards in clinical assessments and instrumental examinations. This will be followed by chewing on the evidence across the disciplines of otolaryngology, gastroenterology, and radiology. Then Georgia Malandraki will lead one of the afternoon sessions on Treatment of Dysphagia: Promoting Evidence and Standards.
- Really, what more could a Speech-Language Pathologist ask for? Change your flight, add a night at the hotel, or at least follow DRS on Twitter / DRS on Facebook and SwallowStudy.com on Twitter / Facebook! (See more social media information below).
- Wake up early on Thursday morning for the 7am Early Riser Session on Respiration – Pulmonary Health. In the discipline of Speech-Language Pathology, there has been discussion on issues that are not covered sufficiently within the graduate curriculum. One of the topics that may be under-represented in graduate education is the respiratory system. Dr James Coyle, PhD, SLP-CCC, BCS-S (ASHA Fellow) of the University of Pittsburg, has worked for years to correct that. He has presented at ASHA Conventions and ASHA Healthcare Business Institutes to help SLPs understand the relationship between dysphagia and the respiratory system. To further your understanding, Dr Ralph Fregosi, PhD will discuss Respiratory Control Mechanisms Across the Age Span. Then, Dr David McFarland, PhD will cover Respiratory Function and Modification Related to Swallowing.
- Have you hugged a Radiologist today? The Dysphagia Research Society is truly a multidisciplinary force. Ever since Dr Bronwyn Jones, MD, FRACP, FRCR was part of the founding team of the Dysphagia Research Society 25 years ago (along with Dr Reza Shaker and others), the radiologist’s perspective has been an invaluable part of the organization. (Dr Bonwyn Jones was the second president of DRS from 1993-1994 after Dr Reza Shaker, and she was the Dysphagia journal’s editor-in-chief for 20 years, prior to Dr Reza Shaker now). I am glad to see another radiologist, Dr. Cheri L. Canon, MD, FACR, on the DRS faculty for this year’s annual meeting. Dr Canon is with the Department of Radiology at the University of Alabama at Birmingham. She will be presenting on Wednesday, February 24th during the post-graduate course with “Dysphagia: Misused and Misunderstood, A Radiologist’s Perspective,” and “Achalasia, Should be a Fairly Easy Diagnosis, Right?”
- A new era in oropharyngeal cancer: Dr Jonas T Johnson, FACS will highlight HPV in his talk on Wednesday morning titled: Oropharyngeal Cancer in the Era of HPV. There will also be scientific paper presentations on head and neck cancer on Thursday at 11am.
A major highlight will be with the Dodds-Donner Lecture on Friday at 10:15am with Dr Jonas T Johnson presenting on “The Importance of Dysphagia in Head and Neck Practice.”
“HPV+ cancer is very different from that of patients I treated 20 years ago, who were smokers, drinkers and much older,” per Cynthia Wagner, MS, CCC-SLP, BCS-S of Beth Israel Deaconess Medical Center in Boston. Wagner’s passion is evident when she discusses her young patients who have “so much life left to live; so many good years ahead.” She added:
“I was always passionate about doing more to help people with dysphagia to achieve the best possible outcomes. Now, I’m even more focused on prevention of negative outcomes by early intervention to better preserve swallowing muscle strength, bulk, range of motion and function during and immediately after chemotherapy and radiation for head and neck cancer. I refuse to allow my patients to develop a devastating swallowing disorder that they may have for the rest of their lives, when doing targeted exercises and maintaining as much PO intake as possible during chemotherapy and radiation can prevent or lessen long term dysphagia. If my patients can “fire” me at their 6-8 week post-radiation modified barium swallow study, then I’ve done my job!!
7. Viscosity, Standardization & Recalibration of our Definitions: Last year Dr Catriona Steele and a multi-center team from Canada and the United States presented poster #98 on Prevalence of Impaired Swallowing with Thin and Gum-Thickened Barium Stimuli. At that time they studied swallowing safety and efficiency in adults over the age of 50 while drinking thin liquid, mildly-thick, moderately-thick, and extremely-thick barium.
Note the new labels for thickened liquids: See why we need these standardized solid and liquid labels and descriptions in my first blog and second blog on the topic. Check out the standardized diets created last year by the International Dysphagia Diet Standardisation Initiative at www.iddsi.com.
Impaired Safety = Penetration-Aspiration Scale scores greater than or equal to 3.
Impaired Efficiency = boluses eliciting 3 or more swallows or with residue filling 25% or more of the valleculae or pyriform sinuses.
I am looking forward to Dr Steele’s presentation this year where the team aimed to create normative reference data from patients with no problems in safety or efficiency when swallowing thin and thickened liquids. Dr Steele gave me a sneak peak:
“We will be able to illustrate exactly which aspects of pharyngeal phase swallowing are altered with thicker consistencies (using gum-thickened liquids in “normals”). So, the audience will be able to learn where the bolus is typically located at the onset of the hyoid burst, how long stage transition duration should be and whether the timing and duration of laryngeal vestibule closure changes as boluses get thicker. We hope that these data will become a useful reference for clinicians when they are analyzing videofluoroscopy studies from their own patients, to enable them to identify features that fall within or outside the “normal limits” seen in safe and efficient swallowing of different consistencies. Some of our findings argue for a recalibration of our definition of “normal” or “typical” swallowing.”
8. Stay tuned to the very end for your cerebellum! Don’t miss the final session on Saturday, February 27th, starting at 4:30. Phoebe Macrae, Ianessa Humbert and Rebecca German will re-introduce us to the cerebellum! Per the session titles, they will cover how the cerebellum manages motor learning, mastication and swallowing function, covering adults with cerebellar damage and the developing brain.
Now for My Homework:
What do I need to review prior to DRS?
PCORI & Quality Metrics
- What is PCORI?
PCORI, which stands for Patient Centered Outcomes Research Institute (www.pcori.org), was created in 2010 when congress passed the Patient Protection and Affordable Care Act. Dr Diane Bild, MD, MPH from PCORI in Washington, DC will be speaking on Saturday on PCORI and Comparative Effectiveness Research Opportunities. PCORI funds this comparative clinical effectiveness research (CER). PCORI could spell big opportunities in dysphagia research for new investigators and students in our DRS audience.
Dr Douglas J. Van Daele, MD, FACS, this year’s DRS president, noted the following on the DRS website regarding Clinical Effectiveness Research (CER): “Clinical effectiveness techniques and the patient centered outcomes research institute (PCORI) are methods of investigation introduced in the past few years to attempt to study disease in a more real world setting.”
- PCORI’s Vision: “Patients and the public have the information they need to make decisions that reflect their desired health outcomes.”
- PCORI’s Mission: “PCORI helps people make informed healthcare decisions, and improves healthcare delivery and outcomes, by producing and promoting high-integrity, evidence-based information that comes from research guided by patients, caregivers, and the broader healthcare community.
- PCORI’s Goal: “The goal of our work is to determine which of the many healthcare options available to patients and those who care for them work best in particular circumstances. We do this by taking a particular approach to CER called Patient-Centered Outcomes Research (PCOR), research that addresses the questions and concerns most relevant to patients, and we involve patients, caregivers, clinicians, and other healthcare stakeholders, along with researchers, throughout the process.”
2. Quality Metrics Revisited:
The buzz word of “Quality Metrics” has also entered our session topics this year. Prior to Dr Bild’s PCORI session, Dr John Pandolfino, MD will be speaking on Quality Metrics: Approaches Using HRM as a Model.
Quality Metrics are measures that have been developed to support self-assessment and quality improvement at all levels in healthcare: from the provider and individual clinic/hospital level to a system-wide healthcare level (Bonow, et al., 2008). These may be tools and clinical practice guidelines or more formalized standards.
Practice guidelines direct the clinician to provide quality-evidence-based care, where failure to follow such guidelines would result in suboptimal patient outcomes (Bonow, et al., 2008).
A more formal aspect of quality metrics is performance measures, which are peer-reviewed measures which are standardized and rigorous enough for broad public reporting and pay-for-performance programs.
Recall my prior post about ASHA’s metrics of NOMS, which report on patient outcomes. Within the field of dysphagia, I believe we need to question: Are ASHA’s functional measures for swallowing extensive and rigorous enough when they primarily focus on diet as an outcome measure?
Maybe you have been performing continuous quality improvement (CQI) projects in your facilities for years, but now healthcare dollars, incentives, penalties and reimbursements will be tied to the numbers. Tying reimbursements to patient safety issues like hospital acquired infections (HAIs) will push the institutions to enact policies/procedures and guidelines to prevent infections. A more controversial way of measuring a hospital’s quality is by using the hospital’s 30-day readmission rates. See this interesting blog by Dr Ashish Jha, MD about the problems and potential benefits of accountability with this quality metric.
The concept of metrics has been heard recently from Doctors Ianessa Humbert and Emily Plowman through their course on Critical Thinking in Dysphagia Management (CTDM). This is described as a “metric-guided diagnosis and treatment planning” approach which will help clinicians deal with the new pay-for-performance delivery model. Per the course, clinicians learn how to use clinical decision trees to make recommendations based on sound rationales. Clinicians learn how to track “the effectiveness of treatments provided to individual patients,” and how to “demonstrate long-term clinical effectiveness in practice.”
Summary & Social Media:
Whether this is your 20th DRS Annual Meeting or your first, there will be many exciting surprises and adventures to be had. Regarding the Lip Sync Battle: What happens in Tucson, stays in Tucson!
Rinki Varindani Desai, MS, CCC-SLP is extremely excited by the fact that #DRS2016 is her first DRS and she is presenting a poster. She shared:
“Clinically, I am eagerly looking forward to the post-graduate course. I am most excited to learn more about the research aspect of our field first-hand. I believe that every researcher must have knowledge about how their research is clinically relevant and every clinician must learn how to think like a researcher. I hope to be able to to do that after DRS.”
DRS president, Dr Douglas J. Van Daele, MD, FACS, reminds us that “team-based and interprofessional care has been a buzzword in the healthcare community over the past several years,” but the Dysphagia Research Society was founded on that concept almost 25 years ago. Our 24th annual meeting and post-graduate course will focus on evidence-based best practices in research and in direct patient care.
Social Media Tips:
New this year: It has become a common practice to take pictures of slides at conventions for quick dissemination via social media. However, in an effort to share information in social media while respecting the researcher’s individual needs (i.e., copy-written information), all oral and poster presenters will note whether or not they approve photography of their presentation. DRS will provide a list of those that do not approve of photography of their presentation. For those that do not approve photography:
- Poster presentations will contain a sign: “Photography is Prohibited of this Poster.”
- Oral presenters will include a slide at the beginning of the presentation stating: “Photography is prohibited during their presentation.”
Follow on Social Media:
Follow Dysphagia Research Society:
Twitter: Follow www.twitter.com/Official_DRS
Use #DRS2016 on all your Tweets
Facebook: Like Dysphagia Research Society and post on our wall www.Facebook.com/DysphagiaResearchSociety
Follow SwallowStudy.com (official blogger for #DRS2016) for live tweets/posts:
Be sure to download a free QR app prior to DRS, if you don’t have one already on your smartphone. Then open your QR app, hold your phone over the QR code provided (as if taking a picture), and you will be instantly connected to the meeting’s website. The DRS QR code is available on the back of your brochure and will be available at the meeting.
Bonow RO, Masoudi FA, Rumsfeld JS, et al. (2008). ACC/AHA Classification of care metrics: Performance measures and quality metrics: A report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol, 52 (24), 2113-2117. doi:10.1016/j.jacc.2008.10.014.