560 Schedule With Abstracts
2 February 2018
presented. Our nursing leader will address barriers to
effective nursing documentation, which constitutes
the vast majority of clinical information, including dif-
ficulties with technical Local Coverage Determina-
tions, struggles around complex prognostication,
and limitations inherent to hospice electronic medical
record systems. During the second half of the interdis-
ciplinary presentation, the physician team will present
4 evidence-based tools and articles that cut across dis-
ease states that will inform prognostic abilities of phy-
sicians completing Certification of Terminal Illness
(CTI) documentation and support their prognostic
claims. They will use examples from real cases showing
well- and poorly written face-to-face and CTI notes, re-
working those with opportunities for improvement us-
ing the presented tools to reinforce audience
learning.
Counting Sheep: A Rational Approach to
Managing Insomnia (TH305)
Jennifer Pruskowski, PharmD BCPS CGP CPE, Univer-
sity of Pittsburgh School of Pharmacy, Pittsburgh, PA.
Alycia Dalbey, PA, University of Pittsburgh Medical
Center, Pittsburgh, PA. Eric Prommer, MD HMDC
FAAHPM, University of California, Los Angeles and
VA HPM Program, Los Angeles, CA. Neal Weisbrod,
MD, University of California, Los Angeles and VA,
Los Angeles, CA.
Objectives
 Review the associated factors and necessary diag-
nostic factors for insomnia.
 Compare nonpharmacological interventions with
pharmacological agents for insomnia.
 Design rational therapeutic plans for patients
suffering from insomnia.
Insomnia is defined as the subjective perception of dif-
ficulty with sleep initiation, duration, consolidation,
and/or quality of sleep that occurs despite adequate
opportunity for sleep. Insomnia correlates with pa-
tient satisfaction and with quality of life and is under-
reported. It causes patients discomfort and suffering,
and leads to increased fatigue, pain intolerance, irrita-
bility and depressive mood, psychological distress and
daytime impairment. The general pathophysiology of
primary insomnia centers on hyperarousal during
sleep. Research shows that multiple neurotransmitters
and cytokines influence wakefulness and represent
appealing pharmacotherapeutic targets. The primary
goal of insomnia treatment should be first to look
for and relieve any underlying disorder leading to
sleep disturbance. This requires multimodal treat-
ment, including both pharmacologic and non-phar-
macologic therapies. Nonpharmacologic therapies
consist of combining attention to sleep hygiene and
cognitive-behavioral therapy. Pharmacologic
Vol. 55 No.
treatments consist of an ever growing array of
approved and off label therapies. Approved therapies
include benzodiazepine agonists, benzodiazepines,
melatonin receptor agonists, tricyclic agents, and orex-
in receptor antagonists. Off-label therapies include an-
tidepressants, antipsychotics, antiepileptic analgesics,
and herbal products. Each of these agents benefit pa-
tients at various points of the sleep cycle and their
appropriate use helps to tailor drug management for
each patient. Understanding drug pharmacokinetics
helps to tailor drug management to the type of sleep
disturbance such as sleep latency or sleep mainte-
nance. This multidisciplinary session consisting of
palliative care specialists and clinical pharmacists will
enable attendees to: 1.) Understand the pathophysi-
ology of insomnia and how to take a sleep history.
2.) Learn how to systematically look for reversible
causes of insomnia. 3.) Understand the pharmacology
of drugs available to treat insomnia and where they
work in the sleep cycle. 4.) Develop pharmacologic
treatment plans for treating insomnia in the ICU, pa-
tients with dementia, mood disorders and neurode-
generative disorders.
Five Steps to Build an Effective Payer-
Provider Partnership for Innovative
Palliative Care Models (TH306)
Jatin Dave, MD MPH, New England Quality Care Alli-
ance, Watertown, MA. Parag Bharadwaj, MD
FAAHPM, Sentara Healthcare, Norfolk, VA. Tom
Gualtieri-Reed, MBA BA, Spragens & Associates LLC,
Chapel Hill, NC. Dana Lustbader, MD, ProHEALTH,
New York, NY. Bruce Smith, MD MACP, Cambia
Health Solutions, Seattle, WA.
Objectives
 Describe the value of Palliative Care from the
payer and provider perspective to achieve
quadruple aim.
 Discuss how palliative care can help achieve the
Quadruple Aim.
 Describe actions payers are taking to integrate
palliative care into payment models, care manage-
ment programs, and benefits.
 List five steps to build effective payer-provider
partnerships to support those with serious illness.
Recent changes in the health care environment with
shifting and shared risk have created unique opportu-
nities for payers and palliative care providers to part-
ner in the care of the most medically complex
individuals. There is an increasing focus on the
quadruple aim: better care, better health, lower costs
and improving the work-life of those who deliver
care. Considering the added value of palliative care
and challenges in adequate volume-based reimburse-
ment for palliative care, such payer-provider