The Role of JAK Inhibitors
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Exploring the Future of IBD Care: The Role of JAK Inhibitors Live Visiting Professorship Program: Outcomes Report Gilead Sciences Grant ID: 06209 Overview Activity Description: One-hour live educational visiting professorship programs (VPPs) implemented in academic and community hospitals throughout the U.S. offered an update on the latest research and treatment recommendations for inflammatory disease. Topics included the role of the JAK/STAT signaling pathway in immune mediated diseases, up-to-date knowledge of the efficacy and safety of investigational JAK inhibitors, and the role of new and emerging JAK inhibitors in the treatment paradigm in IBD. These grand round meetings incorporated case presentations, didactic lectures, and clinical topic discussions. Enduring activity launched November 26, 2019 (outcomes reported separately). Activities occurred: August 21, 2019 – January 27, 2020 15 VPPs supported; 17 VPPs executed Credit: 1.0 AMA PRA Category 1 Credit(s)TM Sponsored by: The Academy for Continued Healthcare Learning (ACHL) Supported by: An educational grant from Gilead Sciences, Inc. Intended Audience: US-gastroenterologists, and other allied health care professionals interested in the JAK/STAT signaling pathway and applications to treatment of IBD Activity Page (Print and Digital) Live Activity Snapshots Program Dates & Locations INSTITUTION NAME LOCATION PROGRAM FACULTY TOTAL PERCENT TARGET DATE LEARNERS SPECIALITY AUDIENCE Northwell Health- The Center for Manhasset, NY 8/21/19 Bruce Sands, MD 20 90% (Gastroenterology) Liver Disease Valley Hospital Medical Center 43% (Gastroenterology) Las Vegas, NV 9/18/19 Gil Melmed, MD 23 (GI Workshop) 22% (Internal Medicine) University of Maryland (GI Division) Baltimore, MD 9/18/19 Raymond Cross, MD 25 88% (Gastroenterology) Emory University School of Medicine 100% (Gastroenterology) Atlanta, GA 10/7/19 Thomas Ullman, MD 16 (Division of Digestive Diseases) The University of Vermont Medical 100% (Gastroenterology) Burlington, VT 10/15/19 Thomas Ullman, MD 18 Center (GI Division) Advocate Lutheran General Hospital 36% (Gastroenterology) Park Ridge, IL 10/23/19 Joel Pekow, MD 25 (GI Division) 64% (Internal Medicine) 24% (Gastroenterology) Aventura Hospital and Medical Aventura, FL 10/23/19 David Kerman, MD 17 76% (Internal Medicine) Center 26% (Gastroenterology) Dignity Health- St. Bernardine San Bernardino, 10/28/19 Gil Melmed, MD 19 37% (Internal Medicine) Medical Center CA St. Jude Comprehensive Digestive 100% (Gastroenterology) Fullerton, CA 10/28/19 Gil Melmed, MD 7 Health Program Dates & Locations (cont.) INSTITUTION NAME LOCATION PROGRAM FACULTY TOTAL PERCENT TARGET DATE LEARNERS SPECIALITY AUDIENCE Beth Israel Deaconess Medical Center 86% (Gastroenterology) Boston, MA 10/30/19 Thomas Ullman, MD 14 (Division of Gastroenterology) 80% (Gastroenterology) Howard University (GI Division) Washington, DC 11/13/19 Raymond Cross, MD 15 92% (Gastroenterology) Atrium Health (GI Division) Charlotte, NC 11/21/19 Joel Pekow, MD 12 The University of Oklahoma College of 10% (Gastroenterology) Medicine- Digestive Diseases and Oklahoma City, OK 12/04/19 Bincy Abraham, MD, MS 39 62% (Internal Medicine) Nutrition 76% (Gastroenterology) Parkview Medical Center Pueblo, CO 12/04/19 Joel Pekow, MD 21 Lehigh Valley Health Network-Cedar Crest Campus 71% (Gastroenterology) Allentown, PA 12/17/19 Raymond Cross, MD 24 (bi-monthly combined colorectal-GI IBD case conference) 4% (Gastroenterology) 18% (Internal Medicine) Raymond Cross, MD George Washington University Washington, D.C. 12/19/19 83 78% (Other: Primary Care, Rheumatology, Pulmonology etc.) MedStar Georgetown University Washington, D.C. Raymond Cross, MD 93% (Gastroenterology) 1/27/2020 27 Hospital (GI Division) Faculty Information CHAIR Russell Cohen, MD, FACG, AGAF* Bruce Sands, MD, MS Director, Inflammatory Bowel Disease Center Chief of the Dr. Henry D. Janowitz Co-Director, Advanced IBD Fellowship Division of Gastroenterology Program Dr. Burrill B. Crohn Professor of Medicine The University of Chicago Medical Center Icahn School of Medicine at Mount Sinai Chicago, IL Mount Sinai Health System New York, NY *Content and faculty advisor, no speaking engagements Bincy Abraham, MD, MS Raymond Cross, MD, MS, AGAF, FACG Director, Gastroenterology Fellowship Program Director, Inflammatory Bowel Disease Program Director & Distinguished Professor, Co-Director, Digestive Health Center Fondren Inflammatory Bowel Disease Program University of Maryland Medical Center Houston Methodist Baltimore, MD Houston, TX Faculty Information (cont.) Joel Pekow, MD David Kerman, MD Assistant Professor of Medicine Associate Professor of Clinical Medicine Section of Gastroenterology, Director, Gastroenterology Fellowship Program Hepatology, and Nutrition University of Miami Miller School of Medicine University of Chicago Medicine and Jackson Memorial Hospital Biological Sciences Miami, FL Chicago, IL Gil Melmed, MD, MS Thomas Ullman, MD Co-Director, Chief, Division of Gastroenterology Clinical Inflammatory Bowel Disease Montefiore Medical Center Division of Gastroenterology Albert Einstein College of Medicine Department of Medicine New York, NY Cedars-Sinai Medical Center Los Angeles, CA Executive Summary Final Participation 405 Clinical Participants; 196 Certificates Issued Practicing Type 85% Physicians, 3% Fellows, 4% NPs/PAs, 2% Nurses, 2% Pharmacists, 3% Other HCPs Objectivity & Balance Objectivity and balance rated as good/excellent by 100% of learners Learning Objectives 100% of learners strongly agree or agree that all learning objectives were met, with an average rating of 4.0/4.0 Faculty The faculty were rated good or excellent across all areas by 100% of learners, with an average rating of 3.97. Executive Summary An effect size of 0.91 indicates that learners are now ~51.98% more knowledgeable of the content assessed than prior to participating in this education. 83% of learners intend to make one more change in their practice as a result of this education. Specifically, 64% of learners plan to select a different therapy for their IBD patients who fail to demonstrate mucosal healing. Changes will impact 1,099 to more than 4,067 IBD patients each month. A 30-day follow-up survey data reveals that 73% of survey respondents made one or more changes to their practice following exposure to this education. Cost, patient compliance issues and lack of time to assess/counsel patients were reported as the most common barriers to implementing changes in practice Following the activity learners demonstrated increased knowledge with the MOA of emerging JAK inhibitors and the available safety data from JAK inhibition in RA. Future Education Opportunities Case based education on selection of therapy, monitoring response, and application of new agents. Clinical trial efficacy and safety data with the JAKs in IBD as data become available. Role of the JAK/STAT signaling pathway in the inflammation and disease progression of IBD. Expert based perspectives reviewing applications in practice once therapy is available. Cohen’s d Effect Size This Effect Size calculation includes baseline and posttest completers and encompasses all five pre/post-test questions. Baseline Post-Test Mean 31% Mean 54% Standard Standard Deviation 0.248 Deviation 0.257 Sample Size 50 Sample Size 141 Cohen’s d Effect Size = 0.91 An effect size of 0.91 indicates that learners are now ~51.98% more knowledgeable of the content assessed than prior to participating in this education. Cohen (1988): .2 = small, .5 = medium, .8 = large Wolf (1986): .25 = educationally significant, .50 = clinically significant Outcomes Reporting Methodology • Activity-related changes in clinical knowledge, competence and confidence were evaluated by using a baseline survey of gastroenterologists and internal medicine healthcare professionals of comparable competency to the VPP attendees. • A posttest and evaluation were distributed to VPP attendees and the two datasets were used for baseline-versus-post-educational comparison. • Total responses (n) may fluctuate as all feedback and survey questions were optional. Participation Participants Certificates Participation by Specialty 405 196 Gastroenterology Participation by Clinician Type Internal Medicine Primary Care 8% 2%2%3% 2% Physician 2% Rheumatology 2% 3% 85% Fellow Cardiology 3% 3% Nurse Pulmonology 4% Nurse Practitioner Surgery 50% Physician Assistant 5% Other Pharmacists Other HCPs 25% Learning Objectives Please rate the following objectives to indicate if you are better able to: Analysis of Respondents Rating scale: 4=Strongly Agree; 1=Strongly Disagree Discuss the role of the JAK/STAT signaling pathway in the inflammation and 4.0 disease progression of IBD Compare and contrast the cytokine pathways targeted by JAK inhibitors under 4.0 investigation for IBD Interpret the clinical trial efficacy and safety data of available and emerging 4.0 JAK inhibitors investigated for Crohn’s disease and ulcerative colitis Identify IBD patients who may require a change in therapy due to lack or loss 4.0 of response 100% of learners agreed that all learning objectives were met, with an average rating of 4.0! Clinicians who agree that the content contributes valuable information that will 99% assist in improving quality of care for patients N=194 Faculty Evaluation Please rate the faculty on the criteria listed Ability to effectively convey the subject matter Respondents Rating scale: 4=Excellent; 1=Poor Bruce Sands, MD, MS (Chair) (n=1) 4.0 (n=4) Bincy Abraham, MD, MS (n=1) 3.93