For 25 years, care has been at the heart of everything PPMD does. We strive to ensure that people living with Duchenne are living longer, stronger lives, by helping you access expert healthcare providers, a comprehensive team of sub-specialists, and cutting edge treatments. One way we do this is by regularly visiting and assessing clinics in the U.S. to ensure they are complying with the standards of care and services that have been established in the Duchenne Care Guidelines through PPMD’s Certified Duchenne Care Center Program. All Certified Duchenne Care Centers (CDCCs) have met the requirements for, and agree to provide, optimal standardized care and services.

But changes happen and transparency is important. PPMD wants to be sure that you are aware of any changes that may be happening with the care and services that you receive at our CDCCs. Twice a year, the Certification Committee checks in with the CDCCs to see if there changes that they would like to share with you. Below is a summary of those changes.

The CDCC network has now grown to 25 incredible centers across the United States, includes more than 700 medical providers and serves more than 3,300 patients and their families.  These 25 centers are sites to 79 clinical trials, enrolling more than 1,150 patients, who are either currently enrolled or in active recruitment (these are averages based the number of subjects and the number of sites for each trial).

Evaluating Your Care and Services

Between January 2018 and January 2019, 363 Clinical Experiences Surveys were completed across 23 Certified Duchenne Care Centers. Patient ages across the CDCCs ranged from 1 – 60 years old, with the greatest percentage being between 5 – 18 years old (80.21%). In the past 18 months, parents and patients report:

• 241 are taking corticosteroids (prednisone: 86; deflazacort 139).
• 180 are taking daily steroids and 51 are taking weekend doses.
• 80.2% received the influenza vaccine.
• 245/342 received a copy of their last note or have access to the note in EHR
• 94%received a pulmonary function test
• 92% had cardiac imaging (echocardiogram 41%, cMRI 14%)
• 90% have had genetic testing
• 69% reported having their vitamin D levels checked (25 OH vitamin D)
• Nearly all patients reported having seen a neuromuscular specialist, cardiology, pulmonary, physical therapy. More than 50% had seen social work, nutrition and occupational therapy
• Clinical trials discussions were reported by 60% of patients/parents
• 75% of patients were encouraged to update their information in The Duchenne Registry
• 25% of patients reported being involved currently in a clinical trial or an extension phase of a clinical trial
• 97% of participants reported being satisfied (24%) or very satisfied (73%) with their care

Bi-Annual Report of Each Center

Center	Certified	Director(s)	Care Coordination	Number of Duchenne/Becker Patients in Past 12 mo	In good CDCC Standing	Changes in Faculty, Staff and Programing
American Family Children’s Hospital	September 5, 2018	Jennifer Kwon (Neurology)	Cory Sieburg, APRN	31	Yes	New Neurologist/center director, Jennifer Kwon
Ann and Robert H. Lurie Children’s Hospital	December 1, 2016	Nancy Kuntz (Neurology)	Kristen Alianello, RN	162	Yes	No changes reported
Benioff Children’s Hospital (UCSF)	November 1, 2017	Jonathan Strober (Neurology)	Audrey Glancy Malaer, RN	50	Yes	Dietician Makiko Omori, RD
Children’s Hospital Colorado	June 1, 2014	Sue Apkon (PM&R), Julie Parsons (Neurology)	Alison Ballard, APRN	224	Yes	New: co-director, Sue Apkon (PM&R), David Brumbaugh (GI), Richard Roberts (endocrine)
Children’s Hospital of the King’s Daughters	January 29, 2019	Crystal Proud (Neurology)	Erika Paradiso, RN	80	Yes	New certification
Children’s Hospital Wisconsin	November 6, 2018	Matthew Harmelink (Neurology)	Gretchen Heckel, MSN, Nurse clinician neurology	60	Yes	New certification
Children’s Mercy Hospital	March 1, 2016	Ann Modrcin (PM&R)	Alexis Lutz, APRN	70	Yes	No changes reported
Children’s National Hospital	November 1, 2018	Diana Bharucha Goebel (Neurology)	Kathleen Smart	58	Yes	Sally Evans, PM&R, leaving April 1.
CHLA	March 1, 2016	Leigh Ramos-Platt (Neurology)	Arlene Deseo, RN	100	Yes	New: Dr. Ryabets, (endocrinology); Abbu D’Angelo (genetic counselor); new program hiring men with DMD/BMD as Spanish translators
Cincinnati Children's Hosptial Medical Center	June 1, 2014	Cuixia Tian (Neurology), Mary McMahon (PM&R)	Allison Egbert, Program Manager; Kristine Barnett and Ashley Jenk, RN Care Coordinators	426	Yes	Current Neurology providers: Drs. Cuixia Tian and Irina Rybalsky, DNP Wendy Chouteau; Current cardiology providers: Drs. Thomas Ryan, Chet Villa and Sam Wittekind
Duke Children’s NM Center	June 1, 2015	Eddie Smith (Neurology)	Pam Green, RN	153	Yes	New: Robert Lark (Orthopedics); Azita Sadeghpour (Genetics counselor); Gary Maslow (Psychiatry)
Gillette Children’s Hospital	July 1, 2017	Randall Richardson (Neurology)	Kristin Moran, RN and Michaela Geffre, RN	121	Yes	Addition of Dr. Carla Grossman, Neurology
Kennedy Krieger Institute	November 14, 2014	Kathryn Wagner (Neurology)	Angie Lasseth, Coordinator; Michael Munchel, RN	171	Yes	No changes reported
Lucille Packard Foundation for Children’s Health	March 1, 2015	John Day (Neurology)	Jessica Guzman, RN	133	Yes	No changes reported
Massachusetts General	December 1, 2014	David Dredge (Neurology)	Catie Becker, APRN; New Coordinator: Jenny Sar, Patient Services Coordinator	38	Yes	No changes reported
Nationwide Children’s Hospital	April 1, 2014	Kevin Flanigan (neurology)	Cassandra Karingada, APRN	346	Yes; recertification 4/1/2019	New Care Coordinator Cassandra Karingada, APRN
Nemours AI DuPont	August 1, 2017	Mena Scavina (Neurology)	Jennifer Hultberg, RN	90	Yes	No changes reported
Seattle Children’s	September 1, 2014	Fawn Leigh, neurology now co-director with Molly Fuentes, PM&R	Kiko Vanzandt, RN	120	Yes	New: co-directors Fawn Leigh (neurology), Molly Fuentes (PM&R). Neurology NP: Ashley Thibodeau, APRN
UC Davis	January 1, 2017	Craig McDonald (PM&R), Nanette Joyce (PM&R)	Erica Goude and Mandy Walker, RN	327	Yes	A number of new providers; please consult the website
UCLA	September 1, 2016	Perry Sheih (Neurology), Stan Nelson (Genetics), Nancy Halnon (Cardiology)	Jenna Gewirtz, APRN	216	Yes	No changes reported
University of Iowa	February 1, 2015	Kathy Matthews (Neurology)	Christina Trout, APRN	115	Yes	Seth Pearlman is leaving end of April – Dr. Mathews will absorb his patients; Tim Starner and Princy Ghera (pulmonary); Michelle Staron (PA) and Vernant Exil (cardiology)
University of Rochester	February 11, 2019	Emma Ciafaloni (Neurology)	Deb Guntrum, APRN	48	Yes	New certification
University of Utah/Primary Children’s Hospital	April 26, 2019	Russell Butterfield (Neurology)	Meagan Bernatz, APRN	92	Yes	New certification
University of Virginia	November 28, 2018	Rebecca Scharf (Developmental Pediatrics)	Sarah Pickell, MSN, RN, CNL	45	Yes	New certification
Yale New Haven Children’s Hospital	December 1, 2016	Cristian Ionita (Neurology)	Louise Lanouette, RN, CDE	35	Yes	Addition of Child Psychologist (Paige Lembeck) to the NM team

A full list of providers at each of the CDCCs can be found here.

2018/2019 CDCC Happenings

The PPMD Healthcare Professionals Summit was held January 23-25, 2019.  The purpose of the meeting was to provide the opportunity to interact and to build collaborations across CDCCs; essentially to develop a framework, build on prior accomplishments (MD CARE Act, PDUFA V, 21^st Century Cures Act, Benefit/Risk Framework, ICD-10 code), and to work together within this infrastructure to provide access to comprehensive care and approved therapies.

Physicians, sub-specialists, nurses, and clinical research coordinators from over 40 academic institutions – including 23 CDCCs, 4 international providers, and 14 additional US institutions providing pediatric and adult Duchenne care – attended this two-day Summit. In addition, we are joined by 12 of our industry partners and legislative representatives. A full review of the Summit can be found here.

While the updated Care Considerations encouraged new guidelines for care, there was not enough space in the journal to share all of the information that the subspecialty authors thought was important. For that reason, several of the subspecialties published articles in Pediatrics. We are introducing these articles one at a time. Emergency Care and Respiratory Care have been shared; the rest will be shared throughout the year.

The Monitoring Process

The CDCC is monitored by the CDCC Certification Committee – a steering committee of 19 individuals who represent several areas of neuromuscular subspecialty care, parents, industry and PPMD –review each application and site visit summary, and make suggestions/recommendations regarding certification.  If center issues arise, this committee gathers to discuss the issue and potential solutions, and to discuss these solutions with the center.  It is then the responsibility of the committee to follow up on the solution, to make sure that that recommendations are followed and that the issue is resolved.

In addition to the expertise offered by the expert clinicians at our CDCCs, PPMD is available to offer medical guidance when needed, referral and connection to appropriate medical personal and genetic counseling to patients, parents and providers.  We are available when you need us and will do our very best to make sure that you get the information and assistance that you need.

This year, after 5 years of certification, our first CDCCs will begin the process of re-certification.  We will also embark on a pilot process to certify Adult CDCCs, offering care and services especially appropriate to our adult community.  In addition, as there is growing global interest in certification, we will continue to develop a process and program for the Global CDCC program.

PPMD will continue to work to provide the care and services that our Duchenne community will need for decades to come.

Your Input is Vital

The Clinical Experiences surveys that we ask you to complete each year, let the CDCC Certification Committee know what elements of care and what services you are receiving, and what you like and what you do not like about the care and services at your center. Your input is vital to the continued improvement of this program. We put all of your responses together each year and give those back to the centers, who use these responses to improve the care and services at each of their centers.

In addition, the Certification Committee takes a deeper dive into any issues or concerns that are raised, and the centers use your feedback to continuously improve the care and services that you are receiving at your center. Your completing the Clinical Experiences Survey annually is vital to the continuous improvement of the centers and our program.

Reminders for Families in Emergency Situations

If you are headed to the emergency room or the hospital, please remember:

• Take the PPMD emergency card with you (available in English or Spanish)
• Take a copy of the summary of your last neuromuscular visit with you or a brief one page summary of your/your child’s care
• Download, and keep handy, the PPMD mobile app
• Take any equipment that you use at home (cough assist, BiPAP, etc.) and medications that you take, with you
• Take a copy of your last ECG with you. (All people living with Duchenne have an abnormal baseline ECG. Providing the emergency team with your baseline heart rate and rhythm will help them to know if anything has changed.)
• Keep the information regarding oxygen use and appropriate anesthesia available for you and the emergency room staff
• Call your neuromuscular team and let them know what is happening
• Be sure that your neuromuscular team is talking with the emergency staff and are guiding your care
• If you/your child has developed an “emergency care plan,” take that as well
• If you need assistance, call the PPMD office at 800-714-5437. If the office is closed, Kathi Kinnett is available at kathi@parentprojectmd.org or 513-260-4004.