The Patient Journey and the Clinical Team

Transcription

1 The Patient Journey and the Clinical Team Colette M Bridgman Consultant in Dental Public Health Associate Specialist Adviser PCC On Secondment to NHS CB

2 In this short presentation I will: Introduce needs and demand context Explain the patient journey/care pathway and the importance of the whole team understanding, measuring and reviewing need and risk at a practice population and individual patient level Relate using a care pathway and how this offers the opportunity to using the team differently by modelling some pilot periodontal pathways... And then Ben is going to share his real life experiences of doing just that..

3 Understand need and its relationship with demand NEED Unmet Need Appropriate Use Met Need Avoidable Use Need to achieve met need & Appropriate use of services DEMAND

4 Need/risk led assessment and the patient journey in a clinical dental practice setting 4 Action planning for change 1 What population? 5 Review Variations b/n clinicians? 2 Measuring impact Learning from OHR Any behaviour change? Clinical changes? Same or new pathway? Delivering advice and treatment in a care pathway approach Individual advice and assessment Importance for self care & communication Is the correct skill level delivering?... Your Practice list Established & stable? New patients? 3 Prioritisation Identifying problems and challenges OHNA -clinical, social and medical history Consistent data capture Clinical need and risk For different needs & groups Use of resources practice team surgery time What are effective and acceptable interventions? Care pathway preventive DBOH / Treatment?

5 You will be capturing need and individual patient risks using a consistent data set you can describe your practice population RAG status captured for a practice important at practice, individual clinician and patient level: Capitation/Registration/quality

6 Pilot Practices RAG status overall breakdown Breakdown of the overall RAG status for all patients who have received an Oral Health Assessment (OHA) in the care pathway of existing pilots this relates well to ADHS intelligence It assists us in planning services and reporting outcomes. of care delivered for the resources we have

7 Quality: How can the team help to deliver a care pathway approach and achieve: The right people Doing the right thing well In the right order At the right time In the right place With the right outcome All with attention to patients needs A needs led care pathway approach helps to describe and support clinicians with decision making on what needs to happen and in what sequence? By whom? There are opportunities in many dental practices for change. A care pathway prompts clinicians to use the available evidence base and will require the team to adapt to become change agents for patients on their journey through a pathway, to transfer responsibility to them by giving personalised advice, tailored to their individual need and risks, to help them maintain and improve their OH rather, than just be deliverers of items of treatment and generic advice.

8 There are many studies on defining and measuring quality. What do we need to understand to achieve it in dentistry? Force Field Analysis is one useful tool Try to think: What are the driving forces? What are the restraining forces? How can we add balloons or remove weight? Can your team assist? A needs/risk led care pathway uses this principle to support

9 How Can Care Pathways help drive up quality and value? And how can you get the whole team involved? 5 Ss from Japan Seiketsu Standardisation Shitsuke Discipline Everyone on the team understanding and doing things the way they are supposed to be done! Can the admin staff support communication? It is important that the whole team understands the patient journey. Care Pathway Approach Needs Led Standard Assessment & review Evidence informed prompts for advice and intervention Outcome measured Supports effective use of resources Being part of the pilot programme will allow you to test how you can use the team differently. Given the contract value you have -can the practice be more effective & efficient meet unmet need for some and challenge avoidable use by others? DCPs with additional skills can give advice and tooth brush instruction, use plaque indices, apply FV etc Many courses on offer including PCCs Train the Trainer Prevention in Practice

10 Now to PERIO modelling.outcome Measures How does outcome measurement work in a pathway approach? The outcome indicators are derived from clinical elements of the standardised primary dental care patient assessment OHNA. The information will be captured again at review the OHR and achievement is described as maintaining or improving a patient s condition. Measure Active decayed teeth (dt) aged 5 years old and under, reduction in number of carious teeth/child 50% Under 5s active decay (dt) improved or maintained Active Decayed Teeth (DT) aged 6 years old and over, reduction in number of carious teeth/child 75% over 6 s improved or maintained Active Decayed Teeth (DT) reduction in number of carious teeth/dentate adult 75% improved or maintained 75% patients with BPE improved or maintained at oral health review 50% patients with BPE 2 or more with sextant bleeding sites improved at oral health review

11 Patient attends Standard Risk Assessment Urgent Risk Assessment Personal Preventive Advice Offer Professional Preventive engagement Urgent Care and Personal Preventive Advice Engagement agreed ICMs and treatment based on pathways Patient unwilling or unable to accept Treatment limited by Patient compliance Option to enter standard pathway How might this be modelled for patients in a green pathway? And how for a red perio patient who is? 1.Compliant and responsive or 2. Unwilling or unable to make changes advised

12 Review Recommendations changes to matrices in Green Periodontal Pathway Advice or IC changes For patients in with green clinical findings (no need no risk) No sextant with a BPE of 2 or more (except the lower anterior) ICs removed (previously ICMs 6/12 or 12 months based on modifying factors) Rationale there are no evidence based professional preventive actions, only those in the direct control of the patient i.e. tooth brushing there reinforcement does not require surgery time OHNA Comprehensive need and risk assessment - Do the exam once well Reinforce good habits TBI and non smoking and communicate no need or risk CoTBand 1 PCR and set OHR for 1 year? If new patient to practice or if existing patient used to coming in every 6 or 9 months consider skill mix appt at patient usual recall appointment time -explain does not need a repeat exam try to move to: OHNA Reinforce good habits TBI and non smoking Cot Band 1 PCR set OHR 2 year

13 The Patient Journey Red Perio Draft Pathway Model journey on a continuing care pathway -clinical consensus Please find Draft care pathway in your pack Given current regulations PCR and Bands / CoTapply & run concurrently in pilot Band 1 a and Band 1 both attract a PC if applicable. This is how it could be modelled in your practice How many of these visits could the team assist with?

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15 3 Rs Clinicians need to follow pathway guidance, offer and provide evidence informed interventions, treatment and advice. Or explain and note the reasons for not doing so? OHNA -Recommendations -follow preventive advice, interventions and treatment as outlined in pathway Outline Risks of a patient not adhering to advice and/or not attending for continuing care Note any Refusals non compliance in record You are not responsible for maintaining a patient s OH they are.and that can be challenging

16 Our own Royal Family in NW - is illustrative of that some patients can be a huge challenge -not all will value OH -not all will be contemplative of change at first OHNA or adhere to your advice or be willing or able to make changes -but make an offer of continuing care at every OHNA & OHR and many do eventually respond Remember the three Rs! Get the team involved

17 The Clinical pathway a clinicians perspective.

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19 Aims and Objectives Understanding where we have been Our issues How we have over come them Where we are going to in the future.

20 Once upon a time.

21 My Practice Stats

22 How will the care pathway affect your practice? Diary space, and time EDDNs / therapist usage Paper work

23 Car Crash mouths

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25 So where s the honey? We are actually doing something to prevent decay. Skill mix is evolving. The patient has to take responsibility for their teeth.