Monthly Campaign Webinar. March 16, 2017
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1 Monthly Campaign Webinar March 16, 2017
2 TODAY S WEBINAR Together 2 Goal Updates Webinar Reminders Goal Post March Newsletter Highlights Minimally Disruptive Medicine & Diabetes Q&A Dr. Victor Montori of Mayo Clinic Use Q&A or chat feature 2017 AMGA FOUNDATION
3 WEBINAR REMINDERS Webinar will be recorded today and available the week of March 20 th Together2Goal.org Website (Improve Patient Outcomes Webinars) distribution Participants are encouraged to ask questions using the Chat and Q&A functions on the right side of your screen 2017 AMGA FOUNDATION
4 GOAL POST NEWSLETTER: MARCH UPCOMING DATES Upcoming Dates March 22-25: AMGA 2017 Annual Conference March 31: Blinded, comparative data reports sent to participating organizations Note: date has changed to accommodate Annual Conference activities 2017 AMGA FOUNDATION
5 GOAL POST NEWSLETTER: MARCH CAMPAIGN SPOTLIGHT Campaign Spotlight Together 2 Goal measure leaders C.O.R.E. Program selections 2017 AMGA Foundation stars 2017 AMGA FOUNDATION
6 GOAL POST NEWSLETTER: TOGETHER 2 GOAL MEASURE LEADERS 90 th percentile in one or more campaign measures Aurora Health Care Baton Rouge Clinic Central Virginia Family Physicians Coastal Carolina Health Care, PA Columbia St. Mary s Physicians Ascension Health Excela Health Medical Group Geisinger Health System Harbin Clinic, LLC Hattiesburg Clinic, P.A. Mountain View Medical Group, P.C. Olmsted Medical Center Premier Medical Associates, P.C. PriMed Physicians ProHealth (NY) ProHealth Physicians, Inc. Scripps Medical Foundation Sharp Community Medical Group Sharp Rees-Stealy Medical Group, Inc. The Polyclinic ThedaCare Physicians University of Michigan Medical Group USMD Health System Wellmont Medical Associates WESTMED Medical Group, P.C AMGA FOUNDATION
7 GOAL POST NEWSLETTER: C.O.R.E. PROGRAM SELECTIONS Selected to participate in C.O.R.E. (Changing Outcomes with Resources and Engagement) training program Mercy East Communities Mercy Medical Group/Dignity Health Norton Medical Group 2017 AMGA FOUNDATION
8 GOAL POST NEWSLETTER: 2017 AMGA FOUNDATION STARS Advocate Medical Group Carle Physician Group Cleveland Clinic Crystal Run Healthcare Kelsey-Seybold Clinic Mercy Mercy Medical Group (CA) Ochsner Health System Park Nicollet HealthPartners Care Group Premier Medical Associates, P.C. Prevea Health Riverside Medical Group Sharp Rees-Stealy Medical Group Summit Medical Group, P.A. Sutter Medical Foundation The Iowa Clinic UPMC Susquehanna Health Medical Group USMD Health System Wake Forest Baptist Health (formerly Cornerstone Health Care) WESTMED Medical Group Wilmington Health 2017 AMGA FOUNDATION
9 GOAL POST NEWSLETTER: MARCH RESOURCE OF THE MONTH Resource of the Month 2017 AMGA FOUNDATION
10 GOAL POST NEWSLETTER: GOAL-GETTERS Send us your Goal-Getter submissions! 2017 AMGA FOUNDATION
11 TODAY S SPEAKER Victor M. Montori, MD Mayo Clinic 2017 AMGA FOUNDATION
12 Minimally Disruptive Medicine Toward careful and kind diabetes care Victor M. Montori, MD, MSc Professor of Medicine KER UNIT Center for Clinical and Translational Sciences Mayo
13 Disclosure Statement I do not have financial relationships to disclose.
14 Multiple chronic conditions On dialysis Lives with son and his family Does not speak English Bland diet Contact by phone
15 What is best for me? What is best for my family? Is our care the answer?
16 Age, sex, genes Violence Chronic Multi Loneliness Poverty Pollution stress morbidity Obesity Alienation
17 Barnett et al. Lancet 2012
18 Comorbidities are common Dumbreck et al. BMJ 2015;350:h949
19 Antidepressant + antihyperglycemic Responsiveness Do the other conditions and their management impact Neuropathy + Antihypertensive + Anticonvulsant Baseline risk Diabetes + HTN + Hyperlipidemia Richardson and Doster J Clin Epidemiol 2014
20 Expected interactions between guidelines Drug-disease interactions rare, but for chronic kidney disease. Drug-drug interactions are common, and ~20% serious Dumbreck et al. BMJ 2015;350:h949
21 Observational Observational RCT RCT RCT RCT RCT RC
22 Evidence-based guidelines Care pathways Quality measures Specialist care are disease focused and context blind Increasingly complex regimens Limited to no prioritization Poor care coordination Overwhelmed patients and families
23 The work of being a patient Sense-making work Organizing work and enrolling others Doing the work Reflection, monitoring, appraisal Gallacher et al. Annals Fam Med 2012
24 New work Prepare for the consultation Watch educational video Bring questions; be ready for new ones Record and review the visit Review the medical record Communicate via portal and transmit data Self-measure, self-monitor, self-manage Manage appointments, prescriptions, bills Keep family and important others informed Take care of significant other Advocate for self and others
25 Prevalence of Treament Burden Clinicians ask for too much, the work is too hard, and it gets delayed or not get done. More common in low SES and sicker patients who were more likely to delegate. Nationally representative survey of 2040 >65 Americans Wolff JL, Boyd CM. JGIM :
26
27 Purpose Workload Resilience Literacy Bandwidth Health Capacity Financial Social Environmental
28 Imbalance workload + capacity
29 Workload-capacity imbalance? Workload Life Treatment burden Capacity Sick Personal Functional Socio-economical
30 Web Statin Choice
31 What aspect of your next diabetes medicine would you like to discuss first? Mullan et al Arch Intern Med 2009 KER UNIT Mayo Clinic Video / Web
32 LeBlanc A et al. JAMA Int Med 2015
33 Summary of Mayo experience Age: (avg 65) Primary care, ED, hospital, specialty care 74-90% clinicians want to use tools again Adds ~3 minutes to consultation 58% fidelity without training Effects on SDM are similar in vulnerable populations Variable effect on clinical outcomes, cost Wyatt et al. Implement Sci 2014; 9: 26 Coylewright et al CCQO 2014, 7: 360-7
34 Mayo Foundation for Research and Education
35 Adoption 12,000/month Google Analytics
36 Workload-capacity imbalance? Treatment burden Capacity Prioritize (SDM) De-prescribe Coaching Self management training Palliative care Mental health Physical and occupational therapy Financial and resource security services Community and governmental resources
37
38 25 yrs and 42 RCTs 30-day readmission Interventions supporting capacity 30% more effective Shippee N et al JCE 2012 Leppin A et al. JAMA Intern Med 2014
39 System-focused approach to MDM System-focused A. Reduce waste for the patient / caregiver In accessing + using healthcare/other services In enacting self-care B. Team-based care Train primary care team in MDM C. Policy review Guidelines/quality measures respectful of patient capacity
40 Accountability Physical and mental health Role function Disease control Imbalance of workload : capacity Burden of illness Burden of treatment Satisfaction with and ease of access, continuity, transitions Adapted from NQF: MCC Measurement Framework 2012
41 WORKLOAD CAPACITY
42 Capacity Workload Capacity Workload Coping threshold Coping threshold Gallacher et al. ABC of Multimorbidity 2014
43 Minimally Disruptive Medicine Is a way of caring for patients that minimizes the disruption healthcare causes in people s lives by reducing the burden of treatment. CAREFUL and KIND CARE
44 What is best for me? What is best for my family? Is our care the answer?
45
46
47 More about shared decision making: More about MDM:
48 TODAY S SPEAKER Questions? 2017 AMGA FOUNDATION
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