A Path to Self-actualization: Maximizing Quality of Life for People with Chronic Disease Lisa Bujno, APRN Associate Chief Nurse, Quality and Performance White River Junction VAMC May 12, 2015 May 12, 2015
Agenda NH Landscape & Chronic Disease Burden Determinants of Health Maslow s Hierarchy of Needs VA Programs Making a Difference Health Impact Pyramid NH State Health Improvement Plan (SHIP) Changing the Context
NH Landscape 1.3 million people Aging population Stagnant birth rate (9.9) Increasing diversity Migration: -1.2/1000 Unemployment @3.9% Crime rate rising ER visits increasing Rising healthcare costs
Growing Chronic Disease Burden 34.9% overweight and 25.8% obese 17.2% reported smoking 4.2% ever diagnosed with coronary heart disease 4.3% ever diagnosed with heart attack 2.3% ever diagnosed with stroke 9.1% ever diagnosed with diabetes; 21.3% among those aged 65 and older 11.0% had current asthma in 2013
The Story of Mr. H 64 y male Dx of Polymyositis Disabled Confined to wheelchair with limited use of L arm, no use of R arm Homebound Married, wife works
Determinants of Health
Maslow s Hierarchy of Needs
Medical Center: White River Junction, VT Community Based Outreach Clinics (CBOC s): Rutland, Burlington, Newport, Bennington and Brattleboro, VT Littleton and Keene, NH
VA Programs Making a Difference Home Based Primary Care Home Telehealth Geriatrics & Extended Care Recreational Therapy Image courtesy of cooldesign /FreeDigitalPhotos.net
Home Based Primary Care (HBPC) Serves frail, chronically ill veterans with complex health care needs who require comprehensive, longitudinal home care services
HBPC Services Primary care visits at home by a physician, nurse practitioner or physician's assistant Nursing care management Coordination of services by a social worker Therapy visits from a physical, occupational, or speech therapist Mental health services Nutrition counseling Medication management
HBPC Outcomes Reduction of inpatient admissions by 43.9% Reduction of inpatient days by 60% 10% reduction in repeat falls 95% immunization rate for influenza; 98% for pneumoccus End of life protections: DNR (91%), advanced directives (100%), long-term planning (100%)
Home Telehealth Uses health informatics, disease management and telehealth technologies to target care and case management Changes the location where health care services are routinely provided Home telehealth, Clinical Video Telehealth, and Store-and-Forward modalities
Telehealth Services Clinical Video Telehealth (CVT) Mental Health CVT in Home(SCI, PT, OT ) Podiatry Ear, Nose & throat (ENT) Physical Therapy (PT) Wound / Ostomy Care Occupational Therapy (OT) Neurology Speech Therapy (ST) Nursing Preop Diabetes 1:1 Visits Pain Nutrition 1:1 Visits Genomics Weight Loss Group Hearing Aid Management Weight Loss Group Women Cardiology Weight loss 1:1 Ambulatory Monitoring Spinal Cord Injury (SCI) with Boston VAMC Urology
Telehealth Services Home Telehealth Diabetes Hypertension Chronic Obstructive Pulmonary Disease Heart Failure Dementia Support for Caregivers Weight Loss Pallative Care Smoking Cessation Store and Forward Dermatology Tele-Retinal Imaging
Telehealth Outcomes Improved access to care and quality of life Improved patient self-management 25% decrease in length of stay 19% reduction in hospital admissions 9.8% mortality rate in HT patients versus 16.58% in Non-HT patients High satisfaction rates among veteran patients Darkins, A. (2008) Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics, Home Telehealth, and Disease Management to Support the Care of Veteran Patients with Chronic Conditions, TELEMEDICINE and e-health Adam Darkins et. al (2014). Reduced Cost and Mortality Using Home Telehealth to Promote Self-Management of Complex Chronic Conditions: A Retrospective Matched Cohort Study of 4,999 Veteran Patients TELEMEDICINE and e-health, 20, 50. Decreased unscheduled primary care visits
Geriatrics & Extended Care (GEC) Programs to maximize each Veteran s functional independence and lessen the burden of disability on Veterans, their families, and caregivers Focus on shared decision making Institutional and non-institutional care options
GEC Services Skilled home care/homemaker & Home Health Aide Adult Day Health Care Hospice/Palliative Care Medical Foster Home Respite Care: in home or hospital Caregiver Support Veteran Independence Program
GEC Outcomes Improved functional independence Reduced caregiver stress and improved family functioning Better coordination of care with non-va providers Veterans can remain in their homes longer Reduced cost
Recreational Therapy Provide recreation activities to treat and maintain the physical, mental and emotional well-being of Veterans with disabilities, illnesses or other disabling conditions. Use a variety of techniques, including arts and crafts, sports, games, dance, music and community integration activities Assist Veterans with disabilities to integrate into the community by helping them use community resources and recreational activities
Recreational Therapy Services MOVE! Adaptive sports programs Greenhouse gardening Arts and crafts Music
Recreational Therapy Outcomes Improves physical well being such as weight management and controlling diabetes and hypertension Improves social functioning and help Veterans develop new leisure skills Enhances creative expression and break down barriers for cultural expression
The Story of Mr. H HBPC has made the biggest difference to me and my wife. Reduced burden of time spent navigating the health system to get needed care Frees time to spend with family and pursue hobbies
Maslow s Hierarchy of Needs
Health Impact Pyramid
NH SHIP: Top 10 health priorities Tobacco Obesity/Diabetes Cardiovascular Disease Misuse of alcohol and drugs Cancer Prevention Asthma Healthy Mothers & Babies Infectious Disease Injury Prevention Emergency Preparedness
Changing the Context Leverage Points in a System Information flow System rules and goals Paradigm Image courtesy of olovedog/freedigitalphotos.net
Next Steps Image courtesy of Paul Martin Eldridge /FreeDigitalPhotos.net Integrate Maslow s principles into everyday practice Help patients fulfill their needs beyond medical care & safety Support policy changes that promote self-actualization for people with chronic diseases
Questions? Lisa Bujno, MSN, APRN Associate Chief Nurse, Quality & Performance 802-295-9363 x5380 Lisa.bujno@va.gov