MINI SUMMIT VIII: Patient Engagement and Patient Satisfaction March 15, 2011 3:45 pm 5:45 pm
The Patient-Centered Medical Home: Journey on an Oregon Trail Mary M. Minniti, CPHQ Quality Improvement Director PeaceHealth Medical Group Eugene, Oregon
Inspiration from Caregivers Pursuing Perfection Clinical Care Specialists and Patient/Family Advisors PeaceHealth Senior Health and Wellness Center- Gerontology Institute [Our First Medical Home] PeaceHealth Medical Group Medical Home Innovation Pilot- Team Fillingame
Today s Highlights : Engaging Patients in their Care Enlisting Patients/Families in Primary Care Home Standards Development Enhancing the Patient Experience through: Expanding staff roles and skills Utilizing tools for both patients and staff support Understanding and assessing a critical Vital Sign to increase effective patient interventions
In 2008 Americans spent $2.4 trillion on health care. Modifiable behaviors drive at least 70% of utilization More than 80% of the risk for developing cancer in the United States is correlated to lifestyle- based factors. American Cancer Society. Detailed Guide: Cancer What Are The Risk Factors for Cancer? 90% of the risks associated with heart attack are lifestyle based. Effect of Potentially Modifiable Rish Factors Associated with Myocardial Infarction in 52 countries: Lancet. 364: 937-52
Determinants of Health and Their Contribution to Premature Death 30% 40% 15% 5% 10% Social Environ Medical Behavior Genetic Schroeder, S. New England Journal of Medicine 2007;357:1221-8
Control: Who Really Makes the Decision? 100 Patients/Families Control 0 The System Low Acuity High
Team Fillingame Barb Care Facilitator Becky Health Coach Patient Family Mike Health Coach Dr. Ralph Physician Jacque Wellness Coordinator Susan Nurse Practitioner Cathy RN Care Manager
Engaging Patients in their Care Patient Orientations- Introduction to Team Concept Quarterly Newsletters on Health and Wellness Providing incentives - pedometers, recognition Asking - What is Important to You? What would you like to work on? How do you best learn? Encouraging family involvement Strength-based approach Appreciative Inquiry Motivational interviewing and patient-centered goal-setting Utilizing peer support through Shared Medical Appt.
Fred Patient Ultimate Manager of Health It takes a team to provide excellent healthcare today. You are its most important member! Your values, beliefs, and needs help shape the choices you make to maintain your health.
Making Resources Available Chronic Care Self-Management Class State designated regional training center 31 Classes Held 8 in Spanish ; 23 in English 384 Participants On Line is not enough! 112 Spanish; 272 English 18 different sites in Lane County
Referrals to Community Resources
Enlisting Patients in Medical Home Development Involving patients and families in quality improvement and strategic initiatives Inviting patients and families as ongoing partners through a Patient Advisory Council Influencing regional and statewide healthcare initiatives
Medication Oversight Safety Team Patient Family Advisors joined QI Safety initiative to support medication reconciliation efforts underway Initiated patient education effort to improve medication partnership Advisors continue to do community outreach at senior centers and encourage sustained focus by the organization on this important topic
PHYSICIAN COUNCIL Chris Bolz, MD, Family Medicine John Lipkin, MD, Behavioral Health Frank Littell, MD, Hospitalist Rick Kincade MD, Family Medicine Chair Henry Veldman, FACHE Rick Kincade, MD PHOR Regional Vice President Physician Council Chair Quality Committee ~ Tamara Barstow, MD, Chair Finance Committee ~ Chris Miles, Interim Chair Patient Advisory Council ~ Patty Black & Willa Reich, Chairs Chris Miles, MHA Chief Operating Officer Currently Vacant Operations Director Adult & Family Med. Mary Backus Executive Director Gerontology Jeff Larkin, MD Med. Director Gerontology Jill Chaplin, MD Chief of of Adult & Family Med. Tom Ewing, MD Chief Medical Officer Gay Wayman Leadership Development Kathi Levell, FACMPE Executive Director Planning Tracy Ellis Business Development Ashlee Burnett Manager Hospitalists Frank Littell, MD Regional Medical Director Hospitalists Naomi Fish Risk Management Trish Litton Professional Staff Services Jennifer Potter Manager Pediatrics John Dunphy, MD Chief of of Pediatrics Mary Minniti Quality Improvement Shannon Surber Operations Director Specialties David Lippincott, MD Chief of of Specialties Terry Stimac Operations Director Specialties Bob Brasted, MD Chief of of Behavioral Health Services N:\Workgrps\QI-PHMG\Quality Dept Basics\Orientation for New Physicians\Orientation Handouts\PHMG Org Chart BW.ppt
Patient Advisors Promoting Self-Management Your Health Care and Safety - The Team Approach at PeaceHealth This project was supported by grant number P20HS017143 from the Agency for Healthcare Research and Quality. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Agency for Healthcare and Research Quality.
Oregon s s Patient-Centered Primary Care Home Standards State-wide group recommended standards for medical home January June 2010 Cross section of healthcare stakeholders Created standards that inform the Health Fund Authority work on Incentives and Outcomes Committee Barbara Starfield, national expert, believes Oregon standards are most comprehensive and on-target to date [September 2010 Oregon AAFP Meeting]
PC-PC Home Core Attributes The influence of Patient and Family Advisors PERSON AND FAMILY CENTERED CARE Recognize that I am the most important member of my care team - and that I am ultimately responsible for my overall health and wellness. Communication, education and self-management support, experience of care
Enhancing the Patient Experience Prepared, Proactive Practice Teams- Health Care Partners Expand roles- not just tasks it s about relationships Certified Medical Assistants Health Coaches Everyone working at the top of their license Extensive communication and coaching training Team Development Building on the strengths of the individual patient and supporting their continued growth and success in reaching their health goals Fixing is not the same as Healing
Tools to Help Patients and the Healthcare Team Electronic tools: Patient Portals to Medical Records, websites and/or Personal Health Records Shared Decision-making Programs Booklets, DVD or VHS On key topics: Choosing Healthcare That s Right for You; Living with Heart Failure; Back Surgery, Breast Cancer Treatment Options, etc. The New Vital Sign - Patient Activation The Patient Activation Measure is a 10 13 question survey that assesses an individual s knowledge, skills and confidence essential to self management
On-Line Tools for Self-Management
Reliable Sources of Information
Shared Decision Making Communication process between healthcare provider and patient/family providing information about: options, outcomes, probabilities, and scientific uncertainties of available treatment options Patient values Relative importance patient places on benefits and harms. For an optimal outcome, decisions that are less clear, sometimes referred to as preference-sensitive conditions, must take into account the needs, desires, and lifestyle of the individual patient.
Four basic segments of activation or self management competency emerge 10-15% of nat l population 20-25% of nat l population 35-40% of nat l population 25-30% of nat l population 28
Behavior varies considerably by level of activation Source: US National sample 2004
Visual Scan of PAM responses
Activation Model = Patient-centered Approach Giving the patient s agenda attention and priority Ask-- don t tell The goal is to build capacity not just compliance Listening, joint-problem solving, affirmation Addressing the specific challenges associated with the individual s level of activation Developing skills and knowledge that lay a foundation for the next higher level Building confidence by a series of small successes
Activation Level 4 3 2 1 Acuity Coaching For Activation Right Resource for Patient Needs Care Facilitator / Peer Support Health Coach RN, WC NP + Team Health Coach NP + Team NP, RN, WC Wellness Coord RN, WC, NP MD, RN, WC RN Care Mgr NP MD, RN Low Medium High
Coaching for Activation Website
For more information: Mary Minniti, CPHQ mminniti@peacehealth.org 541-687-6173 Other websites of interest: www.oregon.gov/oha/publications www.informedmedicaldecisions.org www.sharedcareplan.org www.insigniahealth.com Oregon Medical Home Standards Shared Decision Making Programs Personal Health Record Patient Activation Measure