PATIENT- CENTERED CARE: BOTH IN INDIVIDUAL CONVERSATIONS WITH PATIENTS AND IN PRACTICE TRANSFORMATION EFFORTS Integrated Network Engagement Summit 9/21/17 Aimee English, MD
OVERVIEW Engaging patients and families in direct care Background Shared decision making tools Action Plans Program Requirements Engaging patients and families in practice transformation Background Various Methods Tips for Success Support Materials Program Requirements
INDIVIDUAL PATIENT ENGAGEMENT
WHO MANAGES CHRONIC DISEASE? Patient Themself Spouses Personal Care Givers Siblings Parents Friends Providers Case Managers Social Workers Nurses
RISING RATES OF CHRONIC ILLNESS Wu, Shin-Yi, and Green, Anthony. Projection of Chronic Illness Prevalence and Cost Inflation.RAND Corporation, October 2000 Medical Expenditure Panel Survey 2006.
STAGES OF ACTIVATION Stage 1: Beliefs about the importance of the patient role More likely to: Adhere to treatment regimens, get preventive care, participate more in decisions about their care, engage in healthy behaviors, seek out and use health information, when controlling for health status, gender, age, and income level. Stage 2: Knowledge and confidence necessary to take action More likely to: Use EDs, be hospitalized, have higher costs of care, have poorer health outcomes across a variety of diseases, have unmet medical needs and delay care. Stage 3: Actually taking action Stage 4: Staying the course under stress Hibbard J, Stockard J, Mahoney E, and Tusler M. Development of the Patient Activation Measur (PAM): Conceptualizing and Measuring Activation in Patients and Consumers. Health Sciences Research. 2004; 39(4): 1005-1026. Hibbard J, Greene J, and Overton V. Patients with Lower Activation Associated with Higher Costs; Delivery System Should Know Their Patients Scores. Health Affairs. 2013. 32(2): 216-222.
EXAMPLES OF SELF- MANAGEMENT EDUCATION/SUPPORT Goal-setting action plans Interactive Patient Education Motivational Interviewing Shared care plans (with collaborative goalsetting) Shared Decision Aids Tracking tools journaling, My Fitness Pal, Mood Tracker Self-triage tools
COCHRANE REVIEW: DECISION AIDS Decision Aids for People Facing Health Treatment or Screening Decision. (N= 105 studies including 31,043 participants) Results: increased knowledge (MD 13.27/100; 95% CI 11.32-15.23) improved accurate perception of risks (RR 2.10, 95% CI 1.66-2.66) lower decisional conflict d/t feeling uninformed (MD -9.28/100 95% CI -12.20 to -6.36) reduced proportion of people who were passive in decision making (RR 0.68; 95% CI 0.55 to 0.83) unknown effect on visit time 2.6 minutes longer (24 vs. 21 min) Stacey D, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews. 12 Apr 2017.
DECISION AIDS Ottawa Hospital Research Institute: https://decisionaid.ohri.ca/azlist.html Mayo: http://shareddecisions.mayoclinic.org/decision-aidinformation/decision-aids-for-chronic-disease/ AHRQ http://effectivehealthcare.ahrq.gov/index.cfm/tools-andresources/patient-decision-aids/ Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L, Wu JHC. Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD001431. DOI:
ACTION PLANS Coleman M. Supporting Self-Management in Patients with Chronic Illness. American Family Physician. 2005. 72 (8); 1503 1510.
ACTION PLANS
SIM REQUIREMENTS SIM: Implement shared decision making tools or aids in two health conditions, decisions or tests as component of shared decisionmaking, one of which in primary care must be related to BH and in CMHC must be related to physical health. Track use of shared decision making aids using one of the following methods: 1. A metric tracking the proportion of patients and families eligible for the decision aid who receive the decision aid; OR 2. Quarterly counts of patients and families receiving individual aids. SIM Milestones. 2016.
2017 NCQA REQUIREMENTS Knowing and Managing Your Patients, Competency F, 22: Provides access to educational resources, such as materials, peer support sessions, group classes, online self-management tools or programs (1 credit) Knowing and Managing Your Patients, Competency F, 24: Adopts shared decision-making aids for preferencesensitive conditions (1 credit)
CPC+ TRACK 1 REQUIREMENT 4.2 Assess practice capability and plan for support of patients self-management.
ENGAGING PATIENTS AND FAMILIES IN PRACTICE TRANSFORMATION
BACKGROUND
BACKGROUND When patients assist in selecting quality improvement topics the choices they make are more aligned with core components of the Chronic Care Model. Time to reach consensus is only minimally increased (by 10%). Boivin, A.; Lehoux, P.; Lacombe, R.; Burgers, J.; Grol, R., Implement Sci 2014, 9.
METHODS OF ENGAGING PATIENTS & FAMILIES OR GETTING FEEDBACK Experience Surveys PFAC QI Teams Leadership Mtgs One-time Focus Groups Group Concept Mapping Waiting Room Rounds LaNoue M, et al. Concept Mapping as a Method to Engage Patients in Clinical Quality Improvement. Ann Fam Med. 2016, 14(2): 370 376.
METHODS OF ENGAGING PATIENTS & FAMILIES OR GETTING FEEDBACK Experience Surveys PFAC QI Teams Leadership Mtgs Focus Groups? Group Concept Mapping Waiting Room Rounds
ENGAGING PATIENTS IN PRACTICE TRANSFORMATION: TIPS FOR SUCCESS Recruit Thoughtfully Methods The right patient Meeting times selection Seek representation Define advisor roles/mission upfront
ENGAGING PATIENTS IN PRACTICE TRANSFORMATION: TIPS FOR SUCCESS Have a clear mission that s well understood by leadership, clinic members, and advisors.
ENGAGING PATIENTS IN PRACTICE TRANSFORMATION: TIPS FOR SUCCESS Ask patient advisors for feedback? Engage patients early in an intervention.
ENGAGING PATIENTS IN PRACTICE TRANSFORMATION: TIPS FOR SUCCESS Ask patient advisors for feedback? Otherwise, they might feel tokenistic or that their advice won t matter.
SIM REQUIREMENTS SIM: Assess and improve patient and family experience of care by selecting at least one of the following: Regular patient and family surveys at least quarterly Patient and family advisory council that meets at least quarterly. Develop communication(s) to patients, families, and the clinic about the specific changes the practice is implementing, including efforts as a result of, or influenced by, your practice survey/pfac activities. SIM Milestones. 2016.
2017 NCQA REQUIREMENT Team Based Care and Practice Organization, Competency A, 04: Patients/families/caregivers are involved in the practice s governance structure or on stakeholder committees (2 credits)
CPC+ TRACK 1 REQUIREMENT 4.1 Convene a PFAC (patient family advisory council) at least once in PY2017, and integrate recommendations into care, as appropriate
QUESTIONS?/ COMMENTS? aimee.english@ucdenver.edu