Presented by Kay Bensing, MA, RN

Presented by Kay Bensing, MA, RN

At the end of this 1-hour session, participants will be able to: Discuss how healthcare consumers evaluate the quality of the healthcare they receive Identify goals for consumer-driven healthcare Describe strategies to promote consumer involvement Discuss the learning curve for nurses and other healthcare providers to assist consumers to co-manage their care

Conclusion Ample data available to healthcare consumers But Don t know how to access or interpret quality information Example: CMS nursing home data

Many people don think there is any problem related to quality in healthcare There is a cultural bias in the U.S. Americans believe more in healthcare is better; the doctor is always right, and we have best healthcare system in the world. Trudy Lieberman, senior health policy editor, Consumer Reports

Response to Negative Reports When press reports stories of poor healthcare quality, the public doesn t believe the report. Thinks if there is a problem, the government will take care of it and the public will be protected. Trudy Lieberman

Safe Effective Patient-Centered Timely Efficient Equitable

Executive summary: Seeks to increase access to high-quality, affordable healthcare for all Americans. The law requires the Secretary of Health and Human Services to implement the National Strategy for Quality Improvement for Health Care, to be updated annually and presented to Congress.

April 12, 2011: When it comes to quality, new poll shows Americans give U.S. health care low grades. Harvard School of Public Health 1,034 adults surveyed on quality of care, results presented at annual meeting of American Hospital Association, Washington, DC

55% of all polled gave healthcare a C or D grade; 11% an F grade When asked to rate where they go for hospital care, 57% said the same hospital they ve gone for years as opposed to 38% that had better quality ratings Consumers need to step up to the plate and take more accountability for their care. Risa Lavisso-Mourey, MD, PhD, CEO, Robert Wood Johnson Foundation

Better Care: Improve the overall quality by making healthcare patient-centered, reliable, accessible and safe Healthy People/ Healthy Communities: Improve health of U.S. populations by supporting proven interventions to address behavioral, social and environmental determinants of health Affordable Care: for consumers, employers and government

Make care safer by reducing harm Ensure person and family are engaged as partners in their care Promote effective communication and coordination of care Promote the most effective prevention and treatment practices Work with communities to promote wide use of best practices to enable healthy living Make quality care more affordable by developing and spreading new health care delivery models

Leapfrog Group HEDIS (Health Effectiveness and Data Information Set) The 100,000 Lives Campaign Protecting 5 million lives from harm Pay-4-Performance? Dashboards and Metrics

Long before ACA became law, there was consensus among healthcare experts if consumers were educated with the right information, they could be activated to: Demand high-quality services from providers Share decision making with clinicians Self-manage their healthcare with guidance

The guiding principle is if health is on the table, then the patient and his family must be at the table every table now. Donald Berwick, MD, former CMS commissioner

Clinicians reluctant to share knowledge lack of time Consumer advocacy groups have not been invited to the table Clinicians not convinced sharing adverse events can result in positive outcomes Exception: Michelle Malizzo Ballog-2008 transparency led to positive outcome

2007: Robert Wood Johnson Foundation Partners with Academy Health, DC-based health policy experts and researchers Product: Five white papers on consumer activation, decision making, health plan choice, provider and Rx choice and how to navigate the healthcare system Gaps in previous research

Holds potential to spur health quality improvements, particularly in patient safety and decision making in Rx Must not be viewed as a silver bullet; consumers have neither the power nor skills to transform healthcare systems on their own Requires a joint effort on the part of consumers, providers, payers, insurers and policymakers

Uniformity in website data comparing performance HHS set standards for collecting and reporting data Accountable Healthcare Organizations (ACOs): Alternative healthcare delivery system Consumer-Based Care Transition Program

Assessing for the barriers can be a nightmare!

Being a patient in the U.S. is like being dropkicked into a foreign country: You can t speak the language; you don t have a map; you don t know who is in charge, and all you want to do is go home. Jesse Gruman, PhD, president of Center for Advancing Care, has had four cancer diagnoses and now is spokesperson to improve navigation in healthcare

Patient navigation is a process in which patients and families move through a complex healthcare continuum to seek healthcare that results in positive outcomes Structural Innovations: Few Examples Focused Factories

How much do you know about your own healthcare? First, educate yourself. Then educate consumers about their health and healthcare not just at your work site but also in the community.

Holly

1. Bensing, K. (2002). Advocating quality care. Retrieved July 5, 2012 from the World Wide Web: http://nursing.advanceweb.com/article/advocating-quality-care-3.aspx 2. LDI Health Policy Seminar. (2002). Measuring and improving health care quality: towards meaningful solutions. Retrieved July 7, 2012 from the World Wide Web: http://www.upenn.edu/ldi/pandel.html 3. Butcher, L. (2004). Differing definitions of quality lead to disparate health rankings. Retrieved July 1, 2012 from the World Wide Web: www.bizjournals.com/kansascity/stories/2004/11/01/story8.html 4. National Strategy for Quality in Improvement in Health Care. (2011). Report to Congress. Retrieved July 2, 2012 from the World Wide Web: http://www.healthaffairs.org/healthpolicybriefs/brief.php?brief_id=45 5. Harvard University. (2011). When it comes to quality, new poll shows Americans give U.S. health care low grades. Retrieved July 10, 2012 from the World Wide Web: http://www.hsph.harvard.edu/news/press-releases/poll-us-health-care-quality 6. Lenape, L., & Berwick, D. (2009) Transforming healthcare: A safety imperative. Retrieved 26, 2012 from the World Wide Web: http://www.ncbi.nlm.nih.gov/pubmed/199554517