Mapping Patient-Centered CareM.Procuniar, BSN-RN, BA; S.Murphy, MSN-RN

Standard RegisterCurrent Events

The Problem How We Measure Up

How Technology Can Help

Recommendations for Practice

It is with good reason that the Joint Commission is

proposing requirements for the Hospital Accreditation

Program to include advancing effective communication,

cultural competence and patient-centered care. There is

growing evidence from respected organizations that

health care providers can improve clinical outcomes in the

acute care space by aligning themselves with patients’

needs and making them part of the care team.

Disclosure

Authors of this presentation have the following to disclose concerning possible financial or personal relationships with commercial entities that may have a direct or indirect interest in the subject matter of this presentation:

M.Procuniar: Employed by Standard Register

S.Murphy: Employed by Standard Register

Washington

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South Carolina

North Carolina

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West

VirginiaMaryland

Delaware

Pennsylvania

Maine

New Hampshire

Vermont

Rhode IslandNew York

Connecticut

New Jersey

Massachusetts

“How often did nurses always communicate well with patients?”

66-73%

74-75%

76-77%

78-80%

National Average is 75%

Per HCAHPS: “Communicated well” means explained things

clearly, listened carefully, treated patients with courtesy &

respect.

Washington

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Idaho

Utah

Arizona

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Colorado

Wyoming

Nebraska

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Michigan

Wisconsin

Minnesota

Iowa

Missouri

Arkansas

Louisiana

Indiana

IllinoisOhio

Kentucky

Tennessee

Alabama

Florida

Georgia

South Carolina

North Carolina

Virginia

West

VirginiaMaryland

Delaware

Pennsylvania

Maine

New Hampshire

Vermont

Rhode IslandNew York

Connecticut

New Jersey

Massachusetts

“How often did doctors always communicate well with patients?”

71-77%

78-80%

81-82%

83-86%

National Average is 80%

Per HCAHPS: “Communicated well” means explained things

clearly, listened carefully, treated patients with courtesy &

respect.

Washington

Oregon

California

Nevada

Idaho

Utah

Arizona

Montana

Texas

New

Mexico

Alaska

Hawaii

Colorado

Wyoming

Nebraska

Oklahoma

Kansas

North Dakota

South Dakota

Michigan

Wisconsin

Minnesota

Iowa

Missouri

Arkansas

Louisiana

Indiana

IllinoisOhio

Kentucky

Tennessee

Alabama

Florida

Georgia

South Carolina

North Carolina

Virginia

West

VirginiaMaryland

Delaware

Pennsylvania

Maine

New Hampshire

Vermont

Rhode IslandNew York

Connecticut

New Jersey

Massachusetts

“What percent of patients were given written information about

what to do during their recovery at home?”

74-80%

81%

82-83%

84-87%

National Average is 81%

Per HCAHPS: Patients reported whether they were given written

information about symptoms or health problems to watch for

during their recovery.

Washington

Oregon

California

Nevada

Idaho

Utah

Arizona

Montana

Texas

New

Mexico

Alaska

Hawaii

Colorado

Wyoming

Nebraska

Oklahoma

Kansas

North Dakota

South Dakota

Michigan

Wisconsin

Minnesota

Iowa

Missouri

Arkansas

Louisiana

Indiana

IllinoisOhio

Kentucky

Tennessee

Alabama

Florida

Georgia

South Carolina

North Carolina

Virginia

West

VirginiaMaryland

Delaware

Pennsylvania

Maine

New Hampshire

Vermont

Rhode IslandNew York

Connecticut

New Jersey

Massachusetts

“What percent of patients gave the hospital

an overall rating of 9 or 10 (high)?”

56-63%

64-66%

67-68%

69-72%

National Average is 65%

Per HCAHPS: Patients rated hospitals from 0-10; “worst hospital

possible” to “best hospital possible.”

Washington

Oregon

California

Nevada

Idaho

Utah

Arizona

Montana

Texas

New

Mexico

Alaska

Hawaii

Colorado

Wyoming

Nebraska

Oklahoma

Kansas

North Dakota

South Dakota

Michigan

Wisconsin

Minnesota

Iowa

Missouri

Arkansas

Louisiana

Indiana

IllinoisOhio

Kentucky

Tennessee

Alabama

Florida

Georgia

South Carolina

North Carolina

Virginia

West

VirginiaMaryland

Delaware

Pennsylvania

Maine

New Hampshire

Vermont

Rhode IslandNew York

Connecticut

New Jersey

Massachusetts

“What percent of patients would definitely recommend the

hospital to their family or friends?”

61-65%

66-68%

69-71%

72-75%

National Average is 68%

Per HCAHPS: From choices of “definitely”, “probably”, or “would

not” recommend.

Improve Quality, Safety, Efficiency while reducing

Disparities

Improve Patient and Family Engagement

Ensure information gets to where Care is

Coordinated

Improve population of Public Health

information

HITECH Focus Areas

Record demographics: including Preferred Language and Ethnicity

Send reminders to patients for preventive/follow-up care: based on Patient Preferences, Demographic Data, or Specific Conditions

Report quality measures to CMS (Ambulatory Care)

Produce lists of patients by Specific Condition for Quality Improvement, Reducing Disparities, and Outreach

Provide patients w/ a copy of health information (electronic or otherwise)

Implement 5 Decision Support rules: including patient Demographic Data, Diagnosis, or Condition

Provide a clinical summary to patients for each office visit

NPRM “Meaningful Use” Criteria:

IHI• Patient-Centered Care is a “multi-faceted challenge”

AHRQ• 20% of adults cannot read above a 5th grade level

NNLM

• “Health Literacy includes the ability to understand….not simply the ability to read.”

NPSF

• Poor health literacy and ineffective communication costs the US economy $100-200 billion a year

TJC

• “Appropriate communication is necessary for ensuring quality and safety in healthcare.”

• Foreign language, disease or disability, vision or hearing impairment

• Provides cohesive care using rules-based engine rather than end-user judgment

Business Logic

• Visually impaired

• Provides a way to serve elderly populations

Large Font Text

• Blind or severely visually impaired

• Provides a way to serve auditory learners

Embedded Audio Files

• Reading or health literacy impairment

• Provides material in lay terms; pediatric populations can also be better served

Material presented at lower grade levels

• Disease or disability, visual, hearing or cognitive impairment

• Provides a way to introduce difficult topics as an “ice breaker”

Photo-Novellas

• Cognitive or health literacy impairment

• Provides “change as you go” capability to electronic documents

Ink-on-Glass or

SmartFormTechnology

• Disease or disability, hearing or cognitive impairment

• Provides material in a form relevant to today’s society; can incorporate multiple learning styles

Video Media

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

National 30 Day Risk Adjusted Readmission Rate

Heart Attack

Heart Failure

Pneumonia

Project BOOST

Interdisciplinary Care Team

Uses the “teach back” method

72hr follow-up calls to patients

Incorporates relevant

technology: iPhone & YouTube

Result: 30-day readmission

rates decreased from 12% to 7%, Patient satisfaction

increased from 52% to 68%

Project RED

Nurse Discharge Advocates

Deploys colorful,

graphical, easy-to-read

discharge documents

Uses interactive technology:

an avatar named

“Louise”

Discharge documents

describe “After-

hospital Care”

Clinical pharmacists call patients

(2-4d) to discuss meds & inquire about

problems

Result: Both 30-day

readmission rates and ED

visits decreased

by 30%

Develop community connections

Work to eliminate barriers to successful care transitions

Engage patients, families, & caregivers in addressing HC issues

Focus on specific patient populations

Focus on stages within care delivery

Focus on organizational strengths

HRET: How to reduce avoidable readmissions

Analyze readmit rates by sourceof readmission

Analyze readmit rates along a timeline (7d, 30d, 60d, 90d)

Is there improvement in patient

retention/loyalty?

Is there measurable improvement in

health/wellness within specific disease classes as a result of changed

behavior?

Have readmission rates decreased beyond the

HCAHPS reportable data?

Evidence Base

“The problem with communication…is the illusion

that it has been accomplished.” -George Bernard Shaw

The current state of affairs can be seen using such indicators

as the Hospital Consumer Assessment of Healthcare Providers

and Systems (HCAHPS) survey. In fact, in 2009 over 3700

hospitals reported their HCAHPS results to CMS. It is our

recommendation that, in addition to the standardized HCAHPS

surveys, additional areas for improvement in tracking

measures exist.

In 2009 the ARRA HITECH Act was passed, giving hospitals and healthcare

providers an incentive to install and use technology in a “meaningful” way. The

impetus behind this Act is four focus areas developed by the National Quality

Forum. These focus areas are directly related to patient-centered care and the

aims of improving patient communication as seen in Health Literacy. Likewise,

the incentive goals found within the IFR and NPRM released by the ONC and HHS

support the use of technology in the aim to improve communication and patient-

centered care.

Non-English speaking populations continue to

grow while our communities struggle with

health and wellness. Culturally-sensitive,

clinically-relevant communications adapted to

the appropriate literacy level can be powerful

tools for engaging patients in our care.

With advancements in information technology

and digital printing, hospitals can create highly

personalized documents and communication

aids; enabling their staff to care more

effectively for patients with diverse needs.

© 2010 Standard Register