mapping patient centered care
TRANSCRIPT
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
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
“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
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
“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