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TRANSCRIPT
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PATIENT-
CENTERED
CARE:
BOTH IN INDIVIDUAL CONVERSATIONS
WITH PATIENTS AND IN PRACTICE
TRANSFORMATION EFFORTS
Integrated Network Engagement Summit
9/21/17
Aimee English, MD
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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
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INDIVIDUAL PATIENT
ENGAGEMENT
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WHO MANAGES
CHRONIC DISEASE?
Providers
Case Managers
Social Workers
NursesPatient Themself
Spouses
Personal Care Givers
Siblings
Parents
Friends
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RISING RATES OF
CHRONIC ILLNESS
Medical Expenditure Panel Survey 2006.
Wu, Shin-Yi, and Green, Anthony. Projection
of Chronic Illness Prevalence and Cost
Inflation.RAND Corporation, October 2000
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STAGES OF ACTIVATION
Stage 1:
Beliefs about the
importance of the
patient role
Stage 2:
Knowledge and
confidence
necessary to take
action
Stage 3:
Actually taking
action
Stage 4:
Staying the course
under stressHibbard 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.
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.
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.
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.
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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
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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.
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DECISION AIDS
Ottawa Hospital Research Institute:
• https://decisionaid.ohri.ca/AZlist.html
Mayo:
• http://shareddecisions.mayoclinic.org/decision-aid-
information/decision-aids-for-chronic-disease/
AHRQ
• http://effectivehealthcare.ahrq.gov/index.cfm/tools-and-
resources/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:
10.1002/14651858.CD001431.pub4.
https://decisionaid.ohri.ca/AZlist.htmlhttp://shareddecisions.mayoclinic.org/decision-aid-information/decision-aids-for-chronic-disease/http://effectivehealthcare.ahrq.gov/index.cfm/tools-and-resources/patient-decision-aids/
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ACTION PLANS
Coleman M. Supporting Self-Management in Patients with Chronic Illness. American Family Physician. 2005. 72 (8); 1503 – 1510.
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ACTION PLANS
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SIM REQUIREMENTS
SIM:
• Implement shared decision making tools or aids in two health
conditions, decisions or tests as component of shared decision-
making, 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.
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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 preference-
sensitive conditions (1 credit)
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CPC+ TRACK 1
REQUIREMENT
4.2 Assess practice capability and plan for support of
patients’ self-management.
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ENGAGING PATIENTS AND
FAMILIES IN PRACTICE
TRANSFORMATION
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BACKGROUND
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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.
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METHODS OF ENGAGING
PATIENTS & FAMILIES OR
GETTING FEEDBACK
PFAC
QI TeamsLeadership Mtgs
One-time Focus
Groups Waiting Room Rounds
Group Concept
Mapping
Experience
Surveys
LaNoue M, et al. Concept Mapping as a Method to Engage Patients in Clinical Quality Improvement. Ann Fam Med. 2016, 14(2): 370 – 376.
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METHODS OF ENGAGING
PATIENTS & FAMILIES OR
GETTING FEEDBACK
PFAC
QI TeamsLeadership Mtgs
Focus Groups
Waiting Room Rounds
Group Concept
Mapping
Experience
Surveys
?
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ENGAGING PATIENTS IN PRACTICE
TRANSFORMATION:
TIPS FOR SUCCESS
Recruit Thoughtfully
• Methods
• The “right” patient
• Meeting times
selection
• Seek representation
• Define advisor
roles/mission upfront
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Have a clear mission that’s well understood by leadership, clinic
members, and advisors.
ENGAGING PATIENTS IN PRACTICE
TRANSFORMATION:
TIPS FOR SUCCESS
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Ask patient
advisors for
feedback?
Engage patients early in an intervention.
ENGAGING PATIENTS IN PRACTICE
TRANSFORMATION:
TIPS FOR SUCCESS
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Ask patient
advisors for
feedback?
Otherwise, they might feel tokenistic or that their advice won’t matter.
ENGAGING PATIENTS IN PRACTICE
TRANSFORMATION:
TIPS FOR SUCCESS
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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.
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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)
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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
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QUESTIONS?/
COMMENTS?