Transcript The Good, The Bad, and - Institute for Patient- and Family

“Integrating Electronic Technology in a Patientand Family-Centered Clinical Model:
The Good, The Bad, and Lessons Learned”
Patricia Sodomka, FACHE
Senior Vice President, Patient- and Family-Centered Care, MCG Health, Inc.
Director, Center for Patient- and Family-Centered Care, Medical College of Georgia
Christine Abbott
Patient Advisor, Family Faculty, MCG Health, Inc.
Institute for Family-Centered Care
3rd International Conference on Patient- and Family-Centered Care
Partnerships for Enhancing Quality and Safety
July 30 – August 1, 2007 // Seattle, Washington
Augusta Multiple Sclerosis Center
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Based at the Medical College of Georgia
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Augusta, Georgia
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Dr. Mary Hughes, Medical Director
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1,500 patients enrolled
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2,500+ visits/year
The Augusta Multiple Sclerosis Center:
A Patient Family Centered Care Odyssey
Institute of Medicine:
Health Care in the 21st Century
10 Rules for Healthcare
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Care is based on continuous healing relationships
Care is customized according to patient needs and values.
The patient is the source of control.
Knowledge is shared and information flows freely.
Decision making is evidenced-based.
Safety is a system property.
Transparency is necessary.
Needs are anticipated.
Waste is continuously decreased.
Cooperation among clinicians is a priority.
Rule #3 – The Patient is the Source of Control
 Patients should be given the necessary
information and the opportunity to exercise the
degree of control they choose over health
care decisions that affect them.
 The health systems should be able to
accommodate differences in patient
preferences and in encourage shared decision
making.
The “AHA” Moment - 2001
 What “we” wanted
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Research
A new building
More doctors
A “cure”
 What the “patients and
families” wanted
 Accessible bathroom
 Someone to return
phone calls
 Access to psychological
support
 Self management
support
MS Advisory Council
Transforming Episodic Medical Care
The Chronic Care Model
Functional and Clinical Outcomes
The Problem
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Limited resources
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Need to prioritize interventions
Our Solution:
Collaborative Care/Self Management
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Psychology Services
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Technology – My HealthLink
Exploring the Mind of MS
“A Collaborative Approach to the Treatment of
Mental Health Issues in Multiple Sclerosis”
Mitzi Williams, MD – Neurology Resident, Future MS Fellow
Mary Hughes, MD – Director of Augusta MS Center
Lara Stepleman, PhD – Director of HIV and Multiple Sclerosis Psychological Services
A Stimulus For Change
• Up to 80% suffer from Depression
• 7X higher suicide rate vs. general population
Identifying a Need
 Improved recognition of mental health issues in
patients
 Increased availability of mental health services
for patients and families
 Utilizing those who are best able to provide these
services
Collaboration
Key players involved:
 Augusta MS Center
 MS Center Patient Advisory Council
 MCG Psychology program within
Department of Psychiatry and Health
Behavior
Participation
 Design a solution that patients will utilize
 Patient Input vital to program design
 Providing a resource, not a punishment
MS Psychology Consultation Service
Goal Statement:
“The goal of the MS Psychological Services
Program is to remove barriers to the
emotional well-being of MS patients through
convenient, compassionate, and coordinated
psychological services provided during routine
MS medical appointments.”
Examples of MS Patient Research that
Grew from the MS Psychology Program
ECTRIMS (Madrid, 2006)
• Predicting depression and anxiety in a multiple sclerosis clinic population: The
contributions of illness severity, illness management, and perceived cognitive
impairment.
• Overcoming Mental Health Care Barriers for Individuals with MS: Innovations
in Psychological Consultation.
ECTRIMS (Prague, 2007)
• The development of an educational intervention for MS-related sexual intimacy
concerns.
• Using problem-solving therapy to treat depression within the MS clinic setting.
• Utilization of mental health services by MS centers in the US.
Journal of MS Care (2007)
• Problem solving therapy for depression: A pilot intervention for MS care
settings. International Journal of MS Care, 9, p. 76.
• MS psychological consultation: Addressing the mental health needs of
individuals with MS. International Journal of MS Care, 9, p.76.
The Missing Link
“Empowering Patients Living with Multiple
Sclerosis to Self-Manage Their Health”
Aim Statement
 The intent of this project is to improve the health of patients with MS
by enabling them to partner with care providers in the management of
their health care.
Our numerical goals for this work are:
• 100% of patients enrolled in My HealthLink with documented self
management goals.
• 80% of patients/families enrolled in My HealthLink will rate their level
of satisfaction with self management support as highly or extremely
satisfied.
• 50% of patients/families enrolled in
My HealthLink will continue to use the
program 3 months after their initial
enrollment date.
“Empowering Patients Living with Multiple
Sclerosis to Self-Manage Their Health”
The Business Case
Premise
 Effective patient self management will reduce the
reliance on phone calls to the physicians’ office
 This will result in cost savings in terms of
physician/staff time and realization of opportunity
costs for increased revenue in marginal patient
volume.
 My HealthLink will reduce patient
phone calls by 50%
Implementation of My HealthLink
Results - Quantitative
 Measurement Tool
 Ten chronic disease self-management parameters
and the Stanford Patient Education Research
Center’s Self-Efficacy for Managing Chronic
Disease 6-Item Scale.
 All MS patients were asked to fill out this survey
every 3 months for a 12-month time period, whether
or not they used the My HealthLink product.
 Results
 The data did not show the predicted improvement in
self-management parameters
• limited sample size
• short time interval
• lack of control group
Stanford Self Efficacy Question 6:
 How confident are you that you can do
things other than just taking medications
to reduce how much your illness affects
your everyday life?
 The goal was 80% will rate this as
“highly or extremely” satisfied
 Results ranged from 35% to 78% over
the 6 month period
Results - Qualitative
 Measurement Tool
 MS Patient/Family Advisory Council provided
verbal and written feedback at 3, 6, 9, and 12
months after start of the project.
 The Wrap Up Meeting at the End of the
Project
• How could the MS center help the patients
and families in managing their chronic
condition and did this project help?
The Patients and Families
Speak
 Physical Access
 Need easier access for wheelchairs
 Functional Support
 There is a need for help outside of the institution, in
the home, outside of the medical visit
 All function issues are local
 MS patients need to be able to “smell the roses
outside". This was a key point.
 There needs to be an advocate for function issues
 OT is a "bust".
 A forum on home design would be a great local topic.
 The fundamental question a practitioner should ask is:
"How hard is it to go to bed and get out of bed?"
 Instead of Habitat for Humanity, how about Habitat for
Mobility.
The Patients and Families
Speak
 Insurance
 Insurance won't reimburse for medical
equipment, relating to function, such as manual
v. auto bed.
 Medicare won't pay for most equipment, etc
relating to MS, since it is considered not to be a
"neuromuscular" disease.
 MS, the disease, has many faces and there are
a myriad of function issues, that can't be
standardized or categorized into one area.
The Patients and Families
Speak
 Clinic Operations
 The staffing and clinic needs cannot be
standardized for a hospital clinic, thus normal
staffing ratios, benchmarks don't work.
 There needs to be a "mobility" assessment done
at the visit. This would be called a functional
needs assessment.
 The clinic should be a support clearinghouse,
but not a brochure clearinghouse. The patients
need boots on the ground in their environment
outside of the hospital to help and offer support.
 A mobility assessment counselor would be
helpful.
The Unexpected Success
 Efficacy of using a patient advisor in the clinic to
enroll and train patients on the MyHealthLink system.
 It was clear, through feedback from the patient/family
advisory group, that this program was beneficial.
 Most importantly, the qualitative feedback from the
MS Patient/Family Advisory Council reinforced the
value of engaging patients and families in the design
and review of clinical delivery systems (in this case,
as it pertains to disease self-management).
The Essential Role of the Patient Advisor
Christine Abbott
Patient Advocate Extraordinaire
Patient Advisor Requests for ePHR Enhancements
 Mechanism to document routine health
information (mammogram, dental visit, eye
exam, etc)
 Place to document cholesterol, exercise, diet
 Include National MS Society hyperlink
 Hook into MS Watch.org (shared solutions)
 Increase font size
 Medication center improvements
Platform for Next Research Grant/Project
 3 year study focused on hypertension in
primary care practices and the use of the
ePHR
 Randomized controlled trial of 720 patients
and 20 physicians
 7 month period of design enhancement with
30 local and 10 national patient advisors
Platform for Next Research Grant/Project
Measure impact of use of an patient enhanced ePHR on:
 Patient activation
 Perceptions of care
 Blood pressure
 BMI
 Lipid levels
 Patient-MD communication
 Adherence to treatment guidelines
 Utilization of medical services