Transcript Patient Engagement

Patient and Community
Engagement in Healthcare
Our Quality Strategy
Better Health
for the
Population
Better Care
for
Individuals
Lower Cost
Through
Improvement
Benefit Redesign - Patient Engagement
Different Strategies for Different Healthcare Spend Segments
Those with
severe, acute
illness or
injuries
% Total
Healthcare
Spend
Those with
chronic
illness
% of Members
Those who
are well or
think they
are well
MobileFirst Patient Consumer
Practice transformation away from episode of care
Preventive
Medicine
Chronic Disease
Monitoring
Medication
Refills
Acute Care
Test Results
DOCTOR
Master Builder
Case
Manager
Source: Southcentral Foundation, Anchorage AK
Behavioral
Health
Medical
Assistants
Nursing
Parallel Team Flow Design: the glue is real data, not a doctor’s brain
Chronic
Disease
Monitoring
Medication
Refills
Healthcare
Support
Team
Point of
Care Testing
Acute
Care
Test
Results
Case
Manager
Source: Southcentral Foundation, Anchorage AK
Preventive
Medicine
Clinician
Acute
Mental
Health
Complaint
Medical
Assistants
Chronic
Disease
Compliance
Barriers
Behavioral
Health
A comprehensive approach helps reduce costs while improving care
KNOWLEDGE
INTERVENTION
Identify and influence individuals
and populations, and recognize
intervention opportunities
Drive evidence-based and
standardized care planning
LEARNING
Apply new insights from
interactions and outcomes
to enable continuous
transformation
COLLABORATION
WELLNESS
COORDINATION
Deliver care and monitor progress across
clinical and social requirements
Assess and engage
individuals and
stakeholders to drive
individualized care plans
Asking New Questions
From
To
How many patients can you see?
How many patients’ problems can you solve?
From
To
How can we encourage and convince patients to get required prevention?
From
To
How often should a physician see a patient to optimally monitor a condition?
How can we create systems that significantly increase that patients get
required prevention?
What is the best way to optimally monitor a condition?
*Source: 2014 Kaiser Permanente Jack Cochran
What is Patient Experience?
• How the patient journey (and the dynamic,
associated human interactions and emotional
response) is experienced and interpreted by an
individual
• A subjective measure of a patient's experiences. It
looks at a care provider's offering from the
standpoint of the patient's holistic experience
Why it matters?
Better Health Better Care -Mutuality and
Patient Centeredness
‘We are determined to put the needs of
patients at the centre of our health
service…and learn from patient experience,
good and bad, in improving how we design
and deliver services’
Shared ownership and partnership working
with patients
What do Patients want?
•
•
•
•
Fast access to a reliable health service
Effective treatment delivered by professionals
Participation in decisions & respect
Clear, comprehensive information and support
for self care
• Continuity of care
Picker Survey 2007
Enam Dimensi Mutu Pelayanan Kesehatan
Kemudahan
akses
Berpusat
pada pasien
Efisien
Efektif
Berkeadilan
Mutu
Pelayanan
Aman
Kesehatan
http://www.who.int/management/quality/assurance/QualityCare_B.Def.pdf
Quality Patient
Care
Safe & Effective
External ‘process’/journey
Patient Experience
Rights
Based
Approach
Admission/
Referral
Expectations
Assessment/
Treatment
Human ‘internal’/experience
Clarity about
purpose
“what happens
to me”
Anxiety
Empathy
/Engagement
Intervention/
Treatment
Explanation of
procedure/risks
involved
Choices offered/
patient/carer
engagement
Discharge Plan/
Exit System
Role
of
the
healthcare
professional
- Understanding
aftercare/self care
- Compliance assured
- Lifestyle change
- Where to get help
Clinical
Outcome
What has been done to
patient
Impact on patient
Transforming Relationships
• Supporting Patients and Carers to engage in
improving services at local level
• Surveys, Focus groups and patient stories
• Clinical supervision to promote reflection as
an everyday part of work
• Creating opportunities to support staff in
driving improvement in patient care
• Patient experience embedded into CPD and
staff feedback
Patient Engagement
• Is a process of patients
becoming invested in their own
care.
• Develops with conversation
between patients and providers
and patients setting their own
self-management or self-care
goals.
• The role of the patient is no
longer that of a passive recipient
of care.
• The Wagner Chronic Care
model suggests engaged
activated patient have improved
quality measures.
• Harvard Business and Medical
Schools June, 2013 Healing
Ourselves Conference,
addressing healthcare’s
innovation, cites “making
consumerism really work” as a
key imperative to improving
health care quality and cost.
Recent Payer, State and Federal Initiatives
promote Patient Centered Medical Homes
(PCMHs), providing:
• Whole-person focus
• Long-term provider partnerships, not
sporadic, hurried visits
• Provider-led teams coordinate care,
especially prevention/chronic conditions,
plus other providers’ care, community
support
• Enhanced access and patient engagement
Benefits of PCMHs:
Improved health care value
• Higher quality, lower costs preventing the need for
hospital and ER admissions
– Quality Gains And Cost Savings Through Adoption Of Medical Homes,
Fields, Leshen, Patel, Health Affairs, May 2010
• Improved satisfaction – patients & clinicians
– Patient-Centered Medical Home Demonstration, Reid et al, American
Journal of Managed Care, September 2009
The Joint Commission PCMH Standards
•
•
•
•
•
Patient-centered care
Comprehensive care
Coordinated care
Superb access to care
A system-based
approach to quality
and safety
• Patient can select their
care providers,
consideration of
patient’s cultural,
linguistic and
educational
preferences, patient
involvement in
treatment, support for
self-management
Public Health Management Corporation
Nursing Network
PHMC Health Connection
Rising Sun Health Center
Pre-intervention
patient focus groups:
• Expressed confusion and concern about medication use, diet and self
management of diabetes.
– “I am on two medications for my blood pressure and three for my
diabetes. It is back and forth, back and forth trying to get the results they
want.”
– “You have to stay stable; you have to eat breakfast on time and you have to
eat between meals.”
• Stressed difficulty adopting a diet that would allow them to lose
weight or maintain a better blood sugar level.
– “Sometimes I get nervous, like when I don’t eat…I realize my sugar is
low…it can go under 70 , that’s when I feel it.”
• Indicated family support was important to their efforts to take
medication, eat better and try to be physically active.
– “I love junk food, but my husband does not let me eat it.”
– “My granddaughter or daughter will call me and ask, Nana did you take
your medicine?”
• Identified the areas of self-care management with which they needed
assistance to improve their health outcomes.
– “It is easy for them to tell you what you need to do, but hard for you to do
it.”
– “Eating right, exercising , reducing stress…”
– “Some of the pills make you nauseous and/or sleepy.”
Intervention:
RN Care Managers Coached Patients
on their selected self-management goals
• Reducing stress
• Exercise
• Nutrition
• LDL
• Smoking Cessation
• Blood Pressure
• Statistically significant increase
in self-management goals
related to stress, exercise and
nutrition (p=>.0001)
• Statistically significant decrease
in LDL and number of
cigarettes smoked (p=>.0o01) at
12 months
• Statistically significant decrease
systolic and diastolic blood
pressure (p=>.0o01) at 18
months
Examples of Self-Management Goals
• Wish to increase exercise
for improved
cardiovascular health – I
will get off the bus two
stops earlier on my way to
and from work.
• Nutrition related to desire
to loose weight – I will
replace sugary drinks,
both juice and soda, with
water and unsweetened
tea.
Outcome Measures
• Body Mass Index
• Hemoglobin A1C
• Clinically significant
reductions in BMI
(40%) and A1C (25%),
but not statistically
significant
SF 12 Outcome Measures
• Medical Outcomes Short Form measures
perceptions of the patient’s own health to
include: general health, physical functioning,
bodily pain, vitality, social functioning, role
limitation physical, role limitation emotional,
physical health and mental health.
• Subjects had statistically significant positive
changes in bodily pain, role limitation
emotional and mental health.
Post-intervention
patient focus groups:
• Expressed better understanding of medication use, diet and self
management of diabetes, hypertensions and lipid levels because RN
Care Manager took time with them and helped patients to set monthly
goals.
– “Because I didn’t have a clue what was going on with being a diabetic and
you really took time out to help me.”
– “You helped me out with my smoking. I am down to half a pack per day.”
• Meeting one on one with RN Care Managers provided very personal
individualized assistance in taking small steps to improve their health
over time.
– “My cholesterol is really good. Like I was shocked when my heart doctor
told me it was perfect because it was sky high.”
– “Yeah, me with the junk food and I stopped. I drink water and I eat alot of
vegetables and fruit.”
• Both parents and children supported patients efforts to take
medication, reduce their stress, eat better, decrease or stop smoking
and to be more physically active.
– “All of my family stopped smoking.”
– My mother started buying more healthy stuff for the house.”
• RN Care Managers and clinic staff are encouraging and caring, when
you have insurance and when you do not.
– “I love this clinic and program, because a few months ago my insurance
ran out. No one would provide my medicine but here the nurse
practitioner went to the back and gave me some. ”
– “The RN Care Manager is very dedicated and sincere. I feel it is more than
just a program to her.”
•Posters were placed in the waiting
rooms as well as other locations in all
of the participating clinics.
•Corresponding brochures with a
short description of each decision aid
were provided to be handed out either
in the waiting room or by providers
in the exam rooms.
•Decision aids have been added.
Diabetes Only
Pre-Viewing Health Info
at Temple vs Other Demo Sites
 Temple (n=35)
 Other Demo Sites (n=292)
Diabetes Only
Post-Viewing Total Taking or Planning to Talk About
Medications at Temple vs Other Demo Sites
Cholesterol
Meds
Blood
Pressu
re
TODAY - Key Priorities:
Keeping the Patient at
the center of all we do
• Patient-Centric health care and health record by
– Laying the groundwork for interoperability with
standards, testing & certification
– Facilitating broad implementation of health
information exchange
• Patient Engagement by enabling patient
– Access
– Action
– Attitude
Focus on INTEROPERABILITY in the
Stage 2 Meaningful Use Criteria
• E-prescribing (ambulatory and inpatient discharge)
• Transition of Care summary exchange:
• Create & transmit from EHR
• Receive & incorporate into EHR
• Lab tests & results from inpatient to ambulatory
• Public health reporting – transmission to:
• Immunization Registries
• Public Health Agencies for syndromic surveillance
• Public health Agencies for reportable lab results
• Cancer Registries
• Patient ability to View, Download and Transmit their
health data to a 3rd Party
• Create an export summary of patient data, in order to
enable data portability
Focus on PATIENT ENGAGEMENT in the
Stage 2 Meaningful Use Criteria
• Reminders for preventive/follow-up care
provided
• Educational resources identified and provided
• Online access to personal health information
(portal, PHR)
• Visit Summaries provided
• Patients can send secure messages to their
provider
• Patients can View, Download and Transmit to 3rd
Party
Back in the Day…
“The
obedience of a
patient to the
prescriptions of his
physician should be
prompt and implicit.
[The patient] should
never permit his own
crude opinions as to
their fitness to
influence his
attention to them.”
- AMA’s Code of
Medical Ethics (1847)
And Now…
“Patients share the
responsibility for their own
health care….”
- AMA’s Code of Medical Ethics
(current)
“Patients can help. We can be a
second set of eyes on our medical
records. I corrected the mistakes
in my health record, but many
patients don't understand how
important it will be to have
correct medical information, until
the crisis hits. Better to clean it up
now, not when there’s time
pressure.”
– Dave deBronkart (ePatient Dave)
ONC’s Consumer Engagement
Strategy:
The Three A’s
Access
Attitudes
Support a shift in attitudes and
expectations regarding consumer
(and provider) roles.
Give consumers electronic
access to their health
information.
Action
Action
Catalyze development of tools and
services that help consumers (and
providers) take action using their
health information.
TOMORROW –
The biggest challenges in our future
Improved
outcomes
Advanced
clinical
processes
Data capturing
and sharing
Stage 3
Stage 2
Stage 1
Stages of
Meaningful Use
Smarter Healthcare
36.3%
32.2%
12.8%
-15.6%
10.5%
18.9%
15.0%
Drop in hospital days
Drop in ER use
Increase Chronic Medication use
Total cost
Drop Inpatient specialty care costs
Ancillary costs down
Outpatient specialty down
Outcomes of Implementing Patient Centered Medical
Home Interventions: A Review of the Evidence from
Prospective Evaluation Studies in the US - PCPCC Oct 2012
24 July 2014 Michigan Blues’ patient-centered medical home program
shows statewide transformation of care YEAR 6
•9.9 percent lower rate of adult ER visits
•27.5 percent lower rate of adult ambulatory care sensitive
inpatient stays
•11.8 percent lower rate of adult primary care sensitive ER
visits
•8.7 percent lower rate of adult high-tech radiology usage
•14.9 percent lower rate of pediatric ER visits
•21.3 percent lower rate of pediatric primary-care sensitive ER
visits
4,022 primary care doctors at 1,422 practices around the state
in its sixth year of operation. These practices care for more
than 1.2 million BCBSM members.