Mapping Patient-Centered Care M.Procuniar, BSN-RN, BA; S.Murphy, MSN-RN Standard Register Current 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 Illinois Ohio Kentucky Tennessee Alabama Florida Georgia South Carolina North Carolina Virginia West Virginia Maryland Delaware Pennsylvania Maine New Hampshire Vermont Rhode Island New 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 Illinois Ohio Kentucky Tennessee Alabama Florida Georgia South Carolina North Carolina Virginia West Virginia Maryland Delaware Pennsylvania Maine New Hampshire Vermont Rhode Island New 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 Illinois Ohio Kentucky Tennessee Alabama Florida Georgia South Carolina North Carolina Virginia West Virginia Maryland Delaware Pennsylvania Maine New Hampshire Vermont Rhode Island New 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 Illinois Ohio Kentucky Tennessee Alabama Florida Georgia South Carolina North Carolina Virginia West Virginia Maryland Delaware Pennsylvania Maine New Hampshire Vermont Rhode Island New 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 Illinois Ohio Kentucky Tennessee Alabama Florida Georgia South Carolina North Carolina Virginia West Virginia Maryland Delaware Pennsylvania Maine New Hampshire Vermont Rhode Island New 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 5 th 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 SmartForm Technology • 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 source of 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