PATIENT- CENTERED CARE...under stress Hibbard J, Stockard J, Mahoney E, and Tusler M. Development of the Patient Activation Measur (PAM): Conceptualizing and Measuring Activation in

PATIENT-

CENTERED

CARE:

BOTH IN INDIVIDUAL CONVERSATIONS

WITH PATIENTS AND IN PRACTICE

TRANSFORMATION EFFORTS

Integrated Network Engagement Summit

9/21/17

Aimee English, MD

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

INDIVIDUAL PATIENT

ENGAGEMENT

WHO MANAGES

CHRONIC DISEASE?

Providers

Case Managers

Social Workers

NursesPatient Themself

Spouses

Personal Care Givers

Siblings

Parents

Friends

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

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.

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

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.

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.

ACTION PLANS

Coleman M. Supporting Self-Management in Patients with Chronic Illness. American Family Physician. 2005. 72 (8); 1503 – 1510.

ACTION PLANS

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.

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)

CPC+ TRACK 1

REQUIREMENT

4.2 Assess practice capability and plan for support of

patients’ self-management.

ENGAGING PATIENTS AND

FAMILIES IN PRACTICE

TRANSFORMATION

BACKGROUND

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.

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.

METHODS OF ENGAGING

PATIENTS & FAMILIES OR

GETTING FEEDBACK

PFAC

QI TeamsLeadership Mtgs

Focus Groups

Waiting Room Rounds

Group Concept

Mapping

Experience

Surveys

?

ENGAGING PATIENTS IN PRACTICE

TRANSFORMATION:

TIPS FOR SUCCESS

Recruit Thoughtfully

• Methods

• The “right” patient

• Meeting times

selection

• Seek representation

• Define advisor

roles/mission upfront

Have a clear mission that’s well understood by leadership, clinic

members, and advisors.

ENGAGING PATIENTS IN PRACTICE

TRANSFORMATION:

TIPS FOR SUCCESS

Ask patient

advisors for

feedback?

Engage patients early in an intervention.

ENGAGING PATIENTS IN PRACTICE

TRANSFORMATION:

TIPS FOR SUCCESS

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

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.

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)

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

QUESTIONS?/

COMMENTS?

[email protected]