Mapping Patient-Centered Care
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The Problem Mapping Patient-Centered Care How We Measure Up • Patient-Centered Care is a “multi-faceted challenge” M.Procuniar, BSN-RN, BA; S.Murphy, MSN-RN IHI “How often did doctors always communicate well with patients?” “How often did nurses always communicate well with patients?” Standard Register Washington Washington • 20% of adults cannot read above a 5th grade level Current Events Maine Maine Montana Vermont Montana Vermont AHRQ North Dakota North Dakota Minnesota Minnesota Oregon Oregon New Hampshire New Hampshire Idaho Wisconsin Idaho Wisconsin South Dakota Massachusetts South Dakota Massachusetts New York New York Wyoming Michigan Rhode Island Wyoming Michigan Rhode Island Connecticut Connecticut • “Health Literacy includes the ability to Nebraska Iowa Pennsylvania Nebraska Iowa Pennsylvania NNLM understand….not simply the ability to read.” Improve Quality, Nevada Utah Illinois Indiana Ohio West New Jersey Delaware Nevada Utah Illinois Indiana Ohio West New Jersey Delaware It is with good reason that the Joint Commission is Colorado Virginia Colorado Virginia Kansas Virginia Maryland Kansas Virginia Maryland Safety, Efficiency Improve Patient and California California Missouri Missouri Kentucky Kentucky North Carolina North Carolina Tennessee Tennessee proposing requirements for the Hospital Accreditation Oklahoma Oklahoma while reducing Family Engagement Arizona New Arkansas Arizona New Arkansas • Poor health literacy and ineffective communication Mexico South Carolina Mexico South Carolina Georgia Georgia Alabama Disparities Alabama NPSF costs the US economy $100-200 billion a year Program to include advancing effective communication, Alaska Texas Louisiana Texas Alaska Louisiana Florida • “Appropriate communication is necessary for cultural competence and patient-centered care. There is Hawaii 71-77% Hawaii Florida 66-73% TJC ensuring quality and safety in healthcare.” HITECH growing evidence from respected organizations that 78-80% 81-82% 74-75% 76-77% Focus Areas Per HCAHPS: “Communicated well” means explained things 83-86% Per HCAHPS: “Communicated well” means explained things health care providers can improve clinical outcomes in the clearly, listened carefully, treated patients with courtesy & respect. National Average is 80% clearly, listened carefully, treated patients with courtesy & respect. 78-80% National Average is 75% acute care space by aligning themselves with patients’ “What percent of patients were given written information about Ensure information Improve population needs and making them part of the care team. what to do during their recovery at home?” gets to where Care is of Public Health Washington Coordinated information Maine Montana Vermont North Dakota The current state of affairs can be seen using such indicators Oregon Idaho South Dakota Minnesota Wisconsin New Hampshire Massachusetts as the Hospital Consumer Assessment of Healthcare Providers New York Wyoming Michigan Rhode Island Connecticut NPRM “Meaningful Use” Criteria: Pennsylvania Nebraska Iowa Indiana New Jersey Nevada Ohio Record demographics: including Preferred Language and Ethnicity and Systems (HCAHPS) survey. In fact, in 2009 over 3700 California Utah Colorado Kansas Missouri Illinois Kentucky West Virginia Virginia Delaware Maryland hospitals reported their HCAHPS results to CMS. It is our Arizona New Mexico Oklahoma Arkansas Tennessee North Carolina South Carolina Send reminders to patients for preventive/follow-up care: based on Patient Preferences, Demographic Data, or Specific Conditions recommendation that, in addition to the standardized HCAHPS Alaska Texas Louisiana Alabama Georgia Report quality measures to CMS (Ambulatory Care) surveys, additional areas for improvement in tracking Hawaii Florida 74-80% measures exist. 81% 82-83% Produce lists of patients by Specific Condition for Quality Improvement, Per HCAHPS: Patients reported whether they were given written Reducing Disparities, and Outreach information about symptoms or health problems to watch for 84-87% during their recovery. National Average is 81% Provide patients w/ a copy of health information (electronic or otherwise) Implement 5 Decision Support rules: including patient Demographic Data, “The problem with communication…is the illusion “What percent of patients gave the hospital an overall rating of 9 or 10 (high)?” “What percent of patients would definitely recommend the hospital to their family or friends?” that it has been accomplished.” -George Bernard Shaw Diagnosis, or Condition Washington Washington Maine Maine Montana Vermont Montana Vermont North Dakota North Dakota Minnesota Minnesota Oregon Oregon Provide a clinical summary to patients for each office visit New Hampshire New Hampshire Idaho Wisconsin Idaho Wisconsin South Dakota Massachusetts South Dakota Massachusetts New York New York Wyoming Michigan Rhode Island Wyoming Michigan Rhode Island Connecticut Connecticut Pennsylvania Pennsylvania Nebraska Iowa Nebraska Iowa Indiana New Jersey Indiana New Jersey In 2009 the ARRA HITECH Act was passed, giving hospitals and healthcare Nevada Ohio Nevada Ohio Illinois Illinois Utah West Delaware Utah West Delaware Colorado Virginia Colorado Virginia Kansas Virginia Maryland Kansas Virginia Maryland California California Missouri Missouri providers an incentive to install and use technology in a “meaningful” way. The Kentucky Kentucky North Carolina North Carolina Tennessee Tennessee Oklahoma Oklahoma Arizona New Arkansas Arizona New Arkansas Mexico South Carolina Mexico South Carolina impetus behind this Act is four focus areas developed by the National Quality Alabama Georgia Alabama Georgia How Technology Can Help Forum. These focus areas are directly related to patient-centered care and the Alaska Texas Louisiana Florida Alaska Texas Louisiana Florida Hawaii Hawaii 56-63% 61-65% • Foreign language, disease or disability, vision or aims of improving patient communication as seen in Health Literacy. Likewise, 64-66% 66-68% Business hearing impairment 67-68% 69-71% Logic • Provides cohesive care using rules-based engine the incentive goals found within the IFR and NPRM released by the ONC and HHS Per HCAHPS: Patients rated hospitals from 0-10; “worst hospital possible” to “best hospital possible.” 69-72% National Average is 65% Per HCAHPS: From choices of “definitely”, “probably”, or “would not” recommend. 72-75% National Average is 68% rather than end-user judgment support the use of technology in the aim to improve communication and patient- Large Font • Visually impaired centered care. Text • Provides a way to serve elderly populations With advancements in information technology Evidence Base Embedded Audio • Blind or severely visually impaired • Provides a way to serve auditory and digital printing, hospitals can create highly National 30 Day Risk Adjusted Readmission Rate Files learners personalized documents and communication HRET: How to reduce avoidable readmissions • Reading or health literacy aids; enabling their staff to care more Non-English speaking populations continue to 25.00% Analyze readmit rates by source Analyze readmit rates along a impairment of readmission timeline (7d, 30d, 60d, 90d) Material presented at • Provides material in lay effectively for patients with diverse needs. grow while our communities struggle with lower grade levels terms; pediatric populations can also be health and wellness. Culturally-sensitive, 20.00% better served • Disease or disability, visual, hearing or clinically-relevant communications adapted to Focus on specific patient populations 15.00% Heart Attack cognitive impairment the appropriate literacy level can be powerful Heart Failure Focus on stages within care Photo-Novellas • Provides a way to Pneumonia delivery Focus on organizational strengths introduce difficult topics as an “ice tools for engaging patients in our care. 10.00% breaker” Ink-on-Glass • Cognitive or health literacy impairment 5.00% Develop community connections or • Provides “change as you go” SmartForm capability to electronic documents Recommendations for Practice 0.00% Work to eliminate barriers to successful care transitions Engage patients, families, & caregivers in addressing HC issues Technology • Disease or disability, hearing or cognitive Video impairment • Provides material in a form relevant to today’s society; can incorporate multiple Is there improvement in patient Project BOOST Project RED Media learning styles retention/loyalty? Clinical Result: 30-day pharmacists Result: Both readmission Deploys Uses Discharge Incorporates call patients 30-day rates decreased colorful, interactive documents relevant Nurse (2-4d) to readmission Interdisciplinary Uses the “teach 72hr follow-up from 12% to graphical, technology: describe Is there measurable technology: Discharge discuss rates and ED Care Team back” method calls to patients iPhone & 7%, Patient easy-to-read an avatar “After- Advocates meds & visits Have readmission rates improvement in YouTube satisfaction discharge named hospital inquire decreased increased from documents “Louise” Care” decreased beyond the health/wellness within 52% to 68% about by 30% HCAHPS reportable specific disease classes problems data? as a result of changed Disclosure behavior? 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 © 2010 Standard Register