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Reducing Re-hospitalization: Motivational Interviewing and Health Coaching

Reducing Re-hospitalization: Motivational Interviewing and Health Coaching. Objectives. To understanding the correlation of stage of behavior and motivation level To learn strategies used in motivational interviewing

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Reducing Re-hospitalization: Motivational Interviewing and Health Coaching

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  1. Reducing Re-hospitalization:Motivational Interviewing and Health Coaching

  2. Objectives • To understanding the correlation of stage of behavior and motivation level • To learn strategies used in motivational interviewing • Be able to demonstrate an example of one strategy used in motivational interviewing

  3. You would think…..

  4. Why Don’t People Change? • They don’t see (denial) • They don’t know (lack of education) • They don’t know how to change

  5. Prochaska Stages of Change • Pre-contemplation • Not ready to change • Contemplation • Questioning • Preparation • Testing the waters • Action • Starting new behavior • Maintenance • Sustaining new behavior • Relapse • Revert to old behavior

  6. SO….. What is the Answer?

  7. Health Coaching • Empowering • Motivating • Teaching • Understanding • Partnering • Respecting • Fostering behavior change

  8. Behavior Change

  9. Health Coaching and Motivational Interviewing Motivational Interviewing “A direct, client-centered counseling style for helping clients explore and resolve ambivalence about behavior change.” William Miller,1991

  10. Motivational Interviewing…. • Corresponds to Stages of Change model • Identifies the patient’s motivation • Focuses on portraying empathy and active listening • Supports patient autonomy • An alternative to telling a patient “WHAT THEY SHOULD DO”

  11. MI Strategies Used in Coaching • OARS • Open-ended questions • Affirmation • Reflective Listening • Summarization

  12. O…Open-Ended Questions • Allows for active participation by patient • Does not confine answers to yes or no • Elicits more information • Examples: • Do you eat 3 meals a day? • Tell me about what you ate yesterday.

  13. A…Affirmation • Emphasizes the positives • Helps improve self-efficacy • Keeps the patient motivated • Example • You have done a great job getting your fluid intake under control. Can we use some of those same ideas to work on your salt intake?

  14. R…Reflective Listening • Takes all incoming information and reflects it back to the patient • Listen carefully to the patient rather than planning your response • Example: • Mr. Jones, you sound a little down today. I know it is hard to stay on your diet during the holidays, what have you tried so far to help with this?

  15. S…Summarization • Restating the main points provided by the patient • Can be used in conjunction with reflective listening • Can reveal discrepancies • Example • So, what you are saying is that you really want to try to get your blood sugars under control; but, you’re not ready to commit to monitoring your blood sugars?

  16. How Do You Know You Got it Right? • You are speaking with the patient not at the patient • The patient talks more than you do • The patient is actively talking about behavior change • You are listening carefully and gently directing the conversation • The patient is actively asking for information and advice

  17. When Am I on the Wrong Path? • Ordering or directing the patient • Warning the patient • Giving advice • Persuading with logic, arguing or lecturing • Moralizing or preaching • Judging, criticizing or blaming the patient • Making assumptions about the patient

  18. Three Ways to Ensure Resistance • Take control away from the patient • Misjudge importance, confidence or readiness • Meet force with force

  19. Shared Experience

  20. The Patient IS the Solution • Moving from provider-centered to patient-centered care. • Handing off to the patient and caregivers. • Using tools to support good decision making.

  21. Who is Appropriate for Coaching? • Patients who can participate in self-care or who have a willing caregiver

  22. Who is not Appropriate for Coaching? • Nursing home patients. • Hospice patients. • Dialysis patients. • Patients with mental health issues. • Patients or caregivers must be able to activate for themselves.

  23. Health Coaching Process • At each interaction the coach focuses on the following: • Post-discharge plan of care. • Medications. • Post-discharge follow-up. • Warning signals. • Portable Personal Health Record. • Patient-centered goal.

  24. Next Step…… COACHING!!

  25. Questions? This material was produced by eQHealth Solutions, the Medicare Quality Improvement Organization for Louisiana, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. LA10SoW3C12-2648

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