SCOPE Stanford Care Optimization for Patients & Education Mentor & Resident Orientation 2013-2014

1. SCOPEStanford Care Optimization for Patients & EducationMentor & Resident Orientation 2013-2014 Directors Jori Bogetz MD, Carrie Rassbach MD, & Julia Gabhart MD

2. Great Relationships, Great Medicine “The good physician treats the disease; the great physician treats the patient who has the disease.” Sir William Osler“The Father of Modern Medicine” (1849-1919)

3. Mission Statement To guide residents through the longitudinal experience of providing a Medical Home for diagnostically or therapeutically complex pediatric patients, and thereby improve the quality of care for these patients.

4. SCOPE Provides Residents & Mentors … Opportunities for Investigation Innovation Insight A patient-and-familycentered framework Application of Inspiration

5. Learner-Centered Outcomes Improve attitudes of pediatric residents on caring for CSHCN by 20%. To assess SCOPE’s impact on the behaviors of residents by increasing their confidenceto apply what they have learned in their future practice and care of CSHCN by 20%.

6. SCOPE Provides Patients, Families & Outside PCPs … Structure and coordination to help make patient and family care meet their goals Tools of empowerment Opportunity to share their rich knowledge Continuity of care for a broad population Integrated care

7. Patient-and-Family-Centered Outcomes The goal is to improve their Satisfaction with care obtained at LPCH As assessed by a survey adapted from the Consumer Assessment of Healthcare Providers and Systems (CAHPS)

8. SCOPE Educational Model Participants The SCOPE Physician Faculty Mentors Patients and Their Families Outside PCPs, if applicable Social work, case management support

9. SCOPE Educational Model A. B. A. If the patient’s Primary Care is outside LPCH, their SCOPE physician will establish a Co-Management Agreement with the PCP. • B. If the patient’s Primary Care is at 730 Welch, their SCOPE physician IS their PCP.

10. FAQ: Does the SCOPE physician replace existing providers? NO. The SCOPE physician DOES NOT REPLACE any existing providers. The SCOPE physician works within the existing care team to help the patient and family achieve their goals and increase their autonomy.

11. Patient Selection & Enrollment Patients NEW (or identify selves as inexperienced) to LPCH living within 4-county area Santa Clara, San Mateo, Santa Cruz, and San Francisco Identified by managing physicians/primary care providers throughout LPCH Screened for appropriateness of program and enrolled by program directors Upon agreement by family, primary care physician Matched with residents of best fit

12. The SCOPE Physician Approximately 20 Residents opt-in, providing continuity of care over inpatient and outpatient settings at LPCH and externally Can fulfill 2-week elective opportunity Supports work residents are already doing!

13. Faculty Mentors Approximately 20 Faculty Mentors General Pediatrics (inpatient and outpatient) Subspecialists 1 Resident per faculty Mentor

14. The SCOPE Intervention Patient and family are matched with a SCOPE physician and mentor. The team should meet in person within 2 weeks for an initial orientation, then at least monthly. Patient-centered care is promoted in all patients by use each meeting of the SCOPE Toolkit.

15. Toolkit on peds.stanford.edu  rotations  electives  SCOPE/complex care

17. The SCOPE Intervention: Your Toolkit The SCOPE Toolkit is tailored to each group: Patients & families, mentors, and residents. It is available in English, Spanish, and Vietnamese. Progress on completing the Toolkit is made according to the needs of each family, always with the idea of using it to help achieve: Their GOALS Their EMPOWERMENT.

18. Meet your SCOPE Doctor. • You are ready for SCOPE Graduation when you: • Know your goals of care • Have a plan to meet your goals • Are ready to speak up about your goals and know who to speak to • Are ready to take steps to meet your goals Make goals and build plans to meet these goals. SCOPE Contact Tree SCOPE Timeline:Empower ME! SCOPE Goal Keeper Family & Patient Graduation! Learn to speak up (Advocate) and take steps (Empower) to meet your goals. Your SCOPE Doctor will learn about your child in person. Your SCOPE Doctor will read about your child. Visits to specialists, school, talks with other providers. Home visit and monthly check ins.

19. SCOPE:Empower ME! Family & Patient Graduation Teach Each Other As We Go

20. The SCOPE Intervention Meeting Worksheets for are simply guides, to be completed only as found useful. Key care coordination tools (to be completed by each SCOPE Team): Goal Keeper: Guides each meeting, focus of SCOPE intervention Contact Tree: Establishes for entire care team who the patient should contact, when, for what, and how.

21. Last Updated: ________________ • SCOPE should contact me by: • (Circle the best way to reach you) • Phone: • 1. _________________ • 2. _________________ • 3. _________________ • E-mail: ___________________ My Contact Tree SCOPE Patients: If there is a change in your care plan, please contact your SCOPE doctor. SCOPE doctors: If using your cellphone, provide on outgoing message with instructions for emergencies.

23. The SCOPE Intervention Initial training session for residents, mentors 3 Resident Case-Based Discussions End-Of-Year Feedback Session

24. The SCOPE Intervention Case Managers/Care Coordinators and Social Workers as educators, expert navigators of our system Graduated SCOPE families May serve as peer resources?

25. FAQ: So the SCOPE physician’s role is social, not medical? No. The SCOPE physician’s role embodies the best parts of medicine: Caring for the whole patient Understanding the disease in the context of the patient and family Studying the disease and treatment in depth, as it applies to the patient’s and family’s goals Advocating that others involved in the patient’s care work toward the patient’s goals and patient/family empowerment

26. Expectations of every SCOPE physician Build a relationship with and provide continuity for 1 Child with Special Healthcare Needs (CSHCN) Meet at least once monthly (again, does not have to be in person) Participate in multidisciplinary care team with co-management with subspecialists Explore areas of potential research • Complete in Toolkit: • Plan of Care (which is scanned into Cerner) • Contact Tree • Goal Keeper • Home Visit • Attend at least 1 of 3 Case-Based Discussions throughout year • Attend at end of the year Feedback Session if possible • Develop an understanding of the home and family in the context of a CSHCN

27. Save the dates! • 12/10 12-1pm (case discussion)- LPCH- 3 East • 1/30 12-1pm (case discussion)- LPCH Resident lounge • 3/11 12-1pm (case discussion)- LPCH Resident lounge • 5/21 5-6:30 (End of year wrap-up/feedback session)- LPCH- 3 East

29. Expectations of every SCOPE family Set up goals for care & work with SCOPE physician regularly to meet these goals. Let resident physician know of non-emergent care issues. Respond to SCOPE physician within 48 hours. Tell SCOPE physician of appointments or changes in plan. Learn who to call for specific problems, and how to call them. Goal: Empowerment!

30. Expectations of every SCOPE mentor Meet with the patient, family, and SCOPE physician within the first 2 weeks of enrollment. Meet with the SCOPE physician (phone, e-mail, etc. all acceptable) every month. Be available to answer SCOPE physician’s questions and those triaged from the patient. Foster residents’ research interests related to SCOPE patient or SCOPE curriculum. Attend case discussions as able and all-participant feedback session. Attend Home Visit with resident.

31. Mentor Resources Ideas on how to optimize your mentoring relationship (also in your Toolkit) Gusic ME, Zenni EA, Ludwig S, First LR. Strategies to design an effective mentoring program. J. Pediatr. 2010 Feb;156(2):173-4.e1. A discussion of the balance of appropriate supervision for safe care and allowing professional growth (also in your Toolkit): Patricia Hicks, MD. View from the Association of Pediatric Program Directors: The Role of Supervision in Creating Responsible and Competent Physicians. Academic Pediatrics. Vol. 11, Issue 1, January-February 2011, Pages 9-10. For updated data on experiences families of CSHCN Data Resource Center for Child & Adolescent Health. (2012). 2009-2010 National Survey of Children with Special Healthcare Needs. http://www.childhealthdata.org/learn/NS-CSHCN More first-hand on the patient/family experience Robert A. Naseef. “Special Children, Challenged Parents: The Struggles and Rewards of Raising a Child With a Disability” [Paperback] Philo, Jolene. “Different Dream Parenting: A Practical Guide to Raising a Child with Special Needs” [Paperback]

32. Communication Details: Timing Emergencies -- go to 911 or the ED. We ask the family contact their SCOPE physician once the patient is safely in the ED. We ask that they bring their SCOPE Toolkit, if possible. Urgent issues -- go to the outside PCP, 730 Welch Primary Care answering service (if the patient’s PCP is at 730 Welch), or the appropriate subspecialty service. Non-urgent issues – go to the SCOPE physician. These correspondences will be returned as soon as possible, but within 24 hours. Mentors are back-up if the resident does not return calls in 24 hours. Directors are mentors’ backup.

33. Communication Details: Mode If you e-mail with/regarding your patient/family: Ensure families understand these e-mails may not be truly secure. If they do want to communicate by e-mail, they must sign a consent form. When communicating to other caregivers about a patient, always use “SECURE:” as the start of your subject line. CC relevant care providers. If you give out your cellphone number: Ensure your outgoing message says: “If you are calling regarding a medical emergency, hang up and immediately dial 911.” Then record normal outgoing message.

34. Communication Details: Documentation Document in the medical record (Cerner) any conversation that could potentially influence your patient’s care. SCOPE physicians should detail that they have discussed this conversation and recommendations with the mentor/SCOPE director/other attending physician. CC relevant physicians, including attending with whom the SCOPE physician discussed the topic. Summarize phone calls under General Message/Phone Message. Summarize e-mails and meetings under General Message.

35. SCOPE Pilot #3 Timeline (2013-14)

36. Institutional Support • Stanford University Pediatrics Residency Program • with special thanks to Lyn Kahana and Rebecca Blankenburg • Lucile Packard Children’s Hospital Complex Care Initiative • Designated as the educational arm of the Initiative • with special thanks to John Mark, Christy Sandborg, Karen Wayman • Curricular Support • All parties mentioned above • David Bergman • The Lucile Packard Family Advocacy Council • 1st and 2nd SCOPE Pilot Residents and Mentors! • Financial Support • Lucile Packard Foundation for Children’s Health Young Investigator Award -- Children with Special Healthcare Needs • Department of General Pediatrics • with special thanks to Fernando Mendoza SCOPE Support

37. Many resources are available on the SCOPE Website (under electives on peds.stanford.edu) • All Electronic Copies of the SCOPE Toolkit and related resources are shared with all SCOPE physicians via SCOPE Dropbox. • If you would like to have access to the Dropbox, SCOPE Directors will gladly invite you. Please e-mail us. E-Copies of Toolkit, Patient Resources

38. Thank You For … Your time Your expertise Your dedication to teaching Your dedication to our patients and families Your example of going above and beyond Your feedback … Carrie Rassbach crassbac@stanford.edu Jori Bogetz jbogetz@stanford.edu Julia Gabhart gabharj@pamf.org