Designing for ACCORD with Patients Henry C. Chueh, MD, MS Massachusetts General Hospital

1. Designing for ACCORDwith Patients Henry C. Chueh, MD, MS Massachusetts General Hospital Boston, MA

2. MGH Primary Care Network MGH PCP Network – Adult and FPs Only Revere 2 sites Everett Waltham At MGH IMAWHABMG MWI Charlestown Chelsea2 sites Near MGH MGH Downtown MGH Beacon Hill MGMGSenior HealthMGH Back Bay NECHC MDs = 178 • FTEs = 101 • Practices = 15 • Patients = 155,590

3. Quality Chasm Guidelines Preventive care Medication safety Practice Patient centered care Chronic disease mgmt

4. 24 hours in the life of a PCP “The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care,” a report from the American College of Physicians, 2006 Yarnall KS, et al. Primary care: is there enough time for prevention? Am J Public Health 2003; 93:635 Ostbye T, et al. Is there time for management of patients with chronic diseases in primary care? Ann Fam Med 2005; 3:209

5. “Computerized clinical information systems will help physicians close this quality gap by performing many of the repetitive, protocol-driven tasks.” -- Clement McDonald, 1976 The Promise of Information Technology

6. MGH Quality Measures By Linkage Status

7. How do we design, build and implement the health information technology (HIT) tools to support and encourage busy practitioners and patients to “do the right thing?” Our Challenge …and that they’ll use.

8. Patient-provider linkage is important Inter-visit workflow acceptable Providers will use well-designed tools Diversity of care processes can impact outcomes Preliminary work

9. Consumes time inappropriately Failure can result in poor outcomes1 Fastest growing area of claims2 Patients have interest3 Focus on Follow-up 1 Earnest 2004 2 Shaefer 2000, Boohaker et al 1996, Murff HJ et al 2003 3 IOM 2001, WSJ Poll 2006

11. A Fragile Loop Awareness of Issue Risk assessment Follow-up ? Plan for care Complete care

12. Tend to be physician-oriented and visit-based Minimal effect for interventions that cannot be completed at the point of care Patient-centered approaches rare Often lack the ability to “close the loop” What about Clinical Decision Support Systems?

13. Redesign for Systems to Support Clinical Decisions “Ecologic Framework” Zapka et al 2003, 2004

14. Adjusted for age and insurance status 2 factors associated with appropriate follow-up care: MD documentation of follow-up plan Patient understanding of need for follow-up Poon, Haas, Puopolo 2004 Doctor and Patient Clarity

15. Ambulatory Care Compact to Organize Risk and Decision Making AHRQ Ambulatory Safety and QualityProgram: Health IT ACCORD

16. “Make Clear Decisions Together”

18. Patient-provider centered, informed decisions Preference and choice Self-documenting Explicit agreements with high visibility Fail-safe monitoring Characteristics

19. Patients Providers Patients with Providers Assess concept and initial design directions Identify incentives and barriers Focus Groups

20. Doctors worried about workflow intrusion Patients worried about doctors Patients concerned about potential barriers to access to their doctor Should enhance/increase face time with patients Flexibility needed for ACCORD creation Focus Group Lessons

21. Design models for Partnership Develop systems for Tracking Evaluate impact on Patient experience, quality Specific Aims

22. Create

23. Option Action Observation Time Elements of an ACCORD

28. Propose

31. Review

34. Study Design

35. Systems to SupporttheClinical Decision.

36. Steven Atlas, MD, MPH Jeanhee Chung, MD, MS Richard Grant, MD, MPH Susan Edgman-Levitan, PA Robin Weinick, PhD Yu Chiao Chang, PhD Greg Estey David Berkowicz, MD Michael Yebba Mark Wylie Jeff Ashburner Alicia Wong ACCORD Team