“Integrating Electronic Technology in a Patient- and Family-Centered Clinical Model: The Good, The Bad, and Lessons Learned” Patricia Sodomka, FACHE Senior Vice President, Patient- and Family-Centered Care, MCG Health, Inc. Director, Center for Patient- and Family-Centered Care, Medical College of Georgia Christine Abbott Patient Advisor, Family Faculty, MCG Health, Inc. Institute for Family-Centered Care 3rd International Conference on Patient- and Family-Centered Care Partnerships for Enhancing Quality and Safety July 30 – August 1, 2007 // Seattle, Washington
Augusta Multiple Sclerosis Center • Based at the Medical College of Georgia • Augusta, Georgia • Dr. Mary Hughes, Medical Director • 1,500 patients enrolled • 2,500+ visits/year
The Augusta Multiple Sclerosis Center:A Patient Family Centered Care Odyssey
Institute of Medicine:Health Care in the 21st Century 10 Rules for Healthcare • Care is based on continuous healing relationships • Care is customized according to patient needs and values. • The patient is the source of control. • Knowledge is shared and information flows freely. • Decision making is evidenced-based. • Safety is a system property. • Transparency is necessary. • Needs are anticipated. • Waste is continuously decreased. • Cooperation among clinicians is a priority.
Rule #3 – The Patient is the Source of Control • Patients should be given the necessary information and the opportunity to exercise the degree of control they choose over health care decisions that affect them. • The health systems should be able to accommodate differences in patient preferences and in encourage shared decision making.
What “we” wanted Research A new building More doctors A “cure” What the “patients and families” wanted Accessible bathroom Someone to return phone calls Access to psychological support Self management support The “AHA” Moment - 2001
Transforming Episodic Medical Care The Chronic Care Model Functional and Clinical Outcomes
The Problem • Limited resources • Need to prioritize interventions
Our Solution:Collaborative Care/Self Management • Psychology Services • Technology – My HealthLink
Exploring the Mind of MS“A Collaborative Approach to the Treatment of Mental Health Issues in Multiple Sclerosis” Mitzi Williams, MD – Neurology Resident, Future MS Fellow Mary Hughes, MD – Director of Augusta MS Center Lara Stepleman, PhD – Director of HIV and Multiple Sclerosis Psychological Services
A Stimulus For Change • Up to 80% suffer from Depression • 7X higher suicide rate vs. general population
Identifying a Need • Improved recognition of mental health issues in patients • Increased availability of mental health services for patients and families • Utilizing those who are best able to provide these services
Collaboration • Key players involved: • Augusta MS Center • MS Center Patient Advisory Council • MCG Psychology program within Department of Psychiatry and Health Behavior
Participation • Design a solution that patients will utilize • Patient Input vital to program design • Providing a resource, not a punishment
Goal Statement: “The goal of the MS Psychological Services Program is to remove barriers to the emotional well-being of MS patients through convenient, compassionate, and coordinated psychological services provided during routine MS medical appointments.” MS Psychology Consultation Service
Examples of MS Patient Research that Grew from the MS Psychology Program • ECTRIMS (Madrid, 2006) • Predicting depression and anxiety in a multiple sclerosis clinic population: The contributions of illness severity, illness management, and perceived cognitive impairment. • Overcoming Mental Health Care Barriers for Individuals with MS: Innovations in Psychological Consultation. • ECTRIMS (Prague, 2007) • The development of an educational intervention for MS-related sexual intimacy concerns. • Using problem-solving therapy to treat depression within the MS clinic setting. • Utilization of mental health services by MS centers in the US. • Journal of MS Care (2007) • Problem solving therapy for depression: A pilot intervention for MS care settings. International Journal of MS Care, 9, p. 76. • MS psychological consultation: Addressing the mental health needs of individuals with MS. International Journal of MS Care, 9, p.76.
The intent of this project is to improve the health of patients with MS by enabling them to partner with care providers in the management of their health care. Our numerical goals for this work are: 100% of patients enrolled in My HealthLink with documented self management goals. 80% of patients/families enrolled in My HealthLink will rate their level of satisfaction with self management support as highly or extremely satisfied. 50% of patients/families enrolled in My HealthLink will continue to use the program 3 months after their initial enrollment date. “Empowering Patients Living with Multiple Sclerosis to Self-Manage Their Health” Aim Statement The MisSing Link
Effective patient self management will reduce the reliance on phone calls to the physicians’ office This will result in cost savings in terms of physician/staff time and realization of opportunity costs for increased revenue in marginal patient volume. My HealthLink will reduce patient phone calls by 50% “Empowering Patients Living with Multiple Sclerosis to Self-Manage Their Health” The Business Case Premise The MisSing Link
Results - Quantitative • Measurement Tool • Ten chronic disease self-management parameters and the Stanford Patient Education Research Center’s Self-Efficacy for Managing Chronic Disease 6-Item Scale. • All MS patients were asked to fill out this survey every 3 months for a 12-month time period, whether or not they used the My HealthLink product. • Results • The data did not show the predicted improvement in self-management parameters • limited sample size • short time interval • lack of control group
Stanford Self Efficacy Question 6: • How confident are you that you can do things other than just taking medications to reduce how much your illness affects your everyday life? • The goal was 80% will rate this as “highly or extremely” satisfied • Results ranged from 35% to 78% over the 6 month period
Results - Qualitative • Measurement Tool • MS Patient/Family Advisory Council provided verbal and written feedback at 3, 6, 9, and 12 months after start of the project. • The Wrap Up Meeting at the End of the Project • How could the MS center help the patients and families in managing their chronic condition and did this project help?
The Patients and Families Speak • Physical Access • Need easier access for wheelchairs • Functional Support • There is a need for help outside of the institution, in the home, outside of the medical visit • All function issues are local • MS patients need to be able to “smell the roses outside". This was a key point. • There needs to be an advocate for function issues • OT is a "bust". • A forum on home design would be a great local topic. • The fundamental question a practitioner should ask is: "How hard is it to go to bed and get out of bed?" • Instead of Habitat for Humanity, how about Habitat for Mobility.
The Patients and Families Speak • Insurance • Insurance won't reimburse for medical equipment, relating to function, such as manual v. auto bed. • Medicare won't pay for most equipment, etc relating to MS, since it is considered not to be a "neuromuscular" disease. • MS, the disease, has many faces and there are a myriad of function issues, that can't be standardized or categorized into one area.
The Patients and Families Speak • Clinic Operations • The staffing and clinic needs cannot be standardized for a hospital clinic, thus normal staffing ratios, benchmarks don't work. • There needs to be a "mobility" assessment done at the visit. This would be called a functional needs assessment. • The clinic should be a support clearinghouse, but not a brochure clearinghouse. The patients need boots on the ground in their environment outside of the hospital to help and offer support. • A mobility assessment counselor would be helpful.
The Unexpected Success • Efficacy of using a patient advisor in the clinic to enroll and train patients on the MyHealthLink system. • It was clear, through feedback from the patient/family advisory group, that this program was beneficial. • Most importantly, the qualitative feedback from the MS Patient/Family Advisory Council reinforced the value of engaging patients and families in the design and review of clinical delivery systems (in this case, as it pertains to disease self-management).
The Essential Role of the Patient Advisor Christine Abbott Patient Advocate Extraordinaire
Patient Advisor Requests for ePHR Enhancements • Mechanism to document routine health information (mammogram, dental visit, eye exam, etc) • Place to document cholesterol, exercise, diet • Include National MS Society hyperlink • Hook into MS Watch.org (shared solutions) • Increase font size • Medication center improvements
Platform for Next Research Grant/Project • 3 year study focused on hypertension in primary care practices and the use of the ePHR • Randomized controlled trial of 720 patients and 20 physicians • 7 month period of design enhancement with 30 local and 10 national patient advisors
Platform for Next Research Grant/Project • Measure impact of use of an patient enhanced ePHR on: • Patient activation • Perceptions of care • Blood pressure • BMI • Lipid levels • Patient-MD communication • Adherence to treatment guidelines • Utilization of medical services