Health Promotion and Disease Prevention Program VA Gulf Coast Health Care Systems

1. Health Promotion and Disease Prevention ProgramVA Gulf Coast Health Care Systems Implementing a Behavioral Approach to Health Promotion and Disease Prevention Presenters: Kellee R. Bivens, PhD Sheila Phillips, RN, BSN

2. Objectives: • Describe the TEACH patient education model and discuss its value to primary care staff and patients • Describe how a behavioral approach facilitates patient centered care • Describe the 9 Healthy Living Messages and how they are integrated into the Patient Centered Medical Home model

3. VHA Preventive Care Program • Core Elements: • Infrastructure • Integration with PACT • Tools and Resources

4. Vision of VHA Preventive Care Program The Veteran will experience health promotion and disease prevention (HPDP) clinical interventions that are seamlessly integrated across the continuum of their health care and are delivered in a variety of modalities matched to the Veteran’s needs and preferences. VHA clinicians and clinical support staff will value and participate in the delivery of HPDP interventions for patients as appropriate to each Veteran’s priorities and overall plan of care.

5. A Model for Planned Care* Community Resources and Policies Health System Organization of Health Care Self- Management Support Clinical Information Systems Decision Support Delivery System Design PACT Teamlet Prepared, Proactive Practice Team Informed, Activated Patient Productive Interactions Functional and Clinical Outcomes *E. Wagner, MD, W.A.MacColl Institute, Group Health Cooperative of Puget Sound

6. PACT Transformation A Fundamental Shift in the Process of Care Assumes knowledge drives change Clinician sets agenda Goal is compliance Decisions made by caregiver Assumes knowledge + confidence drives change Patient sets agenda Goal is enhanced confidence Decisions made collaboratively Traditional Care Collaborative Care (Bodenheimer et al, CA Health Care Foundation, 2005)

7. Principles of PACT • Patient-centered • Ongoing relationship with a primary care team • Patient is full partner with team • Comprehensive: whole person orientation • Easier communication

8. Implementing PACT Principles • Staff training in patient-centered communication • TEACH for Success course (health coaching) • Facilitators: Health Behavior Coordinators and Veterans Health Education Coordinators • Motivational Interviewing training • Facilitators: Health Behavior Coordinators • Follow-up mentoring and coaching

9. . TEACH Philosophy • Evidence-based best practice • Holistic approach to patient care • Patient-centered • Patient self-management • Partnerships with patients

10. TEACH Philosophy • Shared decision making • Interdisciplinary process • Practical, specific techniques • Meets The Joint Commission standards • Goal: improve competencies

11. TEACH Target Audience Clinical staff involved in educating patients: • PACT teamlets & expanded teams • Nurses & advanced practice nurses • Physicians & physician assistants • Dietitians • Pharmacists • Psychologists • Social workers • Therapists—physical, occupational, speech, hearing

12. Premises of Course • Health education makes a difference • health outcomes • patient & clinician satisfaction • Health education skills can be learned and mastered with practice

13. TEACH Goals • Skills development—patient-centered health education, health coaching, partnering • Mastery requires practice & feedback • Follow-up: reinforcement & boosters • Participants use strategies & techniques with Veterans

14. TEACH Course Units T Tune in to the Patient E Explore the Patient’s Concerns, Preferences, and Needs A Assist the Patient with Behavior Changes C Communicate Effectively H Honor the Patient as a Partner

15. Introduction • Assess own patient education skills • Course overview

16. Tune in to the Patient • Most effective approaches to build rapport with patients • How to quickly establish & maintain effective relationships with patients • Clinician behaviors that help or hinder effective clinician-patient relationships • Effective listening & questioning skills

17. Explorethe Patient’s Concerns, Preferences and Needs • Components of a learning assessment • How to assess a patient’s level of importance & confidence for a health behavior • Quick needs assessment method • How to detect limitations to learning

18. Assist the Patient with Behavior Change • Health coaching framework • Elements • Benefits • Process • Health coaching practice

19. Communicate Effectively • How to incorporate tailoring into communications with patients • How to help patients deal with strong emotions such as fear • How to deal with patient ambivalence • How to deal with patient resistance

20. Honor the Patient as a Partner • Characteristics of effective clinician-patient partnerships • How to assess clinician & patient preferences for partnering • How to incorporate both clinician and patient perspectives in goal setting, decision making, treatment & learning activities

21. Definition of Health Coaching Health coaching is the practice of health education and health promotion within a coaching context to enhance the well-being of individuals and to facilitate the achievement of their health-related goals. Palmer S, Tubbs I, and Whybrow A. (2003) Health coaching to facilitate the promotion of healthy behaviors and achievement of health-related goals. International Journal of Health Promotion & Evaluation, 41(3), pp. 91-93

22. Health Coaching Characteristics • Collaborative, not directive • Patient-centered • Supports patient autonomy • Empowers patient for self-management

23. Goals of Health Coaching • Help patients • Clarify personal health goals • Implement and sustain healthy behaviors • Reduce negative impact of chronic disease • Guide patients in self-management • Skill development • Problem solving

24. Importance for VHA • Many Veterans have chronic diseases and the number is increasing. • Poor health behaviors lead to and complicate chronic diseases. • Improving poor health behaviors is key to improving health.

25. Benefits of Health Coaching • Consistent with PACT and Preventive Care Program • Framework for making PACT principles and goals operational in practice • Strategies are easy to learn and use • Positive effects for both staff and patients • Health outcomes • Satisfaction

26. Who are the health coaches? • All PACT team members can coach patients • Degree of involvement in health coaching may differ among team members • Trained patients can coach other patients

27. Delivery Models • Face to face during a clinic visit • During group visits • In classes, especially self-management programs • Over the telephone • Via the Internet

28. Process of Health Coaching • Establish a positive relationship with the patient • Develop a partnership with the patient • Explain your role as a coach

29. Process of Health Coaching • Elicit the patient’s concerns and issues • Use active listening skills • Express empathy

30. Process of Health Coaching • Set an agenda with the patient for this session

31. Process of Health Coaching • Connect the coaching topic to the patient’s life goals and values • Focus on the whole person, not just a specific diagnosis or behavior

32. Process of Health Coaching • Acknowledge the patient’s likes, dislikes and preferences • Empower the patient by reminding him/her that the choices are his/hers to make • Offer to help the patient find the answers that will work best for him/her

33. Process of Health Coaching • Ask before telling • Ask what the patient already knows and what the patient wants to know • Provide new information and clarify misperceptions as needed • Invite the patient to consider a different perspective • Confirm the patient’s understanding

34. Process of Health Coaching • Ask the patient how important he/she thinks it is to change

35. Process of Health Coaching • Help the patient set a goal • Ask the patient to identify something he/she can do to improve his/her health

36. Process of Health Coaching • Help the patient create an action plan • Ask the patient how confident he/she is to reach the goal • Help the patient modify the action plan as needed

37. Process of Health Coaching • Develop a follow-up plan with the patient

38. Health Coaching Applications Video Example

39. Motivational Interviewing Intensive facilitator training with follow-up mentoring for: • Health Behavior Coordinators • Veterans Health Education Coordinators • Health Promotion/Disease Prevention Program Managers Training/coaching by Health Behavior Coordinators for: • PACT staff • Other clinicians

40. Health Promotion and Disease Prevention ProgramVA Gulf Coast Health Care Systems How the 9 Healthy Living Messages are integrated into the Primary Care Medical Home Model. Presenter: Sheila Phillips, RN, BSN

41. VA Mission Honor America’s Veterans by providing exceptional health care that improves their health and well being.

42. Health Promotion and Disease Prevention Ultimate GoalTo create the best primary care delivery model in the world and thereby create one of the healthiest populations in the country!

43. Health Promotion and Disease Prevention (HPDP) Initiative • National 2010 Health Care Reform • HPDP initiative provides two parts to the new bill. • National Directive • Joint Commission • National Patient Safety Goals are integrated into HPDP. • Evidence-based care – a systematic review capable of improving quality and consistency in healthcare.

44. - Healthy Living Messages for Veterans - Are actions taken to protect oneself or those you love from disease! • Top five chronic diseases: Cardiovascular, Stroke, Cancer, Chronic Obstructive Pulmonary Disease & Diabetes. • These account for 95 cents out of every dollar spent on health care and two out of three deaths. • The World Health Organization estimates that 80% of heart disease, stroke and type 2 diabetes and > 40% cancers are preventable if you stop smoking, eat healthier and get physically active. • The evidence has lead to the development of the 9 Healthy Living Messages and to encourage our Veterans to chose healthier lifestyles.

46. 1. Get Involved with Your Health Care • Getting involved in your health care. There are many ways to take an active role. Work with your Patient Aligned Care Team (PACT) to improve your health. • WWW.MyHealtheVet.com is now available for veterans to access their health record. Please take advantage of this opportunity.

47. Meaningful Use means providers need to show they are using certified Electronic Health Record technology in ways that can be measured in quality and in quantity. According to Centers for and Medicare Services (CMS), the five broad goals of Meaningful Use are to: • Improve quality, safety, efficiency, and reduce health disparities • Engage patients and families • Improve care coordination • Improve population and public health • Ensure adequate privacy and security for personal health information • The American Recovery and Reinvestment Act of 2009 describes Meaningful Use.

48. 2. Be Tobacco Free • Don’t use tobacco in any form. If you are using tobacco, the VA can help you quit. Avoid second hand smoke. If you are pregnant both you and your baby will benefit when you quit using tobacco. • Tobacco use and exposure to secondhand smoke kill approximately 443,000 people in the United States each year. • VA offers Tobacco Cessation groups, one on one appointments, follow up and medications to help stop tobacco use. www.tobaccofree.org

49. 3. Eat Wisely • Maximize your health by eating wisely. Eat a variety of foods including vegetables, fruits and whole grains. It is important to include fat-free or low-fat mild and milk products in your diet, and limit total salt, fat, sugar and alcohol. • VHA offers nutrition counseling through it’s dietitians. It is easy to get a consult submitted by the RN Care Nurse assigned to your PACT teamlet. • The VHA’s website www.MOVE.org is available to assist you with your nutritional, physical activity & healthy weight.

50. www.MyPyramid.gov, Steps to a Healthier You.