3212014
1
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Todayrsquos Webinar
will be starting soon
For the audio portion of this meeting
Dial 1-888-394-8197
Enter participant code 733225
Patient Engagement
Strategies to keep patients at the center
of the HIV medical home
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Guidelines for Our Online Meeting Room
bull PLEASE TURN OFF YOUR COMPUTER SPEAKERS
bull Kindly mute your phone line
ndash Dial in 1-888-394-8197
ndash Enter participant code 733225
bull Questions amp Interactive activities
ndash Enter questions into the chat room
ndash Polls
bull Evaluation
3
3212014
2
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Todayrsquos Agenda
Patient Engagement amp the PCMH
Steve Bromer MD and Sarah Colvario HIV-MHRC Practice Facilitators
Project CONNECT ldquoCONNECTrdquoing Patients to Their Medical Home
D Scott Batey PhD LCSW PIP Program Manager
University of Alabama at Birmingham (UAB) 1917 Clinic
Peers for Self-management Support
Robert Kavanagh Case Manager
Face to Face Sonoma County AIDS Network
Improving Engagement to Support Quality
Adam Thompson Quality Management Consultant
4
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Learning goals
Participants will
bull Identify three strategies to support patient engagement in the
Patient Centered Medical Home (PCMH)
bull Explain the role of patient navigation in engagement in care
bull Identify benefits and barriers to using peers in patient navigation
bull Understand self-management activities as part of the spectrum
of patient engagement options
bull Understand the role peers can play in quality improvement
activities within your practice
bull Identify one next step for your practice in involving patients in
their care
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Patient Engagement amp
the Patient Centered Medical Home
Steve Bromer MD Director of Practice Facilitation
HIV Medical Homes Resource Center
Sarah Colvario MS Practice Coach
HIV Medical Homes Resource Center
3212014
3
bull ldquoConsumer engagement is the blockbuster drug of the centuryrdquo
ndash Dr Farzad Mostashari former National Coordinator for Health IT
Vital Signs HIV Prevention Through Care and Treatment -- United States MMWR December 2 201160(47)1618-1623
8
3212014
4
PCMH Framework
Building Blocks of High-Performing Primary Care Share-the-CareTM Model
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
5
The Facts
RWJF Engaging Patients Improves Health and Health Care httpwwwrwjforgcontentdamfarmreportsissue_briefs2014rwjf411217
People who are actively engaged in their health care are
bull More likely to stay healthy and manage their conditions
bull Ask their doctors questions about their care
bull Following treatment plans
bull Exercise
bull Eat right
bull Receive health screenings and immunizations
Hibbard JH and Cunningham PJ Research Brief No 8 How Engaged Are Consumers in Their Health and Health Care and Why Does It Matter Washington Center for Studying Health System Change 2008 wwwhschangecomCONTENT10191019pdf
What about for PLHIV
- Patients keep more appointments if providers treat them with dignity and respect listened carefully to them explained in ways they could understand and knew them as persons
Flickinger TE Saha S Moore RD Beach MC Higher quality communication and relationships are associated with improved patient engagement in HIV care J Acquir Immune Defic Syndr 2013 Jul 163(3)362-6
- Self-management programs for people living with HIVAIDS result in short-term improvements in physical psychosocial and health knowledge and behavioral outcomes
Millard T1 Elliott J Girdler S Self-management education programs for people living with HIVAIDS a systematic review AIDS Patient Care STDS 2013 Feb27(2)103-13
- Focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects
Johnson MO1 Dilworth SE Taylor JM Neilands TB Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV Ann Behav Med 2011 Feb41(1)83-91
3212014
6
Who promotes patient engagement in your clinic
bull Engagement should be promoted by all staff members - Primary care providers nurses medical assistantshellip
bull Significant evidence supporting use of lay health workers and
peer outreach workers - Improve ARV adherence - Reduce viral load - Quality comparable to masters-level staff
Roth AM Holmes AM Stump TE Aalsma MC Ackermann RT Carney TS Katz BP Kesterson J Erdman SM Balt CA Inui TS Can lay health workers promote better medical self-management by persons living with HIV An evaluation of the Positive Choices program Patient Educ Couns 2012 Oct89(1)184-90 Naar-King S Outlaw A Green-Jones M Wright K Parsons JT Motivational interviewing by peer outreach workers a pilot randomized clinical trial to retain adolescents and young adults in HIV care AIDS Care 2009 Jul21(7)868-73 Kenya S Jones J Arheart K Kobetz E Chida N Baer S Powell A Symes S Hunte T Monroe A Carrasquillo O Using community health workers to improve clinical outcomes among people living with HIV a randomized controlled trial AIDS Behav 2013 Nov17(9)2927-34
bull Evidence shows patient self-management improves linkage to and possibly retention in care
bull BUT interventions aimed at delivery service design are limited bull What is needed
bull More interventions to improve patient engagement in HIV care AND that well-designed trials of interventions in this area are studied in the future
Brennan A1 Browne JP Horgan M A systematic review of health service interventions to improve linkage with or retention in HIV care AIDS Care 2013 Dec 20
spectrumcenterumichedu
Project CONNECT
ldquoCONNECTrdquoing Patients to Their
Medical Home
D Scott Batey PhD MSW Research amp Informatics Services Center
Division of Infectious Diseases
University of Alabama at Birmingham
3212014
7
Objectives
To familiarize participants with a conceptual
framework to support patient engagement in
the Patient-Centered Medical Home (PCMH)
To explain the role of patient navigation
methods in engagement in care
To provide an overview of one supportive
strategy using peers as navigators
3212014
8
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
Linkage to Care UAB 1917 Clinic
Problem identified Scheduled new patient
appointments often not attended (ldquono showrdquo)
Study of patients calling to establish HIV care
at UAB 1917 Clinic 2004-2006
31 of patients (160 of 522) failed to attend a
clinic visit within 6 mos of initial call
Mugavero et al Clin Infect Dis 200745127-130
3212014
9
Characteristic
ldquoShowrdquo Group
(n=362)
ldquoNo Showrdquo Group
(n=160)
OR (95CI)
Age (years) 393 + 96 371 + 95 084 (068-104)
White male
Minority male
White female
Minority female
125 (345)
154 (425)
31 (86)
52 (144)
32 (200)
76 (475)
20 (125)
32 (200)
10 (Reference)
175 (105-291)
272 (130-568)
239 (127-452)
Private insurance
Public insurance
Uninsured
127 (351)
77 (213)
158 (436)
26 (162)
34 (213)
100 (625)
10 (Reference)
191 (103-354)
262 (156-439)
Days from call to
appointment
256 + 138 302 + 134 132 (114-153)
ldquoNo Showrdquo Phenomenon
Data presented as mean + SD or n (column )
Age OR per 10 years Days from call OR per 10 days
Mugavero et al Clin Infect Dis 200745127-130
Project CONNECT
Client-
Oriented
New Patient
Navigation to
Encourage
Connection to
Treatment
Emerge
Challenges New Identify a
Need
Make a plan
Name It
Empower
Others
Join You
to
Celebrate
Project CONNECT
Program launched January 1 2007
New patients have orientation visit within 5 days of their initial call to the clinic
Semi-structured interview psychosocial questionnaire amp baseline labs
Uninsured patients meet with clinic SW
Prophylactic antibiotics initiated more quickly
Expedited referral for SA MH services
3212014
10
Phase II The CONNECT Visit
Phase I
1 Scheduling within 5 days (plusmn12 days)
2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone
number h) Employer i) Current
HIV meds j) Baseline
income k) Date of
diagnosis 3 Rapport building 4 Reminder call day
before
Phase III
1 ldquoReferralrdquo 2 Rapport
building 3 Tour 4 Follow-up
through 5 Check Labs 6 Mtg at 1st
appointment 7 Reminder call 8 Data Entry
Record Keeping
Questionnaire
Interview (time startedended amp
interviewer)
Other
Standardize Measures Behavioral
bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers
Health Literacy Domestic Violence (clinic would need a protocol)
Circumstances Oriented
Needs
Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration
Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)
Medical Baseline
Adherence Medical knowledge drug history other meds CD4 VL disease history
Labs
Review amp follow-up as appropriate
Linkage
Introduction
CONNECT Program Evaluation
Pre-Post Study Design
Study Period Data from Pre-CONNECT era was collected between
August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)
Post-CONNECT data clients who called to make an
appointment between Jan1 ndash Dec 31 2007
Statistical Analyses
Multivariable logistic regression analysis
Wylie et al 4th International Conference on HIV Treatment Adherence 2009
CONNECT Program Evaluation Characteristic Pre-CONNECT
(n=522)
Post-CONNECT
(n=361)
Unadjusted
p-value
Age 387
97 396
103 018
White male
Minority male
White female
Minority female
157 (301)
230 (441)
51 (98)
84 (161)
131 (363)
149 (413)
28 (78)
53 (147)
025
Private Insurance
Public Insurance
Uninsured
153 (293)
111 (213)
258 (494)
105 (291)
121 (335)
135 (374)
lt001
Days from call to
appointment
270
138
256
101 008
Data presented as mean + SD or n (column )
3212014
11
CONNECT Program Evaluation
Time Period ldquoNo Showrdquo Unadjusted OR
(95CI)
Adjusted
OR (95CI)a
Pre-CONNECT (n=522)
Post-CONNECT (n=361)
307
177
10
048 (035-068)
10
054 (038-076)
a Multivariable model controls for age race sex insurance location of residence and
time from call to scheduled visit
0
5
10
15
20
25
30
35
40
45
Total
White M
ale
Minority M
ale
White Fem
ale
Minority Fem
ale
Private Insurance
Public Insurance
Uninsured
Sociodemographic Characteristics
N
o S
ho
w
Pre-CONNECT
Post-CONNECT
Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups
plt001 plt005
CONNECT Staff Survey
What was liked most about Project CONNECT ldquoImproved quality of carerdquo
ldquoPatients feel more welcome and at-easerdquo
ldquoA decreased no show raterdquo
What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and
ldquofeel overwhelmedrdquo
ldquoConcern over the increased patient load and the resulting
stress on the staffrdquo
ldquoNothing is wrongrdquo with the program
3212014
12
CONNECT Staff Survey
Other Feedback
Overwhelming support bull ldquoIncreased team-approach to carerdquo
bull ldquoI think it has been extremely successful and helpfulrdquo
bull ldquoThis is one of the most effective important new additions to the
1917 Clinic in a decaderdquo
Criticisms
bull ldquoNegative impact on staff time and increased staff exhaustionrdquo
bull ldquoI think project Connect is a great program that has had
successes in achieving quicker visits and improved adherence to
care but has opened many Pandorarsquos boxes regarding staff time
ptrsquos emotions and continued adherence to carerdquo
After CONNECT
What does the future hold
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
2
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Todayrsquos Agenda
Patient Engagement amp the PCMH
Steve Bromer MD and Sarah Colvario HIV-MHRC Practice Facilitators
Project CONNECT ldquoCONNECTrdquoing Patients to Their Medical Home
D Scott Batey PhD LCSW PIP Program Manager
University of Alabama at Birmingham (UAB) 1917 Clinic
Peers for Self-management Support
Robert Kavanagh Case Manager
Face to Face Sonoma County AIDS Network
Improving Engagement to Support Quality
Adam Thompson Quality Management Consultant
4
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Learning goals
Participants will
bull Identify three strategies to support patient engagement in the
Patient Centered Medical Home (PCMH)
bull Explain the role of patient navigation in engagement in care
bull Identify benefits and barriers to using peers in patient navigation
bull Understand self-management activities as part of the spectrum
of patient engagement options
bull Understand the role peers can play in quality improvement
activities within your practice
bull Identify one next step for your practice in involving patients in
their care
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Patient Engagement amp
the Patient Centered Medical Home
Steve Bromer MD Director of Practice Facilitation
HIV Medical Homes Resource Center
Sarah Colvario MS Practice Coach
HIV Medical Homes Resource Center
3212014
3
bull ldquoConsumer engagement is the blockbuster drug of the centuryrdquo
ndash Dr Farzad Mostashari former National Coordinator for Health IT
Vital Signs HIV Prevention Through Care and Treatment -- United States MMWR December 2 201160(47)1618-1623
8
3212014
4
PCMH Framework
Building Blocks of High-Performing Primary Care Share-the-CareTM Model
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
5
The Facts
RWJF Engaging Patients Improves Health and Health Care httpwwwrwjforgcontentdamfarmreportsissue_briefs2014rwjf411217
People who are actively engaged in their health care are
bull More likely to stay healthy and manage their conditions
bull Ask their doctors questions about their care
bull Following treatment plans
bull Exercise
bull Eat right
bull Receive health screenings and immunizations
Hibbard JH and Cunningham PJ Research Brief No 8 How Engaged Are Consumers in Their Health and Health Care and Why Does It Matter Washington Center for Studying Health System Change 2008 wwwhschangecomCONTENT10191019pdf
What about for PLHIV
- Patients keep more appointments if providers treat them with dignity and respect listened carefully to them explained in ways they could understand and knew them as persons
Flickinger TE Saha S Moore RD Beach MC Higher quality communication and relationships are associated with improved patient engagement in HIV care J Acquir Immune Defic Syndr 2013 Jul 163(3)362-6
- Self-management programs for people living with HIVAIDS result in short-term improvements in physical psychosocial and health knowledge and behavioral outcomes
Millard T1 Elliott J Girdler S Self-management education programs for people living with HIVAIDS a systematic review AIDS Patient Care STDS 2013 Feb27(2)103-13
- Focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects
Johnson MO1 Dilworth SE Taylor JM Neilands TB Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV Ann Behav Med 2011 Feb41(1)83-91
3212014
6
Who promotes patient engagement in your clinic
bull Engagement should be promoted by all staff members - Primary care providers nurses medical assistantshellip
bull Significant evidence supporting use of lay health workers and
peer outreach workers - Improve ARV adherence - Reduce viral load - Quality comparable to masters-level staff
Roth AM Holmes AM Stump TE Aalsma MC Ackermann RT Carney TS Katz BP Kesterson J Erdman SM Balt CA Inui TS Can lay health workers promote better medical self-management by persons living with HIV An evaluation of the Positive Choices program Patient Educ Couns 2012 Oct89(1)184-90 Naar-King S Outlaw A Green-Jones M Wright K Parsons JT Motivational interviewing by peer outreach workers a pilot randomized clinical trial to retain adolescents and young adults in HIV care AIDS Care 2009 Jul21(7)868-73 Kenya S Jones J Arheart K Kobetz E Chida N Baer S Powell A Symes S Hunte T Monroe A Carrasquillo O Using community health workers to improve clinical outcomes among people living with HIV a randomized controlled trial AIDS Behav 2013 Nov17(9)2927-34
bull Evidence shows patient self-management improves linkage to and possibly retention in care
bull BUT interventions aimed at delivery service design are limited bull What is needed
bull More interventions to improve patient engagement in HIV care AND that well-designed trials of interventions in this area are studied in the future
Brennan A1 Browne JP Horgan M A systematic review of health service interventions to improve linkage with or retention in HIV care AIDS Care 2013 Dec 20
spectrumcenterumichedu
Project CONNECT
ldquoCONNECTrdquoing Patients to Their
Medical Home
D Scott Batey PhD MSW Research amp Informatics Services Center
Division of Infectious Diseases
University of Alabama at Birmingham
3212014
7
Objectives
To familiarize participants with a conceptual
framework to support patient engagement in
the Patient-Centered Medical Home (PCMH)
To explain the role of patient navigation
methods in engagement in care
To provide an overview of one supportive
strategy using peers as navigators
3212014
8
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
Linkage to Care UAB 1917 Clinic
Problem identified Scheduled new patient
appointments often not attended (ldquono showrdquo)
Study of patients calling to establish HIV care
at UAB 1917 Clinic 2004-2006
31 of patients (160 of 522) failed to attend a
clinic visit within 6 mos of initial call
Mugavero et al Clin Infect Dis 200745127-130
3212014
9
Characteristic
ldquoShowrdquo Group
(n=362)
ldquoNo Showrdquo Group
(n=160)
OR (95CI)
Age (years) 393 + 96 371 + 95 084 (068-104)
White male
Minority male
White female
Minority female
125 (345)
154 (425)
31 (86)
52 (144)
32 (200)
76 (475)
20 (125)
32 (200)
10 (Reference)
175 (105-291)
272 (130-568)
239 (127-452)
Private insurance
Public insurance
Uninsured
127 (351)
77 (213)
158 (436)
26 (162)
34 (213)
100 (625)
10 (Reference)
191 (103-354)
262 (156-439)
Days from call to
appointment
256 + 138 302 + 134 132 (114-153)
ldquoNo Showrdquo Phenomenon
Data presented as mean + SD or n (column )
Age OR per 10 years Days from call OR per 10 days
Mugavero et al Clin Infect Dis 200745127-130
Project CONNECT
Client-
Oriented
New Patient
Navigation to
Encourage
Connection to
Treatment
Emerge
Challenges New Identify a
Need
Make a plan
Name It
Empower
Others
Join You
to
Celebrate
Project CONNECT
Program launched January 1 2007
New patients have orientation visit within 5 days of their initial call to the clinic
Semi-structured interview psychosocial questionnaire amp baseline labs
Uninsured patients meet with clinic SW
Prophylactic antibiotics initiated more quickly
Expedited referral for SA MH services
3212014
10
Phase II The CONNECT Visit
Phase I
1 Scheduling within 5 days (plusmn12 days)
2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone
number h) Employer i) Current
HIV meds j) Baseline
income k) Date of
diagnosis 3 Rapport building 4 Reminder call day
before
Phase III
1 ldquoReferralrdquo 2 Rapport
building 3 Tour 4 Follow-up
through 5 Check Labs 6 Mtg at 1st
appointment 7 Reminder call 8 Data Entry
Record Keeping
Questionnaire
Interview (time startedended amp
interviewer)
Other
Standardize Measures Behavioral
bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers
Health Literacy Domestic Violence (clinic would need a protocol)
Circumstances Oriented
Needs
Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration
Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)
Medical Baseline
Adherence Medical knowledge drug history other meds CD4 VL disease history
Labs
Review amp follow-up as appropriate
Linkage
Introduction
CONNECT Program Evaluation
Pre-Post Study Design
Study Period Data from Pre-CONNECT era was collected between
August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)
Post-CONNECT data clients who called to make an
appointment between Jan1 ndash Dec 31 2007
Statistical Analyses
Multivariable logistic regression analysis
Wylie et al 4th International Conference on HIV Treatment Adherence 2009
CONNECT Program Evaluation Characteristic Pre-CONNECT
(n=522)
Post-CONNECT
(n=361)
Unadjusted
p-value
Age 387
97 396
103 018
White male
Minority male
White female
Minority female
157 (301)
230 (441)
51 (98)
84 (161)
131 (363)
149 (413)
28 (78)
53 (147)
025
Private Insurance
Public Insurance
Uninsured
153 (293)
111 (213)
258 (494)
105 (291)
121 (335)
135 (374)
lt001
Days from call to
appointment
270
138
256
101 008
Data presented as mean + SD or n (column )
3212014
11
CONNECT Program Evaluation
Time Period ldquoNo Showrdquo Unadjusted OR
(95CI)
Adjusted
OR (95CI)a
Pre-CONNECT (n=522)
Post-CONNECT (n=361)
307
177
10
048 (035-068)
10
054 (038-076)
a Multivariable model controls for age race sex insurance location of residence and
time from call to scheduled visit
0
5
10
15
20
25
30
35
40
45
Total
White M
ale
Minority M
ale
White Fem
ale
Minority Fem
ale
Private Insurance
Public Insurance
Uninsured
Sociodemographic Characteristics
N
o S
ho
w
Pre-CONNECT
Post-CONNECT
Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups
plt001 plt005
CONNECT Staff Survey
What was liked most about Project CONNECT ldquoImproved quality of carerdquo
ldquoPatients feel more welcome and at-easerdquo
ldquoA decreased no show raterdquo
What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and
ldquofeel overwhelmedrdquo
ldquoConcern over the increased patient load and the resulting
stress on the staffrdquo
ldquoNothing is wrongrdquo with the program
3212014
12
CONNECT Staff Survey
Other Feedback
Overwhelming support bull ldquoIncreased team-approach to carerdquo
bull ldquoI think it has been extremely successful and helpfulrdquo
bull ldquoThis is one of the most effective important new additions to the
1917 Clinic in a decaderdquo
Criticisms
bull ldquoNegative impact on staff time and increased staff exhaustionrdquo
bull ldquoI think project Connect is a great program that has had
successes in achieving quicker visits and improved adherence to
care but has opened many Pandorarsquos boxes regarding staff time
ptrsquos emotions and continued adherence to carerdquo
After CONNECT
What does the future hold
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
3
bull ldquoConsumer engagement is the blockbuster drug of the centuryrdquo
ndash Dr Farzad Mostashari former National Coordinator for Health IT
Vital Signs HIV Prevention Through Care and Treatment -- United States MMWR December 2 201160(47)1618-1623
8
3212014
4
PCMH Framework
Building Blocks of High-Performing Primary Care Share-the-CareTM Model
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
5
The Facts
RWJF Engaging Patients Improves Health and Health Care httpwwwrwjforgcontentdamfarmreportsissue_briefs2014rwjf411217
People who are actively engaged in their health care are
bull More likely to stay healthy and manage their conditions
bull Ask their doctors questions about their care
bull Following treatment plans
bull Exercise
bull Eat right
bull Receive health screenings and immunizations
Hibbard JH and Cunningham PJ Research Brief No 8 How Engaged Are Consumers in Their Health and Health Care and Why Does It Matter Washington Center for Studying Health System Change 2008 wwwhschangecomCONTENT10191019pdf
What about for PLHIV
- Patients keep more appointments if providers treat them with dignity and respect listened carefully to them explained in ways they could understand and knew them as persons
Flickinger TE Saha S Moore RD Beach MC Higher quality communication and relationships are associated with improved patient engagement in HIV care J Acquir Immune Defic Syndr 2013 Jul 163(3)362-6
- Self-management programs for people living with HIVAIDS result in short-term improvements in physical psychosocial and health knowledge and behavioral outcomes
Millard T1 Elliott J Girdler S Self-management education programs for people living with HIVAIDS a systematic review AIDS Patient Care STDS 2013 Feb27(2)103-13
- Focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects
Johnson MO1 Dilworth SE Taylor JM Neilands TB Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV Ann Behav Med 2011 Feb41(1)83-91
3212014
6
Who promotes patient engagement in your clinic
bull Engagement should be promoted by all staff members - Primary care providers nurses medical assistantshellip
bull Significant evidence supporting use of lay health workers and
peer outreach workers - Improve ARV adherence - Reduce viral load - Quality comparable to masters-level staff
Roth AM Holmes AM Stump TE Aalsma MC Ackermann RT Carney TS Katz BP Kesterson J Erdman SM Balt CA Inui TS Can lay health workers promote better medical self-management by persons living with HIV An evaluation of the Positive Choices program Patient Educ Couns 2012 Oct89(1)184-90 Naar-King S Outlaw A Green-Jones M Wright K Parsons JT Motivational interviewing by peer outreach workers a pilot randomized clinical trial to retain adolescents and young adults in HIV care AIDS Care 2009 Jul21(7)868-73 Kenya S Jones J Arheart K Kobetz E Chida N Baer S Powell A Symes S Hunte T Monroe A Carrasquillo O Using community health workers to improve clinical outcomes among people living with HIV a randomized controlled trial AIDS Behav 2013 Nov17(9)2927-34
bull Evidence shows patient self-management improves linkage to and possibly retention in care
bull BUT interventions aimed at delivery service design are limited bull What is needed
bull More interventions to improve patient engagement in HIV care AND that well-designed trials of interventions in this area are studied in the future
Brennan A1 Browne JP Horgan M A systematic review of health service interventions to improve linkage with or retention in HIV care AIDS Care 2013 Dec 20
spectrumcenterumichedu
Project CONNECT
ldquoCONNECTrdquoing Patients to Their
Medical Home
D Scott Batey PhD MSW Research amp Informatics Services Center
Division of Infectious Diseases
University of Alabama at Birmingham
3212014
7
Objectives
To familiarize participants with a conceptual
framework to support patient engagement in
the Patient-Centered Medical Home (PCMH)
To explain the role of patient navigation
methods in engagement in care
To provide an overview of one supportive
strategy using peers as navigators
3212014
8
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
Linkage to Care UAB 1917 Clinic
Problem identified Scheduled new patient
appointments often not attended (ldquono showrdquo)
Study of patients calling to establish HIV care
at UAB 1917 Clinic 2004-2006
31 of patients (160 of 522) failed to attend a
clinic visit within 6 mos of initial call
Mugavero et al Clin Infect Dis 200745127-130
3212014
9
Characteristic
ldquoShowrdquo Group
(n=362)
ldquoNo Showrdquo Group
(n=160)
OR (95CI)
Age (years) 393 + 96 371 + 95 084 (068-104)
White male
Minority male
White female
Minority female
125 (345)
154 (425)
31 (86)
52 (144)
32 (200)
76 (475)
20 (125)
32 (200)
10 (Reference)
175 (105-291)
272 (130-568)
239 (127-452)
Private insurance
Public insurance
Uninsured
127 (351)
77 (213)
158 (436)
26 (162)
34 (213)
100 (625)
10 (Reference)
191 (103-354)
262 (156-439)
Days from call to
appointment
256 + 138 302 + 134 132 (114-153)
ldquoNo Showrdquo Phenomenon
Data presented as mean + SD or n (column )
Age OR per 10 years Days from call OR per 10 days
Mugavero et al Clin Infect Dis 200745127-130
Project CONNECT
Client-
Oriented
New Patient
Navigation to
Encourage
Connection to
Treatment
Emerge
Challenges New Identify a
Need
Make a plan
Name It
Empower
Others
Join You
to
Celebrate
Project CONNECT
Program launched January 1 2007
New patients have orientation visit within 5 days of their initial call to the clinic
Semi-structured interview psychosocial questionnaire amp baseline labs
Uninsured patients meet with clinic SW
Prophylactic antibiotics initiated more quickly
Expedited referral for SA MH services
3212014
10
Phase II The CONNECT Visit
Phase I
1 Scheduling within 5 days (plusmn12 days)
2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone
number h) Employer i) Current
HIV meds j) Baseline
income k) Date of
diagnosis 3 Rapport building 4 Reminder call day
before
Phase III
1 ldquoReferralrdquo 2 Rapport
building 3 Tour 4 Follow-up
through 5 Check Labs 6 Mtg at 1st
appointment 7 Reminder call 8 Data Entry
Record Keeping
Questionnaire
Interview (time startedended amp
interviewer)
Other
Standardize Measures Behavioral
bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers
Health Literacy Domestic Violence (clinic would need a protocol)
Circumstances Oriented
Needs
Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration
Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)
Medical Baseline
Adherence Medical knowledge drug history other meds CD4 VL disease history
Labs
Review amp follow-up as appropriate
Linkage
Introduction
CONNECT Program Evaluation
Pre-Post Study Design
Study Period Data from Pre-CONNECT era was collected between
August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)
Post-CONNECT data clients who called to make an
appointment between Jan1 ndash Dec 31 2007
Statistical Analyses
Multivariable logistic regression analysis
Wylie et al 4th International Conference on HIV Treatment Adherence 2009
CONNECT Program Evaluation Characteristic Pre-CONNECT
(n=522)
Post-CONNECT
(n=361)
Unadjusted
p-value
Age 387
97 396
103 018
White male
Minority male
White female
Minority female
157 (301)
230 (441)
51 (98)
84 (161)
131 (363)
149 (413)
28 (78)
53 (147)
025
Private Insurance
Public Insurance
Uninsured
153 (293)
111 (213)
258 (494)
105 (291)
121 (335)
135 (374)
lt001
Days from call to
appointment
270
138
256
101 008
Data presented as mean + SD or n (column )
3212014
11
CONNECT Program Evaluation
Time Period ldquoNo Showrdquo Unadjusted OR
(95CI)
Adjusted
OR (95CI)a
Pre-CONNECT (n=522)
Post-CONNECT (n=361)
307
177
10
048 (035-068)
10
054 (038-076)
a Multivariable model controls for age race sex insurance location of residence and
time from call to scheduled visit
0
5
10
15
20
25
30
35
40
45
Total
White M
ale
Minority M
ale
White Fem
ale
Minority Fem
ale
Private Insurance
Public Insurance
Uninsured
Sociodemographic Characteristics
N
o S
ho
w
Pre-CONNECT
Post-CONNECT
Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups
plt001 plt005
CONNECT Staff Survey
What was liked most about Project CONNECT ldquoImproved quality of carerdquo
ldquoPatients feel more welcome and at-easerdquo
ldquoA decreased no show raterdquo
What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and
ldquofeel overwhelmedrdquo
ldquoConcern over the increased patient load and the resulting
stress on the staffrdquo
ldquoNothing is wrongrdquo with the program
3212014
12
CONNECT Staff Survey
Other Feedback
Overwhelming support bull ldquoIncreased team-approach to carerdquo
bull ldquoI think it has been extremely successful and helpfulrdquo
bull ldquoThis is one of the most effective important new additions to the
1917 Clinic in a decaderdquo
Criticisms
bull ldquoNegative impact on staff time and increased staff exhaustionrdquo
bull ldquoI think project Connect is a great program that has had
successes in achieving quicker visits and improved adherence to
care but has opened many Pandorarsquos boxes regarding staff time
ptrsquos emotions and continued adherence to carerdquo
After CONNECT
What does the future hold
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
4
PCMH Framework
Building Blocks of High-Performing Primary Care Share-the-CareTM Model
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
5
The Facts
RWJF Engaging Patients Improves Health and Health Care httpwwwrwjforgcontentdamfarmreportsissue_briefs2014rwjf411217
People who are actively engaged in their health care are
bull More likely to stay healthy and manage their conditions
bull Ask their doctors questions about their care
bull Following treatment plans
bull Exercise
bull Eat right
bull Receive health screenings and immunizations
Hibbard JH and Cunningham PJ Research Brief No 8 How Engaged Are Consumers in Their Health and Health Care and Why Does It Matter Washington Center for Studying Health System Change 2008 wwwhschangecomCONTENT10191019pdf
What about for PLHIV
- Patients keep more appointments if providers treat them with dignity and respect listened carefully to them explained in ways they could understand and knew them as persons
Flickinger TE Saha S Moore RD Beach MC Higher quality communication and relationships are associated with improved patient engagement in HIV care J Acquir Immune Defic Syndr 2013 Jul 163(3)362-6
- Self-management programs for people living with HIVAIDS result in short-term improvements in physical psychosocial and health knowledge and behavioral outcomes
Millard T1 Elliott J Girdler S Self-management education programs for people living with HIVAIDS a systematic review AIDS Patient Care STDS 2013 Feb27(2)103-13
- Focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects
Johnson MO1 Dilworth SE Taylor JM Neilands TB Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV Ann Behav Med 2011 Feb41(1)83-91
3212014
6
Who promotes patient engagement in your clinic
bull Engagement should be promoted by all staff members - Primary care providers nurses medical assistantshellip
bull Significant evidence supporting use of lay health workers and
peer outreach workers - Improve ARV adherence - Reduce viral load - Quality comparable to masters-level staff
Roth AM Holmes AM Stump TE Aalsma MC Ackermann RT Carney TS Katz BP Kesterson J Erdman SM Balt CA Inui TS Can lay health workers promote better medical self-management by persons living with HIV An evaluation of the Positive Choices program Patient Educ Couns 2012 Oct89(1)184-90 Naar-King S Outlaw A Green-Jones M Wright K Parsons JT Motivational interviewing by peer outreach workers a pilot randomized clinical trial to retain adolescents and young adults in HIV care AIDS Care 2009 Jul21(7)868-73 Kenya S Jones J Arheart K Kobetz E Chida N Baer S Powell A Symes S Hunte T Monroe A Carrasquillo O Using community health workers to improve clinical outcomes among people living with HIV a randomized controlled trial AIDS Behav 2013 Nov17(9)2927-34
bull Evidence shows patient self-management improves linkage to and possibly retention in care
bull BUT interventions aimed at delivery service design are limited bull What is needed
bull More interventions to improve patient engagement in HIV care AND that well-designed trials of interventions in this area are studied in the future
Brennan A1 Browne JP Horgan M A systematic review of health service interventions to improve linkage with or retention in HIV care AIDS Care 2013 Dec 20
spectrumcenterumichedu
Project CONNECT
ldquoCONNECTrdquoing Patients to Their
Medical Home
D Scott Batey PhD MSW Research amp Informatics Services Center
Division of Infectious Diseases
University of Alabama at Birmingham
3212014
7
Objectives
To familiarize participants with a conceptual
framework to support patient engagement in
the Patient-Centered Medical Home (PCMH)
To explain the role of patient navigation
methods in engagement in care
To provide an overview of one supportive
strategy using peers as navigators
3212014
8
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
Linkage to Care UAB 1917 Clinic
Problem identified Scheduled new patient
appointments often not attended (ldquono showrdquo)
Study of patients calling to establish HIV care
at UAB 1917 Clinic 2004-2006
31 of patients (160 of 522) failed to attend a
clinic visit within 6 mos of initial call
Mugavero et al Clin Infect Dis 200745127-130
3212014
9
Characteristic
ldquoShowrdquo Group
(n=362)
ldquoNo Showrdquo Group
(n=160)
OR (95CI)
Age (years) 393 + 96 371 + 95 084 (068-104)
White male
Minority male
White female
Minority female
125 (345)
154 (425)
31 (86)
52 (144)
32 (200)
76 (475)
20 (125)
32 (200)
10 (Reference)
175 (105-291)
272 (130-568)
239 (127-452)
Private insurance
Public insurance
Uninsured
127 (351)
77 (213)
158 (436)
26 (162)
34 (213)
100 (625)
10 (Reference)
191 (103-354)
262 (156-439)
Days from call to
appointment
256 + 138 302 + 134 132 (114-153)
ldquoNo Showrdquo Phenomenon
Data presented as mean + SD or n (column )
Age OR per 10 years Days from call OR per 10 days
Mugavero et al Clin Infect Dis 200745127-130
Project CONNECT
Client-
Oriented
New Patient
Navigation to
Encourage
Connection to
Treatment
Emerge
Challenges New Identify a
Need
Make a plan
Name It
Empower
Others
Join You
to
Celebrate
Project CONNECT
Program launched January 1 2007
New patients have orientation visit within 5 days of their initial call to the clinic
Semi-structured interview psychosocial questionnaire amp baseline labs
Uninsured patients meet with clinic SW
Prophylactic antibiotics initiated more quickly
Expedited referral for SA MH services
3212014
10
Phase II The CONNECT Visit
Phase I
1 Scheduling within 5 days (plusmn12 days)
2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone
number h) Employer i) Current
HIV meds j) Baseline
income k) Date of
diagnosis 3 Rapport building 4 Reminder call day
before
Phase III
1 ldquoReferralrdquo 2 Rapport
building 3 Tour 4 Follow-up
through 5 Check Labs 6 Mtg at 1st
appointment 7 Reminder call 8 Data Entry
Record Keeping
Questionnaire
Interview (time startedended amp
interviewer)
Other
Standardize Measures Behavioral
bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers
Health Literacy Domestic Violence (clinic would need a protocol)
Circumstances Oriented
Needs
Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration
Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)
Medical Baseline
Adherence Medical knowledge drug history other meds CD4 VL disease history
Labs
Review amp follow-up as appropriate
Linkage
Introduction
CONNECT Program Evaluation
Pre-Post Study Design
Study Period Data from Pre-CONNECT era was collected between
August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)
Post-CONNECT data clients who called to make an
appointment between Jan1 ndash Dec 31 2007
Statistical Analyses
Multivariable logistic regression analysis
Wylie et al 4th International Conference on HIV Treatment Adherence 2009
CONNECT Program Evaluation Characteristic Pre-CONNECT
(n=522)
Post-CONNECT
(n=361)
Unadjusted
p-value
Age 387
97 396
103 018
White male
Minority male
White female
Minority female
157 (301)
230 (441)
51 (98)
84 (161)
131 (363)
149 (413)
28 (78)
53 (147)
025
Private Insurance
Public Insurance
Uninsured
153 (293)
111 (213)
258 (494)
105 (291)
121 (335)
135 (374)
lt001
Days from call to
appointment
270
138
256
101 008
Data presented as mean + SD or n (column )
3212014
11
CONNECT Program Evaluation
Time Period ldquoNo Showrdquo Unadjusted OR
(95CI)
Adjusted
OR (95CI)a
Pre-CONNECT (n=522)
Post-CONNECT (n=361)
307
177
10
048 (035-068)
10
054 (038-076)
a Multivariable model controls for age race sex insurance location of residence and
time from call to scheduled visit
0
5
10
15
20
25
30
35
40
45
Total
White M
ale
Minority M
ale
White Fem
ale
Minority Fem
ale
Private Insurance
Public Insurance
Uninsured
Sociodemographic Characteristics
N
o S
ho
w
Pre-CONNECT
Post-CONNECT
Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups
plt001 plt005
CONNECT Staff Survey
What was liked most about Project CONNECT ldquoImproved quality of carerdquo
ldquoPatients feel more welcome and at-easerdquo
ldquoA decreased no show raterdquo
What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and
ldquofeel overwhelmedrdquo
ldquoConcern over the increased patient load and the resulting
stress on the staffrdquo
ldquoNothing is wrongrdquo with the program
3212014
12
CONNECT Staff Survey
Other Feedback
Overwhelming support bull ldquoIncreased team-approach to carerdquo
bull ldquoI think it has been extremely successful and helpfulrdquo
bull ldquoThis is one of the most effective important new additions to the
1917 Clinic in a decaderdquo
Criticisms
bull ldquoNegative impact on staff time and increased staff exhaustionrdquo
bull ldquoI think project Connect is a great program that has had
successes in achieving quicker visits and improved adherence to
care but has opened many Pandorarsquos boxes regarding staff time
ptrsquos emotions and continued adherence to carerdquo
After CONNECT
What does the future hold
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
5
The Facts
RWJF Engaging Patients Improves Health and Health Care httpwwwrwjforgcontentdamfarmreportsissue_briefs2014rwjf411217
People who are actively engaged in their health care are
bull More likely to stay healthy and manage their conditions
bull Ask their doctors questions about their care
bull Following treatment plans
bull Exercise
bull Eat right
bull Receive health screenings and immunizations
Hibbard JH and Cunningham PJ Research Brief No 8 How Engaged Are Consumers in Their Health and Health Care and Why Does It Matter Washington Center for Studying Health System Change 2008 wwwhschangecomCONTENT10191019pdf
What about for PLHIV
- Patients keep more appointments if providers treat them with dignity and respect listened carefully to them explained in ways they could understand and knew them as persons
Flickinger TE Saha S Moore RD Beach MC Higher quality communication and relationships are associated with improved patient engagement in HIV care J Acquir Immune Defic Syndr 2013 Jul 163(3)362-6
- Self-management programs for people living with HIVAIDS result in short-term improvements in physical psychosocial and health knowledge and behavioral outcomes
Millard T1 Elliott J Girdler S Self-management education programs for people living with HIVAIDS a systematic review AIDS Patient Care STDS 2013 Feb27(2)103-13
- Focusing on skills related to ART side-effects management show promise for improving ART adherence among persons experiencing high levels of perceived ART side effects
Johnson MO1 Dilworth SE Taylor JM Neilands TB Improving coping skills for self-management of treatment side effects can reduce antiretroviral medication nonadherence among people living with HIV Ann Behav Med 2011 Feb41(1)83-91
3212014
6
Who promotes patient engagement in your clinic
bull Engagement should be promoted by all staff members - Primary care providers nurses medical assistantshellip
bull Significant evidence supporting use of lay health workers and
peer outreach workers - Improve ARV adherence - Reduce viral load - Quality comparable to masters-level staff
Roth AM Holmes AM Stump TE Aalsma MC Ackermann RT Carney TS Katz BP Kesterson J Erdman SM Balt CA Inui TS Can lay health workers promote better medical self-management by persons living with HIV An evaluation of the Positive Choices program Patient Educ Couns 2012 Oct89(1)184-90 Naar-King S Outlaw A Green-Jones M Wright K Parsons JT Motivational interviewing by peer outreach workers a pilot randomized clinical trial to retain adolescents and young adults in HIV care AIDS Care 2009 Jul21(7)868-73 Kenya S Jones J Arheart K Kobetz E Chida N Baer S Powell A Symes S Hunte T Monroe A Carrasquillo O Using community health workers to improve clinical outcomes among people living with HIV a randomized controlled trial AIDS Behav 2013 Nov17(9)2927-34
bull Evidence shows patient self-management improves linkage to and possibly retention in care
bull BUT interventions aimed at delivery service design are limited bull What is needed
bull More interventions to improve patient engagement in HIV care AND that well-designed trials of interventions in this area are studied in the future
Brennan A1 Browne JP Horgan M A systematic review of health service interventions to improve linkage with or retention in HIV care AIDS Care 2013 Dec 20
spectrumcenterumichedu
Project CONNECT
ldquoCONNECTrdquoing Patients to Their
Medical Home
D Scott Batey PhD MSW Research amp Informatics Services Center
Division of Infectious Diseases
University of Alabama at Birmingham
3212014
7
Objectives
To familiarize participants with a conceptual
framework to support patient engagement in
the Patient-Centered Medical Home (PCMH)
To explain the role of patient navigation
methods in engagement in care
To provide an overview of one supportive
strategy using peers as navigators
3212014
8
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
Linkage to Care UAB 1917 Clinic
Problem identified Scheduled new patient
appointments often not attended (ldquono showrdquo)
Study of patients calling to establish HIV care
at UAB 1917 Clinic 2004-2006
31 of patients (160 of 522) failed to attend a
clinic visit within 6 mos of initial call
Mugavero et al Clin Infect Dis 200745127-130
3212014
9
Characteristic
ldquoShowrdquo Group
(n=362)
ldquoNo Showrdquo Group
(n=160)
OR (95CI)
Age (years) 393 + 96 371 + 95 084 (068-104)
White male
Minority male
White female
Minority female
125 (345)
154 (425)
31 (86)
52 (144)
32 (200)
76 (475)
20 (125)
32 (200)
10 (Reference)
175 (105-291)
272 (130-568)
239 (127-452)
Private insurance
Public insurance
Uninsured
127 (351)
77 (213)
158 (436)
26 (162)
34 (213)
100 (625)
10 (Reference)
191 (103-354)
262 (156-439)
Days from call to
appointment
256 + 138 302 + 134 132 (114-153)
ldquoNo Showrdquo Phenomenon
Data presented as mean + SD or n (column )
Age OR per 10 years Days from call OR per 10 days
Mugavero et al Clin Infect Dis 200745127-130
Project CONNECT
Client-
Oriented
New Patient
Navigation to
Encourage
Connection to
Treatment
Emerge
Challenges New Identify a
Need
Make a plan
Name It
Empower
Others
Join You
to
Celebrate
Project CONNECT
Program launched January 1 2007
New patients have orientation visit within 5 days of their initial call to the clinic
Semi-structured interview psychosocial questionnaire amp baseline labs
Uninsured patients meet with clinic SW
Prophylactic antibiotics initiated more quickly
Expedited referral for SA MH services
3212014
10
Phase II The CONNECT Visit
Phase I
1 Scheduling within 5 days (plusmn12 days)
2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone
number h) Employer i) Current
HIV meds j) Baseline
income k) Date of
diagnosis 3 Rapport building 4 Reminder call day
before
Phase III
1 ldquoReferralrdquo 2 Rapport
building 3 Tour 4 Follow-up
through 5 Check Labs 6 Mtg at 1st
appointment 7 Reminder call 8 Data Entry
Record Keeping
Questionnaire
Interview (time startedended amp
interviewer)
Other
Standardize Measures Behavioral
bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers
Health Literacy Domestic Violence (clinic would need a protocol)
Circumstances Oriented
Needs
Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration
Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)
Medical Baseline
Adherence Medical knowledge drug history other meds CD4 VL disease history
Labs
Review amp follow-up as appropriate
Linkage
Introduction
CONNECT Program Evaluation
Pre-Post Study Design
Study Period Data from Pre-CONNECT era was collected between
August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)
Post-CONNECT data clients who called to make an
appointment between Jan1 ndash Dec 31 2007
Statistical Analyses
Multivariable logistic regression analysis
Wylie et al 4th International Conference on HIV Treatment Adherence 2009
CONNECT Program Evaluation Characteristic Pre-CONNECT
(n=522)
Post-CONNECT
(n=361)
Unadjusted
p-value
Age 387
97 396
103 018
White male
Minority male
White female
Minority female
157 (301)
230 (441)
51 (98)
84 (161)
131 (363)
149 (413)
28 (78)
53 (147)
025
Private Insurance
Public Insurance
Uninsured
153 (293)
111 (213)
258 (494)
105 (291)
121 (335)
135 (374)
lt001
Days from call to
appointment
270
138
256
101 008
Data presented as mean + SD or n (column )
3212014
11
CONNECT Program Evaluation
Time Period ldquoNo Showrdquo Unadjusted OR
(95CI)
Adjusted
OR (95CI)a
Pre-CONNECT (n=522)
Post-CONNECT (n=361)
307
177
10
048 (035-068)
10
054 (038-076)
a Multivariable model controls for age race sex insurance location of residence and
time from call to scheduled visit
0
5
10
15
20
25
30
35
40
45
Total
White M
ale
Minority M
ale
White Fem
ale
Minority Fem
ale
Private Insurance
Public Insurance
Uninsured
Sociodemographic Characteristics
N
o S
ho
w
Pre-CONNECT
Post-CONNECT
Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups
plt001 plt005
CONNECT Staff Survey
What was liked most about Project CONNECT ldquoImproved quality of carerdquo
ldquoPatients feel more welcome and at-easerdquo
ldquoA decreased no show raterdquo
What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and
ldquofeel overwhelmedrdquo
ldquoConcern over the increased patient load and the resulting
stress on the staffrdquo
ldquoNothing is wrongrdquo with the program
3212014
12
CONNECT Staff Survey
Other Feedback
Overwhelming support bull ldquoIncreased team-approach to carerdquo
bull ldquoI think it has been extremely successful and helpfulrdquo
bull ldquoThis is one of the most effective important new additions to the
1917 Clinic in a decaderdquo
Criticisms
bull ldquoNegative impact on staff time and increased staff exhaustionrdquo
bull ldquoI think project Connect is a great program that has had
successes in achieving quicker visits and improved adherence to
care but has opened many Pandorarsquos boxes regarding staff time
ptrsquos emotions and continued adherence to carerdquo
After CONNECT
What does the future hold
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
6
Who promotes patient engagement in your clinic
bull Engagement should be promoted by all staff members - Primary care providers nurses medical assistantshellip
bull Significant evidence supporting use of lay health workers and
peer outreach workers - Improve ARV adherence - Reduce viral load - Quality comparable to masters-level staff
Roth AM Holmes AM Stump TE Aalsma MC Ackermann RT Carney TS Katz BP Kesterson J Erdman SM Balt CA Inui TS Can lay health workers promote better medical self-management by persons living with HIV An evaluation of the Positive Choices program Patient Educ Couns 2012 Oct89(1)184-90 Naar-King S Outlaw A Green-Jones M Wright K Parsons JT Motivational interviewing by peer outreach workers a pilot randomized clinical trial to retain adolescents and young adults in HIV care AIDS Care 2009 Jul21(7)868-73 Kenya S Jones J Arheart K Kobetz E Chida N Baer S Powell A Symes S Hunte T Monroe A Carrasquillo O Using community health workers to improve clinical outcomes among people living with HIV a randomized controlled trial AIDS Behav 2013 Nov17(9)2927-34
bull Evidence shows patient self-management improves linkage to and possibly retention in care
bull BUT interventions aimed at delivery service design are limited bull What is needed
bull More interventions to improve patient engagement in HIV care AND that well-designed trials of interventions in this area are studied in the future
Brennan A1 Browne JP Horgan M A systematic review of health service interventions to improve linkage with or retention in HIV care AIDS Care 2013 Dec 20
spectrumcenterumichedu
Project CONNECT
ldquoCONNECTrdquoing Patients to Their
Medical Home
D Scott Batey PhD MSW Research amp Informatics Services Center
Division of Infectious Diseases
University of Alabama at Birmingham
3212014
7
Objectives
To familiarize participants with a conceptual
framework to support patient engagement in
the Patient-Centered Medical Home (PCMH)
To explain the role of patient navigation
methods in engagement in care
To provide an overview of one supportive
strategy using peers as navigators
3212014
8
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
Linkage to Care UAB 1917 Clinic
Problem identified Scheduled new patient
appointments often not attended (ldquono showrdquo)
Study of patients calling to establish HIV care
at UAB 1917 Clinic 2004-2006
31 of patients (160 of 522) failed to attend a
clinic visit within 6 mos of initial call
Mugavero et al Clin Infect Dis 200745127-130
3212014
9
Characteristic
ldquoShowrdquo Group
(n=362)
ldquoNo Showrdquo Group
(n=160)
OR (95CI)
Age (years) 393 + 96 371 + 95 084 (068-104)
White male
Minority male
White female
Minority female
125 (345)
154 (425)
31 (86)
52 (144)
32 (200)
76 (475)
20 (125)
32 (200)
10 (Reference)
175 (105-291)
272 (130-568)
239 (127-452)
Private insurance
Public insurance
Uninsured
127 (351)
77 (213)
158 (436)
26 (162)
34 (213)
100 (625)
10 (Reference)
191 (103-354)
262 (156-439)
Days from call to
appointment
256 + 138 302 + 134 132 (114-153)
ldquoNo Showrdquo Phenomenon
Data presented as mean + SD or n (column )
Age OR per 10 years Days from call OR per 10 days
Mugavero et al Clin Infect Dis 200745127-130
Project CONNECT
Client-
Oriented
New Patient
Navigation to
Encourage
Connection to
Treatment
Emerge
Challenges New Identify a
Need
Make a plan
Name It
Empower
Others
Join You
to
Celebrate
Project CONNECT
Program launched January 1 2007
New patients have orientation visit within 5 days of their initial call to the clinic
Semi-structured interview psychosocial questionnaire amp baseline labs
Uninsured patients meet with clinic SW
Prophylactic antibiotics initiated more quickly
Expedited referral for SA MH services
3212014
10
Phase II The CONNECT Visit
Phase I
1 Scheduling within 5 days (plusmn12 days)
2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone
number h) Employer i) Current
HIV meds j) Baseline
income k) Date of
diagnosis 3 Rapport building 4 Reminder call day
before
Phase III
1 ldquoReferralrdquo 2 Rapport
building 3 Tour 4 Follow-up
through 5 Check Labs 6 Mtg at 1st
appointment 7 Reminder call 8 Data Entry
Record Keeping
Questionnaire
Interview (time startedended amp
interviewer)
Other
Standardize Measures Behavioral
bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers
Health Literacy Domestic Violence (clinic would need a protocol)
Circumstances Oriented
Needs
Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration
Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)
Medical Baseline
Adherence Medical knowledge drug history other meds CD4 VL disease history
Labs
Review amp follow-up as appropriate
Linkage
Introduction
CONNECT Program Evaluation
Pre-Post Study Design
Study Period Data from Pre-CONNECT era was collected between
August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)
Post-CONNECT data clients who called to make an
appointment between Jan1 ndash Dec 31 2007
Statistical Analyses
Multivariable logistic regression analysis
Wylie et al 4th International Conference on HIV Treatment Adherence 2009
CONNECT Program Evaluation Characteristic Pre-CONNECT
(n=522)
Post-CONNECT
(n=361)
Unadjusted
p-value
Age 387
97 396
103 018
White male
Minority male
White female
Minority female
157 (301)
230 (441)
51 (98)
84 (161)
131 (363)
149 (413)
28 (78)
53 (147)
025
Private Insurance
Public Insurance
Uninsured
153 (293)
111 (213)
258 (494)
105 (291)
121 (335)
135 (374)
lt001
Days from call to
appointment
270
138
256
101 008
Data presented as mean + SD or n (column )
3212014
11
CONNECT Program Evaluation
Time Period ldquoNo Showrdquo Unadjusted OR
(95CI)
Adjusted
OR (95CI)a
Pre-CONNECT (n=522)
Post-CONNECT (n=361)
307
177
10
048 (035-068)
10
054 (038-076)
a Multivariable model controls for age race sex insurance location of residence and
time from call to scheduled visit
0
5
10
15
20
25
30
35
40
45
Total
White M
ale
Minority M
ale
White Fem
ale
Minority Fem
ale
Private Insurance
Public Insurance
Uninsured
Sociodemographic Characteristics
N
o S
ho
w
Pre-CONNECT
Post-CONNECT
Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups
plt001 plt005
CONNECT Staff Survey
What was liked most about Project CONNECT ldquoImproved quality of carerdquo
ldquoPatients feel more welcome and at-easerdquo
ldquoA decreased no show raterdquo
What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and
ldquofeel overwhelmedrdquo
ldquoConcern over the increased patient load and the resulting
stress on the staffrdquo
ldquoNothing is wrongrdquo with the program
3212014
12
CONNECT Staff Survey
Other Feedback
Overwhelming support bull ldquoIncreased team-approach to carerdquo
bull ldquoI think it has been extremely successful and helpfulrdquo
bull ldquoThis is one of the most effective important new additions to the
1917 Clinic in a decaderdquo
Criticisms
bull ldquoNegative impact on staff time and increased staff exhaustionrdquo
bull ldquoI think project Connect is a great program that has had
successes in achieving quicker visits and improved adherence to
care but has opened many Pandorarsquos boxes regarding staff time
ptrsquos emotions and continued adherence to carerdquo
After CONNECT
What does the future hold
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
7
Objectives
To familiarize participants with a conceptual
framework to support patient engagement in
the Patient-Centered Medical Home (PCMH)
To explain the role of patient navigation
methods in engagement in care
To provide an overview of one supportive
strategy using peers as navigators
3212014
8
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
Linkage to Care UAB 1917 Clinic
Problem identified Scheduled new patient
appointments often not attended (ldquono showrdquo)
Study of patients calling to establish HIV care
at UAB 1917 Clinic 2004-2006
31 of patients (160 of 522) failed to attend a
clinic visit within 6 mos of initial call
Mugavero et al Clin Infect Dis 200745127-130
3212014
9
Characteristic
ldquoShowrdquo Group
(n=362)
ldquoNo Showrdquo Group
(n=160)
OR (95CI)
Age (years) 393 + 96 371 + 95 084 (068-104)
White male
Minority male
White female
Minority female
125 (345)
154 (425)
31 (86)
52 (144)
32 (200)
76 (475)
20 (125)
32 (200)
10 (Reference)
175 (105-291)
272 (130-568)
239 (127-452)
Private insurance
Public insurance
Uninsured
127 (351)
77 (213)
158 (436)
26 (162)
34 (213)
100 (625)
10 (Reference)
191 (103-354)
262 (156-439)
Days from call to
appointment
256 + 138 302 + 134 132 (114-153)
ldquoNo Showrdquo Phenomenon
Data presented as mean + SD or n (column )
Age OR per 10 years Days from call OR per 10 days
Mugavero et al Clin Infect Dis 200745127-130
Project CONNECT
Client-
Oriented
New Patient
Navigation to
Encourage
Connection to
Treatment
Emerge
Challenges New Identify a
Need
Make a plan
Name It
Empower
Others
Join You
to
Celebrate
Project CONNECT
Program launched January 1 2007
New patients have orientation visit within 5 days of their initial call to the clinic
Semi-structured interview psychosocial questionnaire amp baseline labs
Uninsured patients meet with clinic SW
Prophylactic antibiotics initiated more quickly
Expedited referral for SA MH services
3212014
10
Phase II The CONNECT Visit
Phase I
1 Scheduling within 5 days (plusmn12 days)
2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone
number h) Employer i) Current
HIV meds j) Baseline
income k) Date of
diagnosis 3 Rapport building 4 Reminder call day
before
Phase III
1 ldquoReferralrdquo 2 Rapport
building 3 Tour 4 Follow-up
through 5 Check Labs 6 Mtg at 1st
appointment 7 Reminder call 8 Data Entry
Record Keeping
Questionnaire
Interview (time startedended amp
interviewer)
Other
Standardize Measures Behavioral
bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers
Health Literacy Domestic Violence (clinic would need a protocol)
Circumstances Oriented
Needs
Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration
Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)
Medical Baseline
Adherence Medical knowledge drug history other meds CD4 VL disease history
Labs
Review amp follow-up as appropriate
Linkage
Introduction
CONNECT Program Evaluation
Pre-Post Study Design
Study Period Data from Pre-CONNECT era was collected between
August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)
Post-CONNECT data clients who called to make an
appointment between Jan1 ndash Dec 31 2007
Statistical Analyses
Multivariable logistic regression analysis
Wylie et al 4th International Conference on HIV Treatment Adherence 2009
CONNECT Program Evaluation Characteristic Pre-CONNECT
(n=522)
Post-CONNECT
(n=361)
Unadjusted
p-value
Age 387
97 396
103 018
White male
Minority male
White female
Minority female
157 (301)
230 (441)
51 (98)
84 (161)
131 (363)
149 (413)
28 (78)
53 (147)
025
Private Insurance
Public Insurance
Uninsured
153 (293)
111 (213)
258 (494)
105 (291)
121 (335)
135 (374)
lt001
Days from call to
appointment
270
138
256
101 008
Data presented as mean + SD or n (column )
3212014
11
CONNECT Program Evaluation
Time Period ldquoNo Showrdquo Unadjusted OR
(95CI)
Adjusted
OR (95CI)a
Pre-CONNECT (n=522)
Post-CONNECT (n=361)
307
177
10
048 (035-068)
10
054 (038-076)
a Multivariable model controls for age race sex insurance location of residence and
time from call to scheduled visit
0
5
10
15
20
25
30
35
40
45
Total
White M
ale
Minority M
ale
White Fem
ale
Minority Fem
ale
Private Insurance
Public Insurance
Uninsured
Sociodemographic Characteristics
N
o S
ho
w
Pre-CONNECT
Post-CONNECT
Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups
plt001 plt005
CONNECT Staff Survey
What was liked most about Project CONNECT ldquoImproved quality of carerdquo
ldquoPatients feel more welcome and at-easerdquo
ldquoA decreased no show raterdquo
What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and
ldquofeel overwhelmedrdquo
ldquoConcern over the increased patient load and the resulting
stress on the staffrdquo
ldquoNothing is wrongrdquo with the program
3212014
12
CONNECT Staff Survey
Other Feedback
Overwhelming support bull ldquoIncreased team-approach to carerdquo
bull ldquoI think it has been extremely successful and helpfulrdquo
bull ldquoThis is one of the most effective important new additions to the
1917 Clinic in a decaderdquo
Criticisms
bull ldquoNegative impact on staff time and increased staff exhaustionrdquo
bull ldquoI think project Connect is a great program that has had
successes in achieving quicker visits and improved adherence to
care but has opened many Pandorarsquos boxes regarding staff time
ptrsquos emotions and continued adherence to carerdquo
After CONNECT
What does the future hold
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
8
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
Linkage to Care UAB 1917 Clinic
Problem identified Scheduled new patient
appointments often not attended (ldquono showrdquo)
Study of patients calling to establish HIV care
at UAB 1917 Clinic 2004-2006
31 of patients (160 of 522) failed to attend a
clinic visit within 6 mos of initial call
Mugavero et al Clin Infect Dis 200745127-130
3212014
9
Characteristic
ldquoShowrdquo Group
(n=362)
ldquoNo Showrdquo Group
(n=160)
OR (95CI)
Age (years) 393 + 96 371 + 95 084 (068-104)
White male
Minority male
White female
Minority female
125 (345)
154 (425)
31 (86)
52 (144)
32 (200)
76 (475)
20 (125)
32 (200)
10 (Reference)
175 (105-291)
272 (130-568)
239 (127-452)
Private insurance
Public insurance
Uninsured
127 (351)
77 (213)
158 (436)
26 (162)
34 (213)
100 (625)
10 (Reference)
191 (103-354)
262 (156-439)
Days from call to
appointment
256 + 138 302 + 134 132 (114-153)
ldquoNo Showrdquo Phenomenon
Data presented as mean + SD or n (column )
Age OR per 10 years Days from call OR per 10 days
Mugavero et al Clin Infect Dis 200745127-130
Project CONNECT
Client-
Oriented
New Patient
Navigation to
Encourage
Connection to
Treatment
Emerge
Challenges New Identify a
Need
Make a plan
Name It
Empower
Others
Join You
to
Celebrate
Project CONNECT
Program launched January 1 2007
New patients have orientation visit within 5 days of their initial call to the clinic
Semi-structured interview psychosocial questionnaire amp baseline labs
Uninsured patients meet with clinic SW
Prophylactic antibiotics initiated more quickly
Expedited referral for SA MH services
3212014
10
Phase II The CONNECT Visit
Phase I
1 Scheduling within 5 days (plusmn12 days)
2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone
number h) Employer i) Current
HIV meds j) Baseline
income k) Date of
diagnosis 3 Rapport building 4 Reminder call day
before
Phase III
1 ldquoReferralrdquo 2 Rapport
building 3 Tour 4 Follow-up
through 5 Check Labs 6 Mtg at 1st
appointment 7 Reminder call 8 Data Entry
Record Keeping
Questionnaire
Interview (time startedended amp
interviewer)
Other
Standardize Measures Behavioral
bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers
Health Literacy Domestic Violence (clinic would need a protocol)
Circumstances Oriented
Needs
Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration
Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)
Medical Baseline
Adherence Medical knowledge drug history other meds CD4 VL disease history
Labs
Review amp follow-up as appropriate
Linkage
Introduction
CONNECT Program Evaluation
Pre-Post Study Design
Study Period Data from Pre-CONNECT era was collected between
August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)
Post-CONNECT data clients who called to make an
appointment between Jan1 ndash Dec 31 2007
Statistical Analyses
Multivariable logistic regression analysis
Wylie et al 4th International Conference on HIV Treatment Adherence 2009
CONNECT Program Evaluation Characteristic Pre-CONNECT
(n=522)
Post-CONNECT
(n=361)
Unadjusted
p-value
Age 387
97 396
103 018
White male
Minority male
White female
Minority female
157 (301)
230 (441)
51 (98)
84 (161)
131 (363)
149 (413)
28 (78)
53 (147)
025
Private Insurance
Public Insurance
Uninsured
153 (293)
111 (213)
258 (494)
105 (291)
121 (335)
135 (374)
lt001
Days from call to
appointment
270
138
256
101 008
Data presented as mean + SD or n (column )
3212014
11
CONNECT Program Evaluation
Time Period ldquoNo Showrdquo Unadjusted OR
(95CI)
Adjusted
OR (95CI)a
Pre-CONNECT (n=522)
Post-CONNECT (n=361)
307
177
10
048 (035-068)
10
054 (038-076)
a Multivariable model controls for age race sex insurance location of residence and
time from call to scheduled visit
0
5
10
15
20
25
30
35
40
45
Total
White M
ale
Minority M
ale
White Fem
ale
Minority Fem
ale
Private Insurance
Public Insurance
Uninsured
Sociodemographic Characteristics
N
o S
ho
w
Pre-CONNECT
Post-CONNECT
Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups
plt001 plt005
CONNECT Staff Survey
What was liked most about Project CONNECT ldquoImproved quality of carerdquo
ldquoPatients feel more welcome and at-easerdquo
ldquoA decreased no show raterdquo
What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and
ldquofeel overwhelmedrdquo
ldquoConcern over the increased patient load and the resulting
stress on the staffrdquo
ldquoNothing is wrongrdquo with the program
3212014
12
CONNECT Staff Survey
Other Feedback
Overwhelming support bull ldquoIncreased team-approach to carerdquo
bull ldquoI think it has been extremely successful and helpfulrdquo
bull ldquoThis is one of the most effective important new additions to the
1917 Clinic in a decaderdquo
Criticisms
bull ldquoNegative impact on staff time and increased staff exhaustionrdquo
bull ldquoI think project Connect is a great program that has had
successes in achieving quicker visits and improved adherence to
care but has opened many Pandorarsquos boxes regarding staff time
ptrsquos emotions and continued adherence to carerdquo
After CONNECT
What does the future hold
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
9
Characteristic
ldquoShowrdquo Group
(n=362)
ldquoNo Showrdquo Group
(n=160)
OR (95CI)
Age (years) 393 + 96 371 + 95 084 (068-104)
White male
Minority male
White female
Minority female
125 (345)
154 (425)
31 (86)
52 (144)
32 (200)
76 (475)
20 (125)
32 (200)
10 (Reference)
175 (105-291)
272 (130-568)
239 (127-452)
Private insurance
Public insurance
Uninsured
127 (351)
77 (213)
158 (436)
26 (162)
34 (213)
100 (625)
10 (Reference)
191 (103-354)
262 (156-439)
Days from call to
appointment
256 + 138 302 + 134 132 (114-153)
ldquoNo Showrdquo Phenomenon
Data presented as mean + SD or n (column )
Age OR per 10 years Days from call OR per 10 days
Mugavero et al Clin Infect Dis 200745127-130
Project CONNECT
Client-
Oriented
New Patient
Navigation to
Encourage
Connection to
Treatment
Emerge
Challenges New Identify a
Need
Make a plan
Name It
Empower
Others
Join You
to
Celebrate
Project CONNECT
Program launched January 1 2007
New patients have orientation visit within 5 days of their initial call to the clinic
Semi-structured interview psychosocial questionnaire amp baseline labs
Uninsured patients meet with clinic SW
Prophylactic antibiotics initiated more quickly
Expedited referral for SA MH services
3212014
10
Phase II The CONNECT Visit
Phase I
1 Scheduling within 5 days (plusmn12 days)
2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone
number h) Employer i) Current
HIV meds j) Baseline
income k) Date of
diagnosis 3 Rapport building 4 Reminder call day
before
Phase III
1 ldquoReferralrdquo 2 Rapport
building 3 Tour 4 Follow-up
through 5 Check Labs 6 Mtg at 1st
appointment 7 Reminder call 8 Data Entry
Record Keeping
Questionnaire
Interview (time startedended amp
interviewer)
Other
Standardize Measures Behavioral
bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers
Health Literacy Domestic Violence (clinic would need a protocol)
Circumstances Oriented
Needs
Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration
Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)
Medical Baseline
Adherence Medical knowledge drug history other meds CD4 VL disease history
Labs
Review amp follow-up as appropriate
Linkage
Introduction
CONNECT Program Evaluation
Pre-Post Study Design
Study Period Data from Pre-CONNECT era was collected between
August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)
Post-CONNECT data clients who called to make an
appointment between Jan1 ndash Dec 31 2007
Statistical Analyses
Multivariable logistic regression analysis
Wylie et al 4th International Conference on HIV Treatment Adherence 2009
CONNECT Program Evaluation Characteristic Pre-CONNECT
(n=522)
Post-CONNECT
(n=361)
Unadjusted
p-value
Age 387
97 396
103 018
White male
Minority male
White female
Minority female
157 (301)
230 (441)
51 (98)
84 (161)
131 (363)
149 (413)
28 (78)
53 (147)
025
Private Insurance
Public Insurance
Uninsured
153 (293)
111 (213)
258 (494)
105 (291)
121 (335)
135 (374)
lt001
Days from call to
appointment
270
138
256
101 008
Data presented as mean + SD or n (column )
3212014
11
CONNECT Program Evaluation
Time Period ldquoNo Showrdquo Unadjusted OR
(95CI)
Adjusted
OR (95CI)a
Pre-CONNECT (n=522)
Post-CONNECT (n=361)
307
177
10
048 (035-068)
10
054 (038-076)
a Multivariable model controls for age race sex insurance location of residence and
time from call to scheduled visit
0
5
10
15
20
25
30
35
40
45
Total
White M
ale
Minority M
ale
White Fem
ale
Minority Fem
ale
Private Insurance
Public Insurance
Uninsured
Sociodemographic Characteristics
N
o S
ho
w
Pre-CONNECT
Post-CONNECT
Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups
plt001 plt005
CONNECT Staff Survey
What was liked most about Project CONNECT ldquoImproved quality of carerdquo
ldquoPatients feel more welcome and at-easerdquo
ldquoA decreased no show raterdquo
What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and
ldquofeel overwhelmedrdquo
ldquoConcern over the increased patient load and the resulting
stress on the staffrdquo
ldquoNothing is wrongrdquo with the program
3212014
12
CONNECT Staff Survey
Other Feedback
Overwhelming support bull ldquoIncreased team-approach to carerdquo
bull ldquoI think it has been extremely successful and helpfulrdquo
bull ldquoThis is one of the most effective important new additions to the
1917 Clinic in a decaderdquo
Criticisms
bull ldquoNegative impact on staff time and increased staff exhaustionrdquo
bull ldquoI think project Connect is a great program that has had
successes in achieving quicker visits and improved adherence to
care but has opened many Pandorarsquos boxes regarding staff time
ptrsquos emotions and continued adherence to carerdquo
After CONNECT
What does the future hold
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
10
Phase II The CONNECT Visit
Phase I
1 Scheduling within 5 days (plusmn12 days)
2 Demographics a) Name b) DOB c) Age d) Race e) Insurance f) SSN g) Telephone
number h) Employer i) Current
HIV meds j) Baseline
income k) Date of
diagnosis 3 Rapport building 4 Reminder call day
before
Phase III
1 ldquoReferralrdquo 2 Rapport
building 3 Tour 4 Follow-up
through 5 Check Labs 6 Mtg at 1st
appointment 7 Reminder call 8 Data Entry
Record Keeping
Questionnaire
Interview (time startedended amp
interviewer)
Other
Standardize Measures Behavioral
bullDepression SAAnxiety Social Support Stigma HIV Risk QOL Barriers
Health Literacy Domestic Violence (clinic would need a protocol)
Circumstances Oriented
Needs
Housing Voc Rehab skills education previous current employment income disability social support disclosure basic HIV education readwrite assessment (non standardized) incarceration
Ryan White barriers contact info ADAP forms medical releases -Take home info (telephone rsquos directions etc)
Medical Baseline
Adherence Medical knowledge drug history other meds CD4 VL disease history
Labs
Review amp follow-up as appropriate
Linkage
Introduction
CONNECT Program Evaluation
Pre-Post Study Design
Study Period Data from Pre-CONNECT era was collected between
August 1 2004 ndash July 31 2006 (ldquoNo Showrdquo Study)
Post-CONNECT data clients who called to make an
appointment between Jan1 ndash Dec 31 2007
Statistical Analyses
Multivariable logistic regression analysis
Wylie et al 4th International Conference on HIV Treatment Adherence 2009
CONNECT Program Evaluation Characteristic Pre-CONNECT
(n=522)
Post-CONNECT
(n=361)
Unadjusted
p-value
Age 387
97 396
103 018
White male
Minority male
White female
Minority female
157 (301)
230 (441)
51 (98)
84 (161)
131 (363)
149 (413)
28 (78)
53 (147)
025
Private Insurance
Public Insurance
Uninsured
153 (293)
111 (213)
258 (494)
105 (291)
121 (335)
135 (374)
lt001
Days from call to
appointment
270
138
256
101 008
Data presented as mean + SD or n (column )
3212014
11
CONNECT Program Evaluation
Time Period ldquoNo Showrdquo Unadjusted OR
(95CI)
Adjusted
OR (95CI)a
Pre-CONNECT (n=522)
Post-CONNECT (n=361)
307
177
10
048 (035-068)
10
054 (038-076)
a Multivariable model controls for age race sex insurance location of residence and
time from call to scheduled visit
0
5
10
15
20
25
30
35
40
45
Total
White M
ale
Minority M
ale
White Fem
ale
Minority Fem
ale
Private Insurance
Public Insurance
Uninsured
Sociodemographic Characteristics
N
o S
ho
w
Pre-CONNECT
Post-CONNECT
Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups
plt001 plt005
CONNECT Staff Survey
What was liked most about Project CONNECT ldquoImproved quality of carerdquo
ldquoPatients feel more welcome and at-easerdquo
ldquoA decreased no show raterdquo
What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and
ldquofeel overwhelmedrdquo
ldquoConcern over the increased patient load and the resulting
stress on the staffrdquo
ldquoNothing is wrongrdquo with the program
3212014
12
CONNECT Staff Survey
Other Feedback
Overwhelming support bull ldquoIncreased team-approach to carerdquo
bull ldquoI think it has been extremely successful and helpfulrdquo
bull ldquoThis is one of the most effective important new additions to the
1917 Clinic in a decaderdquo
Criticisms
bull ldquoNegative impact on staff time and increased staff exhaustionrdquo
bull ldquoI think project Connect is a great program that has had
successes in achieving quicker visits and improved adherence to
care but has opened many Pandorarsquos boxes regarding staff time
ptrsquos emotions and continued adherence to carerdquo
After CONNECT
What does the future hold
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
11
CONNECT Program Evaluation
Time Period ldquoNo Showrdquo Unadjusted OR
(95CI)
Adjusted
OR (95CI)a
Pre-CONNECT (n=522)
Post-CONNECT (n=361)
307
177
10
048 (035-068)
10
054 (038-076)
a Multivariable model controls for age race sex insurance location of residence and
time from call to scheduled visit
0
5
10
15
20
25
30
35
40
45
Total
White M
ale
Minority M
ale
White Fem
ale
Minority Fem
ale
Private Insurance
Public Insurance
Uninsured
Sociodemographic Characteristics
N
o S
ho
w
Pre-CONNECT
Post-CONNECT
Note Percentages above the bars in each category represents delta between the Pre and Post-CONNECT groups
plt001 plt005
CONNECT Staff Survey
What was liked most about Project CONNECT ldquoImproved quality of carerdquo
ldquoPatients feel more welcome and at-easerdquo
ldquoA decreased no show raterdquo
What was liked least ldquoPatients receiving too much data prior to their first visitrdquo and
ldquofeel overwhelmedrdquo
ldquoConcern over the increased patient load and the resulting
stress on the staffrdquo
ldquoNothing is wrongrdquo with the program
3212014
12
CONNECT Staff Survey
Other Feedback
Overwhelming support bull ldquoIncreased team-approach to carerdquo
bull ldquoI think it has been extremely successful and helpfulrdquo
bull ldquoThis is one of the most effective important new additions to the
1917 Clinic in a decaderdquo
Criticisms
bull ldquoNegative impact on staff time and increased staff exhaustionrdquo
bull ldquoI think project Connect is a great program that has had
successes in achieving quicker visits and improved adherence to
care but has opened many Pandorarsquos boxes regarding staff time
ptrsquos emotions and continued adherence to carerdquo
After CONNECT
What does the future hold
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
12
CONNECT Staff Survey
Other Feedback
Overwhelming support bull ldquoIncreased team-approach to carerdquo
bull ldquoI think it has been extremely successful and helpfulrdquo
bull ldquoThis is one of the most effective important new additions to the
1917 Clinic in a decaderdquo
Criticisms
bull ldquoNegative impact on staff time and increased staff exhaustionrdquo
bull ldquoI think project Connect is a great program that has had
successes in achieving quicker visits and improved adherence to
care but has opened many Pandorarsquos boxes regarding staff time
ptrsquos emotions and continued adherence to carerdquo
After CONNECT
What does the future hold
Blueprint for HIV Treatment Success
Adapted from Ulett et al AIDS Pt Care STDS 20092341-49 and Mugavero Top HIV Med 200816156-61
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
13
Jefferson County HIVAIDS
Community Coalition FAMILY CLINIC
ldquoCONNECTrdquoing Patients to
Their Medical Home Living Well
Living Well Overview
Purpose To assure HIV-infected persons are self-sufficient with their health
Start date ndash 613 21 participants enrolled
Peer Support Specialists
Project components
Extensive training amp refreshers
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
14
Living Well Lessons Learned
Peer involvement ldquois the bestrdquo
Peers need passion willingness to reach out
amp to increase their capabilitiesgrow
A structured program utilizing a holistic
approach to participants is helpful to peers
For research projects it is important to be
proactive with IRB aligning partners and
required peer trainings
Conclusions
Current healthcare landscape emphasizes
improved health outcomes
Project CONNECT is one strategy for
improving linkage to HIV primary medical
care
Community collaboration can provide
additional opportunities for synergy
Peer navigators may be an important future
strategy to improve linkage to care
Acknowledgments Ashley Bartee BSW
Kathy Gaddis MSW
Stephanie Gaskin MHA
Malcolm Marler DMin
Michael J Mugavero MD MHSc
James L Raper PhD CRNP JD FAANP FAAN FIDSA
Harriette Reed-Pickens
Sherron Wilkes MSW
Anne Zinski PhD
1917 Clinic Cohort University of Alabama at Birmingham (UAB)
Jefferson County HIVAIDS Community Coalition
Project CONNECT Team at the UAB 1917 Clinic
amp
All of the 1917 Clinic Patients who make my work so rewarding
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
15
Robert Kavanagh
Face To Face
Sonoma County
Using Peers for Self-Management
Support
Face to Face
Supportive Services
Case Management
Benefits Counseling
Support Groups
HIV Prevention Speakers Bureau
Outreach
Prevention with Positives
HIV Testing
Ending HIV in Sonoma County while supporting the health and
well-being of people living with HIVAIDS
Sonoma County CA USA
Face to
Face
SRCHC
SCHC
RRHC
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
16
The Shanti LIFE Program in Sonoma County
Health Centers have collaborated with CBO to run this Self-
Management Curriculum
19 cycles
Weekly meetings for 12 weeks each cycle
20-25 participants in each cycle
2-3 Facilitators
3-4 Peer Support Facilitators
Goals of LIFE Program Optimize health outcomes for people living with HIV
Reduce number of people who become infected with HIV
Align with National HIVAIDs Strategy
Clinical program evaluation of LIFE shows that participants
Reduce overall health problems (by 27-44) and overall personal
problems (by 38-50)
Decrease drugalcohol use and other health risking behaviors
Increase adherence to HIV treatment and other health routines
Increase the amount and quality of trusted support in their lives and
Improve coping with grief depression and Survival Stress
Shanti LIFE Program
LIFE stands for Learning Immune Function Enhancement
Course organized around ldquoco-factorsrdquo
A co-factor is a life issue that can impact health
LIFE participants explore their performance on 26
Cofactors and receive the knowledge motivation skills and
support necessary to set and reach goals related to their co-
factor performance and health
This program focuses on peer support and bonding and
emphasizes making contacts and lasting connections with
other HIV+ individuals
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
17
The Co-factors
Psychological
Belief about disease and health
Grief Depression and Loss
Sustained Survival Stress and Crisis Coping
Life Purpose and Goals
Co-factors (continued)
Social
Trusted support
Self-assertiveness
Patientprovider relationship
Altruism and Spirituality
Co-factors (Continued)
Biological
Health risking behaviors
Drugs and alcohol
Toxins and germs
Adherence
Body care
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
18
Each session includes
Presentation on one or more co-factor(s) in large group
Interactive exercise that helps in understanding co-factor
Small group discussion
Tool-box of ways to improve performance on the co-factor
Development of Health Action Plan
Check-in the following week on progress on Action Plan
Personal stories of how LIFE Program
has made an impact
IMPROVING ENGAGEMENT
TO SUPPORT QUALITY
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
19
Dimensions of Quality
How can we better engage patients to improve care
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
20
History of Involvement
bull Fingerprints ndash The Denver Principles Authors
and Souls
bull Blueprints ndash The Ryan White Program Drafters
and Supporters
bull Nuts and Bolts ndash Community Planning Members
bull Betterment ndash Quality Improvement Advocates
Methods of Involvement
bull Agitation
bull Activism
bull Advocacy
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
21
Strategies to Improve Engagement
bull Reorient Involvement for Quality
ndash Integrate patients into system design and
improvement teams
bull Encounter Improvement
ndash Use ldquotouch mappingrdquo to identify and improve
encounters
REORIENT INVOLVEMENT
FOR QUALITY
Strategy One
Collecting Patient Experience
Patient on QM Teams
Focus Groups
Surveys and Assessments
Patient Advisory Bodies
Patient ndash Provider
Solicitation Methods
ndash Patient Advisory Boards
ndash Needs Assessments
ndash Satisfaction Surveys
ndash Focus Groups
ndash Key Informant Interviews
ndash Patient-Provider
Conversations
ndash Patient Representation on
QM Teams
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
22
What am I trying to do
Structures
Patient Advisory Board
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
bull Expectations
ndash Provide Input and Feedback
ndash Share Personal Experience
bull Make-up
ndash Demographic Based
Quality Management Team
bull Qualifications
ndash Meeting Participation
ndash Person Living with HIV
ndash Knowledge and Skills of QM
bull Expectations ndash Provide Input and Feedback
ndash Support QI Activities
ndash Team Responsibilities
bull Make-Up
ndash Skills Based
Patient Advisory Boards
bull Members should
ndash represent the diversity of patients
ndash have a basic understanding of performance
measurement and HIV treatment
ndash understand basics of quality improvement
ndash review clinical quality data to provide feedback
for improvements
ndash generate ideas for improvement strategies
ndash support improvement processes
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
23
Identifying Quality Champions
bull Recruit from your ENTIRE patient population
bull Choose patients who
ndash Are self-managing patients
ndash Demonstrate prosocial behaviors
ndash Express a desire to learn new skills
ndash Are comfortable with and have access to technology
ndash Are able to commit to a defined period of involvement
ndash Can work collaboratively
bull The ldquosqueaky wheelrdquo might not be the best choice
Developing Experts
bull Recognition of patient experience as only a foundation
bull Capacity Building
ndash Advocacy Skills
ndash Performance Measurement
ndash Computational Skills
bull Statistical Calculations
bull Evaluating Data
ndash Quality Improvement amp Management Models
Next Steps hellip
bull Review current patient advisory structures ndash Purpose
ndash Policies and Procedures
ndash Recruitment
bull Identify opportunities for greater involvement ndash Reorient CABs towards quality
bull Identify patient quality champions
bull Develop patient quality experts
bull Integrate patient quality experts into QM Team
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
24
ENCOUNTER IMPROVEMENT
Strategy Two
Handoffs and Handshakes
Touch Points
bull The key moments or events that stand out for
those involved as crucial to their experience
of receiving or delivering a service
bull Touch points are the points of contact with a
service and intensely personal ldquoBig Momentsrdquo
on the journey where one recalls being
touched emotionally or cognitively that cause
deep and lasting memories
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
25
ldquoTouch Pointrdquo Map
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
Mapping lsquoTouch Pointsrsquo
Mapping touch points allows you to
ndash learn from consumer experiences with clinical
visits
ndash determine what is typical and exceptional
ndash probe explanations of experiences
ndash compare provider and users maps
ndash assist in linking care from lsquobeginning to endrsquo
Bate Paul and Glenn Robert Toward More User-Centric OD Lessons From the Field of Experience-Based Design and a Case Study The Journal of Applied Behavioral Science 431 (2007) 41-66
A Walk Through My Clinic
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
26
Next Steps hellip
bull Engage clinical team in development of ldquotouch pointrdquo map
bull Engage patient advisory structures for feedback on ldquotouch pointrdquo map
bull Disseminate blank ldquotouch pointrdquo map to patients
bull Review completed ldquotouch pointrdquo maps to identify trends and potential encounter improvement points (provider and patient)
bull Review findings with patient advisory structures
Key Points
bull Engagement can be overwhelming if you donrsquot understand the community
bull Reorient involvement towards quality
ndash Leverage community strengths
ndash Identify patient quality champions and develop experts
bull Engage patients in quality activities such as ldquotouch pointrdquo mapping
Patient Engagement Spectrum
Patient Patient Patient Patient
Care Team
Care Team
Self-management Pt education Disease goals Health goals Action Plans Pt navigation
Peer support Support groups Self-mngmt groups Group med visits Peer navigation Online peer support Social media
Part of team Board of Directors Pt Advisors Focus Groups CAB QI Team Pt activism
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
27
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Please complete online Webinar Evaluation
httpswwwsurveymonkeycomsPatientEngagementNavigation
by Friday April 11 2014
79
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
80
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Resource Repository httpwwwcareacttargetorgmhrc
81
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82
3212014
28
HIV-MHRC
Franccedilois-Xavier Bagnoud Center
Thank you
82