Building the Foundation for Practice Recognition

and PCMH Transformation

Engaging Patients in Practice Transformation

Laura Makaroff, D.O. Pat Schmidlapp

10/23/2010

The Patient Experience

Why should we engage patients?

IOM Crossing the Quality Chasm Report aims for an improved health care system• Safe• Effective• Patient-Centered• Timely• Efficient• Equitable

Helping the SystemIOM Crossing the Quality Chasm Report

identifies ten rules for system redesign:

1. Care is based on continuous healing relationships

2. Care is customized according to patient needs and values

3. The patient is the source of control4. Knowledge is shared and information flows

freely5. Decision making is evidence-based6. Safety is a system property7. Transparency is necessary8. Needs are anticipated9. Waste is continually decreased10.Cooperating among clinicians is a priority

Joint Principles of the Patient-Centered Medical Home

The Patient Centered Medical Home is an approach to providing

comprehensive primary care for children, youth, and adults. The

PCMH is a health care setting that facilitates partnerships between

individual patients, and their personal physicians.

Joint Principles• Personal physician• Physician directed medical practice• Whole person orientation• Care is coordinated and /or integrated• Quality and Safety are hallmarks of the medical

home:– Practices advocate for their patients to support the

attainment of optimal, patient-centered outcomes that are defined by a care planning process driven by a compassionate, robust partnership between physicians, patients, and the patient’s family.

– Patients actively participate in decision-making and feedback is sought to ensure patients’ expectations are being met.

– Patients and families participate in quality improvement activities at the practice level.

How do we do it?

1. Care of the individual patient2. Practice improvement3. Policy design and

implementation

Key points• Asking patients what matters most

to them is a critical step in engaging patients in their care.

• Providers, patients, and families need new skills for this partnership.

• There is no one-size-fits-all solution;patient engagement will look very different for different practices, patient populations, and individual patient-provider interactions.

• Health IT has the potential to support patient engagement.

Goals

• Respect preferences• Attend to emotional needs• Support autonomy• Share decisions with family and

care team• Free flow of information

Engaged in their own Care

• Communication and Information Sharing

• Self-Care• Decision-making• Safety

Communication and Information Sharing

Patients Practice

•Learn about how the practice works•Get help with organizing and coordinating care

•Create a patient guide to the practice•Brochure to explain the medical home concept •After-visit summaries

Patient Education

Patient Education

Self Care

Patients Practice•Work with providers to identify and monitor treatment and self-care goals •Get help with managing chronic illness •Participate in activities to reduce health risks•Participate in support groups or group visits

•Self-management support•Motivational interviewing•HowsYourHealth.org•Patient Portal•Link to other community resources

Decision-making

Patients Practice•Discuss risks and benefits of different options•Decide jointly with the health care provider on a treatment consistent with values and preferences

•Review evidence-based decision aids•Web-based tools•Clinical rules embedded in EMR

Safety

Patients Practice

•Review medical information and treatment results•Share information about medications and treatments received in other settings•Report on adverse events and potential safety problems

•Anonymous report of safety concerns by patients and staff•Medication reconciliation

Practice Improvement

Patients Practice

•Participate in quality improvement teams•Participate in patient/family advisory councils •Provide feedback through surveys•Help in development of patient materials•Participate in focus groups

•Do “walk-through” to give staff a patient perspective of practice workflow•Focus Groups

Policy

Patients Practice•Serve on policy and quality improvement committees at various levels of private and public sectors•Gather input from other consumers•Participate in training for clinicians or practice teams

•Invite patients to participate in quality meetings/committees•Inform patients of opportunities to interact with policymakers•Encourage organizations to utilize patients in all projects

Another Tool

If all else fails. . .

The Engaged Patient

References

• Engaging Patients and Families in the

Medical Home, AHRQ Publication No. 10-0083-EF, June 2010

• Center for Advancing Health (www.cfah.org)

• www.HowsYourHealth.org• www.ncqa.org