Patient Centered Care: An Interactive session

Linda Delo, D.O. Delo Medical Associates

Delo Medical Associates:

Level 3 Patient Centered Medical Home since 2013

Our practice: Family Physician, Podiatrist, Physical Therapist and PTA, 3 full-time Nurse Practitioners, One full-time and one part-time Physician Assistant, with 35 total employees

Services we offer: Moderate complex lab, ultrasound and echocardiography, Bone Density Testing, Hearing testing: hearing aides, PFT’s, EKG, Allergy testing and treatment and more

Same day appointments, Patient portal, electronic messaging via text, email and phone

Member of The Palm Beach Accountable Care Organization

What is patient centered care?

• “Understanding and respecting patients’ values and preferences and expressed needs are the foundation of patient centered care.”

• Harvey Picker of the Picker Institute

Personized care

coordination and integration

Education, informed decision

making

Emotional support: empathy and emotional

well being as important at evidence based medicine in a HOLISTIC APPROACH

Involvement of family, friends, other care team members not

just the doctor

Care Transitions and continuity

Are patients wanting and expecting more?

• Comprehensive care to meet ALL their needs

• Coordination of care: someone in charge to help navigate the system

• TIMELINESS

• Functioning e-health

• Clear and reliable communication-listen, explain, clarify, consistency of messages across care team

• Convenience: open access, same day scheduling, respect for time

• Empathy and time to be heard

How do YOU feel about patient demands?

• Frustrated about the demands of your patients

• Overwhelmed trying to see and treat patients and clicking boxes in the computer

• Irritated with the questions your patients are asking after their DR GOOGLE consultation

• A fragmented system with lack of communication

• Where do your values lie: with your organization, your clinical autonomy or is caring for the patient truly your goal?

What we need

• Organizational changes that promote systems thinking, collective accountability and team-based care

• Willingness to work as a team player with one goal to care for the patient.

• Willingness to commit to organizing the system to provide timely care

• Willingness to own the failures and pursue remedies

• Embrace e-health to expedite communication and efficiency

Audience Participation

Can anyone share things they have done in their practice to promote team based care?

System changes to improve timeliness in your operations?

How did you correct failures or shortcomings?

How are you using e-Health to expedite communication, efficiency and education?

Collective accountability & team based care

• What things have you done?

• Profit sharing

• ?????

• Delegation of work

• Empowering staff

• Protocols

Organizing the system to provide timely care

• Work flow

• Reducing wait times

• Same day access to providers

• Open access scheduling

• Audience: suggestions on implementation

Failures and Solutions

Open access schedule

Wait times for patients

Data flow between

specialists

Patient education Empowering patients

Encourage patient

Portal use

How do we get there? Are we making progress?

• Primary care is key: prioritize prevention, self-care, taking control of one’s health • Fit bits, health apps that integrate with

health records

• Access and convenience: Urgent care vs ER vs same day appt with their own doctor. Timely referrals

• Financial incentives: PCMH, ACO’s, VALUE over quantity

• Does the public understand the importance of Primary CARE

https://www.youtube.com/watch?v=xgOFi0NzemU&feature=youtu.be INTEROPERABILITY: between physicians, hospitals and patients

Interoperability

Are you providing information with referrals: HOW

What works and what doesn’t

work? Audience???

Stepping stones to the future

Expansion across continuum of care

Meaningful patient engagement

Staff engagement and restoration of joy in work

Focus on system design and accountability

Putting measurement in proper perspective

Supporting patient centered professional practice

• Ensuring training and education is aligned to the delivery of patient care

• Re-orientating and diversifying the nature of the consultation process

• Encouraging coordinated multidisciplinary working

• Establishing a new role for general practice in the changing and expanding primary care landscape

• Collaboration between practices and providers of services

• Improving hours providing care

What it takes to provide patient centered care

• Empowering patients, caregivers and communities through:

• Improving health literacy

• Support of self management

• Personalized care planning

• Embracing new means of accessing care and technologies

• More transparent data on primary care

• Strengthening the patient voice in primary care

HOW can we promote the process?

More money on collaborative models and community based care than hospital based care

Prioritizing information systems and technology for better sharing of information across organizational and professional boundaries

PRIMARY CARE PHYSICIANS: LEAD THE TEAM

Allied health professionals

-Community nursing

-Patient representatives

-Pharmacists -Behavioral health

BEST PRACTICES

Evidence based medicine

Quality: Measure and improve on shortcomings

Informed decision making process: education

Mechanisms of soliciting and acting on patient feedback:

reviewing the surveys and implementing change

Support patients to access services and engage in self care

CLINICAL GUIDELINES

PROMOTE PATIENT CENTERED CARE

PERSONALIZED CARE CARE PLANNING FOR PATIENTS WITH MULTIPLE LONG TERM

CONDITIONS

resources

Royal College of General Practices

https://www.healthissuescentre.org.au/images/uploads/resources/Inquiry-into-patient-centred-care-in-the-21st-century.pdf

Improving the referral process for patients and clinicians

American College of Physicians

If you would like copy of slides or have further questions: lindadelo@gmail.com