Using information technology to improve care for

vulnerable patients

Preliminary Results from the McGill TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) Project

Why this Project? • There is a need to optimize health care delivery from

being disease-focused to being patient- and wellness-focused.

• TAPESTRY hopes to: – develop and enhance public participation in the way

health services are planned and how health decisions are made and delivered

– raise awareness within the health system about community issues facing at risk populations

– find ways to meet the self-identified health goals of at risk populations to assist them with staying healthy longer

2

What is TAPESTRY?

• TAPESTRY’s objective is to deliver truly person-centered care through fostering home-based partnerships between the person, their primary health care team, and their community.

• TAPESTRY’s approach centers on meeting a person’s health goals with the support of trained community volunteers, system navigation, community engagement, and the use of technology.

3

McGill-TAPESTRY

• Partner project for McMaster Family Medicine

• Sites at St. Mary’s (Dr. Ellen Rosenberg) and Queen Elizabeth (Dr. Mark Roper)

• At risk population selected: Canadian Immigrants

4

“Healthy immigrants” to “at-risk”…

5

• High risk of depressive disorder (10-24 m)

• Increase in reporting common CD (after 5 y): -60% more mood disorder, anxiety; -70% more obesity, diabetes; -40% more hypertension;

Focus: Middle East & South Asia

• Higher prevalence of cancer of ME in United States compared to the population living in Middle Eastern countries

• 15% of SA immigrants develop diabetes comparing to 11% in all immigrants

• 10-40 fold higher relative risk of end-stage renal failure among SA immigrants with type 2 diabetes compared to general population

6

Factors that put immigrants at risk…

7

Resettlement stress

Unemployment Poverty

Barriers to access for health services

Natural progress of Health deterioration 30% live under poverty

line (first 10 y)

Acculturation

What can we do? Even with care provided by family physicians, immigrants deteriorate in health in their first 10-years in Canada. To be able to mitigate this deterioration, we need to: • account for how access barriers related to cultural beliefs occurs

and understand how to address this effect

• account for the lived experiences of immigrants as well as their acculturation process

• understand how to improve their integration process and potential

access – are community volunteers a viable solution?

8

Questions addressed by Project

1. Can culturally trained community volunteers help immigrants better

manage their chronic disease?

2. Is information provided by the community volunteers useful for the primary care team in providing care?

3. What is the current acculturation and health beliefs of immigrants with chronic disease and how does this effect objectives 1 and 2?

9

Criteria of Patient Participants • Inclusion:

– >18 years old – Reported at least one of 7 chronic diseases:

• diabetes • obesity • mood disorders/anxiety • chronic disease of the digestive system • high blood pressure • cancer • arthritis

– Have a family doctor at St-Mary’s or QE

• Exclusion: – Severe cognitive impairment or history of violence (where

volunteer might be at risk).

10

Recruitment of Patient Participants at Queen Elizabeth and St-Mary’s

11

List of potential participants queried

from EMR or archivist

Physicians contact their patient directly or through a

mailed letter to introduce the study

If interested, follow up is done by

research assistant to explain the study

and review consent form with participant

Study Timeline From Physician Perspective

12

Home Visit 1: Collect surveys and

set patient goals

Home Visit 2:

Collecting survey info, show video on

health care

Home Visit 3: Qualitative Interview

Report generated and sent to primary

care team

Report generated and sent to primary

care team

Focus group & short survey of clinician

participants

Identify 4-5 patients to participate

Information from Patients • Goal Setting

• Nutrition

• Rapid Assessment of Physical Activity

• Vancouver Index of Acculturation

• Global Healthcare Satisfactions Question

• EQ5D-3L (Quality of Life)

• Patient Centeredness

• Duke Index of Social Support

13

Potentially new/useful information for health care team

Recruitment of Volunteers and Providers

Volunteers:

• 20 volunteers (recruited through several mediums including University clubs)

• Lived in Canada for at least 15 years.

• Provide them with training on online module

Providers from two sites:

• 6-7 family physicians from Queen Elizabeth Health Center and St-Mary’s Hospital: identify 4-5 patients 14

Volunteer Training

• Blended learning – Online Virtual Training Center (10 modules)

• Active learning principles • Engaging reflection questions and quizzes • Online volunteer community

– In Person Full Day Training • Discussions and reflections on online training content • Technical training with iPads and phone service • Role Playing • Further questions or concerns

Virtual Training Center 1. Introduction 2. Cultural Competency (McGill) 3. Healthcare Navigation (McGill) 4. Program Implementation 5. Conflict Resolution 6. Effective Communication 7. Data Gathering Tools 8. Privacy and Confidentiality 9. Health and Safety 10. Information Technology (McGill)

Health Navigation

Participants

• 26 patients recruited with 14 family doctors

• 24 volunteers who completed multiple visits: – 15 female (62%) – Ages 19 – 55 (average age of 37) – All immigrants

21

Data Collected

• Patient data including last qualitative interview

• Focus groups of volunteers

• Individual interviews of doctors 22

Goals Set by Participants (6 Months)

23

Personal well-being activities Companionship Hobbies Trips TV & internet

10

Diet

9

Exercise

8

Help family Education of children Happiness of children Health of relatives

8

Diabetes control

6

Take my pills

6

Job for self or spouse

5

Lose weight

3

Specific help from MD Pain control Effective medication

2

Emotional Manage stress ‘Get out from my sickness emotionally/forget I have a sickness’

2

Preliminary Conclusion

• Social determinants of health are critical

• What is the “head room” to address this by family doctors?

• Immigrants (patients and volunteers) still feel very vulnerable and ”assessed” – little understanding of research

24

McGill Tapestry Team

Clinical Leads: Dr. Ellen Rosenberg, St-Mary’s Hospital Dr. Mark Roper, Queen Elizabeth Health Complex Team members: • Cindy Ibberson, RA • Dr. Tamara Carver, Online Training/Development • Doaa Farid, PhD Candidate • Nina Mamishi, Volunteer Coordinator

25

Contact

gillian.bartlett@mcgill.ca

26

Acknowledgements