Finding Common Ground: Supporting Change in Healthcare and at Home

A new kind of relationship RuthJean Francois, Patient Advisor, Cambridge Health Alliance

What is self-management? “ The individual’s ability to manage the symptoms, treatment, physical and social consequences and lifestyle changes inherent in living with a chronic condition.” Barlow et al, Patient Educ Couns 2002;48:177

What is self-management support? Making and refining the health care system to facilitate patients and families managing chronic health problems self-management. This includes at the level of patient- provider, patient-health care team, patient-health care system and the community. Glasgow et al

What is Self-Management Support? Skills and Tools A change in CULTURE to a whole new relationship –Tom Bodenheimer

Setting the Stage: Patients

Differences Between Acute and Chronic Conditions ACUTECHRONIC BeginningRapidGradual CauseUsually oneMany DurationShortIndefinite DiagnosisCommonly accurate Often uncertain Diagnostic tests Often decisive Often limited value TreatmentCure common Cure rare

Differences Between Acute and Chronic Care Roles ACUTECHRONIC Role of Professional Select and conduct therapy Teacher/coach and partner Role of Patient Lorig 2000 Follow ordersPartner/ Daily manager

Symptom Cycle Vicious Cycle Disease Tense musclesFatigue Depression Anger/Frustration/Fear Stress/Anxiety

A philosophical shift Professional - patient Professional - Patient Patient - Professional Patient - professional Person - professional Person-Person Adapted from Tom Janisse

Learning Community Journey Pilot Collaborative on Self-Management Support

Karen’s Story in NHP Quality Allies and New Health Partnerships – A bigger sea to swim in Finding our place as patient and family faculty More than “giving feedback”, bringing patient and family members in from the beginning

Participation at all levels Patient and family participation on the National Advisory Committee. Patient and family participation on the faculty team. Patient and family participation on the learning community teams.

Changing Practice, Changing Lives 1.Through collaborative self-management support, enhancing partnerships with patients and families. 2.Engaging patients and families in quality improvement and the redesign of ambulatory processes, practices, programs, and facilities.

The Patient The Medical Assistant The Provider Leaves with scripts, referrals, and instructions

Integrated plan Medical & SMG The Patient The Medical Assistant The Provider Other Activated Patients Typical experience with their PCP

First key service… 1) Planning and preparation- MA planned visits with goal setting

2)The Provider- taught how to negotiate a medical plan and integrate with a patient-oriented self-management goal (SMG) BBSWARBBSWAR ACKGROUND ARRIERS UCCESSES ILLINGNESS… CTION PLAN EMEMBER NON-DIRECTIVE COUNSELLING

And our Group Visits… Patients helping Patients… 3) The MINI-group visit 4) The Open-Office Group visit Stressors, depressed mood, barriers, difficulty coping ALWAYS covered Coping strategies develop Both involve goal setting

Participation on QI teams and traveling with the team.

Clinic Patient and Family Advisory Council

Helping to develop informational and educational materials. Teaching classes such as the Healthier Living Series.

Developing Bulletin Boards

Designing charting and documentation forms

Improving Electronic Medical Records

Patient and Family Advisors serve on the Patient Safety and Medicine Reconciliation Committees. Patient and Family Advisors teach residents and medical and nursing students and participate in staff orientation.

Developing peer support and buddy programs, especially for newly diagnosed patients.

Family HealthCare Center, Fargo, ND Creating a Patient Advisory Council, developing patient portals on the Center’s website, and planning, implementation, and evaluating group visits.

Humboldt Del Norte IPA, Eureka, CA Participating on the QI team, teaching classes in the Healthier Living Series, and training peer support group facilitators.

Participating in the design of Web sites.

What’s it like being involved: Dennis Malloy, patient with COPD, Chair of Lambeth Breathe Easy Group ‘You’ve given us the lollipop and we’re not giving it back’