1. DISCUSSION QUESTIONS What challenges do chronically ill patients face in staying out of the hospital? Are today’s medical students prepared to recognize and meet these challenges?

2. Feb 06, 2015 Patient Partners A Student-driven Care Transitions and Home Visit Program

3. MEDICAL EDUCATION AND PATIENT CARE The Model The Curriculum The Core: Health Coaching The Future The Need

4. MEDICAL EDUCATION AND PATIENT CARE The Model The Curriculum The Core: Health Coaching The Future The Need

5. DISCUSSION QUESTIONS What challenges do chronically ill patients face in staying out of the hospital? Are today’s medical students prepared to recognize and meet these challenges?

6. CHALLENGES IN PATIENT CARE Cost of readmissions in the US: $26 billion annually (Lavizzo-Mourey 2013) $17 billion in preventable costs (Lavizzo-Morey 2013) 50% of patients do not see PCP within 2 weeks post- discharge (Dartmouth Atlas, 2011) For heart failure patients 30-day readmission: 20-25% (Lavizzo-Mourey 2013) 6-month readmission: >50% (Lavizzo-Mourey 2013) CMS mandate for hospitals to reduce readmissions (2013)

7. CHALLENGES IN PATIENT CARE “I ran out of my medication and couldn’t get it refilled…so I ended up coming back to the hospital.” “I don’t weigh myself every day because the scale is upstairs.” “I know I’m not supposed to eat salt. I don’t put it on my food but it’s hard to know what has salt.”

8. As healthcare evolves, medical education will need to train students in: Patient-centered care Communication Patient Empowerment Care coordination Health systems change Quality improvement Clinical innovation NEEDS IN MEDICAL EDUCATION

9. THE SOLUTION: PATIENT ACTIVATION

10. MEDICAL EDUCATION AND PATIENT CARE The Model The Curriculum The Core: Health Coaching The Future The Need Need: Julia Model: Frank Curriculum: Teresa Core: Alex Future: Charbel

11. Patient Care Medical Education Patient empowerment Care coordination Access to resources Reducing readmissions Patient-centered care Health coaching skills Quality Improvement skills PATIENT PARTNERS: TRIPLE MISSION Discovery Critical thinking Systems innovations New models of care

12. *Student notifies HF team if problems/concerns arise PATIENT PARTNERS MODEL Patient Referrals Home Visit 3-4 Follow up phone calls Student follows up on and may attend primary care visit Follow up letter and post-survey Hospital Visit and Enrollment

13. Purposes Identify patient needs Track patient self-efficacy and health management Data analysis for program improvement Key components First exposure needs-finding Home visit assessments Follow-up assessments SURVEYS AND DATA COLLECTION

14. BASELINE ADMISSIONS SURVEY GOALS Understanding patients’ concerns about their health and building rapport

15. Helping patients manage their own care within the context of their daily lives HOME VISIT GOALS

16. Helping patients manage their own care within the context of their daily lives HOME VISIT GOALS

17. Bottom line: anything can come up during a home visit, which as it turns out, is the real strength of the home visit model. HOME VISIT

18. MEDICAL EDUCATION AND PATIENT CARE The Model The Curriculum The Core: Health Coaching The Future The Need

19. STUDENT TRAINING CURRICULUM Issues of care transitions Intro to Heart Failure Clinic Conducting home visits Didactics Health coach training Promoting patient empowerment Conducting follow-up phone calls Documentation and analysis Workshops On-site Training Shadowing home visits

20. Clinical competence Leadership development Innovative thinking PATIENT PARTNERS: STUDENT LEARNING GOALS

21. Clinical Experience Stanford Heart Failure/Cardiomyopathy Clinic Early exposure to inpatient ward Service Learning Health coaching/motivational interviewing Home visits Relationship with patients Awareness of biases CURRICULUM DESIGN: CLINICAL COMPETENCE

22. Problem-solving/trouble-shooting Effective communication Interdisciplinary collaboration Recruitment & training Team building CURRICULUM DESIGN: STUDENT LEADERSHIP

23. Protocol and tool development Data collection Experience-driven hypothesis generation Data driven decisions for improvement and innovation CURRICULUM DESIGN: INNOVATION

24. OUR PROGRESS Integrated collaboration with: Stanford Heart Failure Clinic Stanford Coordinated Care Stanford Hospital Aging Adult Services 10 active health coaches, including medical, engineering, and business students

25. MEDICAL EDUCATION AND PATIENT CARE The Model The Curriculum The Core: Health Coaching The Future The Need

26. *Student notifies HF team if problems/concerns arise PATIENT PARTNERS MODEL Patient Referrals Home Visit 3-4 Follow up phone calls Student follows up on and may attend primary care visit Follow up letter and post-survey Hospital Visit and Enrollment

27. A set of communication strategies designed to empower patients to take control of their health and make positive behavioral change. Purpose Medical students take part in a four-hour intensive workshop developed from UCSF health coaching materials. Method HEALTH COACHING AS AN AGENT OF CHANGE

28. HEALTH COACHING WORKSHOP Ask-Teach-Ask Ask: Knowledge, motivation, and goals Teach: Background and suggestions Ask: Motivation, understanding, goals 1-10 motivation scale Asses desire and confidence both before and after the conversation Aim to close with a “7” or above 4-hour Workshop

29. HEALTH COACHING WORKSHOP Close with an action plan Measurable, achievable goals Discuss follow-up Follow-up with the patient Phone Letter 4-hour Workshop

30. Close with an action plan Choose a real-life goal to discuss One patient, one health coach (then switch!) Groups of two HEALTH COACHING PRACTICE

31. HEALTH COACHING PRATICE Ask-Teach-Ask 1-10 motivation scale Suggested topics: Keeping up with current events Keeping in touch with old friends Picking up a new hobby Keeping a journal/diary Demo Workshop

32. MEDICAL EDUCATION AND PATIENT CARE The Model The Curriculum The Core: Health Coaching The Future The Need

33. Timing the hospital visit to patients’ availability Patients overwhelmed Enrolled patient drop out after leaving the hospital Further integration into HF clinic operations Process: In Hospital Addressing all items on home visit check list Time constraints in managing the visit agenda Home visit training Process: Home Visit Developing a structure for data management to: Improve efficiency in the short term; and Streamline the program for long term Data Management CHALLENGES

34. FUTURE GOALS: SHORT-TERM Boost patient enrollment Expand patient base to include patients with other chronic conditions Recruit additional health coaches from multiple disciplines Utilize multi-disciplinary/inter- professional resources

35. FUTURE GOALS: LONG-TERM Integrate health coaching into curriculum Reduce readmissions and healthcare costs Expand beyond Stanford

36. How do patient-centered clinical experiences affect medical education? What challenges do chronically ill patients face outside the hospital that medical students are not aware of? SESSION REFLECTION

37. Contact us at: patientpartners@lists.stanford.edu THANK YOU! PATIENT PARTNERS

38. Program Collaborators Stanford Heart Failure and Cardiomyopathy Center Stanford Coordinated Care Stanford Aging Adult Services Stanford Primary Care Stanford School of Medicine Noora Health Faculty Advisers Students PATIENT PARTNERS TEAMS