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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?
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Feb 06, 2015 Patient Partners A Student-driven Care Transitions and Home Visit Program
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MEDICAL EDUCATION AND PATIENT CARE The Model The Curriculum The Core: Health Coaching The Future The Need
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MEDICAL EDUCATION AND PATIENT CARE The Model The Curriculum The Core: Health Coaching The Future The Need
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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?
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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)
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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.”
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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
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THE SOLUTION: PATIENT ACTIVATION
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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
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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
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*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
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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
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BASELINE ADMISSIONS SURVEY GOALS Understanding patients’ concerns about their health and building rapport
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Helping patients manage their own care within the context of their daily lives HOME VISIT GOALS
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Helping patients manage their own care within the context of their daily lives HOME VISIT GOALS
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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
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MEDICAL EDUCATION AND PATIENT CARE The Model The Curriculum The Core: Health Coaching The Future The Need
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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
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Clinical competence Leadership development Innovative thinking PATIENT PARTNERS: STUDENT LEARNING GOALS
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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
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Problem-solving/trouble-shooting Effective communication Interdisciplinary collaboration Recruitment & training Team building CURRICULUM DESIGN: STUDENT LEADERSHIP
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Protocol and tool development Data collection Experience-driven hypothesis generation Data driven decisions for improvement and innovation CURRICULUM DESIGN: INNOVATION
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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
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MEDICAL EDUCATION AND PATIENT CARE The Model The Curriculum The Core: Health Coaching The Future The Need
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*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
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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
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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
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HEALTH COACHING WORKSHOP Close with an action plan Measurable, achievable goals Discuss follow-up Follow-up with the patient Phone Letter 4-hour Workshop
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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
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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
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MEDICAL EDUCATION AND PATIENT CARE The Model The Curriculum The Core: Health Coaching The Future The Need
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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
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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
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FUTURE GOALS: LONG-TERM Integrate health coaching into curriculum Reduce readmissions and healthcare costs Expand beyond Stanford
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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
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Contact us at: patientpartners@lists.stanford.edu THANK YOU! PATIENT PARTNERS
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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
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