1. Patient Advisory Groups: Effective Utilization for Practice Improvements AKA PAG 101 Kurt B Angstman, MD Medical Director, Mayo Family Clinics Consultant Department of Family Medicine Assistant Professor of Family Medicine Mayo Graduate School of Medicine STFM December 2008

2. DISCLOSURES I have no relevant financial relationships to disclose at this time. I have no relevant financial relationships to disclose at this time.

3. Objectives How a Patient Advisory Group can bring improvement to the quality of care How a Patient Advisory Group can bring improvement to the quality of care Appreciate the multiple role functions of a Patient Advisory Group Appreciate the multiple role functions of a Patient Advisory Group Understand the positive outcomes that have been realized by linking the Patient Advisory Group and the Diamond Depression Project Understand the positive outcomes that have been realized by linking the Patient Advisory Group and the Diamond Depression Project

4. Mayo Family Clinics Patient Advisory Group Mission Statement: Mission Statement: “To establish a patient advocate forum to gain quality experiences, observations, and suggestions for improvement.” “To establish a patient advocate forum to gain quality experiences, observations, and suggestions for improvement.”

5. The Science Most of discussion leads to “We know this is the right direction” Most of discussion leads to “We know this is the right direction” Many times unsure on how to get there… Many times unsure on how to get there…

6. National Forum Institute of Medicine- 2001 Institute of Medicine- 2001 Crossing the quality chasm: a new health system for the 21 st century Crossing the quality chasm: a new health system for the 21 st century U.S. Department of Health and Human Services U.S. Department of Health and Human Services 2007 CAHPS hospital survey chartbook: what patients say about their experiences with hospital care 2007 CAHPS hospital survey chartbook: what patients say about their experiences with hospital care The Joint Commission The Joint Commission

8. Definitions Patient Advocacy Groups Patient Advocacy Groups Patient support groups Patient support groups Usually disease specific Usually disease specific Pediatric cancer Pediatric cancer Grief support Grief support

9. Definitions Focus groups Focus groups Tends to be one “project” Tends to be one “project” Patient education materials Patient education materials Health behavior modifications Health behavior modifications A disease process or condition A disease process or condition Facility remodeling Facility remodeling Short term Short term Though variable Though variable

10. Definitions Patient Advisory group Patient Advisory group Long term Long term Helps practice become : “Patient- centered” Helps practice become : “Patient- centered” Multiple tasks Multiple tasks Members should be diverse and not “single issue” Members should be diverse and not “single issue” Working toward better care for all Working toward better care for all

11. Mayo Family Clinics 32 physicians 32 physicians 6 mid level providers 6 mid level providers Three specialties Three specialties Family Medicine Family Medicine Primary Care Internal Medicine Primary Care Internal Medicine Community Pediatrics Community Pediatrics 41,000+ patients 41,000+ patients

12. Mayo Family Clinics PAG Twelve volunteer members Twelve volunteer members Meeting 3-4 times yearly Meeting 3-4 times yearly Meet with operations manager, medical director and/or assistant medical director Meet with operations manager, medical director and/or assistant medical director Outside attendees–single issue agenda Outside attendees–single issue agenda

13. Patient Advisory Group Functions Input on concepts and processes of the North Clinics Input on concepts and processes of the North Clinics Generate new ideas Generate new ideas Share recent care experiences Share recent care experiences Input through membership on specific committees or projects Input through membership on specific committees or projects

14. Members of PAG Wide representation Wide representation Multiple ages of patients or their parents Multiple ages of patients or their parents Diverse groups Diverse groups Have enough members to have adequate representation- but…not too many Have enough members to have adequate representation- but…not too many

15. Members of PAG Have enough members to be able to have adequate discussion if only 50% show up!! Have enough members to be able to have adequate discussion if only 50% show up!! Ideal group size: 12- 15 Ideal group size: 12- 15

16. PAG 101 Caveats!! Caveats!! Confidentiality Confidentiality Advisory vs. directive Advisory vs. directive May not get “whole” picture May not get “whole” picture Discussion may be focused on one component of the process Discussion may be focused on one component of the process

17. Background Details Volunteer organization Volunteer organization Adjust schedule to their needs Adjust schedule to their needs Our group suggests every 2-3 months from September through May Our group suggests every 2-3 months from September through May NO meetings in the summer!! NO meetings in the summer!! Food generally required and an expectation Food generally required and an expectation

18. Background Details Develop projects/issues that need patient input Develop projects/issues that need patient input Straight forward expectations Straight forward expectations DON’T spend hours – giving information DON’T spend hours – giving information Minimal powerpoints Minimal powerpoints

19. Feedback to PAG Group needs to know what goals of their deliberation Group needs to know what goals of their deliberation How the information will be used How the information will be used Results from prior discussions Results from prior discussions How utilized How utilized BRING BACK actual items developed or discussed. BRING BACK actual items developed or discussed.

20. PAG Leadership Facilitator needs to comfortable with: Facilitator needs to comfortable with: Generating discussion topics Generating discussion topics Group dynamics Group dynamics Generating discussion Generating discussion Round-table Round-table Not allowing individuals to dominate Not allowing individuals to dominate Seek individual input from “less vocal” members Seek individual input from “less vocal” members

21. PAG Leadership Who should be facilitator?? Who should be facilitator?? Needs to be someone who can take action on their decisions Needs to be someone who can take action on their decisions Doesn’t need to be CEO/COO Doesn’t need to be CEO/COO But, the group needs to know that their discussions and opinions are important But, the group needs to know that their discussions and opinions are important

22. Meeting Agenda Is best to have some information sent with the agenda Is best to have some information sent with the agenda Will need some background information Will need some background information Allows time for preparation Allows time for preparation Can “peak” interest in attending Can “peak” interest in attending Patients process information differently than providers Patients process information differently than providers

23. THE SPIN We are now in the next steps of analysis, evaluating consistent rooming processes, reducing replication of unnecessary tasks, provision of service that adds most value and providing quality service. We would like to discuss some of the changes we are considering, and would like your consideration of: □ The use of a Clinical Assistant within the hallway □ The presence of RN staff on the hallway □ Suggestions how we might use alternate Health Staff during your visit without making you feel like you are getting “passed around.” □ How to develop the concept of “Your Health Care Team”? □ How do you feel about receiving Preventive Services during all your visits?

24. THE SPIN A secure electronic patient portal is being developed that would allow you to receive personalized health care through your computer. For example, you could: send your physician a question, complete an evaluation of your medical needs by filling out a questionnaire about your symptoms, receive medication prescriptions, make appointments, etc. all on the computer. We are interested in your thoughts on this. A secure electronic patient portal is being developed that would allow you to receive personalized health care through your computer. For example, you could: send your physician a question, complete an evaluation of your medical needs by filling out a questionnaire about your symptoms, receive medication prescriptions, make appointments, etc. all on the computer. We are interested in your thoughts on this. Would you use it? Would you use it? When would you use it? When would you use it? What types of ailments might you use it for? What types of ailments might you use it for? What will be your response expectations? What will be your response expectations? What should we call it? What should we call it?

25. Topics Covered Recently by the Patient Advisory Group Saturday consolidation Saturday consolidation Integration of all of primary care for Saturday coverage. Integration of all of primary care for Saturday coverage. Care team process Care team process Patient interaction with multiple team members Patient interaction with multiple team members Convenience clinics Convenience clinics Patient acceptance, utilization Patient acceptance, utilization

26. Topics Covered Recently (cont.) Internet portal Internet portal Utilization, patient comfort level Utilization, patient comfort level Patient satisfaction survey results Patient satisfaction survey results Ideas for improvement Ideas for improvement Access initiatives Access initiatives Development of acute access capacity Development of acute access capacity

27. Topics Covered Recently (cont.) Medication reconciliation Medication reconciliation Provider communicating test results to patients Provider communicating test results to patients “New Patient” letter, welcoming new patients “New Patient” letter, welcoming new patients Managing providers panels Managing providers panels

28. Topics Covered Recently (cont.) Patient Service Center Patient Service Center Recommendations for development other patient advisory groups Recommendations for development other patient advisory groups Size, meeting style, frequency etc. Size, meeting style, frequency etc. Parking Parking

29. New Process DIAMOND Depression Project (Depression Improvement Across Minnesota Offering a New Direction) DIAMOND Depression Project (Depression Improvement Across Minnesota Offering a New Direction) ICSI (Minnesota) State wide implementation process ICSI (Minnesota) State wide implementation process A Care Manager model for improved depression management A Care Manager model for improved depression management Started at NW site March 1, 2008 Started at NW site March 1, 2008 Started at NE site September 1, 2008 Started at NE site September 1, 2008

30. Enrollment by Phone

31. Examples of Successes Reviewed with Patient Advisory Group Reviewed with Patient Advisory Group What is needed from patient’s perspective? What is needed from patient’s perspective? Patient information Patient information Provider response Provider response “Warm” transfer of patient from provider to RN care manager “Warm” transfer of patient from provider to RN care manager

32. Examples of Successes Provider scripting Provider scripting “This is the way we treat depression…” “This is the way we treat depression…” “The care manager is an RN who works with me..” “The care manager is an RN who works with me..” Not associated with insurance carrier Not associated with insurance carrier

33. Initial Data after 8 weeks Poster Presentation Angstman et al, Use of a Patient Advisory Group in Implementation of a New Care Model for Depression, Mayo Conference on the Voice of the Patient, November 2008

34. Conclusions Patient centric development improved Patient centric development improved Provider ease in explaining new processes to patients Provider ease in explaining new processes to patients Consistency of message Consistency of message Content of message given to patients with depression Content of message given to patients with depression Patient acceptance of the change in the care model Patient acceptance of the change in the care model

35. Questions?? angstman.kurt@mayo.edu angstman.kurt@mayo.edu