Patient Engagement Toolkit Boosting Patient Knowledge Skills and
+Patient Engagement Toolkit: Boosting Patient Knowledge, Skills and Self-efficacy Mary R. Talen, Ph. D. Director, Primary Care Behavioral Health Northwestern Family Medicine Residency Chicago, IL mtalen@northwestern. edu Behavioral Science Form 2011
+ Overview n Definition and Description of Patient Engagement n Research on Patient Engagement n Tools For Boosting Self-Management n Office-Based Practices and Patient Engagement n Summary and Discussion
+ Rationale for Patient Engagement n PCMH: Patient Experiences n ACO: Role of Patients in Self -Management n Patient-Management Support Systems n Knowledge: disease and medications n Skills: Communication, Shared decision-making, Goal Tracking n Attitudes: Confidence and Self-efficacy
+ What Patient Engagement is Not n http: //www. youtube. com/watch? v=scyx 0 Howu. A&feature=related
+ Standard Care vs. Patient Engagement Standard Care Patient Engagement Care Assumes knowledge drives change Assumes knowledge + confidence drives change Clinician sets agenda Patient participates in agenda Goal is compliance Goal is enhanced confidence and efficacy Decisions made by Provider Physician Mantra: “ Eat Right, Exercise Often, Take your Meds” n (Bodenheimer et al, CA Health Care Foundation, 2005) Decisions made in collaborative partnership
+ What is Patient Engagement? n Components of Engagement n Patient education and health literacy n Medication compliance n Skills in chronic disease management n Healthy behaviors (i. e. , no smoking, nutrition, exercise) n Questions and Communication n Accessing Care n The Ideal Engaged Patient n “Actions individuals and/or families take to obtain the greatest benefit from the healthcare services available to them” (www. cfah. org)
+ Healthcare Providers and Patient Engagement n “The systematic provision of education and supportive interventions n to increase patients’ skills and confidence in managing their health problems, n including regular assessment of progress and problems, goal setting, and problem-solving support. ” n Institute of Medicine Definition (2003):
+ Patient Engagement: Evidence n Addressing knowledge is necessary but not sufficient to produce changes in chronic illness care outcomes n Key strategies for improving outcomes of educational and behavior change interventions: n assessment of patient-specific needs and barriers n goal setting n enhancing skills, problem-solving n follow-up and support n increasing access to resources n Bodenheimer et al, 2002 ; Glasgow et al, 2003; Fisher et al, 2005)
+ Characteristics of Engagement Patient Characteristics Healthcare Team Characteristics Aware and Informed consumers Relationship Building Activated and Involved Exploring patients’ needs, expectations and values Empowered and Self-efficacy Confident in self-management Partners with health care providers Information Sharing and Transparency Collaborative Goal Setting Action Planning Skill Building & Problem Solving Continuity and Follow-up on progress www. newhealthpartnerships. org
+ Conceptual Framework : Attitudes: Confidence, Self. Efficacy, Awareness Skills: Access, Communication, Decision-making Knowledge: Health Status, Disease Process, Medications
+ Patient Activation Measurement: (PAM) n Identifies patient’s belief about role in healthcare n Identifies patient’s health knowledge n Identifies patient’s level of activation in healthcare http: //www. insigniahealth. com/
+ Attitudes: Patient Activation Measurement n http: //www. insigniahealth. com/
+ Attitudes: Confidence and Self. Efficacy Self-Efficacy “They are able who think they are able. ” Virgil n n Tools n “How were you able to accomplish that? “ Shift in focus from what is wrong to what is right In addition to Risk, vulnerability, loss add strength, resilience and endurance Maximize “Good News” “What would be good enough for now? ” n Identify Signature Strengths http: //www. authentichappiness. sas. upenn. edu/testcenter. aspx Positive Health Behavior Changes (Hershberger, 2005)
+ Skills: Communication with Providers Agenda Setting Talen, MR, Grampp, K, Held-Muller, C, Stevens, L, 2011
+ Skills: Making Choices n Asthma Action Plans n http: //www. lungusa. org/lungdisease/asthma/living-withasthma/take-control-of-yourasthma/Asthma. Action. Plan. JUL 2008 -high-res. pdf
+ Skills: Making Choices n Decision Balance Charts n SMART n n Specific n Measurable n Attainable n Realistic n Timetable Motivational Interviewing Process n
+ Skills: Tracking Changes Health Status Tracking n n Diabetes Score Cards n Group Medical Visits n Planned Chronic Care n Follow-Up Continuity Care Chronic Pain Management Score Cards
+ Skills: End of Life Decisions n Primary Care’s Role in Anticipatory Guidance n Opening Discussion n Reflection n Discussions n Act n http: //practicalbioethics. org/about/ model-and-methodology/makingyour-wishes-known-for-end-of-lifecare/
+ Knowledge: Personal Health Overall Health Status n Overall level of health status n Conditions n www. howsyourhealth. org Self-scoring Behavioral Health Screening n n http: //www. moodscope. com/sig n_in. php Family History and Genogram n Physician Teach-back n Medline Plus: http: //www. nlm. nih. gov/medlinepl us/ n Mayo Clinic Patient Information n http: //www. mayoclinic. com/
+ Knowledge: Community Resources and Referrals n http: //cancersupportcommunity. org/hc/Communities/Local. Communities/default. aspx n Health Promotion n http: //www. eriefamilyhealth. or g/patient-services/health-andwellness-programs Erie Family Health Center
+ Obstacles and Opportunities Barriers Opportunities
+ Implementing Patient Engagement Strategies Office Based Protocols n n Standard Agenda Setting Forms at Check-IN Provider – Patient Communication n Using Positive Health Strengths n Shared Goal Setting and Tracking n Case Managers-Patient Communication/relationships n IT apps Self Scoring Screening or Tracking Tools at Triage n Patient Strengths and Efficacy n Health activation strategies n Sign-up, calls, texting for Group Medical Visits and Health Education
+ Summary and Discussion
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