Chronic Conditions in Older Adults: Interventions for Physical Activity and Self-management

Transcription

1 Chronic Conditions in Older Adults: Interventions for Physical Activity and Self-management Solutions-Oriented Approaches to Improving Healthcare for Older Adults, June 20, 2013 Huong Q. Nguyen, PhD, RN, Research Scientist Kaiser Permanente Research

2 Chronic Care Model

3 Self-Management Support the systematic provision of education and supportive interventions by health care staff to: increase patients skills and confidence in managing their health problems, including regular assessment of progress and problems, goal setting, and problem-solving support. ~ Institute of Medicine, 2004, Quality Chasm Summit

4 Multi-morbidity in COPD (+4) Vanfleteren et al (2013) AJRCCM 187(7):728

5 Convergence >> Inactivity-Deconditioning Substantial loss in lung function Anxiety Social isolation/ Depression

6 Why regular exercise (staying active) helps Desensitization to dyspnea (Do more with same level of dyspnea) Skeletal muscles use oxygen better Depression & Anxiety Hyperinflation 6 July 22, Kaiser Foundation Health Plan, Inc. For internal use only.

7 Guideline Based Rx: Pulmonary rehabilitation

8 Medicare reimbursement policies ~$3000/patient

9 Rehab does NOT lead to sustained ac vity X

10 Mercedes Benz or Toyota?

11 Rehab Everywhere 11 July 22, Kaiser Foundation Health Plan, Inc. For internal use only.

12 Rehab Everywhere 12 July 22, Kaiser Foundation Health Plan, Inc. For internal use only. Vidyo.com

13 Rehab Everywhere 13 July 22, Kaiser Foundation Health Plan, Inc. For internal use only.

14 Rehab Everywhere: Automated Tailored Walking Program 14 July 22, Kaiser Foundation Health Plan, Inc. For internal use only.

15 I had a big shock Monday when I called to get my oxygen tanks refiled, and they said I was no longer on day time oxygen. I had been on oxygen 24/7 for twelve years. I called my VA doctor and was informed I passed my walking test. I will admit this has been a tense week for me, it kind of reminded me of when I quit smoking. I did have to stop and rest a little more often but made or came close to my step count most days. The only change to my life has been the Walking Program, I have a long way to go but at least can see some progress. Tell all the staff thanks for me and thou it can be hard let's all keep walking. 15 July 22, Kaiser Foundation Health Plan, Inc. For internal use only.

16 Rehab Everywhere: Dyspnea Self-Management 12 Months edsmp Education/skills training Exercise Collaborative monitoring Ongoing feedback/support fdsmp Education/skills training Exercise Collaborative monitoring Ongoing feedback/support GHE General health education Regular phone calls 1 0 :Dyspnea w/activities 2 0 : Self-Efficacy for Managing Dyspnea & Exercise Nguyen et al (2012) J Pain Sx Mgt

17 Collaborative Monitoring: Exercise & Sxs

18 Collaborative Monitoring: Exercise & Sxs

19 Collaborative Monitoring: Reflections

20 Education Modules

21 Education Sessions: Text Chatting

22 Nurse Dashboard

23 Click to edit Master title style Sample Characteristics Age: 69 (10) Females: 46% Caucasians: 91% College or more: 85% FEV1% predicted: 51 (19) Oxygen use: 27% July Kaiser 22, Foundation 2013 Health Plan, Inc. For internal use only.

24 No differences in dyspnea w/activities Chronic Respiratory Questionnaire Dyspnea Dyspnea with Activities (5-35 ) T: p<.05; GxT: p=.48

25 Improvements in Self-efficacy Self-Efficacy for Managing Dyspnea (0-10) T: p<.001; GxT: p=.06

26 Improvements in Exercise Duration of Endurance Exercise/Wk T: p<.001; GxT: p=24

27 Assess: Exercise Vital Sign in EMR On average, how many days per week do you engage in moderate to strenuous exercise (like a brisk walk)? Response options: 0-7 days On average, how many minutes do you engage in exercise at this level? Response options: 0, 10, 20, 30, 40, 50, 60, 90, 120, and 150 or greater 27 July 22, Kaiser Foundation Health Plan, Inc. For internal use only.

28 Advise/Agree 28 July 22, Kaiser Foundation Health Plan, Inc. For internal use only.

29 Health is not the top barrier

30 Patients have competing demands Patients have the power in chronic disease. Patients decide what to eat, whether to exercise, and how often to take their medications. If people don t want to do something, they won t do it Bodenheimer (2007) Motivating Change

31 Assist: Collaborative Self-Management 1 education session Monthly calls from case manager Action plan w/atb & prednisone 41% COPD Hospitalizations & ED visits n= July 22, Kaiser Foundation Health Plan, Inc. For internal use only. Rice et al 2010 AJRCCM, 182:890

32 Assist: Collaborative Self-Management 5 education sessions Monthly calls x 3 mos & quarterly after from case manager Action plan w/atb & prednisone Hospitalizations Mortality n= July 22, Kaiser Foundation Health Plan, Inc. For internal use only. Fan et al 2012 Ann Int Med 16(10): 673

33 Assist: Care Partner-Family Engagement

34 Assist/Arrange: Profiling & Segmenting

35 Click to edit Master title style Population-based proactive, collaborative technology-enabled, cost-effective, scalable, care management