Linking Patients and Clinicians to Improve the Quality of Care in Asthma Control [B03 ]

Transcription

1 Linking Patients and Clinicians to Improve the Quality of Care in Asthma Control [B03 ] Best-practice CME/CPD Case Study in Coproduction of Health By Kathleen Moreo, RN, BSN, BHSA, CCM, Cm, CDMS Tamar Sapir, PhD

2 Acknowledgments Presentation includes results from a 2015 train-thetrainer asthma program co-supported through educational grants from AstraZeneca and Genentech

3 Disclosure The presenters are employees of PRIME Education, Inc, an accredited provider that received educational grant support for the CME/CPD projects represented in presentation No financial support, guidance, or influence was provided by any commercial supporter to develop or deliver this presentation

4 Learning Objectives Evaluate the impact of tethered clinician and patient educational interventions on co-productive health Establish opportunities for sustainable behavioral change among asthma patients and providers using a train-the-train format

5 Peer Patient & Provider Learning Methods & Design PRIME s Model of Learning

6 Demographics Asthma Treatment Team and Their Patients # Clinicians at Live Activities (N = 103) Physicians 48 NPs/Nurses 55 Patient demographic Average Age Average Disease duration Patients (N=328) 46 yo 15 yrs Moderate-to-severe asthma 65%* 3 exacerbations, past year 70% Hospitalizations, past year 33% Patient enrollment eligibility criteria based on asthma incidence/prevalence areas, number of asthma patients treated, and specialty setting. Patient participation restricted to adult ( 18 years old) moderate-to-severe asthma patients. Asthma specialists pre-qualified 100% of these patients with moderate to severe asthma.

7 Asthma Patient Engagement Pack Health Program: Coaching Touch Points Summary through 2/28/16 Touch point summary Completed touch points 5,894 Average completed touch points per Pack 36.4 Total time invested in tasks (mins) 11,366 Touch points completed by type Record Count 2,500 2,000 1,500 1, ,347 1,402 1,359 0 Call Mailing Text Type

8 Tethered Patient and Provider Surveys

9 Providers Perceived Knowledge About Their Patients % providers reporting high levels of knowledge 100% 80% 60% 40% 20% 0% 80% 79% 76% 76% 73% 71% 56% 49% 49% Asthma Specialists (N = 40) 46% 46% 42% 29%

10 Providers Overestimate their Patients Knowledge About Asthma Disease Control % patients with high levels of knowledge and skills in asthma care 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 44% Patient-Reported (N = 328) Provider-Reported (N = 40) 54% Monitor symptoms 47% 66% Avoid triggers 70% 78% Proper inhaler use 81% 71% List medications used 51% 83% Recognize symptoms of exacerbations

11 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Mismatches in Patient/Provider Perceptions on Treatment Goals 69% Patients-Reported (N = 328) Tethered Asthma Providers (N = 40) 48% Improving ability to perform ADLs 62% 83% Preventing exacerbations 44% 76% Preventing hospitalizations Patients care about current struggles with daily activities Providers focus on preventing exacerbations and hospitalizations

12 Mismatches in Patient and Provider Perceived Barriers to Treatment Plan Adherence Patient-Reported (N = 328) Provider-Reported (N = 40) 80% 70% 64% 71% 73% 71% 60% 50% 40% 46% 51% 39% 43% 30% 20% 10% 24% 12% 9% 10% 0% Adherent to medications Trouble remembering medications Side effects Insurance/ cost of medications Feel "fine" without medications Concerns/fears about medications

13 Patients Interests: Key Questions Patients Ask During Co-productive Health Education Asthma Control 5% Diagnosis and Testing 5% Asthma Types 3% Comorbidities 5% Treatment Goals 5% Treatment types/options 34% Experiences with Care 8% Signs and Symptoms 12% Triggers 23% N =817 questions asked during live sessions

14 Most Important Aspects Patients Learned Recognizing signs of uncontrolled asthma 23% Differentiate asthma medications 25% How to monitor asthma symptoms 26% Importance of medication adherence 26% Patient-reported (N =328)

15 What Patients and Providers Learn in Coproductive Health Education Observed gains in patient knowledge about their disease (N = 328) New treatment options Signs of uncontrolled asthma Steps to control asthma symptoms When to seek medical attention Observed gains in provider knowledge about their patients (N =40) Insight into patients health literacy Insight into patients selfmanagement skills Insight into patients beliefs regarding controlled asthma

16 Impact of Education: Patients Set New Goals Patient-Reported: Most Important Steps To Keep My Asthma Under Control (N =328)

17 Impact of Education: Patients and Providers Set New Goals Asthma patient Asthma specialist I understand much better as to why you ask the questions you do during my appointments. I will start paying more attention to these specific symptoms that are important for you to know - especially the nighttime wheezing. I need to do a better job at asking you the right questions. Simply asking how is your asthma is not specific enough. I think from now on, I will ask about specific triggers and reference some of the uncontrolled vs. controlledcriteria.

18 The Value of Tethered Education How will tethered survey feedback be useful to your practice? What is the value of patientprovider tethered education? Yasmeen Khan, MD, Asthma Specialist Asthma patient of Dr. Khan

19 Impact of Education: What Patients and Providers Report IMPACT OF EDUCATION ON PROVIDERS I can tell my patients learned a lot but I learned a lot about them tonight and think there are better ways to get communication open based on some of what they asked. I can see where my challenges are with getting certain patients to adhere to their treatment plans and I really think this program helped open them up to things as well. -Chicago, IL I really was not expecting so many questions. This only shows how much programs like this are needed. - Louisville, KY This is such a great idea to have an informational session like this. An office visit for them is so formal and I am usually sitting behind a computer asking questions that are most important for treatment. A program like this gives them that extra time to ask all their questions. -Miami, FL IMPACT OF EDUCATION ON PATIENTS It was great to have my doctor explain asthma in a relaxed, comfortable, non-rushed environment. -Bronx, NY I learned about triggers, how to control my symptoms, and information about drugs coming out. -Milford, CT I gained knowledge of types of asthmas and common patients fears. -Winter Park, FL [I like when] the doctor listens to what patients are saying! Be open to changing up the game plan and definitely talk about costs. -Gilbert, AZ My plan is to take better control of my asthma. -Chicago, IL

20 Asthma Specialists Set Action Plans Recommend the train-the-trainer toolkit to my colleagues Continue to conduct small-group education sessions with my asthma patients Encourage my asthma patients to enroll in the health coaching program Engage my patients more frequently in shared decision-making

21 Impact of Coaching Program on Patient Outcomes to Date (Graduated n=82) Patient reported outcomes Start Finish Progress Asthma attacks (per month) Weight (lb.) % Patients skipping medications 21% 7% -14% Smoking packs per week Activity Level (times per week) Healthy Eating (times per week) Understanding Asthma (% w/ 4 concepts) 67% 87% +20% Motivation (% very confident) 69% 92% +23% Understanding Costs (% with 4 concepts) 75% 92% +17%

22 What Did This Program Achieve? Tethered insights forged intent to change behaviors Patient peer-to-peer learning IPE with peer-to-peer learning Patients and providers engage each other in goals and perspectives Reflect on mismatches in perceptions and experiences Follow-on activities for providers and patients Opportunities to set action plans and goals for improvement Achieve improvements in patient-provider relationships Insights into real-world practices Improvements in patient-reported clinical outcomes Sustainability through train-the-trainer toolkit

23 Contact Kathleen Moreo Tamar Sapir Published results of projects in medical journals