Whole Health in Your Practice

Transcription

1 Whole Health in Your Practice 2. THE BIG PICTURE A Little More About This Course NOT...just another training Relies on the wisdom of the group Involves evidence and personal experience Keeps your self care in mind Focuses on building skills that you can apply in your practice tomorrow 1

2 Learning Objectives GOOD: Understand the concept of Whole Health BETTER:...and network with colleagues EVEN BETTER:...and learn skills for your practice BEST:...and implement Whole Health at a team level (and beyond) IDEAL:...AND apply it to your own self care as well What Contributes to This Approach? 2

3 Important Elements of Whole Health in Practice The Circle of Health Personal Health Planning The Aspirations Model 3

4 The Aspirations Model 4

5 Whole Health Encourages You to Think about Your Mission Why are you here in the VA? Why are you here on the planet? What REALLY matters? What do you want your health for? 9 What do you want your health for? People s answers may surprise you! 10 5

6 The Experience: Relationship Between Clinicians and Patients/Families What Matters to the Patient is the basis of their Personalized Health Plan A strong relationship allows the provider to partner with the patient to help create their Plan What matters to me? My Story My Story Relationship Who I am Who I am Purpose in Life = Longer Life 7,108 Americans Ages Followed for 14 years Answered three questions: 1. I don t wander through life 2. I think about the future 3. I feel there is still more to do in life Hill, Psychol Sci, 2014; 25(7):

7 Purpose in Life = Longer Life Regardless of Age Retirement Status Relationships Depression There was a survival benefit (hazard ratio 0.85) if answers indicated a sense of purpose Hill, Psychol Sci, 2014; 25(7): Which statement gets the best response? Statement A Your A1c is clear up to 10. That means your sugars have been really high for a while, and we need to bring them down. Studies show this will put your heart, retinas, nerves, and kidneys at risk. Statement B I know your goal is to dance at your granddaughter s wedding. Keeping your sugars in a good place will help your heart, legs, and the rest of your body be up for it! And it will keep that A1c number down, too. 7

8 What if the Conversation Changed Focus? Worse then Expected Better than Expected Disease Health VHA Strategic Goals, Provide Veterans personalized, proactive, and patient driven health care to optimize health and well being. 1. Incentivize measurable improvements in health outcomes. 1. Align resources to deliver sustained value to Veterans. HOW? Whole Health is one approach 8

9 How do you define Whole Health? 17 FRAMEWORK FOR WHOLE HEALTH: CIRCLE OF HEALTH Components of Proactive Health and Well-being Page 17 9

10 Defining Whole Health Patient centered care that affirms the importance of the relationship and partnership between patients and their community of healthcare providers. The focus is on empowering the self healing mechanisms within the whole person while co creating a personalized, proactive, patient driven experience. This approach is informed by evidence and makes use of all appropriate therapeutic approaches, health care professionals and disciplines to achieve optimal health and well being. Core Concepts for Transforming to Whole Health Holism: People are more than a broken body part or a list of medical problems Self Healing: People possess the innate capacity to heal, and mobilizing that is an important priority Mindful Awareness: Self awareness leads to better health, and there are ways to enhance it Explore.va.gov 10

11 Core Concepts for Transforming to Whole Health Holism: People are All more aspects than of my a broken life are body part or a list of medical problems interconnected and impact my health Self There Healing: are approaches People possess that the can innate capacity to heal, and mobilizing strengthen that or is an weaken important my priority capacity to heal and stay well Mindful Awareness: Self awareness leads to better health, and Paying there are more ways attention to enhance to my it body and mind helps me make better decisions in my self care Explore.va.gov Physical Meaning and Purpose Emotions Life Story Relationships Mind Values Culture Photo credit: Jabi - El de verdad via Foter.com / CC BY-NC 11

12 Our Current Disease Care System Photo credit: ViaMoi via Foter.com / CC BY-NC-ND W6162XA = V9107XA = 68,000 Diagnosis Codes (ICD 9 has 14,025) Struck by a duck Burn due to water skis catching on fire And a Few Others... Collision with roller skater Struck by an orca Bitten by sea lion Sucked into a jet engine Prolonged stay in weightless environment Unspecificed spacecraft accident Hurt at the library Hurt at the opera Accident while knitting Problems in relationship with in laws Photo credit: symtnr via foter.com 12

13 $ Appetite Suppressant $ Triptan Opioids Statin HA Dyslipidemia HTN Obesity Disease Focused Care GERD LBP Depression DM SSRI $ ACE PPI Insulin $ 26 13

14 1. Whole food diet 2. Aerobic Exercise 3. Stress management (60 mins/day) 4. Social Support Mean change in relative telomere length over 5 years with lifestyle intervention compared with control Ornish, Lancet Oncol. 2013;14(11):

15 Personalized, Proactive, Patient-Driven PERSONALIZED A dynamic adaptation or customization of recommended education, prevention and treatment that is specifically relevant to the individual user, based on the user s history, clinical presentation, lifestyle, behavior and preferences. PROACTIVE Acting in advance of a likely future situation, rather than just reacting; taking initiative to make things happen rather than just adjusting to a situation or waiting for something to happen. Using strategies that strengthen the person s capacity for health and healing, such as mind body approaches prior to surgery. PATIENT DRIVEN An engagement between a patient and a health care system where the patient is the source of control such that their health care is based in their needs, values, and how the patient wants to live. This requires that we change the conversation and start from a different place. Mentalhealth.va.gov Personalized, Proactive, Patient-Driven PERSONALIZED A dynamic adaptation or customization Tailor my of care recommended education, prevention and treatment that is specifically relevant to the individual user, based on the user s history, clinical presentation, to me lifestyle, as a behavior personand preferences. PROACTIVE Acting in advance Help of me a likely prevent future situation, future rather than just reacting; taking initiative to make things happen rather than just adjusting to a situation or waiting for problems and prepare for any something to happen. Using strategies that strengthen the person s capacity for health and health healing, problem such as mind body that comes approaches up prior to surgery. PATIENT DRIVEN An engagement between a patient and a health care system where the patient is the source of Support control such me that with their what health care is based in their needs, values, and how matters the patient most wants to live. methis requires that we change the conversation and start from a different place. Mentalhealth.va.gov 15

16 It s Vital to Know the Patient: On Being Sane in Insane Places 8 sane people admitted to different psych hospitals in 1973 All given the diagnosis of Schizophrenia in remission 4 Psychologists 1 Psychiatrist 1 Pediatrician 1 Painter 1 Homemaker Steve took it via Foter.com Average length of stay: Rosenhan DL, Science, 1973;179 (4070): Conclusions: Being Sane Study It could be a mistake, and a very unfortunate one, to consider that what happened to us [as patients] derived from malice or stupidity on the part of the staff. Quite the contrary, our overwhelming impression of them was of people who really cared, who were committed and who were uncommonly intelligent. Where they failed, as they sometimes did painfully, it would be more accurate to attribute those failures to the environment in which they, too, found themselves

17 Precursors to Suicide PTSD, Depression, Sleep disorders, Pain, Substance Abuse All areas where the find it fix it model fails We did the clinical reminders, we met the measures, but we missed their suffering U.S. Air Force photo illustration/airman 1st Class Corey Hook If People Feel Their Care is Centered on Them... They are less likely to die following a major event such as acute myocardial infarction Meterko et al., Health Services Research 45(5): , They are more likely to follow treatment recommendations Haynes et al., Cochrane Database, 2:CD000011, 2008 They trust their care team more Keating et al., J Gen Intern Med, 17(1): 29 39, 2002 Photos: va.gov 17

18 "... Our job in medicine..." "We've been wrong about what our job is in medicine. We think our job is to ensure health and survival. But really it is larger than that. It is to enable well being. And well being is about the reasons one wishes to be alive. Those reasons matter not just at the end of life, or when disability comes, but all along the way. Atul Gawande, MD Being Mortal 35 The Disruptive Innovation The Whole Health System Offers: Human Care Self Care Clinical Care Complementary and Integrative approaches are integral to Self Care and Clinical Care 36 18

19 Whole Health System The Human Element PEERS Personal Health Planning Self Care INTEGRATIVE PROVIDERS Clinical Care CLINICIANS The Future: A Whole Health System 1. The Human Element: Peers Veterans come into the process at the point of enrollment They explore their mission/purpose/aspirations. They begin creating their overarching personal health plan 19

20 The Future: A Whole Health System 2. Self Care: Integrative Providers Not diagnosis or disease based Personal Health Planning CIH programs and services are woven in E.g., stress reduction, yoga, tai chi, mindfulness, nutrition, acupuncture Easy access in the VA or the community Health Coaching The Future: A Whole Health System 3. Clinical Care:Clinicians The other two aspects mesh with clinical care Inpatient and outpatient May take many forms e.g., PACTs, specialty clinics Healing environments Healing relationships Whole Health approach/holistic approaches VA and community 20

21 And All This is Happening! Whole Health Portland Minneapolis Hudson Valley Tomah San Francisco Greater Los Angeles Iowa City St. Louis Columbia Jesse Brown Washington DC Salisbury Boston Baltimore North Texas - Plano Central Arkansas Durham Biloxi = FY16 Whole Health Facilities = FY17 Whole Health Facilities And it will keep happening! All VISN s will be creating Whole Health programs in

22 Our Mission Imagine and implement what you can do to move closer to a Whole Health Care System Practice mindful awareness Share wisdom and network with each other Clearly define what tools & support you need Explore this for ourselves: self care Have fun! Time to Pause and Create You have the answers This is time to put them into action Pause Be Present Proceed Towards Whole Health 22

23 Veterans committed their lives, health, and well being to Mission Success in defense of our country. Now, we can help them be mission ready for their lives, optimizing their health in service of what matters to them. How Will We Identify Success? When Veterans achieve outcomes they never even imagined. 23