Focus on minimally disruptive care to build capacity and set patients up for success, minimize costs and build trust in the provider- patient relationship.
2. Aligning Cost, Quality, and Health
• Background of Minimally Disruptive Care (MDC) Model
• Proposed MDC Solution
• Solutions to meet needs of Slave Lake Family Care Clinic (SLFCC)
• Change Process for MDC Implementation
• Expected Outcomes for SLFCC
• MDC aligned with Current Health Financing Context
3. Background of Issue
• Historical need for comprehensive primary/preventative care services to address
longstanding healthcare analytics
• Perfect storm of factors outside of control for population members
• Traditional challenges for recruitment and retention of health care providers in
rural underserved areas with strong comorbid disease
9. Initiatives to Meet
Needs
Define MDC indicators for patients
satisfaction
Build a Culture of Improvement by
establishing a patient based steering
committee
Focus on minimally disruptive care
examples in multi-disciplinary biweekly
quality rounds which are already in
existence
Present testimony to all stakeholders from
patients and their experience with MDC
Establish clear reporting accountability
and responsibility to members of public
using waiting room public video
messaging, handouts of MDC care and
community presentations at local health
and wellness initiatives
10. Expected Outcomes
Clinical Outcomes
• Overcoming “system” inertia
• Expelling health care paternalism
Research Outcomes
• Appropriate level of diagnosis and
treatment for patients with comorbid
disease burden
• policy and evidence based practice
which champions MDC
11. Realistic Implications and Health Finance
Context
•
• Tangible Culture of Caring
• Proven MDC model cited as a recruitment & retention Incentive
• Improved Patient-derived health indicators
• Regular MDC Community Engagement
• Increased patient satisfaction for comorbid population
• Improved adherence rates and buy in for provider engagement
• Sustainability and champions of MDC care dispersed throughout greater Slave
Lake region
• MDC employed as a Quality Improvement indicator
•
12. References
• Muth, C., van den Akker, M., Blom, J. W., Mallen, C. D., Rochon, J.,
Schellevis, F. G., ... & Perera, R. (2014). The Ariadne principles: how to
handle multimorbidity in primary care consultations. BMC medicine, 12(1),
223.
• Richards, T., Coulter, A., & Wicks, P. (2015). Time to deliver patient centred
care. BMJ, 350, h530.
• Rosenthal, T. C. (2016). Are We Learning More about Patient-centered
Medical Homes (PCMHs), or Learning More about Primary Care?. The
Journal of the American Board of Family Medicine, 29(1), 4-7.
13. Thank you for your
time and attention
Primary Contact:
April Boddy:
april.boddy@albertahealthservices.ca
Editor's Notes
Aligning cost, quality and health is the trifecta of today’s health care environment. Patient centered care is a pillar of the vision for Slave Lake Family Care Clinic.
Focusing on a culture of patient centered care consider the patient that receives more care than they need. Montori, V. M., Brito, J. P., & Murad, M. H. (2013), propose a model of care called minimally-disruptive medicine. It is a patient-centered health care model designed around personal life goals of patients and their capacity to effectively handle chronic disease diagnosis and management.
As we are well aware, SLFCC has an enormous complex high needs population. For example, we have a patient population of 28 % First Nations patients with heavy comorbid disease burden. 1/3 of Slave Lake was destroyed by devastating wildfire in May 2011. We are three hours by road from large urban centers and many people continue to feel disempowered by the collective trauma and challenges of rural loving in Slave to Lake.
“ Traditionally ,ten percent of patients consume 50% of health care” (Rosenthal, 2016). Unfortunately those ten percent at most risk of using services tend to also be less equipped to meet the demands imposed by health care treatment. We must set patient sup for small success that only minimally disrupt their ability to meet life’s demands.
We need to meet people where they have capacity and build on incremental , patient propelled care initiatives. The initiatives are highly personalized for each patient to maximize its relevance for the patient.
Aligning cost, quality and health is the trifecta of today’s health care environment. Patient centered care is a pillar of the vision for Slave Lake Family Care Clinic.
Focusing on a culture of patient centered care consider the patient that receives more care than they need. Montori, V. M., Brito, J. P., & Murad, M. H. (2013), propose a model of care called minimally-disruptive medicine. It is a patient-centered health care model designed around personal life goals of patients and their capacity to effectively handle chronic disease diagnosis and management.
It’s time to get real about delivering person centred care. It’s not a panacea for all of medicine ills, but we should not underestimate its contribution to tackling them. Working collaboratively and sharing decisions about care, services, and research is challenging. It requires a sea change in mindset among health professionals and patients alike. But its rewards are rich and reaped mutually (Richards, Coulter & Wicks, 2015).
Realistically, change is hard. Workflow is hard to change but not impossible. It must be done because our patients health and the collective health of out public system is in jeopardy. Strong leadership is required. Providers are responsible for patient partnership and person centred care. There must be both accountability and responsibility tied to each provider. Feedback from patients and their families and all stakeholders must be used rigorously to inform practice. We can no longer afford to collect data and not improve patient outcomes with that same data.
Realistic implications for MDC are multi focal. Most importantly would be a tangible decrease in low value care for vulnerable patients with comorbid disease burden over time. Also a reduction in conflicts arising from the current guideline driven care of multiple diseases often to the detriment of adherence and reinforcing incapacitation for the vulnerable patient to achieve improved health outcomes (
