Policy brief presentation for online


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  • Lisa,

    Excellent presentation! You discussed two of my passions in primary care! Patient engagement has been our greatest struggle programmatically since we started with our Patient Centered Medical Home. It’s been interesting watching our evolution. We started our CareFirst program with a concept, offer primary care practitioners a nurse and some extra money and see if we can just jump in and coordinate care for their chronically ill patients. We have struggled often in our attempts to get patients engaged in their health. The PCPs struggle and our nurses struggle. We are developing patient packets, learning tools, internet resources. We have taught our teams motivational interviewing techniques. Still, patient engagement is a struggle.

    In a recent article in Health Affairs, Susan Dentzer, Editor-In-Chief, writes an editorial titled “Rx for the “Blockbuster Drug” of Patient Engagement (2013). She discusses the concept of patient engagement as well as patient activation as the missing link to what health care should have been all along.

    The editorial goes on to explain the complexity of patient engagement. Health Care and health care systems are complex. We are all challenged to work and provide care within them, so it is no wonder patients struggle. Providers struggle with enough time to spend with the patients they have, adding the burden of responsibility for improving communication and education of their patients will only increase their frustration. Patients struggle with misconceptions about healthcare and health insurance. They perceive “more expensive care is better care” and getting costlier care is “payback for being gouged by insurers”.

    How do we fix this problem? Can we do better at patient engagement? The evidence continues to show that improved engagement results in improved quality and reduced cost. Patient Centered Medical Homes are a mechanism for changing current paradigms and improving patient engagement. This model considers communication as a central focus of all interactions, beginning with the patient. I am excited you selected this policy for review. If this topic interests you, you may want to read the February 2013 Health Affairs issue. It is all on patient engagement from a variety of perspectives.

    Dentzer, Susan. (2013). Rx for the 'Blockbuster Drug' of Patient Engagement. Health Affairs, 32(2), 202. doi: 10.1377/hlthaff.2013.0037Health Aff February 2013 vol. 32 no. 2 202
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Policy brief presentation for online

  1. 1. Lisa Tayman MS, RN, CEN, CCRN Salisbury University NURS 525
  2. 2. Federal Policy Brief TITLE Patient Engagement. People actively involved in their health and health caretend to have better outcomes—and, some evidence suggests, lower costs
  3. 3. Patient Engagementcalls for reforms to achieve a patient-centered health care system, wherein individual patient preferences, needs, and values are respected and patients guide all clinical decisionscombines patient activation (a patient’s knowledge, skills, ability, and willingness to manage his or her own health care) with interventions designed to promote positive patient behavior, such as obtaining preventive care.
  4. 4. Patient EngagementShared Decision Making= When there are multiple, reasonable treatment options, each with their own risks and benefits, the correct path to follow should be guided by a patient’s unique needs and circumstances
  5. 5. Shared Decision MakingDecision aids such as: booklets, videos, websites, and interactive media are usedAll of these helpful aids will give patients information on the risks and benefits of various treatment options and help them make the choice that most reflects their personal values.
  6. 6. Research on Patient EngagementPatients who received enhanced decision-making support had overall lower medical costs and fewer hospital admissions than for those who received only the usual supportPeople with the least skills and confidence to actively engage in their own health care (patient activation) incur costs between 8-21% higher than patients with higher activation levels
  7. 7. Patient EngagementMay be affected by such factors as: cultural differences, gender, age, and educationFor patients to engage effectively, they must have a certain degree of health literacyOne strategy to incorporate into practice is the “teach-back” method
  8. 8. Teach-Back MethodThe provider will ask the patient to explain back to them what they have learned, such as: their own understanding of their condition, the options available to them, and their intentions to act on the information
  9. 9. Future ResearchMore studies need to be conducted to determine the best practices for engaging patients, as well as determining the extent of the relationship of patient engagement to health care cost savings
  10. 10. Patient EngagementEfforts are under way to hold health care organizations accountable for engaging patients.The National Committee for Quality Assurance surveys patients and ask about whether clinicians engage them in shared decision making or provide support for them to manage their conditions to determine if this quality measure is being met.
  11. 11. State Policy BriefShared decision making and being engaged in their care, increased compliance for such issues as:blood sugar testing for gestational diabetesCPAP use
  12. 12. TelemedicineDefinition: The use of interactive audio, video, or other telecommunications or electronic technology by a licensed health care provider to deliver health care services at a site other than the site the patient is located.
  13. 13. “Telemedicine Recommendations”This report addressed that effective use of telemedicine can increase access to health care, reduce health disparities, and create efficiencies in health care delivery
  14. 14. Telemedicine BenefitsHas the potential to increase access and reduce the cost of care.Both consumers and providers can benefit from telemedicine
  15. 15. TelemedicineConsumers can experience increased access to providers, quicker and more convenient treatment, better continuity of care, and a reduction in lost work time and travel costsProviders can experience instant access to other providers, a reduction of medical errors, and increased efficiency with reduced travel and research times
  16. 16. Research shows:Telemedicineimproves time-to-diagnosisfacilitates access to care for patients in remote regionsincreases patient satisfaction
  17. 17. TelemedicineTelemedicine offers an alternative to the traditional method of care delivery (face to face)Health care organizations faced with provider shortages, access disparities and budget challenges, are adopting telemedicine in order to connect geographically-remote patients with specialists, to allow scarce specialists to be available across networks, and to provide remote monitoring of patients
  18. 18. TelemedicineIt is recommended that payments accurately reflect the cost of delivery for providers and the effectiveness of the treatments must be proven to payers and patients.Payment must be sufficient to cover actual costs, but should not favor telemedicine over face-to-face services
  19. 19. Telemedicine legislationAccording to the Department of Health and Mental Hygiene, telemedicine should be used to address access to care issues related to specialists being located a long distance from patients and not as a replacement for in-person care
  20. 20. TELEMEDICINECurrent fiscal and policy notes: SB 494 regarding developing strategies and recommendations for advancing telemedicine technologiesSB 496 regarding the reimbursement of telemedicine services by MedicaidSB 776 regarding establishing a Task Force on the use of telehealth to improve Maryland health care
  21. 21. Policy recommendationsTo establish a Task Force on the use of telehealth to improve Maryland health careThis task force must assess factors related to telehealth and identify opportunities to use teleheath, as well as collaborate with organizations such as the Rural Maryland Council, and make recommendations regarding the use of telehealth in the State
  22. 22. Patient Engagement & TelemedicinePatient engagement combines patient activation with interventions designed to promote positive patient behaviorInterventions such as telemedicine improves time-to-diagnosis, facilitates access to care for patients in remote regions, and increases patient satisfaction
  23. 23. References Capistrant, G. (2013). Letter to Maryland House of Delegates. Retrieved from: http://www.americantelemed.org/docs/default-source/policy/ata-comments-on-mar Commission on Maryland Cybersecurity Innovation and Excellence-Duties. Maryland General Assembly 2013 Session, SB 494. Retrieved from: http://mgaleg.maryland.gov/webmga/frmMain.aspx?id=sb0494&stab=01&pid=billpa and http://mgaleg.maryland.gov/2013RS/fnotes/bil_0004/sb0494.pdf Health Policy Brief: Patient Engagement. (Feb. 14, 2013). Health Affairs, 1-5. Retrieved from: http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_86.pdf Homko, C.J., Santamore, W.P., Whiteman, V., Bower, M., Berger, P., Geifman- Holtzman, O., and Bove, A.A. (2007). Use of an Internet-Based Telemedicine System to Manage Underserved Women with Gestational Diabetes Mellitus. Diabetes Technology & Therapeutics, 9(3), 297-306. doi: 10.1089/dia.2006.0034
  24. 24. References Maryland Medical Assistance Program – Telemedicine. Maryland General Assembly 2013 Session, SB496. Retrieved from: http://mgaleg.maryland.gov/2013RS/fnotes/bil_0004/sb0494.pdf and http://mgaleg.maryland.gov/2013RS/fnotes/bil_0006/sb0496.pdf Stepnowsky, Jr., C.J., Palau, J.J., Marler, M.R., and Gifford, A.L. (2007). Pilot Randomized Trial of the Effect of Wireless Telemonitoring on Compliance and Treatment Efficacy in Obstructive Sleep Apnea. Journal of Medical Internet Research, 9(2), e14. doi: 10.2196/jmir.9.2.e14 Task Force on the use of telehealth to imfprove Maryland health care. Maryland General Assembly 2013 Session, SB 776. Retrieved from: http://mgaleg.maryland.gov/webmga/frmMain.aspx? id=sb0776&stab=01&pid=billpage&tab=subject3&ys=2013RS and http://mgaleg.maryland.gov/2013RS/fnotes/bil_0006/sb0776.pdf Telemedicine Recommendations. Maryland Quality and Cost Council, December 2011. Retrieved from: http://mhcc.dhmh.maryland.gov/hit/Telemedicine/Documents/sp.mhcc.maryland.gov/ telemed/md_telemedicine_report.pdf