1. The Problem
Mapping Patient-Centered Care How We Measure Up
• Patient-Centered Care is a “multi-faceted challenge” M.Procuniar, BSN-RN, BA; S.Murphy, MSN-RN
IHI “How often did doctors always communicate well with patients?” “How often did nurses always communicate well with patients?”
Standard Register Washington Washington
• 20% of adults cannot read above a 5th grade level
Current Events
Maine Maine
Montana Vermont Montana Vermont
AHRQ
North Dakota North Dakota
Minnesota Minnesota
Oregon Oregon
New Hampshire New Hampshire
Idaho Wisconsin Idaho Wisconsin
South Dakota Massachusetts South Dakota Massachusetts
New York New York
Wyoming Michigan Rhode Island Wyoming Michigan Rhode Island
Connecticut Connecticut
• “Health Literacy includes the ability to Nebraska Iowa
Pennsylvania
Nebraska Iowa
Pennsylvania
NNLM understand….not simply the ability to read.” Improve Quality, Nevada
Utah
Illinois
Indiana
Ohio
West
New Jersey
Delaware
Nevada
Utah
Illinois
Indiana
Ohio
West
New Jersey
Delaware
It is with good reason that the Joint Commission is
Colorado Virginia Colorado Virginia
Kansas Virginia Maryland Kansas Virginia Maryland
Safety, Efficiency Improve Patient and
California California
Missouri Missouri
Kentucky Kentucky
North Carolina North Carolina
Tennessee Tennessee
proposing requirements for the Hospital Accreditation
Oklahoma Oklahoma
while reducing Family Engagement
Arizona New Arkansas Arizona New Arkansas
• Poor health literacy and ineffective communication
Mexico South Carolina Mexico South Carolina
Georgia Georgia
Alabama
Disparities
Alabama
NPSF costs the US economy $100-200 billion a year Program to include advancing effective communication, Alaska
Texas
Louisiana
Texas
Alaska Louisiana
Florida
• “Appropriate communication is necessary for
cultural competence and patient-centered care. There is Hawaii
71-77% Hawaii
Florida
66-73%
TJC ensuring quality and safety in healthcare.” HITECH growing evidence from respected organizations that
78-80%
81-82%
74-75%
76-77%
Focus Areas Per HCAHPS: “Communicated well” means explained things 83-86% Per HCAHPS: “Communicated well” means explained things
health care providers can improve clinical outcomes in the clearly, listened carefully, treated patients with courtesy &
respect. National Average is 80%
clearly, listened carefully, treated patients with courtesy &
respect.
78-80%
National Average is 75%
acute care space by aligning themselves with patients’
“What percent of patients were given written information about
Ensure information Improve population needs and making them part of the care team. what to do during their recovery at home?”
gets to where Care is of Public Health Washington
Coordinated information
Maine
Montana Vermont
North Dakota
The current state of affairs can be seen using such indicators Oregon
Idaho
South Dakota
Minnesota
Wisconsin
New Hampshire
Massachusetts
as the Hospital Consumer Assessment of Healthcare Providers
New York
Wyoming Michigan Rhode Island
Connecticut
NPRM “Meaningful Use” Criteria:
Pennsylvania
Nebraska Iowa
Indiana New Jersey
Nevada Ohio
Record demographics: including Preferred Language and Ethnicity
and Systems (HCAHPS) survey. In fact, in 2009 over 3700 California
Utah
Colorado
Kansas
Missouri
Illinois
Kentucky
West
Virginia
Virginia
Delaware
Maryland
hospitals reported their HCAHPS results to CMS. It is our Arizona New
Mexico
Oklahoma
Arkansas
Tennessee
North Carolina
South Carolina
Send reminders to patients for preventive/follow-up care: based on Patient
Preferences, Demographic Data, or Specific Conditions recommendation that, in addition to the standardized HCAHPS Alaska
Texas
Louisiana
Alabama
Georgia
Report quality measures to CMS (Ambulatory Care)
surveys, additional areas for improvement in tracking Hawaii
Florida
74-80%
measures exist. 81%
82-83%
Produce lists of patients by Specific Condition for Quality Improvement,
Per HCAHPS: Patients reported whether they were given written
Reducing Disparities, and Outreach information about symptoms or health problems to watch for
84-87%
during their recovery. National Average is 81%
Provide patients w/ a copy of health information (electronic or otherwise)
Implement 5 Decision Support rules: including patient Demographic Data,
“The problem with communication…is the illusion “What percent of patients gave the hospital
an overall rating of 9 or 10 (high)?”
“What percent of patients would definitely recommend the
hospital to their family or friends?”
that it has been accomplished.” -George Bernard Shaw
Diagnosis, or Condition
Washington Washington
Maine Maine
Montana Vermont Montana Vermont
North Dakota North Dakota
Minnesota Minnesota
Oregon Oregon
Provide a clinical summary to patients for each office visit New Hampshire New Hampshire
Idaho Wisconsin Idaho Wisconsin
South Dakota Massachusetts South Dakota Massachusetts
New York New York
Wyoming Michigan Rhode Island Wyoming Michigan Rhode Island
Connecticut Connecticut
Pennsylvania Pennsylvania
Nebraska Iowa Nebraska Iowa
Indiana New Jersey Indiana New Jersey
In 2009 the ARRA HITECH Act was passed, giving hospitals and healthcare
Nevada Ohio Nevada Ohio
Illinois Illinois
Utah West Delaware Utah West Delaware
Colorado Virginia Colorado Virginia
Kansas Virginia Maryland Kansas Virginia Maryland
California California
Missouri Missouri
providers an incentive to install and use technology in a “meaningful” way. The
Kentucky Kentucky
North Carolina North Carolina
Tennessee Tennessee
Oklahoma Oklahoma
Arizona New Arkansas Arizona New Arkansas
Mexico South Carolina Mexico South Carolina
impetus behind this Act is four focus areas developed by the National Quality Alabama
Georgia
Alabama
Georgia
How Technology Can Help Forum. These focus areas are directly related to patient-centered care and the
Alaska
Texas
Louisiana
Florida
Alaska
Texas
Louisiana
Florida
Hawaii Hawaii
56-63% 61-65%
• Foreign language, disease or disability, vision or aims of improving patient communication as seen in Health Literacy. Likewise, 64-66% 66-68%
Business hearing impairment