Download Free Medical Improving Chronic Disease Care PowerPoint Presentation

Improving Chronic Disease Care PowerPoint Presentation

DOWNLOAD MEDICAL POWERPOINT PRESENTATION

About This Presentation

Description : Generally, less than 50% of folks with major chronic illnesses receive accepted treatments. Less than 50% have satisfactory levels of disease control.

Tags : chronic disease care,chronic illnesses,chronic disease,diabetes disease management,chronic illness care

Published on : Sep 06, 2022 | Views : 1036 | Downloads : 0

Shareable Url :

Embed Code :

Comment

Transcript

Slide 1-

Improving Chronic Disease Care John Riley PA-C, MS MEDEX Northwest/University of Alaska Anchorage February 27, 2006 Adapted from Ed Wagner MD, MPH MacColl Institute for Healthcare Innovation
Slide 2-

ppt slide no 2 content not found
Slide 3-

ppt slide no 3 content not found
Slide 4-

Obesity* Trends Among U.S. AdultsBRFSS, 1991 (*BMI  30, or ~ 30 lbs overweight for 5’4” person) Source: Mokdad A H, et al. JAMA 2001;286:10 No Data <10% 10%-14% 15-19% 20%
Slide 5-

Obesity* Trends Among U.S. AdultsBRFSS, 1995 (*BMI  30, or ~ 30 lbs overweight for 5’4” person) Source: Mokdad A H, et al. JAMA 2001;286:10 No Data <10% 10%-14% 15-19% 20%
Slide 6-

Obesity* Trends Among U.S. AdultsBRFSS, 2000 (*BMI  30, or ~ 30 lbs overweight for 5’4” person) No Data <10% 10%-14% 15-19% 20% Source: Mokdad A H, et al. JAMA 2001;286:10
Slide 7-

Obesity* Trends Among U.S. Adults BRFSS, 1991, 1995 and 2000 1991 1995 2000 No Data <10% 10%-14% 15-19% 20%
Slide 8-

Prevalence of Inadequate Nutrition by Age and Sex in Alaska 1999-2001 (Combined) Source: AK BRFSS
Slide 9-

Prevalence of Physical Inactivity by Age and Sex in Alaska 1999-2001 (Combined) Source: AK BRFSS
Slide 10-

ppt slide no 10 content not found
Slide 11-

Mrs. Johnson Secretary early fifties Thirsty, losing weight, tired Labs misfiled Diabetes registry not utilized Screenings tests not done Co morbid Mental health issues not addressed Referral info not coordinated Not instructed in glucometer use Confusion about what to do
Slide 12-

What Mrs. Johnson Experienced? Fragmented, discontinuous care Deficits in her clinical care Quality not “embedded” in clinical delivery system Inadequate self-management contributing to suboptimal disease control Care across providers and settings not communicated, much less coordinated
Slide 13-

Is Mrs. Johnson a Rare Case? Generally, less than 50% of folks with major chronic illnesses receive accepted treatments. Less than 50% have satisfactory levels of disease control. Majority of Americans don’t feel that the chronically ill get good care. McGlynn EA, Asch SM, Adams J, et al. N Engl J Med 2003; 348(26):2635-2645
Slide 14-

What people with chronic disease get 27% of hypertensives are adequately treated 25% of eligible patients with atrial fibrillation receive recommended care 58% of people with depression are receiving adequate treatment 64% of CHF patients are receiving recommended care Hyman DJ, Pavlik DN. N Engl J Med 2001; 345:479-486 McGlynn EA, Asch SM, Adams J, et al. N Engl J Med 2003; 348(26):2635-2645
Slide 15-

Hwy 61
Slide 16-

The IOM Quality report:A New Health system for the 21st Century
Slide 17-

What people like Mrs. Johnson with chronic diseases need Information and ongoing support for self-management Continuous, integrated care delivered by an interdisciplinary team Evidence-based clinical management Care following clinical improvement methods Care using informatics
Slide 18-

ppt slide no 18 content not found
Slide 19-

ppt slide no 19 content not found
Slide 20-

ppt slide no 20 content not found
Slide 21-

What’s Responsible for the Quality Chasm? Is it patients like Mrs. Johnson who lack knowledge and motivation, and fail to comply with their doctors’ instructions?
Slide 22-

1. Motivation and adherence are not genetically determined 2. Behavioral interventions are consistently successful in raising adherence 3. Noncompliance is not a patient problem; it is a system failure paraphrased from Dr. Paul Farmer reflecting his experience in Haiti The Evidence:
Slide 23-

Diabetes Care in the U.S.Harris. Diab Care 2000; 23:754-8McGlynn et al. NEJM 2003; 348:2635
Slide 24-

What’s Responsible for the Quality Chasm? Is it ignorant health professionals??
Slide 25-

The Evidence: Much of the variation in care is within a practice--i.e., same clinician treating similar persons differently Studies consistently show gap between professional knowledge and performance Educational interventions not very effective
Slide 26-

A Controlled Trial of Web-based Diabetes Disease Management Hospital-based internal medicine clinics Web tool links timely patient specific information to evidence-based decision support “Annual eye exam by eye care professional recommended” or “consider starting fluvastatin” Web consulted on 42% of visits 600 patients with Type II Meigs et al. Diabetes Care 2003; 26:750.
Slide 27-

Changes in Diabetes Outcome Measures in Intervention Group Meigs et al. Diabetes Care 2003; 26:750. Change in HbA1c -0.2% Change in BP 0.8/-1.8
Slide 28-

Conclusions Baseline levels of diabetes care quality about the same or worse than national averages Elegant cognitive intervention increased use of statins but not eye exams or glycemic or BP control Study conducted at Massachusetts General Hospital Why the poor baseline care, and why the feeble effect?
Slide 29-

What’s Responsible for the Quality Chasm? The IOM Quality Chasm report says: “The current care systems cannot do the job.” “Trying harder will not work.” “Changing care systems will.”
Slide 30-

Usual Chronic Illness Care Oriented to acute illness Focus on symptoms and lab results Patient’s role in management not emphasized Care dependent on provider’s memory and time Interaction often not productive, and frustrating for both patient and provider
Slide 31-

ppt slide no 31 content not found
Slide 32-

It’s like having a Dementor in the exam room!
Slide 33-

ppt slide no 33 content not found
Slide 34-

Disease Management Contains • Population Identification process (Registry) • Evidence-based practice guidelines (Chosen and agreed to by clinicians) • Collaborative practice model to include physicians and support-service providers • Risk identification and matching of interventions with need • Patient self-management education (may include primary prevention, behavior modification programs, and compliance/surveillance) • Process and outcomes measurement, evaluation, and management • Routine reporting/feedback loop (may include communication with patient, physician, health plan and ancillary providers, and practice profiling) • Appropriate use of information technology (may include specialized software, data registries, automated decision support tools, and call-back systems) From Disease Management Association of America, www.dmaa.org
Slide 35-

Randomized trials of system change interventions: Diabetes Cochrane Collaborative Review 41 studies, majority randomized trials Interventions classified as provider-oriented, organizational, information systems, or patient-oriented Patient outcomes (e.g., HbA1c, BP, LDL) only improved if patient-oriented interventions included All 5 studies with interventions in all four domains had positive impacts on patients Renders et al. Diabetes Care 2001;24:1821 Bodenheimer, Wagner, Grumbach. JAMA 2002; 288:1909
Slide 36-

Delivery System Design Practice team has defined roles, uses planned visits and clinical case management to support evidence-based care, and assures regular follow-up and care coordination
Slide 37-

Nurse Case Management RCT-Aubert et al.Change in Treatment and Glycemic Control Between Baseline and 12 Months
Slide 38-

ppt slide no 38 content not found
Slide 39-

Decision Support Use of evidence-based guidelines supported by proven provider education modalities, integration of specialty expertise, and reminder and fail-safe systems (e.g., standing orders)
Slide 40-

Clinical Information System: Registry A database of clinically useful and timely information on all patients provides reminders and feedback and facilitates care planning for individuals or populations
Slide 41-

Self-management Support What is self-management? “The individual’s ability to manage the symptoms, treatment, physical and social consequences and lifestyle changes inherent in living with a chronic condition.” Barlow et al, person Educ Couns 2002;48:177
Slide 42-

Self - Management What it isn’t Didactic Pt Education Sage on the Stage You Should…. Finger wagging Lecturing Waiting for patients to ask for help One time effort Commercial websites Remote monitoring devices What it is Emphasis on patient role Self-Care Skills Self-assessment Problem-solving Care planning Ongoing Empowering
Slide 43-

Effective Self-management Support Patient’s major role in managing her illnesses and treatment emphasized Her knowledge, behaviors and confidence routinely assessed Advice that is based on evidence and presented as information not scolding Clear, collaboratively established goals and treatment plan for improving self-management
Slide 44-

Follow-up Activities in Practice Essential to Sustain the Effect Assessment Collaborative Goal Setting Problem-solving Action Plan Arrange Follow-up
Slide 45-

Effects of Self-management Education on HbA1c Levels across 31 RCTs Norris et al, Diabetes Care 2002; 25:1159
Slide 46-

IF THIS WERE AN FDA DRUGPROPOSAL Generic: SELF-MANAGEMENT/SELF-CARE (Self-Management , Shared Decision-Making , Patient-Centered Care, Patient Education , Health Education , Behavioral Medicine , Mind/Body Medicine ) Indications and Effectiveness – Improves functional status and reduces ER and hospital days in patients with chronic illness – Decreases arthritis pain and office visits by 43% – Decreases cardiac events and risk by 75% – Reduces outpatient utilization by 7-15% Side Effects – Improved mood and patient satisfaction Dosage – PRN, wide therapeutic range Source: David Sobel, MD (KP)
Slide 47-

The Quality ChasmUsual Care versus Improved Care Readmission rates of patients hospitalized with CHF reduced by about 50% Recovery rates from major depression increased 50-100% Children with moderately severe asthma have symptoms 14 fewer days/year Anticoagulated patients in safe and effective range twice as frequently
Slide 48-

Can Real-world Practices Change their System of Care?Chronic Conditions Breakthrough Series Year-long collaborative quality improvement efforts involving multiple delivery systems and faculty Chronic Care Model guides comprehensive system change Three national BTSs with IHI, BPHC Health Disparities Initiative, and Regional BTSs in a dozen states Involving approximately 1000 different health care organizations and various diseases
Slide 49-

BPHC Diabetes Collaboratives 1and 2 involving 180 Community Health Centers and 38,000 diabetic persons Average HbA1c Values
Slide 50-

Results for All Asthma Teams Treatment with Maintenance Anti-Inflammatory Medications
Slide 51-

Premier Health Partners Dayton, Ohio 100 physicians in 36 practices Change began in one practice-spread throughout system ACE-inhibitors for albuminuria was 38% in 1999 and 80% in 2001 A1c < 7% was 42% in 1999 and 70% in 2001
Slide 52-

Disease Management Contains • Population Identification process (Registry) • Evidence-based practice guidelines (Chosen and agreed to by clinicians) • Collaborative practice model to include physician and support-service providers • Risk identification and matching of interventions with need • Patient self-management education (may include primary prevention, behavior modification programs, and compliance/surveillance) • Process and outcomes measurement, evaluation, and management • Routine reporting/feedback loop (may include communication with patient, physician, health plan and ancillary providers, and practice profiling) • Appropriate use of information technology (may include specialized software, data registries, automated decision support tools, and call-back systems) From Disease Management Association of America, www.dmaa.org
Slide 53-

Thank You