DOQIT University

1
DOQ-IT University
2
DOQ-IT University

• Description
• Doctors Office Quality-Information
  Technology University (DOQ-IT U) is a compilation
  of interactive, Web-based learning modules
  designed to guide physician offices through the
  various phases of IT adoption and care
  management. Each module includes education and
  strategies to facilitate electronic health record
  (EHR) and care management improvement.

3
CME Opportunities

• CME Opportunities may be available for
  Performance Improvement CME and Category 2 CME.
  Additional information is available at
  http//www.ama-assn.org.
• Certificates of completion are available upon
  completion of each module.

4
DOQ-IT Categories

• Overview
• EHR Adoption
• Care Management
• Tools and References
• About this Site

5
EHR Adoption Modules

• Assessment
• Planning
• Culture Change
• Vendor Selection
• Operational Redesign
• Implementation
• Education/Improvement

6
Care Management Modules

• Care Management Overview
• Patient Self-Management
• Creating a Team and Supportive Physical
  Environment
• Guidelines, Decision Support and Measurement
• Care Management in Action

7
Module I

• Care Management Overview

8
Care Management Activities

• Patient Specific
• Patient Engagement
• Assessment
• Planning
• Implementation
• Evaluation and Measurement
• Coordination

9
The Patient Care Plan

• A well formulated patient care plan
• should be
• Created by the clinical care team and the patient
• Based upon the patients demographics and
  conditions
• Inclusive of evidence-based clinical guidelines
• Uniquely tailored to the patients needs

10
The Patient Care Plan

• The patient care plan is developed
• collaboratively by the physician, staff and
• patient and includes two elements
• - Medical Management
• - Patient Self-Management Plan
• Handout 1

11
Patient Self-Management Plan

• Key Activities
• Monitoring and problem solving
• Medication administration
• Skills and strategies to manage S/S
• Diet and physical activity
• Coping with emotions
• Reducing unhealthy behaviors

12
Developing an Action Plan

• Key steps to providing self-management
• support are
• - Collaboratively set a goal
• - Develop an action plan to meet the goal
• Arrange follow up to review progress toward
• that goal

13
Care Management

• Definition
• Care Management refers to a set of
  evidence-based clinical care activities tailored
  to the individual patient to ensure each has his
  or her own coordinated plan of care and services.
  Care plans are developed collaboratively and are
  designed and implemented to optimize the
  patients health status and quality of life.

14
Discussion

• How does your office approach care management?

15
Developing an Action Plan

• Physicians are most familiar with the medical
  section of the care plan. Creating the
  self-management element and the patient action
  plan can be less familiar and, therefore, more
  challenging.
• Changes to the care plan should be updated by all
  members of the health care team.
• Provide a copy of his/her plan to each patient.

16
Determining Care Management Goals

• Assess your practice
• Prepare your practice
• Set up optimal care management processes and
  template (Care Management in Action)
• Apply the template to specific conditions

17
Setting Targets for Major Improvement Efforts

• Identify gaps in care delivery improvement
• processes through
• Patient feedback
• Staff feedback
• Physician professional development efforts
• Available population management tools and
  resources
• Payer actions

18
Selecting Targets for Major Care Improvement
Efforts

• Consider
• Preventive care and/or disease opportunities
• Practice clinical focus
• Payer focus (P4P)
• Patient outcome improvement
• Financial status improvement
• Practice infrastructure

19
Module II

• Patient Self-Management

20
Self-Management Support

• The three domains of self-management
• are
• Managing symptoms and disease activity (medical)
• Carrying out normal activities (role management)
• Coping with emotions (emotional management)

21
Self-Management Support (cont.)

• To address these domains, patients
• must engage in a range of self-
• management activities, including
• Monitoring their symptoms and disease activity
• Taking medication
• Adjusting regimens and activity to symptoms
• Choosing proper diet

22
Self-Management Support (cont.)

• Engaging in physical activity
• Reducing unhealthy behaviors
• Seeking professional services
• Coping with a range of emotions

23
Self-Management Support (cont.)

• Old Process of Care
• Assumes knowledge drives change
  
• Clinician sets agenda
• Goal is compliance
• Decisions made by caregiver

• New Process of Care
• Assumes knowledge plus
• confidence drives change
• Patient sets agenda
• Goal is enhanced confidence
• Decisions made collaboratively

24
The Fundamentals

• Fundamentals include
• Relationship building
• Exploring patients needs, expectations and
  values
• Information sharing
• Collaborative goal setting

25
Fundamentals (cont.)

• - Action Planning
• Building skills and problem solving
• Following up on progress

26
System Dynamics

• System Redesign
• Redesign clinical flows to distribute
  responsibility
• for self-management support to several members
• of the team.
• Tools and Resources
• Tools and resources can assist the team to
  deliver
• self-management more efficiently.

27
System Dynamics

• Information Technology
• EHR technology can help document and track
  progress, prompt clinicians and patients and
  enhance information exchange.
• IV. Community Resources
• Links to community resources and programs can
  help clinicians and patients to address
  educational and self-management needs.

28
Relationship Building

• Key Skills Include
• I. Open-ended Inquiry
• Allows patients to share ideas, concerns, and
• expectations in their own words
• II. Reflective Listening
• Enables the clinician to understand the patients
  
• thoughts
• III. Expressing Sympathy
• Allows the patient to feel heard and understood

29
Conviction and Confidence

• Determining the patients conviction and
  confidence levels provides the clinician with
  insight into the patients likelihood of
  successfully changing.
• A confidence scale might be helpful in
  determining a patients level of conviction and
  confidence in successful change.
• Handout 2

30
Information Sharing

• Ask-Tell-Ask
• Askgt For permission to explain clinical
• information
• Askgt What the patient already knows
• Tellgt Adjust your information to the level of
• patient understanding
• Askgt The patient to repeat key elements of the
• information to ensure understanding

31
Action Planning

• Includes assisting patients to
• Identify specific steps and strategies to achieve
  the self-management goal
• Choose tools and resources to enhance goal
  attainment
• Anticipate potential barriers
• Decide on a specific plan
• Handout 3

32
Skill Building

• Patients need both skill and confidence to
• effect behavioral changes, including
• Monitoring disease activity
• Responding to symptoms
• Taking medications
• Changing behavior
• Coping with emotions
• Developing problem-solving skills

33
Problem Solving

• Problem solving usually includes the
• following
• Identifying past successful strategies
• Brainstorming other possible strategies
• Sharing ideas from others
• Rating the attractiveness and potential
  effectiveness of strategies
• Choosing and tracking a specific strategy or
  strategies

34
Following up on Progress

• The follow-up plan should be specified in
• the action plan and should include
• Timing (specific date and time)
• The person who will initiate the follow-up
  contact (patient, team member, etc.)
• The format for how follow-up will occur (call,
  visit, electronic contact, etc.)

35
Following up (cont.)

• Follow-up provides an opportunity to
• assess the patients progress or lack
• thereof
• Inquire about the patients progress.
• Identify and reinforce progress.
• Identify slips or lapses (by expressing empathy
• and affirmation of the patients efforts and
  reframing the slip as an opportunity to learn
  rather than as failure).

36
Following up (cont.)

• Identify existing or potential barriers and
  obstacles.
• Use a problem-solving approach to address
  barriers.
• Revise the action plan to address the same goal
  or add a new goal.
• Establish the next follow-up contact.

37
Putting it all Together

• Break down the tasks
• Consider how and when to accomplish each
  of the self-management support steps during the
  visit.
• II. Use your staff
• Ensure that each staff member is practicing to
  
• the top of his or her capability.
• Consider outside resources to supplement
• education and disease management.

38
This material was prepared by Quality Insights of
Pennsylvania, the Medicare Quality Improvement
Organization for Pennsylvania, under contract
with the Centers for Medicare Medicaid Services
(CMS), an agency of the U.S. Department of Health
and Human Services. The contents presented do not
necessarily reflect CMS policy. Publication No.
9SOW-WV-PA-DE-PREV-08.7 App 9-08