Upload
iola-norman
View
33
Download
2
Embed Size (px)
DESCRIPTION
Connecting Strategies. Connecting Strategies. Pre. Pre. -. -. Identifying Community Resources. Identifying Community Resources. known services and expectations. known services and expectations. Developing Referral Guides. Developing Referral Guides. paper or electronic databases. - PowerPoint PPT Presentation
Citation preview
Common challenges across projects included: 1) need to monitor change in community resources and update contacts 2) re-training and buy-in related to staff turn-over 3) general practice interruptions resulting from new or modified EHRs
Primary care practices and community resources are committed to promoting healthy behaviors but struggle with broken, fragile, and often completely lacking infrastructure to link their efforts.
Integrating Linkages Between Primary Care Integrating Linkages Between Primary Care Practices and Community Resources to Promote Practices and Community Resources to Promote
Healthy BehaviorsHealthy Behaviors Deborah J. Cohen, PhD1; Rebecca S. Etz, PhD1;
Maribel Cifuentes, RN, BSN2; Larry A. Green, MD2; Linda J. Niebauer2
1University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Somerset, NJ, 2University of Colorado Denver, School of Medicine, Denver, CO
Analysis of Change Strategies
Strategies for Change
Lessons Learned and Key Messages
Context and ProblemThe health behavior choices people make are lived out not in a doctor’s office, but in communities.Primary care practices are key settings for identifying unhealthy behaviors (50% of all U.S. office visits annually).Prescription for Health’s mission was to identify, test, and evaluate practical tools and strategies to address: Smoking Unhealthy Diet Lack of Physical Activity Risky Drinking
Project Strategies for Change1
ACORNRichmond, VA
5As-based intervention using Electronic Health Record (EHR) prompts to counsel and refer at-risk patients to four pre-identified resources: web-based counseling, telephone counseling, and group counseling through Weight WatchersTM.
2OKPRN
Oklahoma City, OK
Practice enhancement assistants provide training, monthly performance feedback, and change facilitation. Practices participate in local Quality Improvement (QI) collaborative. EHR-based health risk assessment (HRA) as part of vital signs process. Clinician counseling and referral to community resources for at-risk patients.
3NYCRINGBronx, NY
Reframe 2 year-old well child visit to focus on obesity risk and behavior change. Used new screening tool for HRA, brief clinician counseling and referral to lifestyle coach for intensive counseling and further referral to community resources.
4AAFP
Leawood, KS
Integration of proven interactive telephone voice response system (IVR) into practice. Clinicians provide brief messages, educational materials, and referral to IVR. Patients interact with IVR for weekly counseling and evaluation.
5PRENSA
San Antonio, TX
Extended role of medical assistants to identify patients at-risk for unhealthy behaviors, provide brief counseling, and referral to pre-identified health system and community resources. Use of existing electronic HRA system.
6CECH
Hanover, NH
PDA-based electronic health screener to identify at-risk adolescent patients and to enhance communication and brief counseling offered by physicians. Resource card and referral to community resources for at-risk patients. Listserv made available to share best practices among participating offices.
7NCFMRN
Chapel Hill, NC
Participation in prevention collaborative to promote screening, counseling, and use of electronic and community resources through joint planning and collaborative meetings with local and state agencies. Designated liaison to link practices and community resources. Self-administered patient HRA using tablet PC, prevention registry, brief physician counseling and referral for at-risk patients.
8GRIN
East Lansing, MI
Community Health Referral Liaison role (CHERL) established as adjunct referral mechanism for at-risk patients identified by the practice. CHERL received faxed referral and provided phone counseling and referral to community resources using a guide created pre-intervention. CHERL monitors progress and provides feedback to practices.
Mixed methods evaluation of the Prescription for Health initiative conducted by independent team
Data analyzed included grant applications, site visit field notes and reports, key informant interviews, and diary data
Online diaries kept by each project via bi-weekly entries made over two-year period
Diary data used to understand projects’ implementation experience
Prescription for Health is a national program of the Robert Wood Johnson Foundation in collaboration with the Agency for Healthcare Research and Quality
Visit us at http://www.prescriptionforhealth.org
Eight Prescription for Health projects tested various tools and strategies to identify, counsel, and provide referrals to a diverse population of at-risk patients.
Effects of Changes
Availability of Resource
Affordability of Resource
Accessibility of Resource
Perceived as Value Added
Anchor – Community Resources
Capacity for Risk Assessment
Ability for Brief Counseling
Capacity and Ability to Refer
Awareness of Community Resources
Anchor – Primary Care
Opportunity
to activate
Opportunity
to encourage
Connecting Strategies
Pre - Identifying Community Resources
known services and expectations
Developing Referral Guides
paper or electronic databases
Engaging External Intermediaries
single - point access to resources
Patient Referral
Availability of Resource
Affordability of Resource
Accessibility of Resource
Perceived as Value Added
Anchor – Community Resources
Capacity for Risk Assessment
Ability for Brief Counseling
Capacity and Ability to Refer
Awareness of Community Resources
Anchor – Primary Care
Opportunity
to activate
Opportunity
to encourage
Connecting Strategies
Pre - Identifying Community Resources
known services and expectations
Developing Referral Guides
paper or electronic databases
Engaging External Intermediaries
single - point access to resources
Patient Referral
The projects built a bridge between practices and community resources by using one or more of the following: 1) Pre-identified resource options, 2) Referral guides, 3) External intermediaries. The bridge is anchored on one end by practice characteristics and the other end by community resource characteristics.
Integration of health behavior change strategies into existing systems of care is problematic.Key challenges: fragmented nature of U.S. healthcare system lack of connectivity between practices and services in the community that are needed to
enable behavior change lack of adequate reimbursement lack of appropriate training for practice teams lack of resources necessary to build new care processes and capacities
Need to reach beyond practice walls to establish integrated linkages with existing informational and community resources.
Data entered into ATLAs.ti TM database
Codes and emergent themes identified through series of immersion/crystallization cycles
Emergent theme of “linking” and a general model for linking unfolded
Model for linking included practice and community resource characteristics that influenced ability to initiate, facilitate or prevent connections
The projects’ experience appear to support sociologist Ronald Burt’s hypothesis that “people who stand near holes in the social structure are at higher risk for having good ideas.”
A paradigm shift is necessary. Practices should think of their patients as populations and public health officials should think of practices as key partners in reaching the populations they serve.
Brokers and boundary spanners can play an important role in fostering integrated, systematic solutions for practices and communities.