Session #3 | Supporting Implementation Strategies: Workflows and Communication Techniques to Collect and Use SDOH DataMay 21, 20211:00 – 2:00 pm CT
Dr. Jack Geiger and Dr. John Hatch during construction on the Delta Health Center in Mississippi in 1968 (Photo by Daniel Bernstein)
Shannon RobertsonDirector of Clinical Quality
Courtney SanfordClinical Quality Coordinator
Louisiana PCA Staff Opening Remarks
Session #3: Supporting Implementation Strategies: Workflows and Communication Techniques to Collect and Use SDOH Data
© 2021. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. PRAPARE and its resources are proprietary information of NACHC and its partners, intended for use by NACHC, its partners, and authorized recipients. Do not publish, copy, or distribute this information in part of whole without written consent from NACHC.
Louisiana Primary Care Association (LPCA)Social Determinants of Health (SDOH) Webinar Series
May 21, 2021
Albert Ayson, Jr., MPHAssociate Director, Training & Technical Assistance
AAPCHO
Joe Lee, MSHADirector of Strategic Initiatives & Partnerships
AAPCHO
PRAPARE Team at NACHC & AAPCHO
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PRAPARE Team at NACHC & AAPCHO
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Our National PRAPARE Partnership
Rosy Chang WeirDirector of Research
AAPCHO
Vivian LiResearch Project Manager/Analyst
AAPCHO
Albert Ayson, Jr.Associate Director, T/TA
AAPCHO
Joe LeeDirector of Strategic
Initiatives & PartnershipsAAPCHO
Michelle ProserDirector of Research
NACHC
Sarah HalpinProgram Associate
NACHC
Yuriko de la CruzSDOH Manager
NACHC
Nalani TarrantDeputy Director, Research
NACHC
LPCA Social Determinants of Health Webinar Series
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Friday, May 28, 2021
Session #4 | Supporting Implementation Strategies: Workflows and Communication Techniques to Collect and Use SDOH Data (continued)
Friday, May 14, 2021
Session #2 | Messaging and Engaging Key Stakeholders Around SDOH Data Collection
Friday, May 21, 2021
Session #3 | Supporting Implementation Strategies: Workflows and Communication Techniques to Collect and Use SDOH Data
Friday, May 7, 2021
Session #1 | Strategies to Support SDOH Data Collection and Implementation
Session #3 Learning Objectives
1. Strategize SDOH data collection and health center implementation plans, including ideal workflow models for your population(s) of focus
2. Promote empathic inquiry & patient-centered approaches for collecting SDOH data
3. Practice cultural humility when screening patients for SDOH needs
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Learning Objective #1Strategize SDOH data collection and health center implementation plans, including ideal workflow models for your population(s) of focus
Introduction: Five Rights Framework
© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 8
5 Rights Framework
5 Rights Workflow Considerations
Right Information--WHAT What information in PRAPARE do you already routinely collect?• Part of registration• Part of other health assessments or initiatives
Right Format--HOW How are we collecting this information and in what manner are we collecting it?• Self-Assessment• In-person with staff
Right Person--WHO Who will collect the data? Who has access to the EHR to input the data? Who needs to see the information to inform care? Who will respond to needs identified? • Providers and other clinical staff• Non-Clinical Staff
Right Time--WHEN When is the right time to collect this information so as to minimize disruption to clinic workflow?• Before visit with provider? (before arriving to clinic, while waiting in waiting room, etc.)• During visit?• After visit with provider?
Right Place--WHERE Where are we collecting this information? Where do we need to share and display this information?• In waiting room? In private office?• Share during team huddles? Provide care team dashboards?
9© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association.
Sample PRAPARE Workflow Models for SDOH Data Collection
Who Where When How RationaleNon-clinical staff (patient navigator, community health workers)
In waiting room or in staff office
Before or after provider visit
Administered PRAPARE with patients who would be waiting 30+ mins for provider
Provided enough time to discuss SDH needs. Wanted same person to ask question and address need. Often administer PRAPARE with other data collection effort (Patient Activation Measure) to assess patent’s ability and motivation to respond to their situation.
Nursing staff and/or MAs
In exam room Before provider enters exam room
Administered it after vitals and reason for visit. Provider reviews PRAPARE data and refers to case manager
Wanted trained staff to collect sensitive information. Waiting area not private enough to collect sensitive info
Care Coordinators In office of care coordinator
When Completing chart reviews and administering Health Risk Assessments
Administered PRAPARE in conjunction with Health Risk Assessments
Allows care coordinators to address similar issues in real time that may arise from both PRAPARE and HRA
Any staff (from Front Desk Staff to Providers)
No wrong door approach
No wrong door approach Allows everyone to be part of larger process of “painting a fuller picture of the patient” and taking part in helping the patient
Patient Self-Assessment
At home, in waiting room, etc.
Before visit with provider Self-administered using email, mobile, tablets, kiosks, etc.
Low burden on staff to collect data. Privacy for patient to complete assessment. Utilize time when patient would otherwise be waiting. Staff time can be used to discuss results with patients to address needs.
© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 10
PRAPARE is Now in 26 Languages!
Respond to Needs
• Validated at community health centers for comprehension and cultural competence• New additions include:
Tongan
Swahili
French
Uzbek
Nepali
Lao
Karenni
Chuukese
Bengali
Marshallese
Khmer Karen
Hindi
Russian
Farsi
German
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© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 12
PRAPARE EHR Templates
• FREE EHR Templates Available:• Epic• Cerner*• NextGen*• eClinical Works• Athena• athenaPractice
(formerly GE Centricity)• Greenway Intergy
Available for FREE after signing EULA at www.nachc.org/prapare
• In Development:• Allscripts• Meditech
70% of all health centers
Current 7 + New EHRs = 85-95% of all health centers
* Automatically map to ICD-10 Z codes so you can easily add relevant Z codes to problem or diagnostic list
Recorded demos of each PRAPARE EHR template available at www.nachc.org/prapare
EHR Example #1: eClinicalWorks -Social History Notes
Instructions or the PRAPARE eCW Configuration guide available in Chapter 4 of PRAPARE Implementation and Action Toolkit at www.nachc.org/prapare
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EHR Example #1: eClinicalWorks -Smart Form
PRAPARE eCW Smart Form available in Chapter 4 of PRAPARE Implementation and Action Toolkit at www.nachc.org/prapare
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EHR Example #2: NextGen Template
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EHR Example #3: Greenway Intergy Template
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Need Intergy 11 or higher
Some data in demographics as usual
Other data in PRAPARE template
Health Choice Network has crosswalk
EHR Example #3: Greenway Intergy PRAPARE Report
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EHR Example #4: Athena (Pilot Phase)
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FIRST STEPS TO GET STARTED:Start Where You Are!
1) Engage staff and leadership to identify what other initiatives PRAPARE adds value to
1) Engage staff & patients using 3 X 10 approach so everyone can see how data can be used for care transformation, etc.
1) Complete PRAPARE Readiness Assessment to identify strengths and gaps in capacity (www.nachc.org/prapare)
1) Crosswalk PRAPARE with other data already collected at your organization
1) Select Population of Focus
1) Determine Workflow Model and Staff Involved—Accept all Volunteers!
1) Test PRAPARE EHR template & implementation model with small group (PDSA, 3 X 10 model)
1) Review and update community resource guides to see what’s available to respond to needs
1) Plan out how/when will use data & report on progress & share data with staff and leadership—helps with buy-in
© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association.
Example: SDOH Screening Workflow Process Map
Acknowledgement: Winters Healthcare
20© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association.
Example: SDOH Screening Workflow Process Map
Acknowledgements: Community Health Care Association of New York State (CHCANYS) and HRHCare
21PDF: https://files.constantcontact.com/b6bde37a401/88fa3464-eed6-4898-8a63-0e4ad81aa8bf.pdf
© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association.
Preview of Oregon PCA Workflow Builder
© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 22
OPCA Workflow Builder - MS Excel Document
Breakout Groups & Discussion Guide
© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 23
Breakout Group #1Facilitators: Albert• Discussion Guide (click here)
Breakout Group #2Facilitators: Joe• Discussion Guide (click here)
• Messaging and Engaging Key Stakeholders Around SDOH (20 minutes)○ Access the Google Document, share your ideas, and discuss!
• Large Group Reflection (10 minutes)
Learning Objective #2Promote empathic inquiry & patient-centered approaches for collecting SDOH data
Empathic Inquiry: What is it?
© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 25
• Data collection - the process of gathering and measuring information on variables of interest, in an established systematic fashion that enables one to answer questions and evaluate outcomes
• Assessment -an evaluation of the health status of an individual by performing an examination and/or asking questions. The depth of investigation and frequency vary.
• Empathic Inquiry – the act of asking for information with the intent of understanding the patient’s experiences, concerns and perspectives, combined with a capacity to compassionately communicate this understanding for the purpose of creating human connection between patients and professionals.
Why does empathic inquiry matter?
© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 26
• A review of 25 randomized trials stated, ‘‘One relatively consistent finding is that physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consultations formal and do not offer reassurance’’ (Di Blasi et al, 2001)
• “A retrospective analysis of psychiatrists treating patients with depression reported that practitioners who created a bond had better results in treating depression with placebo than did psychiatrists who used active drug but did not form a bond.” (McKay et al, 2006)
• In a randomized controlled trial studying subjective and objective markers of the severity and duration of infection with a common cold, patients were randomized to three groups: 1) no practitioner interaction, 2) practitioner interaction with effort to limit relationship formation through brevity, lack of eye contact and touch, 3) practitioner interaction enhanced by PEECE:(P) Positive prognosis, (E) Empathy, (E) Empowerment, (C) Connection and (E) Education, as well as a few more minutes of time, eye contact and touch. (Rakel et al, 2010)
Empathic inquiry: Key Elements
© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 27
• Reflective Listening • Affirmations • Autonomy support – “is it ok to review this with you?”
“at any point, you can let me know you’d like to stop.” • Noting strengths of individual • Asking about patient priorities and preferences • Connecting to resources where are appropriate and/or
available
Oregon PCA’s Emptathic Inquiry
© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 28https://youtu.be/9rfmfsMMeEU
Learning Objective #3Practice cultural humility when screening patients for SDOH needs
“Integrated patterns of human behavior that includes the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.”
Source: HHS Office of Minority Health, 2002; Graves, 2011
Defining “Culture”
Defining Cultural Competency
“Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.”
Sources: Alameda County Public Health Department, California; The National Standards for Culturally and Linguistically Appropriate Services in Health Care, adapted from Cross T, Basron B, Dennis K, Issacs M (1989)
Defining Cultural Humility
“Does not require mastery of lists of different cultures and particular health beliefs and behaviors. Entails developing a respectful partnership with diverse individuals, groups, and communities.”
Cultural Competency and Cultural Humility
Source: Tervalon and Murray-Garcia, 1998
Cultural Humility Values
Openness Appreciation Acceptance Flexibility
Cultural Humility Framework
Lifelong learning and critical self-
reflection
Recognizing and changing
power imbalances
Developing institutional
accountability
Source: Tervalon and Murray-Garcia, 1998
Cultural Humility Strategies - Sample
• Motivational Interviewing• Empathy Effect
Lifelong learning and critical self-reflection
• Recognition of Power and Privilege• Patient-Centered Care / Patient as
Expert
Recognizing and changing power
imbalances
• Training and Hiring for Diversity• Adopting National CLAS Standards
Developing institutional accountability
Sources: Tervalon and Murray-Garcia, 1998; AAPCHO, 2021
Respond to Needs
Q&A
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Thank you for joining us!
Joe Lee, [email protected]
Albert Ayson, Jr., [email protected]
Twitter: @prapare_sdoh
Join our Listserv Email: [email protected]
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Closing Remarks & Session Evaluation
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See you next week!Session #4 | Supporting Implementation Strategies: Workflows and Communication Techniques to Collect and Use SDOH Data (continued)May 28, 2021 | 1:00 – 2:00 pm CT
Learning Objectives:1. Develop workflow models for collecting SDOH data and selecting
population(s) of focus2. Promote empathic inquiry & patient-centered approaches for collecting
SDOH date3. Practice cultural humility when screening patients for SDOH needs
Click here to register for the SDOH webinar series