Joseph M. Geskey, DO, MBA Vice President Medical Affairs OhioHealth Doctors Hospital

Transcription

1 Joseph M. Geskey, DO, MBA Vice President Medical Affairs OhioHealth Doctors Hospital

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3 It appears, in fact, that a much smaller proportion of preventable mortality in the United States, perhaps 10-15%, could be avoided by better availability or quality of medical care. McGinnis JM, et al. Health Affairs.2002;21:78

4 Leading determinants of health and their contribution to early death Domains Genetic predisposition Social circumstanes Environmental exposures Behavioral patterns Medical care McGinnis. McGinnis et. al. Health Affairs. 2002;21:83

5 Low Health Literacy-Scope of problem Among adults who received Medicare or Medicaid, 27 percent and 30 percent, respectively, had Below Basic health literacy. Nearly 50% of adults who did not graduate from high school had Below Basic health literacy, compared with 15 percent of adults who ended their education with a high school diploma and 3 percent of adults with a bachelor s degree. Kutner M et al. National Center for Education Statistics; 2006.

6 Health Outcomes and Low Health Literacy

7 The Newest Vital Sign 1. If you eat the entire container, how many calories will you eat? 2. If you are allowed to eat 60 grams of carbohydrates as a snack, how much ice scream could you have? 3. Your doctor advises you to reduce the amount of saturated fat in your diet. You usually have 42 g of saturated fat each day, which includes one serving of ice cream. If you stop eating ice cream, how many grams of saturated fat would you be consuming each day? 4. If you usually eat 2,500 calories in a day, what percentage of your daily value of calories will you be eating if you eat one serving? 5. Pretend you are allergic to the following: penicillin, peanuts, latex gloves and bee stings. Is it safe for you to eat this ice cream? 6. If patient responds no to question 5): Why not?

8 4 Stages of Patient Activation

9 Goals of Disease Management VS

10 Combating the Wimpy phenomenon I'll gladly pay you Tuesday for a hamburger today".

11 Motivational Goal Have to Choose to Self motivation, rather than external motivation, is at the heart of creativity, responsibility, healthy behavior and lasting change

12 Tactical Approaches S M A R T Specific: Linked to overall goal (What will the patient do?) Measurable: How will you demonstrate and evaluate the extent to which the goal has been met? Attainable: How realistic, based on capabilities, is attainment of the goal? Relevant: How does the goal tie into and align with objective Time framed: Goals have a clearly defined timeframe (By when?)

13 The Teach-Back Method Schillinger D, et al. Arch Intern Med.2003;163(1):83-90.

14 Educational strategies for low health literacy patients Screen for health literacy and patient activation Tailor education based on literacy and activation level Employ helpful strategies for limited literacy patients --Use Teach Back to ensure verbal understanding --Present essential information by itself or first --Present information so that higher number is better --Present numerical info in tables rather than text -- Add icon arrays to numerical information --Adding video to verbal narrative Sheridan SL, et al. Journal of Health Communication: International Perspectives 2011;16:sup 3,30-54

15 Doctors Hospital Research Project CHF/COPD Inpatient NVS 0-1 PAM 13 English speaking, No dementia, OH Homereach Enrolled into 4 one hour home education sessions Measure 30-day readmits, PAM-13 and NVS scores Results to date 40 enrolled, 14% 30-day readmission rate OHHR 17.3% 30-day readmit rate (all pts) OHHR 29.4% CHF Medicare patients PAM-13 scores have increased by one level No change in literacy

16 Research Intervention Level 1: Establish role in self-care -Discuss experiences related to healthcare and disappointments with outcome Level 2: Confidence and Knowledge -Understand disease -Discuss lifestyle behaviors -Medication education Level 3: Skills & Behavior -Set behavioral goals -Link symptom improvement to behavior Level 4: Skills and Behavior under different situations -Explore potential difficult times and establish a problem-solving approach to achieve success

17 Samuel Beckett