PATIENT EDUCATION SANFORD STANDARD Enhancing the Patient and Employee Experience Strengthening Health Outcomes Lowering Costs
1 out of 3 patients canâ€™t explain their medications. (Care About Your Care., 2013)
There is perhaps no more critical time than now to shift focus from the health literacy skills of patients to the health literacy-promoting attributes of health care organizations. (Schillinger & Keller, 2012)
PATIENT EDUCATION SANFORD STANDARD VISION Sanford will emulate health literacy attributes within a standardized strategy for the development and management of patient education. The standard will ensure all patients receive quality education and information that promotes enhanced patient and staff experiences, optimal health outcomes and lowered costs. Patient/family/resident and care team conversations are enhanced through use of teaching best practices. These patient teaching strategies include:
ART OF CONVERSATION The teaching process is enhanced when individualized through assessment of: • Preferred learning methods • Current knowledge and confidence level (self-efficacy) • Readiness to make a change (informed through Motivational Interviewing philosophy) • “Need to know” and “need to do” with visual aids when appropriate • Understanding using plain language and teach back
One study examined the use of teach-back among patients with ambulatory care sensitive conditions (ACSCs). Patients who had teach-back experience as part of their care had a 15% lower risk of being admitted (23% lower risk for repeated hospitalization) compared to those without teach back. (Care About Your Care., 2013)
Sixty-five percent of 30-day re-admissions are linked to health literacy issues (Choudhry et al., 2016) Am J Surg. 2016 Mar;211(3): 631-6. doi: 10.1016/j.amjsurg.2015.12.005. Epub 2015 Dec 28.
HEALTH LITERACY Health literacy is defined as the ability to obtain, process, and understand basic health information and services needed to make appropriate health decisions. The patient is able to make appropriate health decisions when the application of patient education science is used through: • use of plain language
• relevant illustrations
• balance of text and white space
• emphasis on the “need to know”
INDIVIDUALS WITH LIMITED HEALTH LITERACY: • Ask fewer questions about their medical care (Menendez et al., 2017)
• Face increased risks of hospitalization and death with a diagnosis of heart failure (Fabri et al., 2017)
• May contribute to opioid misuse with patients who have chronic pain (Rogers et al., 2019)
• Often struggle with self-management skills when suffering from chronic pain (Mackey et al.,2018)
• Have more return phone calls and re-admissions (Choudhry et al., 2019)
It is estimated that poor health literacy contributes an estimated $58 billion in annual health care spending. (The Right Patient Education Tools, 2014).
Most Care is Self Care. Information is best remembered when: â€˘ Presented orally - 14% â€˘ Presented orally along with a visual aid - 80% (Kessels, 2003)
1 out of 2 patients can’t state their diagnosis after leaving the hospital. (Care About Your Care., 2013)
TEACH BACK Teach back involves asking the patient to repeat back critical information in their own words (or demonstrate a self-care task). It is not a quiz for the patient, rather it assesses how well they were taught. Stories highlighting importance of teach back to prevent misunderstandings and link to patient safety: • A mother pours antibiotic medication in her child’s infected ear instead of giving by mouth • A patient takes 2 pills instead of 1 pill when picking up his new prescription when dosage had been increased
Fewer than one-third of adults whose provider gave them instructions reported being asked to describe how they would follow the instructions (e.g., used teach back). (AHRQ, 2019)
EVIDENCEBASED HEALTH LITERACY
ACCURATE AND UNBIASED
AN CE D
MES TCO OU
LOWE RED CO ST
IMPRO VED R D HE E COO INATION R A C AL
IE R E P X PAT IENT AND STAFF E
Deploying a scalable, robust patient education program is central to elevating patient engagement and ultimately serves as a cornerstone of a winning population health management strategy. (The Advisory Board Company, 2015)
Care Coordination: supporting person’s confidence in successful self-care management throughout the continuum of care
FUNDAMENTAL CONCEPTS Health Literacy
• U se of clear, simple, and concise language
• Consistent through multiple portals across the continuum of care
• Focus on essentials
• Convenient for end-users
• Interactive elements
• Relevant illustrations Accurate and Unbiased • Free of commercial bias
• Current and understood Evidence-Based • Scientifically based • Best practice
Individualized • Varied formats to meet individual needs
• Personalized using best practices of learning needs assessment, teaching, and adult learning principles
• Use of EHR and My Sanford Chart Electronic Integration • Assures content is current and up-to-date • Risk protection
• Centralized platform for dynamic use Regulatory Compliance • Meets accreditation standards • Requirement adherence
• Nimble response to change Meaningful Use • Captures regulated reimbursement • Access through MyChart Fiscal Responsibility
Patient Education resources are most helpful when written in the person’s preferred language.
• Standardized material
• Tight alignment to organizational initiatives • Economies of scale
One-third of the newly insured under the Affordable Care Act are non-English speaking. 9
Patient education is a core attribute of the Electronic Health Record.
ALIGNMENT OF ELECTRONIC PATIENT EDUCATION RESOURCES Krames StayWell on Demand in One Chart
Krames StayWell on Demand patient education is integrated within One Chart for health information sheets specific to problem lists or documented diagnoses. Health Information Library on public website Sanford public website access provides health promotion information through digitalized interaction tools such as videos, symptom checker, podcasts, and written information. Discharge 123 (ED Discharge Instructions) Provides standardized discharge instructions for all ED physicians to use for patient education. Krames StayWell video collection for clinics and medical centers Video patient education library provides animated 3D illustrations with printed options. All can be viewed concurrently from multiple access points and prescribed in One Chart prior to or after visits.
Sanford is creating a patient education infrastructure to provide a robust centralized repository of automated patient education resources to all end users and patients.
My Sanford Chart Info Button Integration of Krames StayWell content within My Sanford Chart provides access via PC to Krames Health Information Library and hyperlinks for more information about labs, problem list, etc.
World Clinic Health Library & Krames StayWell on Demand Implementation of Krames StayWell on Demand and Health Library online resources in Costa Rica. Sanford Health Plan Employee Wellness Platform
Platform offers a variety of tools and resources to educate, motivate and support health plan members on their wellness journey. Mobile App Integration of Health Library Mobile access to hundreds of interactive health information videos, quizzes, symptom checker, and pod casts added to the Sanford app.
EMERGING GLOBAL TRENDS 3/4 of the world’s inhabitants have access to a mobile phone, a greater proportion than that of people with access to essential medicines. (National Academy of Sciences, 2013)
44% of those users
people have access to hospital beds.
are in rural areas.
people have access to computers.
people use mobile phones.
DIGITAL PATIENT EDUCATION GUIDING PRINCIPLES • Patient education aims to support patients/clients/residents to be successful in managing their own health. • Educational technology, when leveraged well, can augment but does not replace patient teaching. (London, 1999). • Regardless of modality, assessment of patient’s preferred learning style and barriers is key. (National Academy of Sciences, 2013) Digital Literacy issues affect 16% of adults in the U.S (Mamedova & Pawlowski, 2018). • Efficient work flows are imperative to support successful optimization of educational technology.
SIGNIFICANT MILESTONES AND ACHIEVEMENTS • Advisory Council provides oversight, feedback, and strategic direction. • Implementation and communication plan for enterprise adoption of Patient Education Standardization Strategy established. • Patient Education Sanford Standard courses are core to current and new staff who teach patients. • Patient Education Sanford Standard education provided to all physicians in quarterly mandatory education. • All new providers recieve this education in orientation. • Pocket guide created quick reference by staff for approved quick reference to approved patient education resources. • Provision of quarterly newsletter. • Integration within emerging care delivery models. • Blue ribbon recipient of multiple poster sessions. • Local, state and national dissemination of achievements. • Expanded patient education platform to world clinic to reach and support world clinic customers. • Establishment of formal enterprise periodic review process to assure currency of materials. • Establishment of Interprofessional team to create vision for a digital patient education strategy.
SANFORD GLOBAL GOALS AND OBJECTIVES • Advance Patient Education Standardization Strategy nationally and globally within footprint. • Optimize standardization platform including all mediums: print on-demand, My Sanford Chart, sanfordhealth.org, and videos in multiple languages. • Expand blended learning opportunities to enhance skill development of staff and providers in assessment and patient teaching. • Advance value analysis workflows and processes to realize streamlining and cost savings. • Expand dashboard metrics to include user activity, user activity, trends, and opportunities to partner in strategic care delivery areas. • Leverage established communications plan to assure maturation of understanding and implementation of Patient Education Sanford Standard. • Deepen robust collection of brief “need-to-know” handouts (level 1) in the EHR. • Hardwire a digital patient education strategy. • Establish a robust resident teaching strategy in long term care.
PATIENT EDUCATION SANFORD STANDARD STRATEGIC OUTCOMES 1. E NHANCED PATIENT AND STAFF EXPERIENCE
Service line standardization: • Cardiovascular resources
The Standard contributes to a seamless patient and staff experience at all points of care. It provides efficient access to patient education resources and streamlined work flow processes.
• Enterprise Pre-Surgical Patient Education Guide
2. IMPROVED HEALTH OUTCOMES
• Orthopedic Joint Replacement
A standardized process offers three critical benefits to health outcomes. • First, it supports the strategies of highly reliable, safe care as it provides caregivers assurance that they have convenient and consistent access to evidence-based materials to complement patient teaching. • Second, it provides reinforcement of measures identified to support plans of care, reducing risk and liability. • Thirdly, it contributes to significantly improving overall quality of care by complementing care management strategies and supporting persons being successful and confident in self-care management across the continuum of care. • Sanford initiative examples of coordinated patient education:
• Pediatrics (general and specialty) • Oncology tumor types • Infusion of self-efficacy in group-based initiatives such as Better Choices, Better Health® and Diabetes Prevention Program
3. LOWERED COSTS Seamless navigation across the continuum of care requires the leveraging of consistent patient education teaching and related resources to align with care coordination and organizational strategy. It is important to continue to standardize written material to reduce waste. The Standard drives resources to be vetted in a cost effective way. By defining and adopting a standardized patient education strategy, Sanford Health will significantly enhance patient quality and experience while reducing risk and cost. Cost avoidance will be realized as we embrace a health literacy-promoting standard.
• Colorectal Screening
References: Agency for Healthcare Research and Quality Publication No. 18(19)-0033-8-EF (2019). More effort is needed to ensure patients understand doctors’ instructions. Retrieved from: https://www.ahrq.gov/sites/default/files/wysiwyg/research/ findings/nhqrdr/dataspotlight-health-literacy.pdf Care About Your Care. (2013). Ten things you should know about care transitions [PDF file]. Robert Wood Johnson Foundation. Retrieved rom https://www. rwjf.org/en/library/research/2013/01/ten-things-you-should-know-aboutcare-transitions.html Choudhry, A. J., Baghdadi, Y. M., Wagie, A. E., Habermann, E. B., Heller, S. F., Jenkins, D. H., . . . Zielinski, M. D. (2016). Readability of discharge summaries: With what level of information are we dismissing our patients? The American Journal of Surgery 211(3), 631-636. doi: 10.1016/j.amjsurg.2015.12.005 Choudhry, A. J., Younis, M., Ray-Zack, M. D., Glasgow, A. E., Haddad, N. N., Habermann, E. B., . . . Zielinski, M. D. (2019). Enhanced readability of discharge summaries decreases provider telephone calls and patient readmissions in the posthospital setting. Surgery, 165(4), 789-794. doi:10.1016/j.surg.2018.10.014 Davis, C. (2019). What is teach-back? Institute for Healthcare Improvement. Retrieved from: http://www.ihi.org/education/IHIOpenSchool/resources/Pages/ AudioandVideo/ConnieDavis-WhatIsTeachBack.aspx Fabbri, M., Yost, K., Rutten, L. J., Manemann, S. M., Boyd, C. M., Jensen, D., . . . Roger, V. L. (2018). Health literacy and outcomes in patients with heart failure: A prospective community study. Mayo Clinic Proceedings, 93(1), 9-15. doi:10.1016/j.mayocp.2017.09.018 Health Care Advisory Board. (2015). 4 Tactics to Maximize the ROI of Your Patient Education Program. Retrieved from http://www.advisory.com/research/ health-care-advisory-board/white-papers/2015/4-tactics-to-maximize-the-roiof-your-patient-education-program?WT.mc_id=Email|Insights|WP|HCAB| apr-03-2015|||PatientEngagement||&elq_cid=1428275 Hong, Y. R., Cardel, M., Suk, R., Vaughn, I. A., Deshmukh, A. A., Fisher, C. L., . . . Sonawane, K. (2019). Teach-Back Experience and Hospitalization Risk Among Patients with Ambulatory Care Sensitive Conditions: A Matched Cohort Study. Journal of General Internal Medicine. doi:10.1007/s11606-019-05135-y
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Kessels, R. P. (2003). Patients’ memory for medical information. Journal of the Royal Society of Medicine, 96 (5), 219-22. London, F. (1999). No time to teach?: A nurses guide to patient and family education. Baltimore: Lippincott Williams & Wilkins. Mackey, L. M., Blake, C., Casey, M., Power, C. K., Victory, R., Hearty, C., & Fullen, B. M. (2018). The impact of health literacy on health outcomes in individuals with chronic pain: A cross-sectional study. Physiotherapy. doi:10.1016/ j.physio.2018.11.006 Mamedova, S. & Pawlowski, E. (2018) A description of U.S. adults who are not digitally literate. Retrieved from https://nces.ed.gov/pubs2018/2018161.pdf Menendez, M. E., Hoorn, B. T., Mackert, M., Donovan, E. E., Chen, N. C., & Ring, D. (2016). Patients With Limited Health Literacy Ask Fewer Questions During Office Visits With Hand Surgeons. Clinical Orthopaedics and Related Research®, 475(5), 1291-1297. doi:10.1007/s11999-016-5140-5 Rogers, A. H., Bakhshaie, J., Orr, M. F., Ditre, J. W., & Zvolensky, M. J. (2019). Health literacy, opioid misuse, and pain experience among adults with chronic pain. Pain Medicine. doi:10.1093/pm/pnz062 Schillinger, D. & Keller, D. (2012). Roundtable on Health Literacy; Board on Population Health and Public Health Practice. How Can Health Care Organizations Become More Health Literate: Workshop Summary. Washington (DC): National Academies Press, 2012. Appendix A, The Other Side of the Coin: Attributes of a Health Literate Health Care Organization. Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK201219/#ref_000073 The Right Patient Education Tools: Strategies to improve health outcomes and meet regulatory goals. Milner-Fenwick: Education for Better Health. (2014). Retrieved from http://www.milner-fenwick.com/