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Health Care Management > Patient Centred Care Delivery > Flashcards

Patient Centred Care Delivery Flashcards

1
Q

Two extremes decision making model

A

Paternalism
Consumerism (informed choice)
Shared decision making is the middle

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2
Q

Shared Decision Making steps

A
  1. Choice Talk
    There is exchange of information between a patient and his doctor, medical and personal information included
  2. Option Talk
    Possible options and outcomes are discussed and considered by patient and doctor
  3. Decision talk
    Doctor and patient reach consensus about what needs to be done
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3
Q

Paternalism

A

When talking to your physician about what to do in terms of treatment, the physician decides.

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4
Q

Consumerism/informed choice

A

The patient decides what treatment to follow. The physician simply has to accept the decision.

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5
Q

Ethicist view SDM

A

The right of patients to determine what happend to their bodies is self evident. SDM increases autonomy.

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6
Q

Economist view SDM

A

Increase in consumer power is a means to subject health care providers to market discipline. SDM will increase cost effectiveness.

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7
Q

Epidemiologist view SDM

A

Patients have an almost universal desire to be informed and to be involved in the treatment in one way or another.

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8
Q

Clinicians view SDM

A

More active involvement of patients in decision making process improved treatment relationship with better outcomes as a result
- enhanced patient adherence
- more satisfaction
- better clinical outcomes

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9
Q

Objections SDM

A
  • Options may harm those patients who are having difficulties in decision making. Options may result in growing awareness of missed opportunities.
  • Patients may find it difficult to appreciate outcomes because of their inability to foresee how they themselves will adapt to outcomes.
  • Choice and having a say raise expectations. Disappointment and dissatisfaction lie ahead when clinical realities fail to meet expectations.
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10
Q

SDM is more appropriate for..

A
  • relatively healthy patients
  • patients with active coping skills
  • patients with chronic conditions
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11
Q

SDM is less appropriate for..

A
  • elderly patients
  • less educated patients
  • acute patients
  • minor decisions
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12
Q

appropriate circumstances for SDM

A
  • When there is uncertainty regarding effectiveness or outcome
  • Risks and benefits are equal
  • Patient is willing and able to participate
  • Patient is able to comprehend and appreciate trade offs
  • SDM fits perfectly within the changes of health care
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13
Q

SDM obstacles

A

Lack of resources
- Seeing less patients is unprofitable
- Implementation SDM is costly
Fear of loss of professional autonomy
- Doctors are creatures of habit
Poor communication
- Giving information about risks and possible outcomes can be extremely difficult
Patients needs and expectations
- Belief among doctors that patients do not wish to be fully informed
- Preferences among patients for participation vary
- SDM is a choice

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14
Q

Requirements Sdm

A
  • underlying legislation supporting SDM
  • investment in decision aids, self help, patient support groups, case management
  • Attention SDM for doctors; training programs, skills
  • Spread the positive influences of SDM
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15
Q

Role of professional Acute Care

A

Expert
select en conduct therapy

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16
Q

Role of patient Acute Care

A

Follow orders
passive

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17
Q

Role of professional Chronic Care

A

Teacher/Coach and partner/consultant
Supporting patients

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18
Q

Role of patient Chronic Care

A

Partner/daily manager/own caregiver

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19
Q

What do patients with chronic conditions need?

A

A continuous relationship with a care team and practice system organized to meet their needs for:

  • effective treatment
  • Information and support for their self management
  • More intensive self management
  • Coordination of care across settings and professionals
  • Systematic follow up and assessment tailored to clinical severity
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20
Q

Three p for good chronic care

A

Prepared,
Proactive,
Practice team

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21
Q

What characterizes an informed activated patient

A

Patients have the motivation, information, skills and confidence necessary to effectively make decisions about their health and manage it

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22
Q

What characterized a prepared proactive practice team?

A

Teams of professional have the patient information, decision support, time and resources necessary to deliver high quality care

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23
Q

How can you recognize productive interactions?

A
  • Assessment of self management skills and confidence as well as clinical status
  • Tailoring of clinical management
  • Collaborative goal setting and problem solving resulting in a shared care plan
  • Active, sustained follow up
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24
Q

The Chronic Care Model

A

Community
- Resources and policies

Health System
Healthcare organization
- Self management support
- Delivery system design
- Decision support
- Clinical information systems

These two come together in productive interactions between informed, activated patient and prepared, proactive practice team.

This will result in functional and clinical outcomes

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25
Q

CCM self management support

A

Goal is to empower and prepare patients to manage their health and healthcare.

  • emphasize patients central role in managing health
  • use effective self management support strategies
  • organize internal and community resources
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26
Q

CCM Delivery system design

A

The goal is to assure the delivery planned, effective and efficient care and self management support.

  • define roles and distribute tasks among team members
  • use planned interactions to support evidence based care
  • provide case management services for complex patients
  • ensure regular follow up by care team
  • give care that patients understand and fits cultural background
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27
Q

CCM decision support

A

Goal is to promote clinical care that is consistent with scientific evidence and patient preferences.

  • embed evidence based guidelines into daily clinical practice
  • integrate specialist expertise and primary care
  • use proven provider education methods
  • share guidelines and information with patients
28
Q

CCM clinical information systems

A

Goal is to organize patient and population data to facilitate efficient and effective care.

  • Provide timely reminders for providers and patients
  • Identify relevant subpopulations for proactive care
  • Facilitate individual patient care planning
  • Share information to coordinate care
  • Monitor performance of practice team and care system
29
Q

CCM Health System
Healthcare system

A

Goal is to assure that practices within the organization have the motivation, support and resources needed to redesign their care systems.

  • visibly support improvement at all levels of the organization
  • promote effective improvement strategies aimed at comprehensive system change
  • provide incentives based in quality of care
  • encourage open and systematic handling of problems
  • develop agreements that facilitate care coordination within and across organizations
30
Q

CCM community resources and policies

A

Goal is to help patients access effective and useful services and resources in their surrounding community.

  • Encourage patients to participate in effective communication programs
  • Form partnerships with community organizations to support and develop interventions that fill gaps in needed services
  • Advocate for policies to improve patient care
31
Q

Theory of relational coordination

A

Coordinating work through relationships of shared goals, shared knowledge and mutual respect.

Relational dimensions reinforce and are reinforced by dimensions of communication:
- Frequency
- Timeliness
- Accuracy
- Problem Solving

32
Q

definition of relational coordination

A

a mutually reinforcing process of communication and relating for the purpose of task integration

33
Q

impact of relational coordination

A
  • Improvements in patient related outcomes, such as care quality, well being, satisfaction with care
  • Improvements in professional related outcomes, including job satisfaction
  • Mixed outcomes on the organizational level
34
Q

Characteristics patients with multimorbidity

A
  • Two or more co-existing chronic conditions
  • Complex care needs
  • Single disease-oriented guidelines
  • Uncertainty
  • Time constraints
  • Fragmented care
  • Multiple healthcare providers involved
35
Q

A typology of actions to reduce health inequalities

A
  1. Strengthening individuals
  2. Strengthening communities
  3. Improving living and working conditions
  4. Promoting healthy macro policies
36
Q

WHO definition of health

A

From health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity

37
Q

Dimensions of well being

A

Overall well being
Physical and social well being
Comfort/stimulation and Affection/behaviour confirmation/status
Activities. resources, healthcare services

38
Q

eg self management abilities

A

Taking initiative
Self efficacy beliefs
Investment behavior
Positive frame of mind
multifunctionality
Variety

39
Q

Domains of functioning

A

Social functioning
Cognitive functioning
Physical functioning

40
Q

Whitehead The logic of health inequalities interventions categories

A
  • Observed problem of health inequality
  • Perceived causes of problem
  • Policy goals to address causes
  • Theories about how and why interventions might work to bring change in cause
  • Design of intervention programme
  • Outcome of programme
41
Q

Shortcomings CCM

A
  • Focused mainly on clinically oriented systems and outcomes
  • Difficult to use for prevention and health promotion practitioners
  • Does not encompass the complexity and interplay of social, cultural and economic factors that affect health
  • The capacity of communities in addressing these conditions
42
Q

Expanded Chronic Care Model

A
  • Self-management/ Develop personal skills
  • Delivery system design/ re-orient health services
  • Decision support
  • Information systems
  • Build healthy public policy
  • Create supportive environments
  • Strengthen community action
  • Outcomes
43
Q

Outcomes

A
  • Productive interactions and relationships among community members/groups, healthcare professionals and organizations
  • Functional outcomes
  • Clinical outcomes
  • Population health outcomes
44
Q

Strengthen community action

A
  • Empowerment of communities
  • Partnering with communities to promote community health and healthy environments
45
Q

Create supportive environments

A

Realizing living and employment conditions that are safe, stimulating, satisfying and enjoyable

46
Q

Build healthy public policy

A
  • Policy and legislation aimed at improving population health
  • Safe and healthier goods, services and environments
47
Q

Information systems

A
  • Community data beyond the healthcare system
  • Support information about demographics, population health and trends
48
Q

Decision support 2

A
  • Decision support not only related to disease and treatment
  • Also, evidence on strategies for well being and healthy living
  • Community based best practice
49
Q

Delivery system design/ re orient health services

A
  • Holistic way of providing support to individuals and communities
  • Connections between health and broader social, political economic and physical environmental conditions
50
Q

Self management/ develop personal skills

A
  • Support of self management in coping with disease
  • Also developing skills for health and well being
51
Q

Innovative Care for Chronic Conditions framework (ICCC)

A
  • When health problems are chronic, the acute care practice model doesn’t work
  • ICCC is an adaptions of the CCM for a global perspective
52
Q

What are the current problems on different levels?

A
  • Micro level: Patient interaction problems
  • Meso level: Problems with healthcare organization and links to community
  • Macro level: policy problems
53
Q

The micro level

A
  • Patient interaction problem
  • Patients and families partnering with community partners and healthcare teams
  • Informed, motivated and prepared
54
Q

The meso level

A
  • Healthcare organization elements reframed
  • Community is strongly emphasized
  • Community services should complement organized healthcare
55
Q

The macro level

A
  • Positive policy environment to support care for chronic conditions
  • Leadership, policy integration, financing, allocation of human resources, legislation, partnerships
56
Q

Innovative approached and strategies for managing chronic conditions can successfully:

A
  • Improve disease outcomes
  • Save money and healthcare resources
  • Change patients lifestyle and self-management abilities
  • Improve functioning, productivity and QaL
  • Improve the processes of care
57
Q

Active aging

A

Is the process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age

58
Q

Active aging examples

A
  • Recognizing capacities & resources among older people
  • Anticipate flexibly to aging related needs and preferences
  • Respect their decisions and lifestyle choices
  • Protect the most vulnerable
  • Promote their inclusion and contribution to all areas of community
59
Q

Development of the WHO framework

A

Outdoor space & buildings
Transportation
Communication & information
Housing
Respect & social inclusion
Social participation
Civic participation & employment
Community support & health services

60
Q

Lacy & Backer

A

either or model
Integrated Model
Continuum Model
Cyclical Model

61
Q

Either or model

A

Evidence based and patient centred care are distinct from one another

62
Q

Integrated model

A

group members conceptualized overlapping spheres, creating a band of practice where the pratitioner applies both spheres

63
Q

Continuum model

A

When reviewed as a continuum, EBPCC ranged from purely evidence based to purely patient centred. When viewed as a balance, this model suggests a point at which a clinician incorporates both.

64
Q

Cyclical

A

EBPCC is process that moves from patient centred care through evidence based care and then back to patient centred care. It is more dynamic.

65
Q

eight dimensions of PCC

A

1 respect for patient preferences
2 information education and communication
3 coordination and integration of care
4 emotional support
5 physical comfort
6 involvement of family and close others
7 continuity and transition from hospital to home
8 access to care and services

Health Care Management (3 decks)

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