Care Coordination for the Burmese Population Marjeta Daja and Mina Kini . Diversity and Inclusion Burmese Care Coordination | DiversityRx 2013 Conference | March 11 - 14, 2013
Discussion Focus: Project • Texas Health Description • Lessons Learned Resources as • Next Steps and the system of • Defining Project Advancing the care Objectives and Strategy • Mission, Vision & Outcomes Values • Project Process • Our Burmese • Coordination of Community in Care for Burmese Dallas Patients Organizational Outcomes Context Today’s Journey – 30 minutes
Geography
Refugee Arrival Data - Burmese Burmese Arrival Data/ Dallas Fort Worth Areas 7000 6000 5000 4000 3000 2000 1000 0 2007 2008 2009 2010 2011 2012 TOTAL Series1 668 854 1,541 1,373 1,140 1,153 6729
Where in the world is BURMA USA Burma is located in South-East ASIA
The Burmese Population Kachin Chin Karen Mon Kayah REFUGEES - Different ethnicities: language, culture, experiences
The Expressed Need Started with • Accessing a Burmese Language interpreter Issues • Identifying the right dialect Other Related Issues • Time to explain and seek understanding • CULTURAL Issues of the care process • Access to care and Understanding the Western Medicine model and care expectations • Medication Adherence • Preventive Care processes
Connecting the dots: Recognizing Disparities Factors Barriers to Care •Primary Dimensions •Social Determinants •Economic Factors Image Source: Texas Health Resources 2012 Multicultural Calendar •Environmental Factors
Discussion Focus: Project • Texas Health Description • Lessons Learned Resources as • Next Steps and the system of • Defining Project Advancing the care Objectives and Strategy • Mission, Vision & Outcomes Values • Project Process • Our Burmese • Coordination of Community in Care for Burmese Dallas Patients Organizational Outcomes Context Today’s Journey – 30 minutes
LEAN Process – Multidisciplinary Team Discharge & Getting Treatment (In Access to Care Prevention Patient) Project Sponsor : Dale Leach, Mina Kini (THR) EE Leader: Jazz Patterson, Clint Abernathy Nursing: Debra DuBois, Erin Smith, Melissa Morton, Shanna Brown Kendra Henderson, Molly Montgomery, Julie Anderson, Patti Marks, Chris Brooks, Krisi Ingram, Jean Tan, Rosa Belgard, Kelli Raibick, Shawna Gonzalez, Myesha Bryant WHC, ED, L&D, OB/GYN, Post Partum, Nursery/NICU, Pedi Clinic, Education Operations: Teresa Cannon (ITS), Marjeta Daja (THR),John Engelhard (Pastoral Care), Nancy Hetherington (Admissions), Ruby Manuel (Patient Services), Sandra Pinkerton (THRE), Elsa Phelan (Community Health) Community Members: Luke Saw, Wilma Montz, Kari Brasselero, Julie
Patient Centric Process Design Team & Team Charter & Problem Key Focus Stakeholder Objectives Identification Areas Identification Definition Issues Using •Using LEAN & •Identified by Articulated: Patient/Family CAP Clinical Area Interpretation Journey Flow: approaches Needs Needs & – Clinical, •Patient Cultural Operations & Throughput Issues Community Analysis Partners MULTIDISCIPLINARY WORK -TEAM
Challenges for Clinicians Basic communication challenges Informed consent (concept unknown) Deliver quality care in an appropriate and safe manner Prepare patients for transfer to the Margot Perot Center Educate staff about effective care practices Resource Considerations: Time, Budget, etc
Process Map Patient Arrives at Emergency Room Staff Informs Depts of Patient Calls Patient Arrives at Emergency Room WHC or Patient Arrives at Patient Status (L& D, Staff Gives Physicians the WHC or NICU, PP, Gyn, High Literacy Test Patient Calls Risk, Special Care, Off. For an Physicians Office Patient Arrives at the WHC or Patient Returns for Appt. WHC or Physicians Patient Care Given Newborn) F/U Physicians Off. Office For an Appt. Patient Staff Uses Patient Check Sheet to Patient Care Patient Tour Returns for F/U Presents at L & Given Scheduled and goes on Document D Admitting Tour Understanding Patient Registers and is Patient Fills Out Patient Presents at Patient Receives Directed to Location of Consent Forms and Patient Fills Out Patient(s) L & D Admitting Care from L & D Patient Registers Delivery Patient Gets Initial Teaching Consent Forms Transported Patient Gets and is Directed to Receives Care Initial Teaching and Gets Initial and Admitted Location of Delivery from L & D Teaching to New Area ER Path Only Patient Staff Uses Patient Check Sheet to Patient Receives Patient(s) No Planned Change Receives Care Patient Receives Patient Gets Initial Transported and Patient Receives Patient Receives Receives Care Discharge Document Discharge Teaching Teaching Admitted to New Care Care Teaching Understanding Teaching Patient Education Teaching Area Graphics/ Interpretation Department Coordinat.
Project Core Focus Areas Interpretation Services Care Education Coordination Team Graphical & Community Instruction Outreach Tools
Coordinating Care: Process, Tools and Structure
Interpretation Services Language Identification tools Top2 Language Line Groups Minutes 5000 4500 SPANISH 4000 BURMESE/ KAREN 3500 3000 2500 2000 1500 1000 500 0 Language Language Assistant @ Monitoring WHC Effective Communication
Burmese Interpreter (employee) Effective Communication
Education: Patient Tours WHC – L&D – Newborn Nursery – Post Partum – Pedi Clinic - Pharmacy Care Coordination Tour
Patient Tours: Patient Understanding Check Sheets – Bilingual Translated Forms
Educational Modules Cultural Intelligence - For Healthcare Providers to provide Culturally Competent Care Clinician Education – Cultural Competence
Patient Education tools/Materials • Focus on Health Literacy & Patient Materials • Graphic Explanation & Accuracy of Technical • Exploring various methods of graphical representation Care Tools –Focus on Health Literacy
Patient Education tools/Materials I Speak Card Care Tools –Focus on Health Literacy
Patient Language Identification Tool Care Tools –Focus on Health Literacy
Community Outreach Partnership for Action Research on Social Organization Exploratory Partnership with Care Models: Community Care Navigation Organizations resettling refugees Community Engagement .
IRC Language Assistance Card
Care Coordination through EHR - ED and Inpatient documentation of Primary Language and Interpreter needed, can be found in the Professional Exchange Report . Patient Information Care Connect Tool – Patient Standardization History for WHC Process, Systems and Department Coordination
Translation and Interpreter Services SharePoint Site @ THD Process, Systems and Department Coordination
Discussion Focus: Project • Texas Health Description • Lessons Learned Resources as • Next Steps and the system of • Defining Project Advancing the care Objectives and Strategy • Mission, Vision & Outcomes Values • Project Process • Our Burmese • Coordination of Community in Care for Burmese Dallas Patients Organizational Outcomes Context Today’s Journey – 30 minutes
Tracking Data 2009-2011 Clinical Outcome Interpreting Encounters Cultural & Emerging Needs 88 Total Vaginal Deliveries 14 Total Caesarian Deliveries 90% of patients returned for a Post Partum Visit 95% of patients chose contraception Patient Tours Started tours May 2010 75 Families Toured Interpretation 625 Patients encounters
Improve Health & Wellbeing
Marjeta Daja Diversity Consultant Mina Kini Director Diversity and Inclusion Texas Health Resources www.texashealth.org/diversityandinclusion
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