Workshop 1 Interprofessional Healthcare Models in the Prevention - - PowerPoint PPT Presentation

#XUDisparitiesCollabs

Workshop 1

Interprofessional Healthcare Models in the Prevention and Treatment of Chronic Disease: Integrated Models of Health and Social Care

#XUDisparitiesCollabs

Join our social media discussions

#XUDisparitiesCollabs

#XUDisparitiesCollabs

Accreditation

Participation in this activity earns 1.25 contact hours. To receive credit, participants must complete an evaluation form at the conclusion of this session.

UAN: 0024-0000-14-006-L04-P

#XUDisparitiesCollabs

At the completion of this activity, participants will be able to:

• Discuss substantial models of interprofessional research

models that link health behaviors chronic diseases; and

• Explain how health behavior changes are feasible and

improves health outcomes.

#XUDisparitiesCollabs

OPENING REMARKS Jose Torres-Ruiz, PhD

#XUDisparitiesCollabs

SPEAKERS

Patricia Matthews-Juarez, PhD Paul D. Juarez, PhD

#XUDisparitiesCollabs

At the completion of this presentation, participants will be able to:

• Describe interprofessional health care models that may be implemented in vulnerable

neighborhoods;

• Understand the underlying epigenetic causes of chronic diseases associated with health disparities:
• Discuss the foundation of a targeted multi-factorial environment public health approach that can

address health inequities and environmental injustices at a neighborhood level ; and

• Define the “Public Health exposome model” and public participatory geographic information

system methods and tools that engage community residents in the identification of barriers to health at the neighborhood level.

Paul D. Juarez PhD & Patricia Matthew Juarez, PhD

Research Center On Health Disparities, Equity & the Exposome University of Tennessee Health Science Center

Seventh Health Disparities Conference, Xavier University of Louisiana New Orleans, LA March 11, 2014

 Chronic Diseases

 Cardio-metabolic disease  Cancers  Respiratory disease  AIDS/HIV

 75% of Health Care Dollars are for Treatment

• f Chronic Disease

 Account for Greatest Portion of Health

Disparities

 Genetic Factors Account for only 10-30% of

Chronic Diseases

 Environmental Exposures Account for

Remaining 70-90%

 New Chronic Disease Prevention and

Treatment Paradigms and Models are Needed

 Exposure Science Paradigm  Cumulative Life Exposures from Conception to

Death

 Epigenetics to Behavior

 Environmental Exposures

 Natural  Built  Social  Policy

 Lifespan Approach

 Historically Health Outcomes Research has

been Discipline or Specialty Driven

 Multi-disciplinary  Inter-disciplinary  Trans-disciplinary

 Academic-Community Partnerships  Inter-Professional Collaboration

 Cross disciplinary  Cross specialty  Include academic community partnerships

 Multi-Sector Engagement

 Academic sector  Residents of affected communities  Public sector  Business community  Faith community  Civic organizations

 Translation: from Bench to the Community  Focus on Place not Race, Zip Code not Genetic

Code

 Transdisciplinary  Academic / Community Partnerships  Translational  Targeted Place-based Interventions

Thank You

#XUDisparitiesCollabs

SPEAKER

Angela Odoms-Young, PhD

#XUDisparitiesCollabs

At the completion of this presentation, participants will be able to:

• Describe the factors that contribute to overweight and obesity

in African American women.

• Discuss potential intervention approaches to address obesity

and improve overall health in African American women.

#XUDisparitiesCollabs

SPEAKER

Lakeisha Williams, PharmD, MSPH

Integration of Clinical Pharmacy Services in an Interprofessional Patient Centered Medical Home

LaKeisha Williams, PharmD, MSPH Drug Information Specialist Xavier University of Louisiana College of Pharmacy

Learning Objectives

• Discuss the Patient Centered Medical Home

(PCMH) and Exemplary Care and Learning Site Model.

• Describe the role and impact of pharmacists in

the patient centered medical home.

• Discuss the involvement of a clinical pharmacist

in an interprofessional medical home model.

• Identify future implications for pharmacists in

patient centered medical homes.

Joint Principles of PCMH

American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association. Joint Principles of the patient-centered medical home. Accessed February 12, 2013 at www.pcpcc.net/node/14.

Physician- directed medical practice (team based)

Personal physician Whole-person

• rientation

Coordinated and integrated care Quality and safety Enhanced access Appropriate payment

Patient Centered Medical Home

The Triple Aim

PCMH

Better patient care

Better health

Lower health care costs

Benefits of Implementing the Primary Care Patient-Centered Medical Home: A review of cost and quality results, 2012. Accessed at www.pcpcc.net/files/benefits _of_implementing_the_primary_care_pcmh_0.pdf. Grumbach, Grundy. Outcomes of Implementing Patient Centered Medical Home Interventions: A Review of the Evidence from Prospective Evaluation Studies in the US, 2010

Implementation Outcomes:

• 36.3% Drop in hospital

days

• 32.2% Drop in ER use
• 9.6 % Total cost
• 10.5% Inpatient specialty

costs are down

• 18.9 % Ancillary costs

down

• 15 % Outpatient specialty

down

LSU Health System

• LSU – Health Care Services

Division (HCSD) Clinic

• Ambulatory Services & Clinics
• 1450 Poydras Street
• 20+ clinics
• 96 exams rooms and 12 eye

exam areas

• LSU Healthcare Network

(LSUHN)

• Uptown - 3700 St. Charles

Avenue

• Multi-specialty physician

practices

• 30 specialties

DIME – Diabetes Internal Medicine Clinic

Program Goals

Decrease number of ER visits and hospitalizations Decrease risk

• f related

comorbidities & Improve patient quality of life Improve the healthcare of patients through a team-based care approach Increase productivity

• f all

providers Increase patient access to care and decrease health care costs

Epidemic of Diabetes

• Diabetes affects at least 25 million people in the United States
• Costs an estimated $174 billion in medical expenditures
• Disproportionately affects minority populations
• African American adults are twice as likely than non-

Hispanic white adults to have been diagnosed with diabetes

• African Americans are more likely to experience

complications

• Rate of diabetic ESRD (end stage renal disease) is 2.6

times higher among African Americans than among Caucasians

• Increasing prevalence among the elderly

Agency for Healthcare Research and Quality. Diabetes disparities among racial and ethnic minorities. www.ahrq.gov/research/diabdisp.htm. Office of Minority Health. Diabetes and African

• Americans. http://Minorityhealth.hhs.gov/templates/content.aspx?ID=3017. Centers for Disease Control and Prevention. Diabetes Data & Trends.

www.cdc.gov/diabetes/statistics/prevalence_national.htm.

DIME – Diabetes Internal Medicine Clinic

• Population Management
• Implemented in January 2012
• Use of registry of high risk diabetic patients
• Hemoglobin A1C > 9
• High patient use of Emergency Room(ER)/Hospitalization
• Planned visits/Group visits/Home visits
• Return visits
• Patient Self Management
• Diabetes education
• Patient assessment of readiness for change
• Action plan based on patient determined goals

DIME – Diabetes Internal Medicine Clinic

• Patient Access
• Less wait time for check in
• Patient given phone numbers after hours and on weekends
• Patient Quality Indicators
• Measures of effectiveness include percentage of registry patients that

meet target goals of quality indicators

• Target: 15% improvement over baseline by end of pilot program
• Patient Quality Indicators
• Hemoglobin A1c < 9, <7
• LDL <100
• BP <130/80
• Eye and foot exams
• Aspirin use
• Self-management goals
• Additional Quality Indicators
• Change in ER/Hospitalization rate
• Patient, learner, faculty and staff satisfaction

DIME – Diabetes Internal Medicine Clinic

Exemplary Care and Learning Sites: Linking the Continual Improvement of Learning and the Continual Improvement of Care. Headrick L et al. Acad

• Med. 2011; 86:e6-e7.

Pharmacy Medicine Social Work Public Health Nursing Physician Assistant Team-based Care Quality Improvement

Benefits of Clinical Pharmacist Involvement

• Clinical Pharmacy defined…
• Clinical pharmacists provide

patient care that optimizes medication therapy and promotes health and wellness

• Embraces philosophy of

comprehensive medication management blending specialized therapeutic knowledge, experience, and judgment to ensure optimal patient outcomes

Pharmacotherapy 2008: 28 (6):816-817

Pharmacy Program Goals

Increase patient knowledge of medications Improve the quality of life for patients Improve medication use of ACE/ARBs, lipid lowering agents, aspirin and diabetic agents Improve patient access to medications and community resources Improve medication adherence Improve patient monitoring and screening

• f quality

indicators (Hemoglobin A1C, LDL cholesterol, etc.)

Roles of Clinical Pharmacist

• Medication reconciliation
• Medication review
• Blood pressure agents
• ACE/ARB use
• Lipid agents
• Statin use
• Diabetic agents
• Glucose and Blood Pressure Monitoring
• Medication Adherence
• Medication Access
• Diabetic supplies
• Smoking Assessment*
• Cardiovascular Risk*
• Health Literacy*
• Patient follow-up

**Provide recommendations to team

* Indicates implementation beginning Jan 2014

DIME Pilot Results

August to December 2013

Clinic Location: Poydras Clinic

• St. Charles Clinic

Total # of Patients 40 8 48 # of Patients Discontinued from Program 8 8 Optimal Diabetes Control (out

• f total # of patients at

baseline) 3 (7.5%) 3 # of Remaining Patients 32 8 40 # of Patients with A1C > 9 at end of semester 21 (66%) 8 (100%) 29 % of Patients with 1% positive change at end of semester 19 (59%) 19 # of Patients with positive A1C change at end of semester 25 (78%) 3 (37.5%) 28 # of Patients with decrease in blood pressure 14 (40%) 3 (37.5%) 17

Improved Quality Markers:

• 7.5% of patients

received optimal diabetes control

• 34% of patients

decreased A1C < 9

Patient Experience

• After the first year of program, participants reported the

following:

80%

• Said they

received quality care

83%

• Said they

would recommend the DIME Clinic to

• thers

83%

• Said they

were satisfied with their patient care

83%

• Said they

received teaching about their medications

86%

• Said the clinic

communicated very well to them

Learner Experience

• After the first year of program, learners reported the

following:

70%

• Said they

were more familiar with the key elements of the PCMH

80%

• Said they

were more familiar with the use

• f patient

registry data

96%

• Said they

were more aware of their profession’s limitations

83%

• Said they

were more familiar with the ECLS model

40%

• Agreed that it

is not always possible to share input on patients with the team

Students complete three (3) assessments: 1) Knowledge of Medical Home and Disease Management 2) Teamwork Skills Assessment (Hepburn K et al 2002) 3) Teamwork Attitude Assessment (J Interprof Care Dec 2007).

Program Expansion

• Expanded location to include LSU Faculty Practice Clinic on St.

Charles Ave.

• Hired Quality Incentive Coordinator to measure outcomes and

lead expansion work

• Applying for NCQA accreditation
• Moving beyond diabetes to include other disease states
• Achieve patient goals!

Expansion - Role of the Pharmacist

• Reinforce patient health goals
• Establish smoking cessation program
• Medication adherence protocol
• Moving beyond diabetes to include additional disease states
• Expand clinical knowledge
• Minimize challenges

Clinical Implications

• Pharmacist integration as a member of an interdisciplinary

team can enhance patient knowledge

• Increased clinical knowledge
• Pharmacists are medication and drug information experts
• Participation in patient care by:
• 1) engaging patients in goal setting and self management
• 2) interacting with other learners and faculty on

interprofessional teams

• 3) applying quality improvement methods
• 4) contributing positively to patient care process outcomes

*Great IMPACT on patients*

Acknowledgments

• LSU DIME Program
• Dr. Mary Coleman, MD, PhD, Director
• Dr. Angela McLean, MD,
• Caroline Munson, BS, MBA
• Khaleelah Hasan, MN, RN
• Jean Burke, LCSW
• Ellen Lee, LCSW
• Dr. Yu-Wen Chiu, DrPH
• Dr. Kathleen Kennedy, PharmD, Dean, XUCOP

Thank You

Integration of Clinical Pharmacy Services in an Interprofessional Patient Centered Medical Home

LaKeisha Williams, PharmD, MSPH Drug Information Specialist Xavier University of Louisiana College of Pharmacy llgeorge@xula.edu March 10, 2014

#XUDisparitiesCollabs

Closing Remarks