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

Workshop 1 Interprofessional Healthcare Models in the Prevention and Treatment of Chronic Disease: Integrated Models of Health and Social Care #XUDisparitiesCollabs

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Accreditation UAN: 0024-0000-14-006-L04-P Participation in this activity earns 1.25 contact hours. To receive credit, participants must complete an evaluation form at the conclusion of this session. #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

Jose Torres-Ruiz, PhD OPENING REMARKS #XUDisparitiesCollabs

Patricia Matthews-Juarez, PhD Paul D. Juarez, PhD SPEAKERS #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. #XUDisparitiesCollabs

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 of 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

Angela Odoms-Young, PhD SPEAKER #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

Lakeisha Williams, PharmD, MSPH SPEAKER #XUDisparitiesCollabs

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.

Patient Centered Personal Medical Home physician Physician- directed medical Appropriate practice (team payment based) Joint Principles of Enhanced Whole-person PCMH access orientation Coordinated Quality and and integrated safety care 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.

The Triple Aim Lower Better health care PCMH patient care costs Implementation Outcomes: 36.3% Drop in hospital Better • days health 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 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

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 Improve the Decrease Increase Increase patient Decrease risk healthcare of number of ER productivity of related access to care patients visits and of all comorbidities and decrease through a hospitalizations providers & health care team-based Improve costs care approach patient quality of life

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

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