Internetbased patient selfmanagement support

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Internet-based patientself-management support

• Neal Kaufman, M.D., M.P.H.
• Founder and CEO
• DPS Health

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Why Support Patients Healthy Lifestyles?

• Reduce complications and morbidity
• Improve patient quality of life
• Enhance patient-provider relationships
• Reduce healthcare utilization and cost
• Improve population outcomes
• Generate new service revenue
• Adapt to changing providers structures and
  reimbursement

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Examples of Benefits and ROI from Supporting
Healthy Lifestyles
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Changing Providers Structures and Reimbursement

• Increased consumerism
• Providers lose money with poor outcomes and get
  bonuses for good outcomes
• Changes in organizational approaches (e.g.,
  medical homes in primary care, provider sponsored
  disease management)
• Reimbursement for self-management support
• Reimbursement for episodes of care (e.g., 1
  year of heart failure treatment)

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Challenges Supporting Healthy Lifestyles

• Education is necessary but not sufficient and
  needs to be based on behavioral performance
• Individuals need different types of support
• Support from many places and many people
• Environments vary in ability to support
• Healthcare providers cant meet most needs
• Patients needs change during illness journey
• Solution Support patient self-management

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Self-Management Support

• Concrete actions caregivers take to implement
  the collaborative model and thereby encourage
  patients to be informed and activated to manage
  their chronic condition themselves
• The systematic provision of education and
  supportive interventions to increase patients
  skills and confidence in managing their health
  problems, including assessment of progress and
  problems, goal-setting, and problem-solving
  support.
• Bodenheimer T, Lorig K, Holman H, et. al.
  Patient self-management of chronic disease in
  primary care. JAMA 2002 2882469-2475
• Institute of Medicine. Priority Areas for
  National Action Transforming Health Care
  Quality. Washington DC National Academies
  Press, 2003, p 52

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Elements of Self-Management Support

• Goal-setting and monitoring performance
• Problem-solving strategies
• Enhancing knowledge and skills
• Increasing medication adherence
• Managing symptoms negative emotions
• Building networks of social support
• Navigating the health care system
• Communicating with health care provider

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Traditional Patient Education vs.
Self-Management Education
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Self-Management Support Clinician Competencies

• Provide information to patients
• Encourage healthy behaviors
• Promote actively managing their disease
• Teach patients disease-specific skills
• Train patients in problem-solving skills
• Assist patients with emotional issues
• Provide regular and sustained follow-up
• Institute of Medicine. Priority Areas for
  National Action Transforming Health Care
  Quality. Washington DC National Academies Press,
  2003, p 52

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Self-Management Typology
Patient Self-Management Tools An Overview
Michael J. Barrett California Healthcare
Foundation, June 2005
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Elements of Online Self-ManagementEducation and
Support Interventions

• Content-rich, interactive, multi-media
• Tailored, just in time, personalized education
• Self-assessment tools
• Monitoring of performance and biometrics
• Reports of progress toward goals
• Tools for self-management of condition
• Auto calling interactive voice response
• Online social networking
• Internet Interventions or Patient Education Web
  sites?
• Lee M Ritterband, PhD Frances Thorndike, PhD J
  Med Internet Res 20068(3)e18

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Characteristics of Effective On-line Solutions

• Provide patients with personalized, dynamic,
  easy-to-use, flexible structure
• Integrate education with goal setting, barrier
  mitigation, tracking, planning and robust
  communications tools
• Allow patients to select media platform (e.g.
  internet, cell phone)
• Support patients, clinicians, administrators and
  support networks
• Integrate with clinical practice and technology
  portals, EMR, biometric devices, etc.

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Solution Development Phases (1/2)

• Design intervention
• Translate research-proven clinical protocol
• Map market-driven objectives
• Define users requirements, experiences and
  functional elements
• Complete detailed functional design
• Execute solution
• Define solution architecture
• Configure and/or customize Behavior Change Suite
• Integrate additional applications
• Test and certify application

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Solution Development Phases (2/2)

• Deploy intervention
• Organize clinical roll-out
• Determine operational and support processes
• Operate solution
• Evaluate and evolve
• Obtain feedback from patients and providers
• Create list of enhancement
• Design and execute enhanced intervention
• Deploy and evaluate next version

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The DPS Health Behavior Change Suite
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Behavior Change Suite

• Patient User Experience
• Intervention Flow
• Coach User Experience
• Physical Activity Monitoring and Tracking

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Patient User Experience

• Functionalities for the Patient
• Education
• Assessment
• Goal Setting
• Planning
• Tracking
• Reviewing
• Addressing Barriers
• Messaging Tools
• Integrating Community

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Patient Experience Elements Education
Offer interactive workbooks and quizzes
Stream video, audio or other multi-media
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Patient Experience Assessments
Deliver assessments with dynamic branching logic
that can be used to personalize program
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Patient Experience Elements Goal Setting
Enable the patient to set personal goals and
rewards
Calculate and suggest or set patient goals
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Patient User Experience Secure Messaging
Support secure, HIPAA compliant communications
between patients, coaches and clinicians.
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User Experience Elements Planning
Drag and Drop Planning patient or clinician
planning
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Patient Experience Elements Tracking
Track specific behaviors and patient information
Automate tracking by integrating with a device
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Patient Experience Elements Reviewing
Present patient graphical displays of progress
Create dynamic personalized responses based on
patient success
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Patient Experience Elements Addressing Barriers
Help a patient identify and work through
barriers to adopting behavior
Offer relevant personalized tips
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Patient Experience Community
Offer messaging, chat, forums, or blog
functionality
Allows patient to update friends and receive
support
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Intervention Flow

• Order patients complete tasks relationships
  between tasks, specific dates, and patients
  intervention progress. Flow based on rules from
  patient characteristics, previous tasks, progress
  through intervention, calendar time.
• Education
• Assessment
• Goal Setting
• Planning
• Tracking

• Reviewing
• Addressing Barriers
• Messaging Tools
• Integrating Community

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Coach User Experience

• Functionalities for the Clinician
• Education
• Member progress tracking
• Population tracking
• Key alerts and coach process management
• Pattern recognition

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Coach Patient Tracking

• Give coaches easy access to patient success and
  progress data.
• Improve coach efficiency and enable them to
  effectively intervene.

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Coach User Experience Population Tracking
Reports of groups of patients progress at
different levels in hierarchy
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Coach Experience Key Alerts
Alert coach to pending tasks
Construct alerts on missed or completed actions
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Coach User Experience Process Support
Provide coach template intervention responses
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Physical Activity Monitoring Tracking

• Suzuken (Kenz) Lifecorder Plus e-Step
• Research proven accelerometer
• Physical activity measurement every 4 seconds 9
  levels of intensity with reports every 2 minutes
• Easy to use display of activity by time of day,
  duration (mins), intensity, steps, calories burned

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Virtual Lifestyle Management (VLM) service

• Clinically linked weight management service
  coupling online education, guided self-discovery,
  barrier mitigation, goal setting, monitoring and
  tracking with internet-based coaching to present
  a proven, year-long, engaging intervention.
• VLM potential uses
• Provide support for medium risk diabetes patients
• Extend care management for high risk diabetes
  patients
• Complement health education weight management
• Support employee wellness programs

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Virtual Lifestyle Management (VLM)

• Engages patients for an entire year
• 16 weekly and 8 monthly lessons with streaming
  audio and interactive workbooks
• Dynamic behavior planning and tracking
• Email coaching and secure messaging
• Moderated chat
• Supports coaches with protocol tools
• Efficient patient monitoring functions
• Communication tools
• Patient and population reporting

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VLM Lessons

• 16 Weekly Lessons
• Welcome to Lifestyle Balance Program
• Be a Fat Detective
• Three Ways to Eat Less Fat
• Healthy Eating
• Move Those Muscles
• Being Active a Way of Life
• Tip the Calorie Balance
• Take Charge of Whats Around You
• Problem Solving
• The Four Keys to Healthy Eating Out
• Talk Back to Negative Thoughts
• The Slippery Slope of Lifestyle Change
• Jump Start Your Activity Plan
• Make Social Cues Work for You
• You Can Manage Stress
• Ways to Stay Motivated

• 8 Monthly Lessons
• Social Events and Holidays
• Portion Control / Keeping Track
• Time Management
• Physical Activity Just Do It
• Being Assertive About Healthy Eating and Physical
  Activity
• Low Fat Cooking and Holidays
• Maintaining Physical Activity Having Fun and New
  Challenges
• Winning at Losing
• How-to lectures/lessons
• Orientation,
• Fat tracking
• Activity tracking
• Setting your plans

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Coaching and Support

• Coach sends personalized secure messages based on
  computer generated data to each participant
  regarding individual progress, workbook responses
  and issues.
• Approximately 5-10 minutes per user, per week
• Weekly hosted chat sessions
• Live group orientation (optional)
• Introduction to program and to food logging
• Distribution of pedometer
• Email and call center support for user issues

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VLM Coaching Protocols

• Coaches consider five areas when writing
  coaching notes
• Overall Progress
• Lesson Completion Status
• Action Plan and Worksheet Statements
• Tracking Status
• Fat Consumption
• Calorie Consumption
• Physical Activity Level
• Other Open Issues

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VLM Screenshots

• Examples of VLM screenshots
• Lesson
• Workbook
• Planning
• Tracking
• Results
• Communication Tool
• Coaching Tool
• Population Report

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Patients Complete DPP Courses Online

• Service includes the 16 core DPP lessons and 8
  follow up lessons
• One lesson/week for first four months than eight
  monthly lessons
• Lessons present streaming audio and interactive
  workbooks

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Patients Complete Interactive Workbook Pages

• During the lessons, patients complete workbook
  pages to help them learn and build their action
  plans for the following week.

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Patients Plan Physical Activity
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Patients Track Their Behaviors

• Patients progress through the program and track
  behaviors, starting with their weight and adding
  nutrition and physical activity.

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Patients Review Behaviors

• Patient views tracking results once per week to
  recognize patterns

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Patient/Coach Communication

• Patient and coach stay connected through secure
  email messaging and chat rooms

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Progress Review and Secure Email

• Coach views patient progress sends patient
  personalized template-based email

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Clinician Coach Accesses Reports

• Coach views group reports, check patient
  compliance and generate summaries

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DPS Health

• Dedicated to enhancing the capacity of
  healthcare providers to improve the health of
  their patients through research-proven, online,
  self-management support interventions.
• For information contact
• Neal Kaufman, M.D., M.P.H
• Founder and CEO
• neal.kaufman_at_dpshealth.com