Designing for ACCORD with Patients

1
Designing for ACCORDwith Patients Henry C.
Chueh, MD, MS Massachusetts General
Hospital Boston, MA
2

MGH Primary Care Network
MGH PCP Network Adult and FPs Only

Revere 2 sites
Everett
Waltham
At MGH IMAWHABMG MWI
Charlestown
Chelsea2 sites
Near MGH MGH Downtown MGH Beacon Hill MGMGSenior
HealthMGH Back Bay NECHC

MDs 178 FTEs 101 Practices
15 Patients 155,590
3
Quality Chasm
Guidelines
Preventive care
Medication safety
Practice
Patient centered care
Chronic disease mgmt
4
24 hours in the life of a PCP
The Impending Collapse of Primary Care Medicine
and Its Implications for the State of the
Nations Health Care, a report from the American
College of Physicians, 2006 Yarnall KS, et al.
Primary care is there enough time for
prevention? Am J Public Health 2003 93635
Ostbye T, et al. Is there time for management of
patients with chronic diseases in primary care?
Ann Fam Med 2005 3209
5
The Promise of Information Technology

• Computerized clinical information systems will
  help physicians close this quality gap by
  performing many of the repetitive,
  protocol-driven tasks.
• -- Clement McDonald, 1976

6
MGH Quality Measures By Linkage Status
7
Our Challenge

• How do we design, build and implement the health
  information technology (HIT) tools to support and
  encourage busy practitioners and patients to do
  the right thing?

and that theyll use.
8
Preliminary work

• Patient-provider linkage is important
• Inter-visit workflow acceptable
• Providers will use well-designed tools
• Diversity of care processes can impact outcomes

9
Focus on Follow-up

• Consumes time inappropriately
• Failure can result in poor outcomes1
• Fastest growing area of claims2
• Patients have interest3

1 Earnest 2004 2 Shaefer 2000, Boohaker et al
1996, Murff HJ et al 2003 3 IOM 2001, WSJ Poll
2006
10
(No Transcript)
11
A Fragile Loop
Awareness of Issue
Risk assessment
Follow-up
?
Plan for care
Complete care
12
What about Clinical Decision Support Systems?

• Tend to be physician-oriented and visit-based
• Minimal effect for interventions that cannot be
  completed at the point of care
• Patient-centered approaches rare
• Often lack the ability to close the loop

13
Redesign for Systems to Support Clinical Decisions
Ecologic Framework
Zapka et al 2003, 2004
14
Doctor and Patient Clarity

• Adjusted for age and insurance status
• 2 factors associated with appropriate follow-up
  care
• MD documentation of follow-up plan
• Patient understanding of need for follow-up
• Poon, Haas, Puopolo 2004

15
ACCORD

• Ambulatory Care Compact to Organize Risk and
  Decision Making
• AHRQ Ambulatory Safety and QualityProgram Health
  IT

16
Make Clear Decisions Together
17
(No Transcript)
18
Characteristics

• Patient-provider centered, informed decisions
• Preference and choice
• Self-documenting
• Explicit agreements with high visibility
• Fail-safe monitoring

19
Focus Groups

• Patients
• Providers
• Patients with Providers
• Assess concept and initial design directions
• Identify incentives and barriers

20
Focus Group Lessons

• Doctors worried about workflow intrusion
• Patients worried about doctors
• Patients concerned about potential barriers to
  access to their doctor
• Should enhance/increase face time with patients
• Flexibility needed for ACCORD creation

21
Specific Aims

• Design models for Partnership
• Develop systems for Tracking
• Evaluate impact on Patient experience, quality

22
Create
23
Elements of an ACCORD

• Option
• Action
• Observation
• Time

24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28
Propose
29
(No Transcript)
30
(No Transcript)
31
Review
32
(No Transcript)
33
(No Transcript)
34
Study Design
35
Systems to SupporttheClinical Decision.
36
ACCORD Team

• Steven Atlas, MD, MPH
• Jeanhee Chung, MD, MS
• Richard Grant, MD, MPH
• Susan Edgman-Levitan, PA
• Robin Weinick, PhD
• Yu Chiao Chang, PhD

• Greg Estey
• David Berkowicz, MD
• Michael Yebba
• Mark Wylie
• Jeff Ashburner
• Alicia Wong