Patients at Heart of Health Care Decisions Theme of Recent PCPCC Conference

The need to engage patients and their families in making decisions about their health care emerged as a unifying theme that tied together disparate parts of the most recent Patient-Centered Primary Care Collaborative (PCPCC) conference in Chicago on Oct. 25.

It was another reminder that patients lie at the heart of the patient-centered medical home (PCMH), a theme considered so important that the one-day meeting devoted an entire segment to it.

"All of the things we are going to talk about today and all of the tools and resources are so very important, but if we don't really engage and partner with the patient and don't change that care experience with them, then it is all for naught," said Amy Gibson, chief operating officer of the PCPCC, when introducing the segment.

Several health care professionals and a patient partner provided their own perspectives on the topic during the segment. For example, Juanita Brooks, a patient partner at the Henry Ford Medical Center in Detroit, said it is important for physicians and other health care professionals to really understand the needs of the patient, and that means they need to understand what is going on with their patients at home.

Brooks talked about lines of communication, explaining that many patients may be reluctant to ask physicians questions because of an inherent fear of the health care system.

Christina Zarcadoolas, Ph.D., an adjunct associate professor of preventive medicine at the Mount Sinai Hospital in New York, addressed health literacy, pointing out that 80 percent of high-risk populations read at a fifth-grade level or lower. But electronic health records often are written at a seventh to 10th grade level, and websites often are written at a 12th-grade level or higher.

Thomas LaVeist, Ph.D., director of the Hopkins Center for Health Disparities Solutions at the Johns Hopkins Bloomberg School of Public Health in Baltimore, pointed out that the nation is changing in terms of race, ethnicity and language, which will require that health professionals understand various cultures to care for patients from those cultures.

The discussion about engaging patients and their family members in the health care process spilled over into other sessions, as well, becoming the unifying theme of the day.

For example, Beverly Johnson, president and CEO of the Institute for Patient- and Family-Centered Care, who moderated a panel on comprehensive team-based care, discussed how the patient and the patient's family are viewed as part of the health care team. "I think we need to think about that as we go forward with the patient-centered centered medical home," Johnson said. "It is not all the different disciplines doing things to and for the patient but with the patient."

Kelly Taylor, M.S.N., the clinic director of quality improvement for Mercy Medical Center's accountable care organization in Des Moines, Iowa, and a participant in the panel, noted that her health care system has put touch-screen computers on the walls of the exam rooms. This gives patients and members of the health care team an opportunity to jointly review the patient's health information, she said.

"We stand there with the patient and often with a family member touching the screens, reviewing graphs, reviewing blood pressure, their hemoglobin A1c," said Taylor. "We have all of that information right there for the patient to look at."

Mercy Medical System also has established patient-advisory teams in each of their clinics. These teams have generated strategies for breaking down barriers to care. For example, health care staff members found out from one of the advisory teams that patients did not know who was seeing them in the exam room -- whether it was the physician, the physician assistant or the nurse practitioner.

"The (patients) actually helped design the name tags our clinic staff wears," said Taylor. "They now know who the provider is, what their name is, and that really helps start the patient-provider relationship right away."

Another popular topic during the conference was physician burnout. Christine Sinsky, M.D., a general internist at Medical Associates Clinics in Dubuque, Iowa, and her husband, Thomas Sinsky, M.D., also of Medical Associates Clinics, led a plenary session on the topic.

"How do we breathe life into the principles of the patient-centered medical home, and how do we use those to create joy in practice?" asked Sinsky at the beginning of the presentation.

A member of the board of directors of the American Board of Internal Medicine (ABIM), Sinsky shared the findings of a joy in practice study sponsored by the ABIM Foundation that identified 23 practice sites in the country that provide excellent care and where physicians and staff are thriving.

About half of the practices cited in the study are recognized medical homes, but practices were not required to be medical homes to participate in the study. The practices profiled included large and small practices, urban and rural practices, federally qualified community health centers, and U.S. Department of Veterans Affairs medical centers.

One of the goals of the study was to "focus on work flow from a granular level to determine who does what in a practice," said Sinsky. "We also looked at specific space and technology to understand how those elements either helped or hindered the teams in their work."

The study identified various practice challenges and corresponding innovations developed by the practices. The number one challenge practices encountered was chaotic visits with overfull agendas, said Sinsky. In response, one clinic in the study used staff members to contact patients a day before their appointment to obtain information so the visit goes more smoothly. Staff members ask patients what they want to accomplish during their upcoming appointment, and they review prescriptions with patients.

Sinsky said another clinic in the study has nurses call patients a week or so before their appointments to arrange for patients to have their lab work done ahead of the appointment. This allows patients and their physicians to review lab results during the appointment.

In addition, other study sites streamlined prescription management by renewing certain prescriptions for an entire year, whenever possible, during an annual primary care visit. "This is to avoid having to do the same work over and over again throughout the year," said Sinsky. "I estimate that this saves about 30 minutes of physician time and about 15 minutes of nursing time per physician and per nurse per day."