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Internetbased patient selfmanagement support

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Create list of enhancement. Design and execute enhanced intervention ... Offer messaging, chat, forums, or blog functionality. Allows patient to update friends ... – PowerPoint PPT presentation

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Title: Internetbased patient selfmanagement support


1
Internet-based patientself-management support
  • Neal Kaufman, M.D., M.P.H.
  • Founder and CEO
  • DPS Health

2
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

3
Examples of Benefits and ROI from Supporting
Healthy Lifestyles
4
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)

5
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

6
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

7
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

8
Traditional Patient Education vs.
Self-Management Education
9
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

10
Self-Management Typology
Patient Self-Management Tools An Overview
Michael J. Barrett California Healthcare
Foundation, June 2005
11
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

12
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.

13
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

14
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

15
The DPS Health Behavior Change Suite
16
Behavior Change Suite
  • Patient User Experience
  • Intervention Flow
  • Coach User Experience
  • Physical Activity Monitoring and Tracking

17
Patient User Experience
  • Functionalities for the Patient
  • Education
  • Assessment
  • Goal Setting
  • Planning
  • Tracking
  • Reviewing
  • Addressing Barriers
  • Messaging Tools
  • Integrating Community

18
Patient Experience Elements Education
Offer interactive workbooks and quizzes
Stream video, audio or other multi-media
19
Patient Experience Assessments
Deliver assessments with dynamic branching logic
that can be used to personalize program
20
Patient Experience Elements Goal Setting
Enable the patient to set personal goals and
rewards
Calculate and suggest or set patient goals
21
Patient User Experience Secure Messaging
Support secure, HIPAA compliant communications
between patients, coaches and clinicians.
22
User Experience Elements Planning
Drag and Drop Planning patient or clinician
planning
23
Patient Experience Elements Tracking
Track specific behaviors and patient information
Automate tracking by integrating with a device
24
Patient Experience Elements Reviewing
Present patient graphical displays of progress
Create dynamic personalized responses based on
patient success
25
Patient Experience Elements Addressing Barriers
Help a patient identify and work through
barriers to adopting behavior
Offer relevant personalized tips
26
Patient Experience Community
Offer messaging, chat, forums, or blog
functionality
Allows patient to update friends and receive
support
27
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

28
Coach User Experience
  • Functionalities for the Clinician
  • Education
  • Member progress tracking
  • Population tracking
  • Key alerts and coach process management
  • Pattern recognition

29
Coach Patient Tracking
  • Give coaches easy access to patient success and
    progress data.
  • Improve coach efficiency and enable them to
    effectively intervene.

30
Coach User Experience Population Tracking
Reports of groups of patients progress at
different levels in hierarchy
31
Coach Experience Key Alerts
Alert coach to pending tasks
Construct alerts on missed or completed actions
32
Coach User Experience Process Support
Provide coach template intervention responses
33
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

34
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

35
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

36
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

37
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

38
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

39
VLM Screenshots
  • Examples of VLM screenshots
  • Lesson
  • Workbook
  • Planning
  • Tracking
  • Results
  • Communication Tool
  • Coaching Tool
  • Population Report

40
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

41
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.

42
Patients Plan Physical Activity
43
Patients Track Their Behaviors
  • Patients progress through the program and track
    behaviors, starting with their weight and adding
    nutrition and physical activity.

44
Patients Review Behaviors
  • Patient views tracking results once per week to
    recognize patterns

45
Patient/Coach Communication
  • Patient and coach stay connected through secure
    email messaging and chat rooms

46
Progress Review and Secure Email
  • Coach views patient progress sends patient
    personalized template-based email

47
Clinician Coach Accesses Reports
  • Coach views group reports, check patient
    compliance and generate summaries

48
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
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