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SCOPE Stanford Care Optimization for Patients

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Title: SCOPE: Stanford Care Optimization for Patients & Education Resident-Led, Relationship-Based, Comprehensive Care for Complex Patients Author – PowerPoint PPT presentation

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Title: SCOPE Stanford Care Optimization for Patients


1
SCOPE Stanford Care Optimization for Patients
Education Mentor Resident Orientation
2013-2014
  • Directors Jori Bogetz MD, Carrie Rassbach MD,
    Julia Gabhart MD

2
Great Relationships, Great Medicine
  • The good physician treats the disease
  • the great physician treats the patient who has
    the disease.
  • Sir William Osler The Father of Modern Medicine
  • (1849-1919)

3
Mission Statement
  • To guide residents through the longitudinal
    experience of providing a Medical Home for
    diagnostically or therapeutically complex
    pediatric patients, and thereby improve the
    quality of care for these patients.

4
SCOPE Provides Residents Mentors
  • Opportunities for Investigation
  • Innovation
  • Insight
  • A patient-and-family centered framework
  • Application of Inspiration

5
Learner-Centered Outcomes
  • Improve attitudes of pediatric residents on
    caring for CSHCN by 20.
  • To assess SCOPEs impact on the behaviors of
    residents by increasing their confidence to apply
    what they have learned in their future practice
    and care of CSHCN by 20.

6
SCOPE Provides Patients, Families Outside
PCPs
  • Structure and coordination to help make patient
    and family care meet their goals
  • Tools of empowerment
  • Opportunity to share their rich knowledge
  • Continuity of care for a broad population
  • Integrated care

7
Patient-and-Family-Centered Outcomes
  • The goal is to improve their
  • Satisfaction with care obtained at LPCH
  • As assessed by a survey adapted from the Consumer
    Assessment of Healthcare Providers and Systems
    (CAHPS)

8
SCOPE Educational Model
  • Participants
  • The SCOPE Physician
  • Faculty Mentors
  • Patients and Their Families
  • Outside PCPs, if applicable
  • Social work, case management support

9
SCOPE Educational Model
A.
B.
  • B. If the patients Primary Care is at 730
    Welch, their SCOPE physician IS their PCP.

A. If the patients Primary Care is outside
LPCH, their SCOPE physician will establish a
Co-Management Agreement with the PCP.
10
FAQ Does the SCOPE physician replace existing
providers?
  • NO.
  • The SCOPE physician DOES NOT REPLACE any existing
    providers. The SCOPE physician works within the
    existing care team to help the patient and family
    achieve their goals and increase their autonomy.

11
Patient Selection Enrollment
  • Patients NEW (or identify selves as
    inexperienced) to LPCH living within 4-county
    area
  • Santa Clara, San Mateo, Santa Cruz, and San
    Francisco
  • Identified by managing physicians/primary care
    providers throughout LPCH
  • Screened for appropriateness of program and
    enrolled by program directors
  • Upon agreement by family, primary care physician
  • Matched with residents of best fit

12
The SCOPE Physician
  • Approximately 20 Residents opt-in, providing
    continuity of care over inpatient and outpatient
    settings at LPCH and externally
  • Can fulfill 2-week elective opportunity
  • Supports work residents are already doing!

13
Faculty Mentors
  • Approximately 20 Faculty Mentors
  • General Pediatrics (inpatient and outpatient)
  • Subspecialists
  •  
  • 1 Resident per faculty Mentor

14
The SCOPE Intervention
  • Patient and family are matched with a SCOPE
    physician and mentor.
  • The team should meet in person within 2 weeks for
    an initial orientation, then at least monthly.
  • Patient-centered care is promoted in all patients
    by use each meeting of the SCOPE Toolkit.

15
Toolkit on peds.stanford.edu ? rotations ?
electives ? SCOPE/complex care
16
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17
The SCOPE Intervention Your Toolkit
  • The SCOPE Toolkit is tailored to each group
    Patients families, mentors, and residents.
  • It is available in English, Spanish, and
    Vietnamese.
  • Progress on completing the Toolkit is made
    according to the needs of each family, always
    with the idea of using it to help achieve
  • Their GOALS
  • Their EMPOWERMENT.

18
SCOPE Timeline Empower ME!
Meet your SCOPE Doctor.
  • You are ready for SCOPE Graduation when you
  • Know your goals of care
  • Have a plan to meet your goals
  • Are ready to speak up about your goals and know
    who to speak to
  • Are ready to take steps to meet your goals

Make goals and build plans to meet these goals.
SCOPE Contact Tree
SCOPE Goal Keeper
Family Patient Graduation!
Learn to speak up (Advocate) and take steps
(Empower) to meet your goals.
Your SCOPE Doctor will learn about your child in
person.
Your SCOPE Doctor will read about your child.
Visits to specialists, school, talks with other
providers.
Home visit and monthly check ins.
19
SCOPE Empower ME!
Family Patient Graduation
Teach Each Other As We Go
20
The SCOPE Intervention
  • Meeting Worksheets for are simply guides, to be
    completed only as found useful.
  • Key care coordination tools (to be completed by
    each SCOPE Team)
  • Goal Keeper Guides each meeting, focus of
    SCOPE intervention
  • Contact Tree Establishes for entire care team
    who the patient should contact, when, for what,
    and how.

21
  • SCOPE should contact me by
  • (Circle the best way to reach you)
  • Phone
  • 1. _________________
  • 2. _________________
  • 3. _________________
  • E-mail ___________________

Last Updated ________________
My Contact Tree
Patients If there is a change in your care
plan, please contact your SCOPE doctor. SCOPE
doctors If using your cellphone, provide on
outgoing message with instructions for
emergencies.
22
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23
The SCOPE Intervention
  • Initial training session for residents, mentors
  • 3 Resident Case-Based Discussions
  • End-Of-Year Feedback Session

24
The SCOPE Intervention
  • Case Managers/Care Coordinators and Social
    Workers as educators, expert navigators of our
    system
  • Graduated SCOPE families
  • May serve as peer resources?

25
FAQ So the SCOPE physicians role is social,
not medical?
  • No.
  • The SCOPE physicians role embodies
  • the best parts of medicine
  • Caring for the whole patient
  • Understanding the disease in the context of the
  • patient and family
  • Studying the disease and treatment in depth, as
    it applies to the patients and familys goals
  • Advocating that others involved in the patients
    care work toward the patients goals and
    patient/family empowerment

26
Expectations of every SCOPE physician
  • Complete in Toolkit
  • Plan of Care (which is scanned into Cerner)
  • Contact Tree
  • Goal Keeper
  • Home Visit
  • Attend at least 1 of 3 Case-Based Discussions
    throughout year
  • Attend at end of the year Feedback Session if
    possible
  • Develop an understanding of the home and family
    in the context of a CSHCN
  • Build a relationship with and provide continuity
    for 1 Child with Special Healthcare Needs (CSHCN)
  • Meet at least once monthly (again, does not have
    to be in person)
  • Participate in multidisciplinary care team with
    co-management with subspecialists
  • Explore areas of potential research

27
Save the dates!
  • 12/10 12-1pm (case discussion)- LPCH- 3 East
  • 1/30 12-1pm (case discussion)- LPCH Resident
    lounge
  • 3/11 12-1pm (case discussion)- LPCH Resident
    lounge
  • 5/21 5-630 (End of year wrap-up/feedback
    session)- LPCH- 3 East

28
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29
Expectations of every SCOPE family
  • Set up goals for care work with SCOPE physician
    regularly to meet these goals.
  • Let resident physician know of non-emergent care
    issues.
  • Respond to SCOPE physician within 48 hours.
  • Tell SCOPE physician of appointments or changes
    in plan.
  • Learn who to call for specific problems, and how
    to call them.
  • Goal Empowerment!

30
Expectations of every SCOPE mentor
  • Meet with the patient, family, and SCOPE
    physician within the first 2 weeks of enrollment.
  • Meet with the SCOPE physician (phone, e-mail,
    etc. all acceptable) every month.
  • Be available to answer SCOPE physicians
    questions and those triaged from the patient.
  • Foster residents research interests related to
    SCOPE patient or SCOPE curriculum.
  • Attend case discussions as able and
    all-participant feedback session.
  • Attend Home Visit with resident.

31
Mentor Resources
  • Ideas on how to optimize your mentoring
    relationship (also in your Toolkit)
  • Gusic ME, Zenni EA, Ludwig S, First LR.
    Strategies to design an effective mentoring
    program. J. Pediatr. 2010 Feb156(2)173-4.e1.
  • A discussion of the balance of appropriate
    supervision for safe care and allowing
    professional growth (also in your Toolkit)
  • Patricia Hicks, MD. View from the Association of
    Pediatric Program Directors The Role of
    Supervision in Creating Responsible and Competent
    Physicians. Academic Pediatrics. Vol. 11, Issue
    1, January-February 2011, Pages 9-10.
  • For updated data on experiences families of CSHCN
  • Data Resource Center for Child Adolescent
    Health. (2012). 2009-2010 National Survey of
    Children with Special Healthcare Needs.
    http//www.childhealthdata.org/learn/NS-CSHCN
  • More first-hand on the patient/family experience
  • Robert A. Naseef. Special Children, Challenged
    Parents The Struggles and Rewards of Raising a
    Child With a Disability Paperback
  • Philo, Jolene. Different Dream Parenting A
    Practical Guide to Raising a Child with Special
    Needs Paperback

32
Communication Details Timing
  • Emergencies -- go to 911 or the ED.
  • We ask the family contact their SCOPE physician
    once the patient is safely in the ED.
  • We ask that they bring their SCOPE Toolkit, if
    possible.
  • Urgent issues -- go to the outside PCP, 730 Welch
    Primary Care answering service (if the patients
    PCP is at 730 Welch), or the appropriate
    subspecialty service.
  • Non-urgent issues go to the SCOPE physician.
  • These correspondences will be returned as soon as
    possible, but within 24 hours.
  • Mentors are back-up if the resident does not
    return calls in 24 hours. Directors are mentors
    backup.

33
Communication Details Mode
  • If you e-mail with/regarding your patient/family
  • Ensure families understand these e-mails may not
    be truly secure. If they do want to communicate
    by e-mail, they must sign a consent form.
  • When communicating to other caregivers about a
    patient, always use SECURE as the start of
    your subject line.
  • CC relevant care providers.
  •  
  • If you give out your cellphone number
  • Ensure your outgoing message says If you are
    calling regarding a medical emergency, hang up
    and immediately dial 911. Then record normal
    outgoing message.

34
Communication Details Documentation
  • Document in the medical record (Cerner) any
    conversation that could potentially influence
    your patients care.
  • SCOPE physicians should detail that they have
    discussed this conversation and recommendations
    with the mentor/SCOPE director/other attending
    physician.
  •  
  • CC relevant physicians, including attending with
    whom the SCOPE physician discussed the topic.
  •  
  • Summarize phone calls under General Message/Phone
    Message.
  • Summarize e-mails and meetings under General
    Message.

35
SCOPE Pilot 3 Timeline (2013-14)

36
SCOPE Support
  • Institutional Support
  • Stanford University Pediatrics Residency Program
  • with special thanks to Lyn Kahana and Rebecca
    Blankenburg
  • Lucile Packard Childrens Hospital Complex Care
    Initiative
  • Designated as the educational arm of the
    Initiative
  • with special thanks to John Mark, Christy
    Sandborg, Karen Wayman
  • Curricular Support
  • All parties mentioned above
  • David Bergman
  • The Lucile Packard Family Advocacy Council
  • 1st and 2nd SCOPE Pilot Residents and Mentors!
  • Financial Support
  • Lucile Packard Foundation for Childrens Health
    Young Investigator Award -- Children with Special
    Healthcare Needs
  • Department of General Pediatrics
  • with special thanks to Fernando Mendoza

37
E-Copies of Toolkit, Patient Resources
  • Many resources are available on the SCOPE Website
    (under electives on peds.stanford.edu)
  • All Electronic Copies of the SCOPE Toolkit and
    related resources are shared with all SCOPE
    physicians via SCOPE Dropbox.
  • If you would like to have access to the Dropbox,
    SCOPE Directors will gladly invite you. Please
    e-mail us.

38
Thank You For
  • Your time
  • Your expertise
  • Your dedication to teaching
  • Your dedication to our patients and families
  • Your example of going above and beyond
  • Your feedback
  • Carrie Rassbach crassbac_at_stanford.edu
  • Jori Bogetz jbogetz_at_stanford.edu
  • Julia Gabhart gabharj_at_pamf.org
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