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Results to patients for qi c presentation
The document discusses improving diabetes care by fostering patient engagement and understanding through better communication, particularly with HbA1c test results. A new approach sends test results directly to patients before consultations to enhance their preparedness and involvement in care planning. The initiative has received positive responses, indicating it leads to improved patient empowerment and strengthened partnerships with healthcare professionals.
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Results to patients for qi c presentation
- 1. “Delivering results toyou” Share information. Facilitate diabetes care planning. Dr Pete Davies; [email protected] Sandwell & West Birmingham NHS Trust
- 2. The Problem: • Diabetescare. Too often a passive affair. – Are we surprised if appointments & tests are forgotten or missed? • Cards stacked against patients – Professionals have the power & knowledge and can prepare – Patients cannot easily be prepared • We lack shared understanding – So many tests: which are important? – What does all the data mean?
- 3. “Breaking bad news”in diabetes consultations e.g. HbA1c blood test results • Similar to hearing negative feedback at performance review/appraisal • Can’t take it in • Don’t hear anything else that is said There has to be a better way!
- 4. To achieve betteroutcomes in Long-term Conditions You need all these components Engaged empowered patient Organised proactive system Partnership = Better outcomes
- 5. All eggs inone basket? Engaged empowered patient Organised proactive system Partnership = Better outcomes Service redesign; QoF, etc. Lots of focus, attention and investment“Cinderella”
- 6. Self-care The average personwith diabetes: spends three hours each year with a professional The remaining 8,757 hours, they care for themselves. 3 8,760 =% 0.03 %
- 8. Historical Diabetes Care •Passive – Nurse/doctor agenda – Telling e.g. results of tests, examination etc. – Judging – Prescribing & proscribing • “thou shalt not” – Often time-constrained
- 9. To support SelfCare Get Active! – Patient-led agenda – Share information before the care plan meeting – Allow time for reflection – Patient is • better prepared • Engaged • An active partner
- 10. Understanding Glucose control-HbA1c Test We do not make it easy for patients! • …a surrogate for glucose control • …useful clinically • BUT abstract, not easy to explain, or understand • Units of measurement have changed! – 7% 53mol/mol
- 11. The solution • Whenblood tests are processed • Send HbA1c result direct to person with diabetes – For everyone – Within 5 days (before the care- planning review) – In a form that • communicates meaning • promotes reflection & care planning
- 12. Lean Six-sigma Methodology KeyMoments Force-field analysis Voice of the Customer Survey Root Cause Analysis Inventive problem solving Helped identify key enablers; helped us ‘manage’ resistors Game-changer! Demand high original idea (text message) NOT popular Understanding of HbA1c is poor Identified low health literacy Product design would be critical Incorporate low cost AND high quality- The ‘Personal Mailer’
- 13. Product Design iseverything • Give the result meaning – You don’t have to‘get it’ (i.e. understand A1c) in order to know how your diabetes treatment plan is doing • makes the result easier to understand assimilate into – positive health behaviours, – Engagement in care planning
- 15. Health Literacy &patient/user views • Patient group consultation • Online communities: DAFNE-online (UK) & Tu-Diabetes (international) – Feedback on idea & options for graphics and text via online survey tool
- 16. Professional Help • Onemember of patient group was a graphic designer! • Artwork ideas discussed with 2 independent graphic designers
- 17. Descriptor text Aim fora low reading age – Calculated reading age =‘easy to read’ for a 13-15 or 11 year old, respectively Not bad for an abstract concept
- 21. Design Features Trend present andprevious results Scale Coloured ruler Number and arrow 3 categories linked to NICE & QoF targets Simple descriptors Clear advice “what next” ‘pause, reflect.. bring to consultation’ Goal setting & individualised targets
- 22. Design Features Trend present andprevious results Scale Coloured ruler Number and arrow 3 categories linked to NICE & QoF targets Simple descriptors Clear advice “what next” ‘pause, reflect.. bring to consultation’ Goal setting & individualised targets
- 23. Design Features Trend present andprevious results Scale Coloured ruler Number and arrow 3 categories linked to NICE & QoF targets Simple descriptors Clear advice “what next” ‘pause, reflect.. bring to consultation’ Goal setting & individualised targets
- 24. Design Features Trend present andprevious results Scale Coloured ruler Number and arrow 3 categories linked to NICE & QoF targets Simple descriptors Clear advice “what next” ‘pause, reflect.. bring to consultation’ Goal setting & individualised targets
- 25. Design Features Trend present andprevious results Scale Coloured ruler Number and arrow 3 categories linked to NICE & QoF targets Simple descriptors Clear advice “what next” ‘pause, reflect.. bring to consultation’ Goal setting & individualised targets
- 26. Design Features Trend present andprevious results Scale Coloured ruler Number and arrow 3 categories linked to NICE & QoF targets Simple descriptors Clear advice “what next” ‘pause, reflect.. bring to consultation’ Goal setting & individualised targets
- 27. Design Features Trend present andprevious results Scale Coloured ruler Number and arrow 3 categories linked to NICE & QoF targets Simple descriptors Clear advice “what next” ‘pause, reflect.. bring to consultation’ Goal setting & individualised targets
- 28. Pilot Evaluation 2011 •n=1800 – 8 general practices recruited – 1 specialist practice (PHD) • Evaluated by questionnaire • Administered at time of consultation • Patient and HCP gave their views • We could match the responses
- 29. Quantitative analysis ofResults to Patients Statement % Agreeing/ Strongly agreeing* “Getting my HbA1c result before my appointment helped me” 73% “having my HbA1c result made it easier to talk to my doctor and/or nurse” 76% “I would like to receive my HbA1c result in this way in future” 89% “The fact my patient had their HbA1c result made the consultation easier” 74% Peoplewithdiabete Hea prof *n=178 questionnaires returned for analysis
- 30. Qualitative analysis ofResults to Patients Domain Patient comment Medication adherence (concordance) “getting my result made me take my tablets” Dietary adherence “I’ve been trying hard with my diet, so this really gave me a boost” Empowerment “I will go back to my nurse and ask to go on a diabetes course” Confidence “I can now see that my treatment plan is really working!” Peoplewithdiabe *n=178 questionnaires returned for analysis
- 31. Qualitative analysis ofResults to Patients (2) Domain HCP comment* Understanding diabetes “they wanted to know more about their result” Engagement “before this it was difficult to get her to come” Partnership working “after we’d discussed their result, they could see its value and were all for it” Did this create time pressures? No extra time pressures *n=17 professionals across 8 practices Healthcareprofes
- 32. Present State • Successfulroll-out from December 2011, all Sandwell GP practices • Safeguard excluding screening for diabetes • National interest high, other PCTs/CCGs and patients • Support from my Trust’s CEO = sustainable
- 33. Summary & Conclusions •Patient involvement shaped product quality – enabling better understanding • Sharing information in this way – Was welcomed – Led to positive health behaviours, suggesting people have taken greater control of their diabetes – Enhanced consultations with doctors & nurses, suggesting partnerships were strengthened
- 34. Summary & Conclusions(2) • The project team are firm advocates of Lean and Six-Sigma methodologies • Many other applications of this technology are feasible • Easily transferable to other areas • Lots of options for moving this into the digital health domain
- 35. Acknowledgements Mr Stuart Davis,type 2 diabetes 15 yrs, podiatrist 37 years, Sandwell PCT Ms Dottie Tipton, Service Improvement Manager, SWBH Dr Jenny Harding, pharmacist, Director of Clinical Governance Sandwell PCT Thanks to Lilly UK for providing project support. Thanks to Sandwell Diabetes Support Group for financial support for the pilot
- 36. Understand diabetes. Takecontrol [email protected] Maybe initiatives like ours can help achieve that
Editor's Notes
- #2 Pleasure to be here Title of our project- Delivering… But its about sharing info.
- #5 This is the Better outcomes equation.. After Sue Roberts, Nat Clin Dir for Care Planning It can be applied to any LTC Need it all
- #6 In diabetes there has been a lot of attention given to systems.. Whilst lip service paid to these areas, e.g. local surveys show… little movement in education courses being offered