Decision-making: supporting patients through their healthcare journey

Maggie McDow, Director of Quality, Clinical Governance, and Chief Nursing Officer, Bupa UK28 February 2014

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Our purpose

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Bupa in the UK: ‘Our focus is your health’

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17,000patients

supported with out-of-hospital

care

32,000 people work for Bupa

in the UK

Our Home Healthcare business

provides out-of-hospital healthcare to more than 17,000

patients.

3.5 million claims for treatment every year.

17,900 residents in over 300 care homes

32,000 people work for Bupa

in the UK

2.7m customers

in UK

Nursing at Bupa

Our focus is on the health and wellbeing of our 2.7 million customers in the UK.

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Acute nursing

Health information and advice

Specialist dementia care Community nursing

Home medication delivery

Health coaching

Occupational health

Enablement care

Specialist nursing

Parenteral nutrition

How we strive to consistently deliver the very best care

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High quality care

Delivering care that is right for each individual

Ensuring the care our customers receive meets professional standards

Providing care according to established clinical pathways

Measuring and reviewing outcome data

High quality service

Acting as an effective steward of patients’ time and resources

Demonstrating professionalism

Ensuring informed financial consent

Asking customers for their feedback to support continuing improvement

Shared decision-making: at the heart of Bupa’s 2020 vision

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I trust Bupa to be there for me

Bupa is committed to tackling rising

healthcare cost while ensuring better

outcomes

Our global commitment to shared decision-making

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• Sanitas Responde: 35 nurses offer a telephone service in prevention, chronic disease management and other areas such as smoke cessation, stress or depression

• Bupa Health Dialog HQ in Boston: DECISION Dialog® program - built on the principle that empowered consumers can take charge of their healthcare decisions

• Bupa Health Dialog Australia: In Australia, Bupa Health Dialog touched the lives of more than 51,000 people in 2012

• Bupa Global Second medical opinion (Advanced medical): Access to a second opinion from leading experts in the relevant field, who review diagnosis & treatment plan & recommend any change

Health coaching in practice:Exploring patient needs for decision-making and providing support

Karen Abinett, Health Coach, Bupa

Facilitate appropriate use of healthcare

Empower individuals with information, skills, confidence, and motivation

Health coaching mission

Improve health and quality of care

Health coaching

Meet individualswhere they

are

Engageindividuals

Identify opportunities

Guide individuals

where they need to be

Developa plan

Goa

lsTo

ols

Approved

Web sites

There is more than one way to achieve goals.

Communication

skills

Decision aids Client resources

Shared

Decision-Making

Framework

Long term

Condition

Framework

Community

resources

Health coaching model

Motivational

Interviewing

Decision – making journeyDecision – making journey

Building & maintaining the allianceBuilding & maintaining the alliance

What is shared decision-making?

A healthcare professional

communicates information about the

options, outcomes, probabilities, and

scientific uncertainties of

treatment options

A patient communicates his or her values and

the relative importance he or

she places on benefits and

harms

Patient

Experts

MDT

Health CoachPhysician

Information exchange

Flow

Direction

Type

Amount

Deliberation

Deciding on treatment

to implement

One way (usually)

Provider to patient

Clinical

Minimum legally required

Provider and colleagues

Provider

One way (primarily)

Provider to patient

Clinical

All relevant for decision-

making

Patient (& others)

Patient

Two way

Provider and patient

Relevant for patient needs in context of the situation

Provider and patient (potentially others)

Providerand patient

Clinical and personal

Models of decision-making

Paternalistic Shared Informed

The purpose of shared decision-making is to:

• Improve the quality of health decision-making and healthcare by helping individuals and their doctors communicate about the personal side of illness prevention and treatment.

• Provide evidence-based, unbiased medical information to a person who is facing a healthcare decision while also taking into consideration that individual’s values, beliefs, and preferences.

Bupa’s approach to shared decision making

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- Patients and clinicians work together throughout

- The patient has a clear view of all options

- Decisions based on evidence and patient preference

- Decisions made jointly by patients and clinicians

Working together

- Goes further than traditional informed consent

- Identifies an individual's values and preferences for risk and benefits, and the probabilities of possible outcomes

More than informed consent

-Decision aids providing access to reliable, evidence based information-Counselling from a health coach-A system to support the delivery of a patient’s preferences

Support tools

Health coaching in practice at Bupa

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No decision about me without me

Risk stratification to identify customer

needs

Improved outcomes

Decision aids

•Supporting customers since early 2008 •Treatment Options Service created in 2011, coaching to over 12,000 customers to date

•Team of eight nurses

Using intelligent analytics to ensure targeted coaching for customers with most need for treatment decisions and chronic condition support

Support from booklets and DVDs to allow patients to take information about their condition and treatment decisions away to digest at their own pace.

SDM and Whole Person Health Coaching help people make informed decisions about their health, leading to better outcomes and patient experience

Preference-sensitive care conditions (PSC)

Herniated Disc

Hip & Knee arthritis

Early stage breast cancer

Prostatecancer

Coronary artery disease

Benign uterine conditions

Decision-support framework Health Dialogue 2010®

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Exploring decisional

needsIdentifying and

providing decision support

Evaluating the quality of decisions

Individuals’ experience of Shared Decision Making

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SDM – treatment for early stage prostate cancer

SDM – treatment for herniated disc

SDM – Health Coaching telephone call

Are decision aids alone sufficient?

Control group

Information

only (video

& booklet)

Informationand nurse-led

interview just before

specialist visit

1. 2. 3.

CASE STUDY

Aim: Evaluate effect of decision aids with and without interviews.

894 women in UK with uncomplicated menorrhagia were randomly allocated to one of three study arms:

Empowering patients to make quality medical decisions

Interview and info group women were significantly less likely to have hysterectomy.

Interview and info group had lower medical costs compared to control and info-only groups.

There were no differences in health outcomes (SF-36).

Summary

• Provide evidenced-based, unbiased information

• Clarify personal beliefs, values, and preferences

• Enhance provider/patient communication

ProvideClarify

Enhance

Assessing the impact of shared decision-making

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Customers more informed = often less invasive treatments

89% of customers are extremely or very satisfied with the service

Offering support to people with chronic conditions has allowed them to manage their conditions better

Conservative treatment choices have led to a reduction of 300+ surgeries

Claims savings of 10% across engaged customers, generating 14% claims savings

Our future vision for shared decision making within Bupa

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• Deliver helpful and effective online decision aids to support SDM

• Customers with preference sensitive conditions will have the option of Health Coaching and/or the use of decision aids

• All Bupa recognised clinicians, therapists and other healthcare professionals to understand our approach to SDM

• Share and learn from best practice on SDM within both the private and public sectors

• Continue to develop and expand our health coaching team

For more information on Bupa visit www.bupa.co.uk or speak to us on Stand 4.