Using information technology to improve care for vulnerable patients
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Transcript of Using information technology to improve care for vulnerable patients
Using information technology to improve care for
vulnerable patients
Preliminary Results from the McGill TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) Project
Why this Project? • There is a need to optimize health care delivery from
being disease-focused to being patient- and wellness-focused.
• TAPESTRY hopes to: – develop and enhance public participation in the way
health services are planned and how health decisions are made and delivered
– raise awareness within the health system about community issues facing at risk populations
– find ways to meet the self-identified health goals of at risk populations to assist them with staying healthy longer
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What is TAPESTRY?
• TAPESTRY’s objective is to deliver truly person-centered care through fostering home-based partnerships between the person, their primary health care team, and their community.
• TAPESTRY’s approach centers on meeting a person’s health goals with the support of trained community volunteers, system navigation, community engagement, and the use of technology.
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McGill-TAPESTRY
• Partner project for McMaster Family Medicine
• Sites at St. Mary’s (Dr. Ellen Rosenberg) and Queen Elizabeth (Dr. Mark Roper)
• At risk population selected: Canadian Immigrants
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“Healthy immigrants” to “at-risk”…
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• High risk of depressive disorder (10-24 m)
• Increase in reporting common CD (after 5 y): -60% more mood disorder, anxiety; -70% more obesity, diabetes; -40% more hypertension;
Focus: Middle East & South Asia
• Higher prevalence of cancer of ME in United States compared to the population living in Middle Eastern countries
• 15% of SA immigrants develop diabetes comparing to 11% in all immigrants
• 10-40 fold higher relative risk of end-stage renal failure among SA immigrants with type 2 diabetes compared to general population
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Factors that put immigrants at risk…
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Resettlement stress
Unemployment Poverty
Barriers to access for health services
Natural progress of Health deterioration 30% live under poverty
line (first 10 y)
Acculturation
What can we do? Even with care provided by family physicians, immigrants deteriorate in health in their first 10-years in Canada. To be able to mitigate this deterioration, we need to: • account for how access barriers related to cultural beliefs occurs
and understand how to address this effect
• account for the lived experiences of immigrants as well as their acculturation process
• understand how to improve their integration process and potential
access – are community volunteers a viable solution?
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Questions addressed by Project
1. Can culturally trained community volunteers help immigrants better
manage their chronic disease?
2. Is information provided by the community volunteers useful for the primary care team in providing care?
3. What is the current acculturation and health beliefs of immigrants with chronic disease and how does this effect objectives 1 and 2?
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Criteria of Patient Participants • Inclusion:
– >18 years old – Reported at least one of 7 chronic diseases:
• diabetes • obesity • mood disorders/anxiety • chronic disease of the digestive system • high blood pressure • cancer • arthritis
– Have a family doctor at St-Mary’s or QE
• Exclusion: – Severe cognitive impairment or history of violence (where
volunteer might be at risk).
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Recruitment of Patient Participants at Queen Elizabeth and St-Mary’s
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List of potential participants queried
from EMR or archivist
Physicians contact their patient directly or through a
mailed letter to introduce the study
If interested, follow up is done by
research assistant to explain the study
and review consent form with participant
Study Timeline From Physician Perspective
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Home Visit 1: Collect surveys and
set patient goals
Home Visit 2:
Collecting survey info, show video on
health care
Home Visit 3: Qualitative Interview
Report generated and sent to primary
care team
Report generated and sent to primary
care team
Focus group & short survey of clinician
participants
Identify 4-5 patients to participate
Information from Patients • Goal Setting
• Nutrition
• Rapid Assessment of Physical Activity
• Vancouver Index of Acculturation
• Global Healthcare Satisfactions Question
• EQ5D-3L (Quality of Life)
• Patient Centeredness
• Duke Index of Social Support
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Potentially new/useful information for health care team
Recruitment of Volunteers and Providers
Volunteers:
• 20 volunteers (recruited through several mediums including University clubs)
• Lived in Canada for at least 15 years.
• Provide them with training on online module
Providers from two sites:
• 6-7 family physicians from Queen Elizabeth Health Center and St-Mary’s Hospital: identify 4-5 patients 14
Volunteer Training
• Blended learning – Online Virtual Training Center (10 modules)
• Active learning principles • Engaging reflection questions and quizzes • Online volunteer community
– In Person Full Day Training • Discussions and reflections on online training content • Technical training with iPads and phone service • Role Playing • Further questions or concerns
Virtual Training Center 1. Introduction 2. Cultural Competency (McGill) 3. Healthcare Navigation (McGill) 4. Program Implementation 5. Conflict Resolution 6. Effective Communication 7. Data Gathering Tools 8. Privacy and Confidentiality 9. Health and Safety 10. Information Technology (McGill)
Health Navigation
Participants
• 26 patients recruited with 14 family doctors
• 24 volunteers who completed multiple visits: – 15 female (62%) – Ages 19 – 55 (average age of 37) – All immigrants
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Data Collected
• Patient data including last qualitative interview
• Focus groups of volunteers
• Individual interviews of doctors 22
Goals Set by Participants (6 Months)
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Personal well-being activities Companionship Hobbies Trips TV & internet
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Diet
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Exercise
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Help family Education of children Happiness of children Health of relatives
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Diabetes control
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Take my pills
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Job for self or spouse
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Lose weight
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Specific help from MD Pain control Effective medication
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Emotional Manage stress ‘Get out from my sickness emotionally/forget I have a sickness’
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Preliminary Conclusion
• Social determinants of health are critical
• What is the “head room” to address this by family doctors?
• Immigrants (patients and volunteers) still feel very vulnerable and ”assessed” – little understanding of research
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McGill Tapestry Team
Clinical Leads: Dr. Ellen Rosenberg, St-Mary’s Hospital Dr. Mark Roper, Queen Elizabeth Health Complex Team members: • Cindy Ibberson, RA • Dr. Tamara Carver, Online Training/Development • Doaa Farid, PhD Candidate • Nina Mamishi, Volunteer Coordinator
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