Joint Commission on Quality and Safety Journal May Volume Number Microsystems in Health - PDF document

Joint Commissionon Quality and SafetyMay 2003 Volume 29 Number 5 Part 4. Planning Patient-Centered CareJohn H. Wasson, MD ty) to best meet a patient’s needs. Background:Clinical microsystems are the essential May 2003 Volume 29 Number 5tems are planned to be effective, timely, and efficientPlanning Care Well: Exemplary Clinicaltouch pads to collect information on the patient’s gener-shared decision making to best match the patient’sIntermountain Health Care Shock Trauma Intensive Careis given a touch-screen computerpatient’s evaluation and treatment.ment of the patient’s concerns. Mostinformation to the patient’s needs.subsequent office visits the patient’s symptoms, func-touch-screen computer.Joint Commissionon Quality and Safety model figure: Wagner EH: Chronic disease management. What will it take to Schematic of the Planned (Chronic) Care Model within minutes. Despite all the activity and technology,the Norumbega Evergreen Woods primary care office(Bangor, Me) is interviewed by a patient representativefor the problem, organized for easy review, and suggeststhe patient’s quality of life and sense of independence,P’s. They have the information and knowledge needed tothat underlie much of current practice (Table 1, p 230). months and years of tests to understand their four P’s.As described in detail previously,P’s of a clinical microsystem provides deeper knowledgepatient’s ability to absorb information or to act on infor-telephone, patient registries, and e-mail and Web-basedtechnologies. Technology facilitates the extension ofJoint Commissionon Quality and SafetyMay 2003 Volume 29 Number 5 are available at www.PKC.com May 2003 Volume 29 Number 5way services and care are planned.Finally, exemplary microsystemscapacity. This capacity is spread acrossThe microsystem staff must make231) and Table 2 (p 232). By incorpo-able 2 (p 232). By incorpo-model and practice assessment forms can be found at www.improvingJoint Commissionon Quality and Safety Negative attitude or mythPatient self-management skill isAll paths lead to a doctor.A perfect example: 70% of theentry, the practice flow immediate-“clog” the system with low-doctor.walls, in the community. Table 1. Common Myths Rejected by Effective Joint Commissionon Quality and SafetyMay 2003 Volume 29 Number 5 care are designed to meet individual patient needs. PCP, primary care physician; PRN, as needed. Service and Information Flow in a Microsystem May 2003 Volume 29 Number 5ness into practice flow. Furthermore, for a significantsufficient self-management support. Table 2 lists Joint Commissionon Quality and Safety Health Care OrganizationOrganization’s business plan includes measurablethe culture is an organizational priority.Community Resources and PoliciesEmphasize the patient’s central role in managing Table 2. Attributes of Planned Care a microsystem’s staff resources go well beyond the num-must ask itself who, what, when, where, and how.Table 2.2. With what measure will the problem be identified?Will the measure be paper based or electronic? Will itFinally, the microsystem has to consider follow-up andA Low-Tech Example for AmbulatoryThe technology-heavy examples of the Spine Center,are a prerequisite for excellent patient-centered care. Wenow describe a process called CARE Vital Signs to illus-for expensive technology. physician’s private examining room. The assessment, mon-In contrast to usual care, with the CARE Vital Signspatient-relevant issues while obtaining the patient’sthe patient’s confidence with his or her self-managementskills, and age-/gender-specific completion of necessaryWhen an issue is identified during the CARE Vital SignsJoint Commissionon Quality and SafetyMay 2003 Volume 29 Number 5 May 2003 Volume 29 Number 5An example of the CARE Vital Signs form is shown inFigure 3 (pp 235–236). A patient may have few needs forthe usual way, except that the relatively healthy patientis given the completed CARE Vital Signs form and isurged to refer to free, Web-based materials for addition-agree, assist and arrange.www.howsyourhealth.org for a more complete assess-needs. When CARE Vital Signs is used, about half of aapproach to introduce CARE Vital Signs. For example,by introducing CARE Vital Signs for patients aged 50–55,would use CARE Vital Signs on another age group. Afterwould have experienced better assessment, advice,CARE Vital Signs is an example of a how a genericVital Signs approach is an efficient, standardized gate-way to effective patient self-management. However, itis evident that the use of a CARE Vital Signs form willroles and processes. Inefficiently, they struggle “just to meet today’s demands.” They do not feel that theyRobert Wood Johnson Foundation for grant 036103, which supported Joint Commissionon Quality and Safety Joint Commissionon Quality and SafetyMay 2003 Volume 29 Number 5 The CARE Vital Signs sheet (available at www.howsyourhealth.org) illustrates a patient found to have painself-management of these conditions. HYH, How's Your Health. CARE Vital Sign Form May 2003 Volume 29 Number 5Joint Commissionon Quality and Safety CARE Vital Signs Form (continued) Joint Commissionon Quality and SafetyMay 2003 Volume 29 Number 5 1. Nelson EC, et al: Microsystems in health care: Part 1. Learning fromhigh-performing front-line clinical units. Jt Comm J Qual Improv28:472–493, 2002. 2. Godfrey MM, et al: Microsystems in health care: Part 3. Planningpatient-centered services. Joint Commission Journal on Quality andSafety29:159–170, 2003. References John H. Wasson, MD,is Professor, Community andSchool, Hanover, New Hampshire. Marjorie M. Godfrey,is Director, Clinical Practice Improvement,Dartmouth-Hitchcock Medical Center, Lebanon, Director, Quality Education, Measurement and Research, Dartmouth-Hitchcock Medical Center. J. Mohr, MSPH, PhD,Safety Research for Pediatrics, University of Chicago,Paul B. Batalden, MD,is Director, Health CareElizabeth.A.Koelsch@Hitchcock.org. 3. Bodenheimer T, Wagner EH, Grumbach K: Improving 4. Bodenheimer T, Wagner EH, Grumbach K: Improving primary carefor patients with chronic illness. The chronic care model, Part Two.7. Bodenheimer T, et al: Patient self-management of chronic disease in9. Wasson JH, et al: Telephone care as a substitute for routine clinic fol-outpatient practice: Time to get back to basics. 12. Magari ES, Hamel MB, Wasson JH: An easy way to measure qualitywith Diabetes and Heart Failure Teams.