1st Edition

Finding What Matters Most to Patients
Forming the Foundation for Better Care




ISBN 9781138339873
Published January 23, 2019 by Productivity Press
138 Pages 5 B/W Illustrations

USD $51.95

Prices & shipping based on shipping country


Preview

Book Description

Research shows that the importance of patient-reported outcomes, improved decision support, and care coordination is growing rapidly as new payment models transform healthcare delivery. This has led to the use of new measures and communication techniques, including shared decision-making and motivational interviewing.

Using patient-reported outcomes at the point of service helps providers identify what matters most to the patient in front of them now. Describing treatment options and deciphering a patient’s preferences effectively is a process, which has been likened to arriving at a diagnosis. Providers make a medical diagnosis by discerning a patient’s primary complaints, past history, exam findings, and test results. A preference diagnosis can be thought of similarly. Providers work with their patients to identify what matters most to them, discuss the risks and benefits of the available treatment options, and support the patient as needed through the decision-making process. Once informed of their options, patients frequently chose treatments that require modifying their habits. Motivational interviewing helps patients and providers understand what matters most now and design care plans that provide appropriate support.

While many healthcare providers and leaders may be familiar with patient-reported outcomes from research articles, and have heard of shared decision-making and motivational interviewing, few have experience using them. Fewer still understand how each relates to the other. This book helps leaders and healthcare providers better understand how to use patient-reported data to their advantage at the point of service. The book provides the background for developing shared knowledge and shared language, along with extensive examples of dialogue between providers and patients. In addition, the book contains personal interviews of subject matter experts who have significant experience using these measures. The result is a comprehensive understanding of how these measures and techniques can help providers, organizations, and patients navigate this modern healthcare management opportunity.

Table of Contents

    Contents

    Forward: Eugene C. Nelson........................................... xi

    Forward: Victor M.Montori ........................................ xvii

    Acknowledgments ...................................................... xxi

    Author ...................................................................... xxiii

    1 The long road to finding what matters most

    to patients .............................................................. 1

    1.1 The siren call of the business case ..........................3

    1.1.1 The faulty logic of the business case............5

    1.2 A history of outcomes measurement.......................8

    1.3 Patient-reported outcomes evolve ........................11

    2 Introducing the OODA loop ................................. 17

    2.1 OODA loop background .......................................19

    2.2 The OODA loop applied to patient care...............20

    3 Patient-reported measures help find what

    matters most......................................................... 23

    3.1 Patient-centered outcome measurement...............24

    3.2 Patient-reported outcome measures .....................26

    3.2.1 Generic PRO tools ......................................26

    3.2.2 Condition-specific PRO tools......................27

    3.3 Patient-generated outcome measure.....................28

    3.3.1 CollaboRATE...............................................28

    3.4 Where PROs are heading.......................................29

    3.4.1 Point-of-care PROs......................................30

    4 Patient-reported measures in action..................... 33

    4.1 An initial visit..........................................................35

    5 Shared decision-making helps find what

    matters most......................................................... 39

    5.1 The 3-Talk Model of shared decision-making ......42

    5.1.1 Team Talk ...................................................43

    5.1.2 Option Talk.................................................43

    5.1.3 Decision Talk ..............................................44

    6 Shared decision-making in action......................... 47

    6.1 Team Talk ..............................................................51

    6.2 Option Talk ............................................................51

    6.3 Decision Talk .........................................................56

    7 Motivational interviewing helps find what

    matters most......................................................... 61

    7.1 Overcoming ambivalence and increasing

    confidence..............................................................62

    7.2 Processes of motivational interviewing.................63

    7.2.1 Engaging .....................................................63

    7.2.2 Focusing......................................................64

    7.2.3 Evoking .......................................................64

    7.2.4 Planning ......................................................64

    7.3 Techniques to facilitate the processes...................65

    7.3.1 Expressing empathy....................................65

    7.3.2 Developing discrepancy.............................65

    7.3.3 Avoiding argumentation .............................66

    7.3.4 Rolling with resistance................................66

    7.3.5 Supporting self-efficacy ..............................66

    8 Motivational interview in action........................... 67

    8.1 An example of motivational interviewing

    during a follow-up visit..........................................68

    9 Putting the elements together in practice........... 73

    9.1 Applying the care team model...........................73

    9.2 Conclusion..........................................................77

    10 Subject matter expert interviews ........................ 79

    10.1 Kevin Bozic ........................................................80

    10.2 Ted Rooney ........................................................87

    10.3 Libby Hoy...........................................................93

    10.4 William Kramer ..................................................97

    10.5 Carla Marienfeld ...............................................100

    10.6 Matt Handley ....................................................103

    10.7 David Rosengren..............................................108

    10.8 Amanda Brownell ............................................112

    10.9 Albert W. Wu....................................................115

    10.10 Conclusion........................................................121

    Index ................................................................ 125

    ...
    View More

    Author(s)

    Biography

    Thom Walsh, PhD, is the Founder and Chief Strategy Officer

    of Cardinal Point Healthcare Solutions, an Adjunct Lecturer at

    the Dartmouth Institute for Health Policy and Clinical Practice,

    and a Visiting Associate Professor of Community Medicine at

    the Oxley College of Health Sciences at the University of

    Tulsa. He holds an MS degree in Physical Therapy, an MS in

    Clinical Evaluative Sciences, and a PhD in Health Policy.

    Known as an excellent teacher and mentor, he draws on

    extensive clinical, research, and consulting experience to help

    people and organizations to navigate a rapidly changing

    healthcare environment. His clinical career spanned private

    practice and academic settings, including the development

    and launch of a multidisciplinary spine center at the

    Dartmouth-Hitchcock Medical Center. His writings on

    patient-reported outcome measures, healthcare costs and

    utilization, shared decision-making, motivational interviewing,

    and ethical leadership have appeared in numerous publications,

    including the BMJ, JAMA, Spine, The Journal of Healthcare

    Management, Forbes, The New America Foundation, and

    The Atlantic. His first book, Navigating to Value in Healthcare,

    was released in 2017. Dr. Walsh also enjoys hiking,

    running, reading, and writing. He volunteers with a mountain

    search and rescue unit and Team Rubicon, a disaster relief and

    humanitarian aid organization.

    Reviews

    "Healthcare providers are coming to understand their vital role in fostering patients’ informed choices and co-developing care plans. Now, it is time for healthcare executives to step-up and to ensure this moral imperative is reflected in their organizations’ culture and practices. In Finding What Matters Most to Patients, Walsh details an approach to delivering care that will enable executives to proclaim and assure patients, "Yes, that’s what we do here." – William A Nelson PhD, MDiv. Healthcare and Organizational Ethicist, The Dartmouth Institute for Health Policy and Clinical Practice

    "Dr. Walsh infuses humanity into the labyrinth of modern healthcare delivery. Utilizing patient-reported outcomes as meaningful data drives our health systems to operationally evolve into a consumer-centric model, akin to nearly all other service-based industries. Such attention to the drivers of clinical performance will, as Dr. Walsh opines, incentivize the sustainable delivery of high-value care. These deep insights will hold us all (patients, providers, payers - alike) to higher levels of accountability and clinical confidence." – Helena Rosenthal, MPH, Healthcare Partners, A DaVita Medical Group

    "Walsh specifies practical methods for applying patient-reported measures, shared decision-making, and motivational interviewing to improve their delivery of care. This is a must read for anyone focused on increasing value in healthcare." – Jordan Harmon, MHA, AVP of Value, Hospital for Special Surgery and Director, Costs of Care Inc.

    "In Finding What Matters Most to Patients, Thom Walsh lays out the principles of patient-engaged care and shows how patients' values and preferences belong at the center of value-based healthcare. This inspiring book lifts essential ideas out of the closed worlds of academia and policymaking and puts them in the hands of medical students, physicians, and care providers, offering actionable models for changing the culture of healthcare delivery and empowering them to partner with patients to achieve the best patient-defined outcomes. Your patients will thank you for reading this book." – Tara Montgomery, Principle, Civic Health Partners and Adjunct Lecturer, Tufts University School of Medicine

    "What strikes me most about "Finding" is how useful it is for patients. They too need more knowledge and more skills in order to better advocate for care that aligns with their goals and preferences. This book can help patients gain that wisdom. - Lori Nerbonne, RN, Patient Advocate Specialist, Winchester Hospital, Massachusetts

    "When does a person become a patient? In "Finding What Matters To Patients" we are ushered into a path of care meant for patients who value providers willing to learn about them, not just their illness. The path is practical, person-centered, and flexible to leverage the refined complexities of medical science while honoring and harnessing the untapped wisdom people bring into every exam room: themselves. In this book, Dr. Walsh offers a path toward better care, better value, and better experience in healthcare. I am certain every person who becomes a patient will celebrate practitioners who apply this approach." – Dr. Marcus M. McKinney, LPC, President, Reimagining Care, Ariadne Labs Affiliate, Assistant Professor, UCONN School of Medicine