Patient – Centered Care

1. Patient – Centered Care Unit 4: Supporting Patient – Driven Care Coordination Lecture c – Information – Driven Patient Education This material (Comp 25 Unit 4) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

2. Supporting Patient – Driven Care Coordination Learning Objectives • Objective 1: Explain the importance of patient – driven care coordination • Objective 2: List ways a patient can use technology to drive care decisions • Objective 3: Describe the concept of patient – initiated information exchange

3. Definition • Patient education includes materials and activities that provide information to patients to improve their health behaviors and health status. An educated patient is better prepared to participate in their care, prevent errors, improve their outcomes, and impact the length of health care interventions.

4. Introduction • How can we help patients to be full partners in their health care? • A knowledgeable and educated patient is better prepared to participate in shared decision – making • For more information on shared decision – making, see component 25 unit 7 • Patient education delivered during a hospital stay or a clinic visit is not retained • Patients who understand their hospital discharge instructions are 30% less likely to be readmitted to the hospital

5. What do patients want? • Information available on demand • Information that is sent proactively • Information that is personal • Information that is interactive • Emotional support that is available along with the information

6. Vision • Patient empowerment through knowledge • Interactive technology that allows the patient to control acquisition of knowledge • Education and information that is delivered at a place and time when patient is ready to learn

7. Technology • Television • Videos • Internet • Email • Health education apps • EHR driven patient education • Patient portals

8. Television • Patient information delivered by television is found in many inpatient settings • These systems allow patients and families to select and view health education of their choosing during an inpatient stay

9. Television (Cont’d – 1) • Patient – driven; learn when ready and able • May not absorb information due to health status • May not include all topics needed • Information is not customized to the patient • Relies on memory

10. Video / DVD • Flexible use: • Hospital, clinic, or home – based • View and review information when patient is ready to learn • Relies on memory • Minimally interactive • Not customized to patient needs • Must have video or DVD player technology

11. Internet • There is a wealth of health information on the Internet • Information can be used either independently by the patient to research their health condition or the patient can be linked or directed to health information on the Internet by their health care provider

12. Internet (Cont’d – 1) • Patient can view and review when they are ready to learn • Web sites may be interactive and can measure and reinforce learning • Must have Internet access and viewing device

13. Email • Vendors are working on email – based products that will allow care providers to send health information or links to resources to patients based on specified criteria • Can be automated • Patient can view when they are ready to learn • Greater personalization of information • Provider can track patient learning activity • Patient must have email address and device to view information

14. Health education apps and games • More physicians and health care providers are prescribing or recommending health apps to patients as an educational and behavioral change technology • Mobile technology; patient can learn at any time or place • Interactive elements to measure, reinforce, and practice learning • Not yet widely adopted by physicians, but use is growing • Patient must have mobile technology and Internet connection to use

15. EHR – driven education • Education is ordered in EHR and sent to patient viewing device in hospital • Patient views when they are ready to learn • Completion of education flows back into EHR, where caregivers can assess understanding and reinforce education • Requires specific vendor technology, but is not offered by all vendors

16. Patient portals • Episode – specific information is available when the patient is ready to learn • Information can be shared with family and friends • Portal may provide links to large health information databases • Patients and family can browse and research health information

17. Barriers • Many technologies exist or are emerging to support the goal of interactive and on – demand patient education • There are barriers that decrease the ability of the patient to manage their own health education needs • Health literacy • Language • Culture • Health care culture • Environmental culture • Technology

18. Health literacy • “The degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” • (Institute of Medicine, 2004) • Skills to navigate the health care system • Skills to communicate with health care providers • Majority of U.S. population possesses intermediate level of health literacy

19. Language • Limited English proficiency impacts comprehension of patient health information • Lower English literacy correlates with decreased adherence to health promotion behaviors from providers

20. Culture • Information – driven patient education can only be successful if cultural factors support acquisition and use of health information • Health care • Transition to partnership – based care model • Empowered patient • Environment • Technology must be present • Technology must support the patient in health behavior change efforts

21. Technology • Equipment needed to view videos, DVD, and TV – based interventions • Internet connection is needed for emerging patient education tools • Email address is required for interaction with health care providers • Patients need to be able to understand and use technology

22. Unit 4: Supporting Patient – Driven Care Coordination, Summary – Lecture c, Information – Driven Patient Education • A knowledgeable and educated patient is better prepared to participate in shared decision – making • Technology can be used to improve the delivery of health information so that the patient can view information at the time and place where they are readiest to learn • Although barriers such as health literacy, limited English proficiency, and culture exist, there are many types of technology that have been designed to empower the patient to gain the knowledge needed to successfully manage their own health

23. Supporting Patient – Driven Care Coordination References – Lecture c References Armenakis, A, & Kiefer, C. Social and cultural factors related to health, Part A: recognizing the impact. Presentation presented at Global Health Education Consortium; 2007. The Beryl Institute. (2011). Patient satisfaction and patient education increase when hospitals offer interactive technology. Enhancing the Patient Experience through the Use of Interactive Technology. Available at: http://www.theberylinstitute.org/news/60203/Patient-Satisfaction-and-Patient-Education-Increase-When-Hospitals-Offer-Interactive-Technology.htm. Cassano, C. (2015). Technology and patient education. Available from: http://nursing.advanceweb.com/Features/Articles/Technology-Patient-Education.aspx Frydman, G. (2014). Some underlying principles of patient-driven healthcare. Patient-Driven Care. Available from: http://www.patientdriven.org/2014/03/some-underlying-principles-of-patient-driven-healthcare/ Institute of Medicine. (2004). Health literacy: a prescription to end confusion. Available from: http://nationalacademies.org/hmd/reports/2004/health-literacy-a-prescription-to-end-confusion.aspx

24. Supporting Patient – Driven Care Coordination References – Lecture c (Cont’d – 1) References U.S. Department of Health and Human Services. Health literacy - fact sheet: health literacy basics. Available from: http://health.gov/communication/literacy/quickguide/factsbasic.htm U.S. Department of Health and Human Services. Health literacy - fact sheet: health literacy and health outcomes. Available from: http://health.gov/communication/literacy/quickguide/factsliteracy.htm

25. Unit 4: Supporting Patient – Driven Care Coordination, Lecture c – Information-Driven Patient Education This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004.