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Impact of Patient Engagement on Treatment Decisions and Patient-Centered Outcomes in the Implementation of New Guidelines for the Treatment of Blood Cholesterol. goals. Update members on recently submitted PCORI application

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goals

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  1. Impact of Patient Engagement on Treatment Decisions and Patient-Centered Outcomes in the Implementation of New Guidelines for the Treatment of Blood Cholesterol

  2. goals • Update members on recently submitted PCORI application • Highlight PPRNet’s planned approach to patient-centered and patient engaged research in implementation of cholesterol guidelines

  3. PATIENT-CENTERED OUTCOMES RESEARCH INSTITUTE • Independent, non-profit organization authorized under Affordable Care Act • “Fund research that will provide patients, their caregivers and clinicians with the evidence-based information needed to make better-informed health care decisions” • Funded >$200 million in research in 2013

  4. PCORI PRIORITIES • Research will help answer these questions: “Given my personal characteristics, conditions and preferences, what should I expect will happen to me?” “What are my options and what are the potential benefits and harms of those options?”

  5. PCORI PRIORITIES • Research will help answer these questions: “What can I do to improve the outcomes that are most important to me?” “How can clinicians and the care delivery systems they work in help me make the best decisions about my health and healthcare?”

  6. PPRNET RESEARCH AND THE PCORI VISION • New approach to projects • Patient and stakeholder engagement • Input on project design • Identifying outcomes of interest • Monitoring project progress • Dissemination of results

  7. WHAT WE KNOW • Cardiovascular disease remains a relevant problem • Cholesterol is a key modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD)

  8. WHAT WE KNOW • American College of Cardiology/American Heart Association published revised guideline on the Treatment of Blood Cholesterol (TBC) in late 2013 • Major shift in focus • Emphasis on patient- centered approach • Clinical controversies

  9. WHAT WE KNOW

  10. ASCVD Risk ReductionPractice-Level Report

  11. ASCVD Risk Reduction PLR

  12. WHAT WE DON’T KNOW • How to implement a patient-centered approach to discussion of treatment options in “real world” practice • What types ofpractice-basedinterventions promote patient-centered decision making

  13. AIMS OF THE PROPOSED PROJECT • Compare the impact of a patient-engaged, practice-based intervention to promote patient-centered care (PE-TRIP) to Usual PPRNet Implementation on concordance with the TBC guideline and patient-reported outcomes among 30 PPRNet practices

  14. AIMS OF THE PROPOSED PROJECT 2. Synthesize “lessons learned” during TBC guideline implementation to identify a set of strategies that promote concordance with the TBC guideline and patient-centered discussions of treatment options in primary care practice

  15. PROJECT ACTIVITIES • All practices: “typical” guideline implementation • Introductory webinar on TBC guideline • Quarterly reports • “Patient-engaged” intervention practices • Site visits • “Best practice” meeting + webinars

  16. PROJECT ACTIVITIES • Patient surveys on patient-reported outcomes • Focus groups among high performing practices

  17. ENGAGING clinician stakeholders

  18. ENGAGING patients

  19. Patient input What matters most to you? “What it is in my situation that leads the doctor to make such a recommendation” “I trust the advice of my doctor” What should your doctor’s role be in helping you make these decisions? “Provide information I can use to self-educate” “I generally ask what the doctor would do in my situation”

  20. Patient input “I lost my father to a massive coronary event at the age of 63 and my sister had a heart attack at 50. I had high cholesterol and with diet and medicine that is now under control. I think the key lies in within our power to prevent.” “Being a patient with diabetes that also receives treatment for high cholesterol this is something very near and dear to my heart.”

  21. WHAT NEXT? September 2014 Funding decisions October 2014 Gather additional stakeholder input November 2014 Resubmission prn December 2014 Start project if funded!

  22. What is required of practices? • Open to all members! • Routine PPRNet data extracts • Introductory site visit • Direct patients to online survey • If randomized to intervention, invite patients to participate, send representatives to network meeting and host 4 site visits • If invited, send representatives to “best practice” focus group

  23. Incentives to participate • Opportunity to inform real-world patient-centered implementation of guidelines • Facilitated PPRNet quality and safety improvement assistance • Concrete example for PCMH “Patient Advisory Council” objective • Financial incentives for practices ($250/provider/year) and patient advisors ($25/activity)

  24. Input on resubmission • Controversial – interest in this? • More input from patients? How?

  25. WHAT DOES THIS MEAN FOR YOU? • We may need your help! • Agree to participate (if funded) • Reach out to patients • Update letters of support

  26. SUMMARY • We are committed to developing “meaningful” PCORI applications and look forward to your input! (See next presentation…)

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