a path to self-actualization - snhahec presentation cdc 2015.pdfspeech therapy (st) nursing preop...
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A Path to Self-actualization:
Maximizing Quality of Life for People with
Chronic Disease
Lisa Bujno, APRN
Associate Chief Nurse, Quality and
Performance
White River Junction VAMC
May 12, 2015
May 12, 2015
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Agenda
• NH Landscape & Chronic Disease Burden
• Determinants of Health
• Maslow’s Hierarchy of Needs
• VA Programs Making a Difference
• Health Impact Pyramid
• NH State Health Improvement Plan (SHIP)
• Changing the Context
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NH Landscape
• 1.3 million people • Aging population • Stagnant birth rate (9.9) • Increasing diversity • Migration: -1.2/1000 • Unemployment @3.9% • Crime rate rising • ER visits increasing • Rising healthcare costs
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Growing Chronic Disease Burden
• 34.9% overweight and 25.8% obese
• 17.2% reported smoking
• 4.2% ever diagnosed with coronary heart disease
• 4.3% ever diagnosed with heart attack
• 2.3% ever diagnosed with stroke
• 9.1% ever diagnosed with diabetes; 21.3% among those aged 65 and older
• 11.0% had current asthma in 2013
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The Story of Mr. H
• 64 y male
• Dx of Polymyositis
• Disabled
• Confined to wheelchair with limited use of L arm, no use of R arm
• Homebound
• Married, wife works
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Determinants of Health
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Maslow’s Hierarchy of Needs
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Medical Center: White River Junction, VT
Community Based
Outreach Clinics
(CBOC’s): Rutland, Burlington,
Newport, Bennington and
Brattleboro, VT
Littleton and Keene, NH
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VA Programs Making a Difference
• Home Based Primary Care
• Home Telehealth
• Geriatrics & Extended Care
• Recreational Therapy
Image courtesy of cooldesign /FreeDigitalPhotos.net
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Home Based Primary Care (HBPC)
• Serves frail, chronically ill veterans with complex health care needs who require comprehensive, longitudinal home care services
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HBPC Services
• Primary care visits at home by a physician, nurse practitioner or physician's assistant
• Nursing care management
• Coordination of services by a social worker
• Therapy visits from a physical, occupational, or speech therapist
• Mental health services
• Nutrition counseling
• Medication management
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HBPC Outcomes
• Reduction of inpatient admissions by 43.9%
• Reduction of inpatient days by 60%
• 10% reduction in repeat falls
• 95% immunization rate for influenza; 98% for pneumoccus
• End of life protections: DNR (91%), advanced directives (100%), long-term planning (100%)
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Home Telehealth
• Uses health informatics, disease management and telehealth technologies to target care and case management
• Changes the location where health care services are routinely provided
• Home telehealth, Clinical Video Telehealth, and Store-and-Forward modalities
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Telehealth Services
Clinical Video Telehealth (CVT) Mental Health CVT in Home(SCI, PT, OT ) Podiatry Ear, Nose & throat (ENT) Physical Therapy (PT) Wound / Ostomy Care Occupational Therapy (OT) Neurology Speech Therapy (ST) Nursing Preop Diabetes 1:1 Visits Pain Nutrition 1:1 Visits Genomics Weight Loss Group Hearing Aid Management Weight Loss Group Women Cardiology Weight loss 1:1 Ambulatory Monitoring Spinal Cord Injury (SCI) with Boston VAMC Urology
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Telehealth Services
Home Telehealth Store and Forward
Diabetes Hypertension Chronic Obstructive Pulmonary Disease Heart Failure Dementia Support for Caregivers Weight Loss Pallative Care Smoking Cessation
Dermatology Tele-Retinal Imaging
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Telehealth Outcomes
• Improved access to care and quality of life
• Improved patient self-management
• 25% decrease in length of stay
• 19% reduction in hospital admissions
• 9.8% mortality rate in HT patients versus 16.58% in Non-HT patients
• High satisfaction rates among veteran patients Darkins, A. (2008) Care Coordination/Home Telehealth: The Systematic Implementation of Health Informatics, Home Telehealth, and Disease Management to Support the Care of Veteran Patients with Chronic Conditions, TELEMEDICINE and e-HEALTH
Adam Darkins et. al (2014). Reduced Cost and Mortality Using Home Telehealth to Promote Self-Management of Complex Chronic Conditions: A Retrospective Matched Cohort Study of 4,999 Veteran Patients TELEMEDICINE and e-HEALTH, 20, 50. Decreased unscheduled primary care visits
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Geriatrics & Extended Care (GEC)
• Programs to maximize each Veteran’s functional independence and lessen the burden of disability on Veterans, their families, and caregivers
• Focus on shared decision making
• Institutional and non-institutional care options
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GEC Services
• Skilled home care/Homemaker & Home Health Aide
• Adult Day Health Care
• Hospice/Palliative Care
• Medical Foster Home
• Respite Care: in home or hospital
• Caregiver Support
• Veteran Independence Program
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GEC Outcomes
• Improved functional independence
• Reduced caregiver stress and improved family functioning
• Better coordination of care with non-VA providers
• Veterans can remain in their homes longer
• Reduced cost
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Recreational Therapy
• Provide recreation activities to treat and maintain the physical, mental and emotional well-being of Veterans with disabilities, illnesses or other disabling conditions.
• Use a variety of techniques, including arts and crafts, sports, games, dance, music and community integration activities
• Assist Veterans with disabilities to integrate into the community by helping them use community resources and recreational activities
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Recreational Therapy Services
• MOVE!
• Adaptive sports programs
• Greenhouse gardening
• Arts and crafts
• Music
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Recreational Therapy Outcomes
• Improves physical well being such as weight management and controlling diabetes and hypertension
• Improves social functioning and help Veterans develop new leisure skills
• Enhances creative expression and break down barriers for cultural expression
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The Story of Mr. H
“HBPC has made the biggest difference to me and my wife.”
• Reduced burden of time spent navigating the health system to get needed care
• Frees time to spend with family and pursue hobbies
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Maslow’s Hierarchy of Needs
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Health Impact Pyramid
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NH SHIP: Top 10 health priorities
• Tobacco
• Obesity/Diabetes
• Cardiovascular Disease
• Misuse of alcohol and drugs
• Cancer Prevention
• Asthma
• Healthy Mothers & Babies
• Infectious Disease
• Injury Prevention
• Emergency Preparedness
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Changing the Context
• Leverage Points in a System
– Information flow
– System rules and goals
– Paradigm
Image courtesy of olovedog/FreeDigitalPhotos.net
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Next Steps
• Integrate Maslow’s principles into everyday practice
• Help patients fulfill their needs beyond medical care & safety
• Support policy changes that promote self-actualization for people with chronic diseases
Image courtesy of Paul Martin Eldridge /FreeDigitalPhotos.net
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Questions?
Lisa Bujno, MSN, APRN Associate Chief Nurse, Quality & Performance 802-295-9363 x5380 [email protected]