results to patients for qi c presentation
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“Delivering results to you”
Share information. Facilitate diabetes care planning.
Dr Pete Davies; p.davies@nhs.netSandwell & West Birmingham NHS Trust
The Problem:• Diabetes care. Too often a passive affair.
– Are we surprised if appointments & tests are forgotten or missed?
• Cards stacked against patients– Professionals have the power & knowledge
and can prepare– Patients cannot easily be prepared
• We lack shared understanding– So many tests: which are important? – What does all the data mean?
“Breaking bad news” in diabetes consultationse.g. HbA1c blood test results
• Similar to hearing negative feedback at performance review/appraisal
• Can’t take it in• Don’t hear anything else
that is said
There has to be a better way!
To achieve better outcomes in Long-term ConditionsYou need all these components
Engaged empowered
patient
Organised proactive
system
Partnership
= Better outcomes
All eggs in one basket?
Engaged empowered
patient
Organised proactive
system
Partnership
= Better outcomes
Service redesign; QoF, etc.
Lots of focus, attention and investment“Cinderella”
Self-careThe average person with diabetes:
spends three hours each year with a professional
The remaining 8,757 hours, they care for themselves.
3
8,760=% 0.03 %
Historical Diabetes Care
• Passive– Nurse/doctor agenda– Telling e.g. results of
tests, examination etc.– Judging– Prescribing &
proscribing • “thou shalt not”
– Often time-constrained
To support Self Care
Get Active!– Patient-led agenda– Share information before the
care plan meeting– Allow time for reflection– Patient is
• better prepared
• Engaged
• An active partner
Understanding Glucose control- HbA1c TestWe do not make it easy for patients!
• …a surrogate for glucose control
• …useful clinically
• BUT abstract, not easy to explain, or understand
• Units of measurement have changed!– 7% 53mol/mol
The solution
• When blood tests are processed
• Send HbA1c result direct to person with diabetes– For everyone – Within 5 days (before the care-
planning review)– In a form that
• communicates meaning• promotes reflection & care planning
Lean Six-sigma MethodologyKey Moments
Force-field analysis
Voice of the Customer Survey
Root Cause Analysis
Inventive
problem solving
Helped identify key enablers; helped us ‘manage’ resistors
Game-changer!Demand high
original idea (text message) NOT popular
Understanding of HbA1c is poor
Identified low health literacy
Product design would be critical
Incorporate low cost AND high quality-
The ‘Personal Mailer’
Product Design is everything
• Give the result meaning– You don’t have to‘get it’ (i.e. understand A1c)
in order to know how your diabetes treatment plan is doing
• makes the result easier to understand assimilate into– positive health behaviours, – Engagement in care planning
Health Literacy & patient/user views
• Patient group consultation
• Online communities: DAFNE-online (UK) & Tu-Diabetes (international)– Feedback on idea & options for graphics and
text via online survey tool
Professional Help
• One member of patient group was a graphic designer!
• Artwork ideas discussed with 2 independent graphic designers
Descriptor text
Aim for a low reading age
– Calculated reading age =‘easy to read’ for a 13-15 or 11 year old, respectively
Not bad for an abstract concept
Design FeaturesTrendpresent and previous results
ScaleColoured ruler
Number and arrow
3 categorieslinked to NICE & QoF targets
Simple descriptors
Clear advice “what next” ‘pause, reflect.. bring to consultation’
Goal setting & individualised targets
Design FeaturesTrendpresent and previous results
ScaleColoured ruler
Number and arrow
3 categorieslinked to NICE & QoF targets
Simple descriptors
Clear advice “what next” ‘pause, reflect.. bring to consultation’
Goal setting & individualised targets
Design FeaturesTrendpresent and previous results
ScaleColoured ruler
Number and arrow
3 categorieslinked to NICE & QoF targets
Simple descriptors
Clear advice “what next” ‘pause, reflect.. bring to consultation’
Goal setting & individualised targets
Design FeaturesTrendpresent and previous results
ScaleColoured ruler
Number and arrow
3 categorieslinked to NICE & QoF targets
Simple descriptors
Clear advice “what next” ‘pause, reflect.. bring to consultation’
Goal setting & individualised targets
Design FeaturesTrendpresent and previous results
ScaleColoured ruler
Number and arrow
3 categorieslinked to NICE & QoF targets
Simple descriptors
Clear advice “what next” ‘pause, reflect.. bring to consultation’
Goal setting & individualised targets
Design FeaturesTrendpresent and previous results
ScaleColoured ruler
Number and arrow
3 categorieslinked to NICE & QoF targets
Simple descriptors
Clear advice “what next” ‘pause, reflect.. bring to consultation’
Goal setting & individualised targets
Design FeaturesTrendpresent and previous results
ScaleColoured ruler
Number and arrow
3 categorieslinked to NICE & QoF targets
Simple descriptors
Clear advice “what next” ‘pause, reflect.. bring to consultation’
Goal setting & individualised targets
Pilot Evaluation 2011
• n=1800– 8 general practices recruited– 1 specialist practice (PHD)
• Evaluated by questionnaire• Administered at time of consultation• Patient and HCP gave their views• We could match the responses
Quantitative analysis of Results to Patients
Statement % Agreeing/ Strongly agreeing*
“Getting my HbA1c result before my appointment
helped me”
73%
“having my HbA1c result made it easier to talk to my
doctor and/or nurse”
76%
“I would like to receive my HbA1c result in this way in
future”
89%
“The fact my patient had their HbA1c result made the
consultation easier”
74%
Peo
ple
with
di
abet
es
Hea
lthca
repr
ofes
sion
als
*n=178 questionnaires returned for analysis
Qualitative analysis of Results to Patients
Domain Patient comment
Medication adherence (concordance)
“getting my result made me take my tablets”
Dietary adherence “I’ve been trying hard with my diet, so this really gave me a boost”
Empowerment “I will go back to my nurse and ask to go on a diabetes course”
Confidence “I can now see that my treatment plan is really working!”
Peo
ple
with
di
abet
es
*n=178 questionnaires returned for analysis
Qualitative analysis of Results to Patients (2)
Domain HCP comment*
Understanding diabetes “they wanted to know more about their result”
Engagement “before this it was difficult to get her to come”
Partnership working “after we’d discussed their result, they could see its value and were all for it”
Did this create time pressures? No extra time pressures
*n=17 professionals across 8 practices
Hea
lthca
re p
rofe
ssio
nals
Present State• Successful roll-out from December 2011,
all Sandwell GP practices
• Safeguard excluding screening for diabetes
• National interest high, other PCTs/CCGs and patients
• Support from my Trust’s CEO = sustainable
Summary & Conclusions• Patient involvement shaped product quality
– enabling better understanding
• Sharing information in this way– Was welcomed– Led to positive health behaviours, suggesting
people have taken greater control of their diabetes
– Enhanced consultations with doctors & nurses, suggesting partnerships were strengthened
Summary & Conclusions (2)
• The project team are firm advocates of Lean and Six-Sigma methodologies
• Many other applications of this technology are feasible
• Easily transferable to other areas
• Lots of options for moving this into the digital health domain
Acknowledgements
Mr Stuart Davis, type 2 diabetes 15 yrs, podiatrist 37 years, Sandwell PCTMs Dottie Tipton, Service Improvement Manager, SWBHDr Jenny Harding, pharmacist, Director of Clinical Governance Sandwell PCT
Thanks to Lilly UK for providing project support.Thanks to Sandwell Diabetes Support Group for financial support for the pilot
Understand diabetes. Take control
p.davies@nhs.net
Maybe initiatives like ours can help achieve that
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