care that fits in practice

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Care that Fits In Practice The ICAN Discussion Aid and Evolution of Practice

Kasey R. Boehmer, PhD, MPH Martina Mookadam, MD

KER UNIT & Division of Family Medicine Mayo Clinic Minnesota & Arizona

[email protected]

@krboehmer @kaseyrebekah


ICAN Development


Barnett et al. Lancet 2012

Workload

Capacity

access use self-care

Outcomes

Burden of illness

Life

Burden of treatment

Scarcity Shippee N et al JCE 2012

The work of being a patient

Sense-making work Organizing work and enrolling others

Doing the work Reflection, monitoring, appraisal Gallacher et al. Annals Fam Med 2012

Capacity

Workload Biography Resources Environment Work Social

Boehmer K et al BMC Fam Prac 2016

Evidence synthesis

Observation clinical encounters

Designers Study team

Patient advisory groups Clinicians

Stakeholders

Initial prototype

Field testing

Modified prototype

Final Communication Tool

Evaluation (trial)

\

Boehmer KR, et al. 2016, BMC Health Serv Res.


Activity


ICAN in Real-World Clinical Practice


Mayo Clinic Arizona Family Medicine • 4 clinics • Thunderbird Clinic • Our TEAM: 3 physicians, 2 NP’s, 5 LPN’s/MA’s,

1 team RN, 1 RN care coordinator, 1 IBH specialist, panel manager (0.3 FTE) and MTM pharmacist (0.4 FTE), psychiatrist (.4 FTE).

• We look after 5K patients


7%

6%

4%

9%

15%

23%

19%

13%

3%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

0-20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 >90

Thunderbird Paneled Patients by Age Range (%)

0-20

21-30

31-40

41-50

51-60

61-70

71-80

81-90

>90


Frank June 2018


Frank Oct 2018


Mayo Clinic Arizona Experience

• 2016 ICAN tool: 9% of patients referred for additional services based on answering yes to 3 or more burdens. (77 of 890 patients).

• November 2017 NAPCRG Poster • Early 2018: Modified tool • Using as communication and screening • Depending on preference and style of provider


ICAN 2018 to Present • Sensitivity of picking up patients needing

referrals seems to be better • Data from first 12 months shows approx. 28%

of patients admit to 3 or more burdens. • 49% answered 0 or did not complete • 23% admitted to 1 or 2 burdens • Range is 3-13 for patients being referred • Average is 4.5 for patients being referred • Approx. 50% of all referrals: IBH • Remainder split between care coordination,

SW, RN HTN, Dietitian, Diabetes Group Visits


Did not complete

No Burdens

1 Burden

2 Burdens

3 Burdens

4 Burdens

5 Burdens

6 Burdens

7 Burdens

8 Burdens

9 Burdens

12 Burdens

13 Burdens

0=39%

NA=11%

1=15% 2=7%

3=10%

4=4%

5=5%

2% 1%

≥1 = 50%

≥3 = 29%


0

10

20

30

40

50

60

70

80

90

Series1


A Work in Progress…

How ICAN helped our team develop an innovative approach to managing chronic conditions.


A theme was emerging.

Most common burdens identified by patients in our practice: • 1. Being Active • 2. Healthy Diet • 3. Managing Stress • 4. Sleep • 5. Emotional Life


Boehmer et al., BMJ Open 2019


Solutions began to evolve organically


Quality Improvement?

Time Frame?

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&ved=2ahUKEwjQmvqh9rzkAhWHsp4KHWl0ByYQjRx6BAgBEAQ&url=https://www.doc.gold.ac.uk/%7Erandr002/coolsite/2016/11/11/5-brainstorming-done/&psig=AOvVaw1MxvEMouV057mIjU1Akg2S&ust=1567884203035421


What else?

Group CBT for Insomnia and Anxiety Expanded services for chronic condition management Better health for the healthcare team! Capacity Coaching for our Care Coordinator Health Coaching Selective for our Medical Students Research Questions


http://minimallydisruptivemedicine.org/ican

ALL NEW! ICAN Discussion Aid Toolkit:

[email protected]

@krboehmer

@kaseyrebekah

care that fits in practice

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