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Decision-making: supporting patients through their healthcare journey
Maggie McDow, Director of Quality, Clinical Governance, and Chief Nursing Officer, Bupa UK28 February 2014
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Our purpose
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Bupa in the UK: ‘Our focus is your health’
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17,000patients
supported with out-of-hospital
care
32,000 people work for Bupa
in the UK
Our Home Healthcare business
provides out-of-hospital healthcare to more than 17,000
patients.
3.5 million claims for treatment every year.
17,900 residents in over 300 care homes
32,000 people work for Bupa
in the UK
2.7m customers
in UK
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Nursing at Bupa
Our focus is on the health and wellbeing of our 2.7 million customers in the UK.
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Acute nursing
Health information and advice
Specialist dementia care Community nursing
Home medication delivery
Health coaching
Occupational health
Enablement care
Specialist nursing
Parenteral nutrition
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How we strive to consistently deliver the very best care
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High quality care
Delivering care that is right for each individual
Ensuring the care our customers receive meets professional standards
Providing care according to established clinical pathways
Measuring and reviewing outcome data
High quality service
Acting as an effective steward of patients’ time and resources
Demonstrating professionalism
Ensuring informed financial consent
Asking customers for their feedback to support continuing improvement
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Shared decision-making: at the heart of Bupa’s 2020 vision
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I trust Bupa to be there for me
Bupa is committed to tackling rising
healthcare cost while ensuring better
outcomes
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Our global commitment to shared decision-making
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• Sanitas Responde: 35 nurses offer a telephone service in prevention, chronic disease management and other areas such as smoke cessation, stress or depression
• Bupa Health Dialog HQ in Boston: DECISION Dialog® program - built on the principle that empowered consumers can take charge of their healthcare decisions
• Bupa Health Dialog Australia: In Australia, Bupa Health Dialog touched the lives of more than 51,000 people in 2012
• Bupa Global Second medical opinion (Advanced medical): Access to a second opinion from leading experts in the relevant field, who review diagnosis & treatment plan & recommend any change
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Health coaching in practice:Exploring patient needs for decision-making and providing support
Karen Abinett, Health Coach, Bupa
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Facilitate appropriate use of healthcare
Empower individuals with information, skills, confidence, and motivation
Health coaching mission
Improve health and quality of care
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Health coaching
Meet individualswhere they
are
Engageindividuals
Identify opportunities
Guide individuals
where they need to be
Developa plan
Goa
lsTo
ols
Approved
Web sites
There is more than one way to achieve goals.
Communication
skills
Decision aids Client resources
Shared
Decision-Making
Framework
Long term
Condition
Framework
Community
resources
Health coaching model
Motivational
Interviewing
Decision – making journeyDecision – making journey
Building & maintaining the allianceBuilding & maintaining the alliance
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What is shared decision-making?
A healthcare professional
communicates information about the
options, outcomes, probabilities, and
scientific uncertainties of
treatment options
A patient communicates his or her values and
the relative importance he or
she places on benefits and
harms
Patient
Experts
MDT
Health CoachPhysician
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Information exchange
Flow
Direction
Type
Amount
Deliberation
Deciding on treatment
to implement
One way (usually)
Provider to patient
Clinical
Minimum legally required
Provider and colleagues
Provider
One way (primarily)
Provider to patient
Clinical
All relevant for decision-
making
Patient (& others)
Patient
Two way
Provider and patient
Relevant for patient needs in context of the situation
Provider and patient (potentially others)
Providerand patient
Clinical and personal
Models of decision-making
Paternalistic Shared Informed
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The purpose of shared decision-making is to:
• Improve the quality of health decision-making and healthcare by helping individuals and their doctors communicate about the personal side of illness prevention and treatment.
• Provide evidence-based, unbiased medical information to a person who is facing a healthcare decision while also taking into consideration that individual’s values, beliefs, and preferences.
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Bupa’s approach to shared decision making
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- Patients and clinicians work together throughout
- The patient has a clear view of all options
- Decisions based on evidence and patient preference
- Decisions made jointly by patients and clinicians
Working together
- Goes further than traditional informed consent
- Identifies an individual's values and preferences for risk and benefits, and the probabilities of possible outcomes
More than informed consent
-Decision aids providing access to reliable, evidence based information-Counselling from a health coach-A system to support the delivery of a patient’s preferences
Support tools
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Health coaching in practice at Bupa
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No decision about me without me
Risk stratification to identify customer
needs
Improved outcomes
Decision aids
•Supporting customers since early 2008 •Treatment Options Service created in 2011, coaching to over 12,000 customers to date
•Team of eight nurses
Using intelligent analytics to ensure targeted coaching for customers with most need for treatment decisions and chronic condition support
Support from booklets and DVDs to allow patients to take information about their condition and treatment decisions away to digest at their own pace.
SDM and Whole Person Health Coaching help people make informed decisions about their health, leading to better outcomes and patient experience
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Preference-sensitive care conditions (PSC)
Herniated Disc
Hip & Knee arthritis
Early stage breast cancer
Prostatecancer
Coronary artery disease
Benign uterine conditions
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Decision-support framework Health Dialogue 2010®
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Exploring decisional
needsIdentifying and
providing decision support
Evaluating the quality of decisions
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Individuals’ experience of Shared Decision Making
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SDM – treatment for early stage prostate cancer
SDM – treatment for herniated disc
SDM – Health Coaching telephone call
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Are decision aids alone sufficient?
Control group
Information
only (video
& booklet)
Informationand nurse-led
interview just before
specialist visit
1. 2. 3.
CASE STUDY
Aim: Evaluate effect of decision aids with and without interviews.
894 women in UK with uncomplicated menorrhagia were randomly allocated to one of three study arms:
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Empowering patients to make quality medical decisions
Interview and info group women were significantly less likely to have hysterectomy.
Interview and info group had lower medical costs compared to control and info-only groups.
There were no differences in health outcomes (SF-36).
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Summary
• Provide evidenced-based, unbiased information
• Clarify personal beliefs, values, and preferences
• Enhance provider/patient communication
ProvideClarify
Enhance
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Assessing the impact of shared decision-making
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Customers more informed = often less invasive treatments
89% of customers are extremely or very satisfied with the service
Offering support to people with chronic conditions has allowed them to manage their conditions better
Conservative treatment choices have led to a reduction of 300+ surgeries
Claims savings of 10% across engaged customers, generating 14% claims savings
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Our future vision for shared decision making within Bupa
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• Deliver helpful and effective online decision aids to support SDM
• Customers with preference sensitive conditions will have the option of Health Coaching and/or the use of decision aids
• All Bupa recognised clinicians, therapists and other healthcare professionals to understand our approach to SDM
• Share and learn from best practice on SDM within both the private and public sectors
• Continue to develop and expand our health coaching team