hotspotting education - beyond flexner · invisible curriculum build awareness, resiliency and...
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Hotspotting Education
Gayle Christiansen, MCPContent and Experience Curation
• Membership organization with 22-member board; incorporated non-profit• About 80 full-time staff• $9.02 million annual budget: Mix of foundation & federal grants, technical assistance & care coordination contracts, & hospital support
Overview of Camden Coalition
In Camden, 1% of the population accounts for30% of health care receipts
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OUTLIERS are patients are in the long tail of data
What problem are we trying to solve?
PoliceJail
The next generation: student hotspotters
VISIBLE CURRICULUM Build awareness, knowledge and skill
INVISIBLE CURRICULUM Build awareness, resiliency and skill
VISIBLE CURRICULUM Build awareness, knowledge and skill• Intervention models – COACH; patient stories• Care philosophies - Harm reduction; TIC• Engagement/coordination of community and
community of care providers• Effective teaming• Skills & techniques – Identifying & enrolling pts; MI
INVISIBLE CURRICULUM Build awareness, resiliency and skill• Psychological flexibility
• adapt to fluctuating situational demands• reconfigure mental resources• shift perspective• balance competing desires, needs, and life domains
• Acceptance/Problem-solving dialectic • Resist what is effectively resistible• Accept the unchangeable• Focus on effective action
• Emotion regulation/Distress tolerance• Tolerate what cannot be immediately influenced• Regulate difficult emotions so they can be channeled into
effective action
Transformative Learning:
“transforms problematic frames of reference to make them more inclusive, discriminating, reflective, open
and emotionally able to change”
(Mezirow, 2009, p.22)
• Experiencing a disorienting dilemma• Undergoing self-examination• Conducting a critical assessment of
internalized assumptions and feeling a sense of alienation from traditional social expectations
• Relating discontent to the similar experiences of others---recognizing that the problem is shared
• Exploring options for new ways of acting
• Building competence and self-confidence in new roles
• Planning a course of action• Acquiring the knowledge and skills
for implementing a new course of action
• Trying out new roles and assessing them
• Reintegrating into society with the other perspective
Mezirow (1975)
Stages of transformative learning experiences
Healthcare on the curveDenialTreat part of the patient--avoid ambiguous areasMake a protocol to avoid discomfort in lieu of addressing problemAvoid engagement/information (keep Pandora’s Box shut)
DefeatUnconsciously competentSwimming in your laneLimited problem-solvingDetached care
HostilityReactivity to patients/colleaguesPresent to polarize vs. problem-solveUncompromising rigidityContemptuous campaigning
BlameBlame patient, system, provider or workerLimited or no problem solving
• If I educate a patient enough they will follow the care plan
• My role with patients is to be a problem-solver to fix all their health problems
• I am competent when the patient makes the change I am suggesting
• If the patient goes to their appointments they will be healthy
• Our systems, when navigated correctly, can address patient complexity
• We have a social service safety net resourced to help people with their social needs
Myths debunked by confronting complexity
Moving through the curveDisorienting DilemmaUncovering complexityLearning patient’s storySeeing patient in home
Patient PresentationsWrap-up eventMaking a case for this work
Moving through the curveDisorienting DilemmaUncovering complexityLearning patient’s storySeeing patient in home Case Conferencing
Mosaic CurriculumTeaming
Case ConferencingMosaic CurriculumTeaming
Case ConferencingMosaic CurriculumTeaming
Preceptorship Approach
• Model unconditional positive regard
• Dispute the “fix-it” framework
• Promote reflective practice• Connect feedback to
curriculum content and use of tools/skills
• Recognize strengths and resiliency
• Acknowledge the difficulty of the work
• Model balance between curiosity and expert advice
• Use a change process framework
• Support coping and distress tolerance
• Anchor in the relationship
Camdenhealth.org/curriculum
Moving through the curveDisorienting DilemmaUncovering complexityLearning patient’s storySeeing patient in home
Patient PresentationsWrap-up eventMaking a case for this work
Case ConferencingMosaic CurriculumTeaming
Case ConferencingMosaic CurriculumTeaming
Case ConferencingMosaic CurriculumTeaming
Patient Presentations
Developments in the Works
Student Hotspotting Expansion
Complex.care
Health
Claims
Health Plan
EMS
Public
Census
Social Services
Housing
SNAP
Child Services
School Property
Law enforcement
Courts ParolePolice Corrections
Camden ARISEData included in Camden ARISE
Data not yet available
OverlappingPopulations
National Center for Complex Health and
Social Needs
Goals of a national center• Convene and connect those in the field
• Educate the workforce, both new and veteran
• Encourage new investment in programs
• Advocate for policy reform
• Encourage research and the development of an evidence base
National Center for Complex Health and Social Needs ConferenceThursday, Dec. 8 and Friday, Dec. 9Sheraton Society Hill, Philadelphia, PA
Discussion
Gayle Christiansene: [email protected]: www.camdenhealth.org
Your Turn
In small groups, choose one of the following to address. Include in your development how you will have others experience the importance of SDOH.
• Persuade the city to provide transportation to free clinics
• Write an op ed to your local newspaper• Persuade the CEO of your health system to address
neighborhood issues• Persuade a non-traditional partner to work with you• Other
Additional Slides
Spatial Analysis ofCamden Hospital
CostsSeveral buildings(e.g.) annually generate $1+ million in hospital costs.
6% of city blocks account for 18% of patients and 37% of receipts.
January 2002 – June 2008
Camden Coalition of Healthcare Providers
Theory of Change
Data
Inter
vent
ion P
arad
igms
Trad
itiona
l Med
icine
Diabetes Heart Failure COPD ESRD
Hotsp
ottin
g
Community-Based Multi-disciplinary Care Management for Vulnerable Populations
Triage
Bedside Engagement
Bedside Care Planning
Camden Coalition Care Plan Domains
Home Visits
Accompaniment to PCP
Graduation
• Acceptance frameworkUnconditional Positive Regard (Carl Rogers)EmpathyHarm reductionMotivational interviewing
• Trauma informed care• Holistic, patient-centered approach• COACH Framework
Therapeutic Relationships
The ACO
Camden Coalition ACO• 38,000 covered lives representing 95% of Camden’s Medicaid population• 15 primary care practices• 3 hospitals• 2 contracts with Medicaid managed care organizations
Traditional Response to Homelessness
Homeless
Shelter placement
Transitional housing
Permanent housing
Housing As Healthcare
Sam Tsemberis, Founder of Pathways
Success of Pathways to Housing
Dr. Tsemberis and the Pathways Program were able to demonstrate 85-90% housing retention, as compared to 60% or less in other models of supportive housing
WhyHousing First at the Camden Coalition?
Peter
Driving Diagnosis• COPD exacerbation
• Acute Asthma Exacerbation
• Hypertension
• GERD
Social Indicators • Experiencing homelessness (1+ year in shelter)
• Limited Income ($210/month)
• History of incarceration
• Limited Social Support
• Generalized Anxiety Disorder, Major Depressive Disorder
• In remission from Substance Disorder Dependence from Alcohol
Hospital Utilization• Frequent ED Visits• Frequent Inpatient Admissions to local hospitals
A Camden Partnership