SCOPESCOPEStanford Care Optimization for Patients Stanford Care Optimization for Patients

& Education& Education

Mentor & Resident Orientation 2013-Mentor & Resident Orientation 2013-2014 2014

Directors Jori Bogetz MD, Carrie Rassbach MD, & Julia Gabhart MD

Great Relationships, Great Medicine

• “The good physician treats the disease; the great physician treats the patient who

has the disease.” Sir William Osler“The Father of Modern Medicine”

(1849-1919)

Mission Statement

• To guide residents through the longitudinal

experience of providing a Medical Home for

diagnostically or therapeutically complex

pediatric patients, and thereby improve the

quality of care for these patients.

SCOPE Provides Residents & Mentors …

• Opportunities for Investigation

• Innovation

• Insight

• A patient-and-family centered framework

• Application of Inspiration

Learner-Centered Outcomes

• Improve attitudes of pediatric residents on caring for CSHCN by 20%.

• To assess SCOPE’s impact on the behaviors of

residents by increasing their confidence to apply what they have learned in their future practice and care of CSHCN by 20%.

SCOPE Provides Patients, Families & Outside PCPs …

• Structure and coordination to help make patient and family care meet their goals

• Tools of empowerment

• Opportunity to share their rich knowledge • Continuity of care for a broad population

• Integrated care

Patient-and-Family-Centered Outcomes

The goal is to improve their

• Satisfaction with care obtained at LPCH– As assessed by a survey adapted from the Consumer

Assessment of Healthcare Providers and Systems (CAHPS)

SCOPE Educational Model

• Participants

o The SCOPE Physician

o Faculty Mentors

o Patients and Their Families

o Outside PCPs, if applicable

o Social work, case management support

SCOPE Educational Model

• B. If the patient’s Primary Care is at 730 Welch, their SCOPE physician IS their PCP.

A. B.

A. If the patient’s Primary Care is outside LPCH, their SCOPE physician will establish a Co-Management Agreement with the PCP.

FAQ: Does the SCOPE physician replace existing providers?

NO.

The SCOPE physician DOES NOT REPLACE any existing providers. The SCOPE physician works within the existing care team to help the patient

and family achieve their goals and increase their autonomy.

Patient Selection & Enrollment

• Patients NEW (or identify selves as inexperienced) to LPCH living within 4-county area• Santa Clara, San Mateo, Santa Cruz, and San Francisco

• Identified by managing physicians/primary care providers throughout LPCH

• Screened for appropriateness of program and enrolled by program directors

Upon agreement by family, primary care physician Matched with residents of best fit

The SCOPE Physician

• Approximately 20 Residents opt-in, providing continuity of care over inpatient and outpatient settings at LPCH and externally

• Can fulfill 2-week elective opportunity

• Supports work residents are already doing!

Faculty Mentors

• Approximately 20 Faculty Mentors o General Pediatrics (inpatient and outpatient)o Subspecialists

 • 1 Resident per faculty Mentor

The SCOPE Intervention

• Patient and family are matched with a SCOPE physician and mentor.

• The team should meet in person within 2 weeks for an initial orientation, then at least monthly.

• Patient-centered care is promoted in all patients by use each meeting of the SCOPE Toolkit.

Toolkit on peds.stanford.edu rotations electives SCOPE/complex care

SCOPE

Physician Toolkit

Contents Topic Section

● Emergency Letter – Copy of patient’s Emergency Letter 1

● Contact Tree – Copy of patient’s Contact Tree

2

● Patient/Family Goal Keeper & Meeting Worksheets 3

● My Goals & Mentor Meeting Worksheets 4

● Care Plan – Copy of patient’s Care Plan 5

● SCOPE Pacts – What my SCOPE family and I have agreed upon. Co-management agreements with associated care providers.

6

● Key Consult Notes – Important information from specialists 7

● My Learning – Literature relevant to my patient and Children with Special Healthcare Needs

8

● Letter on CPR Wishes – Copy of my SCOPE patient’s wishes for end of life care

9

● Other Important References – Community, hospital, and other informational resources

10

● My Research – Related to my patient or Children with Special Healthcare Needs

11

My SCOPE Patient’s Picture

and Name

Me, the SCOPE physician

My SCOPE Family’s Picture and Names

SCOPE

The SCOPE Intervention: Your Toolkit

• The SCOPE Toolkit is tailored to each group: Patients & families, mentors, and residents.

• It is available in English, Spanish, and Vietnamese.

• Progress on completing the Toolkit is made according to the needs of each family, always with the idea of using it to help achieve:– Their GOALS– Their EMPOWERMENT.

SCOPE SCOPE TimelineTimeline:: Empower ME!Meet your SCOPE Doctor.

Your SCOPE Doctor will read about your child.

Your SCOPE Doctor will learn about your child in person.

Make goals and build plans to meet these goals.

Home visit and monthly check ins.

Learn to speak up (Advocate) and take steps (Empower) to meet your goals.

Family & Patient Graduation!

Visits to specialists, school, talks with other providers.

SCOPE Contact Tree

SCOPE Goal Keeper

You are ready for SCOPE Graduation when you:•Know your goals of care•Have a plan to meet your goals•Are ready to speak up about your goals and know who to speak to•Are ready to take steps to meet your goals

SCOPE:SCOPE: Empower ME!

Teach Each Other As We Go

Family & Patient Graduation

The SCOPE Intervention

• Meeting Worksheets for are simply guides, to be completed only as found useful.

• Key care coordination tools (to be completed by each SCOPE Team):– Goal Keeper: Guides each meeting, focus of

SCOPE intervention

– Contact Tree: Establishes for entire care team who the patient should contact, when, for what, and how.

My Contact Tree

SCOPE

Patients: If there is a change in your care plan, please contact your SCOPE doctor.

SCOPE doctors: If using your cellphone, provide on outgoing message with instructions for emergencies.

SCOPE should contact me by: (Circle the best way to reach you)

•Phone: • 1. _________________

• 2. _________________

• 3. _________________

•E-mail: ___________________

Last Updated: ________________

The SCOPE Intervention

• Initial training session for residents, mentors

• 3 Resident Case-Based Discussions

• End-Of-Year Feedback Session

The SCOPE Intervention

Case Managers/Care Coordinators and Social Workers as educators, expert navigators of our system

Graduated SCOPE families• May serve as peer resources?

FAQ: So the SCOPE physician’s role is social, not medical?

No.

The SCOPE physician’s role embodies the best parts of medicine:

•Caring for the whole patient•Understanding the disease in the context of the

patient and family•Studying the disease and treatment in depth, as it applies to the

patient’s and family’s goals•Advocating that others involved in the patient’s care work toward

the patient’s goals and patient/family empowerment

Expectations of every SCOPE physician

• Build a relationship with and provide continuity for 1 Child with Special Healthcare Needs (CSHCN)• Meet at least once monthly

(again, does not have to be in person)

• Participate in multidisciplinary care team with co-management with subspecialists

• Explore areas of potential research

• Complete in Toolkit:• Plan of Care (which is scanned into

Cerner)• Contact Tree• Goal Keeper• Home Visit

• Attend at least 1 of 3 Case-Based Discussions throughout year

• Attend at end of the year Feedback Session if possible

• Develop an understanding of the home and family in the context of a CSHCN

Save the dates!

• 12/10 12-1pm (case discussion)- LPCH- 3 East

• 1/30 12-1pm (case discussion)- LPCH Resident lounge

• 3/11 12-1pm (case discussion)- LPCH Resident lounge

• 5/21 5-6:30 (End of year wrap-up/feedback session)- LPCH- 3 East

Expectations of every SCOPE family

• Set up goals for care & work with SCOPE physician regularly to meet these goals.

• Let resident physician know of non-emergent care issues.• Respond to SCOPE physician within 48 hours.

• Tell SCOPE physician of appointments or changes in

plan. • Learn who to call for specific problems, and how to call

them.

• Goal: Empowerment!

Expectations of every SCOPE mentor

• Meet with the patient, family, and SCOPE physician within the first 2 weeks of enrollment.

• Meet with the SCOPE physician (phone, e-mail, etc. all acceptable) every month.

• Be available to answer SCOPE physician’s questions and those triaged from the patient.

• Foster residents’ research interests related to SCOPE patient or SCOPE curriculum.

• Attend case discussions as able and all-participant feedback session.

• Attend Home Visit with resident.

Mentor Resources

• Ideas on how to optimize your mentoring relationship (also in your Toolkit)• Gusic ME, Zenni EA, Ludwig S, First LR. Strategies to design an effective mentoring

program. J. Pediatr. 2010 Feb;156(2):173-4.e1.

• A discussion of the balance of appropriate supervision for safe care and allowing professional growth (also in your Toolkit):• Patricia Hicks, MD. View from the Association of Pediatric Program Directors: The

Role of Supervision in Creating Responsible and Competent Physicians. Academic Pediatrics. Vol. 11, Issue 1, January-February 2011, Pages 9-10.

• For updated data on experiences families of CSHCN• Data Resource Center for Child & Adolescent Health. (2012). 2009-2010 National

Survey of Children with Special Healthcare Needs. http://www.childhealthdata.org/learn/NS-CSHCN

• More first-hand on the patient/family experience• Robert A. Naseef. “Special Children, Challenged Parents: The Struggles and

Rewards of Raising a Child With a Disability” [Paperback] • Philo, Jolene. “Different Dream Parenting: A Practical Guide to Raising a Child with

Special Needs” [Paperback]

Communication Details: Timing

• Emergencies -- go to 911 or the ED. • We ask the family contact their SCOPE physician once the

patient is safely in the ED.

• We ask that they bring their SCOPE Toolkit, if possible.

• Urgent issues -- go to the outside PCP, 730 Welch Primary Care answering service (if the patient’s PCP is at 730 Welch), or the appropriate subspecialty service.

• Non-urgent issues – go to the SCOPE physician.• These correspondences will be returned as soon as possible,

but within 24 hours.

• Mentors are back-up if the resident does not return calls in 24 hours. Directors are mentors’ backup.

Communication Details: Mode

• If you e-mail with/regarding your patient/family:• Ensure families understand these e-mails may not be truly

secure. If they do want to communicate by e-mail, they must sign a consent form.

• When communicating to other caregivers about a patient, always use “SECURE:” as the start of your subject line.

• CC relevant care providers.

 • If you give out your cellphone number:

• Ensure your outgoing message says: “If you are calling regarding a medical emergency, hang up and immediately dial 911.” Then record normal outgoing message.

Communication Details: Documentation

• Document in the medical record (Cerner) any conversation that could potentially influence your patient’s care.

• SCOPE physicians should detail that they have discussed this conversation and recommendations with the mentor/SCOPE director/other attending physician.

 • CC relevant physicians, including attending with whom the SCOPE

physician discussed the topic. • Summarize phone calls under General Message/Phone Message.

• Summarize e-mails and meetings under General Message.

SCOPE Pilot #3 Timeline (2013-14)

SCOPE Support

Institutional Support• Stanford University Pediatrics Residency Program

• with special thanks to Lyn Kahana and Rebecca Blankenburg• Lucile Packard Children’s Hospital Complex Care Initiative

Designated as the educational arm of the Initiative• with special thanks to John Mark, Christy Sandborg, Karen Wayman

Curricular Support• All parties mentioned above• David Bergman• The Lucile Packard Family Advocacy Council• 1st and 2nd SCOPE Pilot Residents and Mentors!Financial Support• Lucile Packard Foundation for Children’s Health Young Investigator Award --

Children with Special Healthcare Needs• Department of General Pediatrics

• with special thanks to Fernando Mendoza

E-Copies of Toolkit, Patient Resources

• Many resources are available on the SCOPE Website (under

electives on peds.stanford.edu)

• All Electronic Copies of the SCOPE Toolkit and related

resources are shared with all SCOPE physicians via

SCOPE Dropbox.

• If you would like to have access to the Dropbox, SCOPE Directors will

gladly invite you. Please e-mail us.

Thank You For …

• Your time

• Your expertise

• Your dedication to teaching

• Your dedication to our patients and families

• Your example of going above and beyond

• Your feedback …

Carrie Rassbach crassbac@stanford.eduJori Bogetz jbogetz@stanford.eduJulia Gabhart gabharj@pamf.org