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Session #3 | Supporting Implementation Strategies: Workflows and Communication Techniques to Collect and Use SDOH Data May 21, 2021 1:00 – 2:00 pm CT Dr. Jack Geiger and Dr. John Hatch during construction on the Delta Health Center in Mississippi in 1968 (Photo by Daniel Bernstein)

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Page 1: Session #3 | Supporting Implementation Strategies

Session #3 | Supporting Implementation Strategies: Workflows and Communication Techniques to Collect and Use SDOH DataMay 21, 20211:00 – 2:00 pm CT

Dr. Jack Geiger and Dr. John Hatch during construction on the Delta Health Center in Mississippi in 1968 (Photo by Daniel Bernstein)

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Shannon RobertsonDirector of Clinical Quality

Courtney SanfordClinical Quality Coordinator

Louisiana PCA Staff Opening Remarks

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Session #3: Supporting Implementation Strategies: Workflows and Communication Techniques to Collect and Use SDOH Data

© 2021. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. PRAPARE and its resources are proprietary information of NACHC and its partners, intended for use by NACHC, its partners, and authorized recipients. Do not publish, copy, or distribute this information in part of whole without written consent from NACHC.

Louisiana Primary Care Association (LPCA)Social Determinants of Health (SDOH) Webinar Series

May 21, 2021

Albert Ayson, Jr., MPHAssociate Director, Training & Technical Assistance

AAPCHO

Joe Lee, MSHADirector of Strategic Initiatives & Partnerships

AAPCHO

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PRAPARE Team at NACHC & AAPCHO

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PRAPARE Team at NACHC & AAPCHO

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Our National PRAPARE Partnership

Rosy Chang WeirDirector of Research

AAPCHO

Vivian LiResearch Project Manager/Analyst

AAPCHO

Albert Ayson, Jr.Associate Director, T/TA

AAPCHO

Joe LeeDirector of Strategic

Initiatives & PartnershipsAAPCHO

Michelle ProserDirector of Research

NACHC

Sarah HalpinProgram Associate

NACHC

Yuriko de la CruzSDOH Manager

NACHC

Nalani TarrantDeputy Director, Research

NACHC

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LPCA Social Determinants of Health Webinar Series

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Friday, May 28, 2021

Session #4 | Supporting Implementation Strategies: Workflows and Communication Techniques to Collect and Use SDOH Data (continued)

Friday, May 14, 2021

Session #2 | Messaging and Engaging Key Stakeholders Around SDOH Data Collection

Friday, May 21, 2021

Session #3 | Supporting Implementation Strategies: Workflows and Communication Techniques to Collect and Use SDOH Data

Friday, May 7, 2021

Session #1 | Strategies to Support SDOH Data Collection and Implementation

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Session #3 Learning Objectives

1. Strategize SDOH data collection and health center implementation plans, including ideal workflow models for your population(s) of focus

2. Promote empathic inquiry & patient-centered approaches for collecting SDOH data

3. Practice cultural humility when screening patients for SDOH needs

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Learning Objective #1Strategize SDOH data collection and health center implementation plans, including ideal workflow models for your population(s) of focus

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Introduction: Five Rights Framework

© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 8

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5 Rights Framework

5 Rights Workflow Considerations

Right Information--WHAT What information in PRAPARE do you already routinely collect?• Part of registration• Part of other health assessments or initiatives

Right Format--HOW How are we collecting this information and in what manner are we collecting it?• Self-Assessment• In-person with staff

Right Person--WHO Who will collect the data? Who has access to the EHR to input the data? Who needs to see the information to inform care? Who will respond to needs identified? • Providers and other clinical staff• Non-Clinical Staff

Right Time--WHEN When is the right time to collect this information so as to minimize disruption to clinic workflow?• Before visit with provider? (before arriving to clinic, while waiting in waiting room, etc.)• During visit?• After visit with provider?

Right Place--WHERE Where are we collecting this information? Where do we need to share and display this information?• In waiting room? In private office?• Share during team huddles? Provide care team dashboards?

9© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association.

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Sample PRAPARE Workflow Models for SDOH Data Collection

Who Where When How RationaleNon-clinical staff (patient navigator, community health workers)

In waiting room or in staff office

Before or after provider visit

Administered PRAPARE with patients who would be waiting 30+ mins for provider

Provided enough time to discuss SDH needs. Wanted same person to ask question and address need. Often administer PRAPARE with other data collection effort (Patient Activation Measure) to assess patent’s ability and motivation to respond to their situation.

Nursing staff and/or MAs

In exam room Before provider enters exam room

Administered it after vitals and reason for visit. Provider reviews PRAPARE data and refers to case manager

Wanted trained staff to collect sensitive information. Waiting area not private enough to collect sensitive info

Care Coordinators In office of care coordinator

When Completing chart reviews and administering Health Risk Assessments

Administered PRAPARE in conjunction with Health Risk Assessments

Allows care coordinators to address similar issues in real time that may arise from both PRAPARE and HRA

Any staff (from Front Desk Staff to Providers)

No wrong door approach

No wrong door approach Allows everyone to be part of larger process of “painting a fuller picture of the patient” and taking part in helping the patient

Patient Self-Assessment

At home, in waiting room, etc.

Before visit with provider Self-administered using email, mobile, tablets, kiosks, etc.

Low burden on staff to collect data. Privacy for patient to complete assessment. Utilize time when patient would otherwise be waiting. Staff time can be used to discuss results with patients to address needs.

© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 10

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PRAPARE is Now in 26 Languages!

Respond to Needs

• Validated at community health centers for comprehension and cultural competence• New additions include:

Tongan

Swahili

French

Uzbek

Nepali

Lao

Karenni

Chuukese

Bengali

Marshallese

Khmer Karen

Hindi

Russian

Farsi

German

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© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 12

PRAPARE EHR Templates

• FREE EHR Templates Available:• Epic• Cerner*• NextGen*• eClinical Works• Athena• athenaPractice

(formerly GE Centricity)• Greenway Intergy

Available for FREE after signing EULA at www.nachc.org/prapare

• In Development:• Allscripts• Meditech

70% of all health centers

Current 7 + New EHRs = 85-95% of all health centers

* Automatically map to ICD-10 Z codes so you can easily add relevant Z codes to problem or diagnostic list

Recorded demos of each PRAPARE EHR template available at www.nachc.org/prapare

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EHR Example #1: eClinicalWorks -Social History Notes

Instructions or the PRAPARE eCW Configuration guide available in Chapter 4 of PRAPARE Implementation and Action Toolkit at www.nachc.org/prapare

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EHR Example #1: eClinicalWorks -Smart Form

PRAPARE eCW Smart Form available in Chapter 4 of PRAPARE Implementation and Action Toolkit at www.nachc.org/prapare

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EHR Example #2: NextGen Template

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EHR Example #3: Greenway Intergy Template

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Need Intergy 11 or higher

Some data in demographics as usual

Other data in PRAPARE template

Health Choice Network has crosswalk

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EHR Example #3: Greenway Intergy PRAPARE Report

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EHR Example #4: Athena (Pilot Phase)

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FIRST STEPS TO GET STARTED:Start Where You Are!

1) Engage staff and leadership to identify what other initiatives PRAPARE adds value to

1) Engage staff & patients using 3 X 10 approach so everyone can see how data can be used for care transformation, etc.

1) Complete PRAPARE Readiness Assessment to identify strengths and gaps in capacity (www.nachc.org/prapare)

1) Crosswalk PRAPARE with other data already collected at your organization

1) Select Population of Focus

1) Determine Workflow Model and Staff Involved—Accept all Volunteers!

1) Test PRAPARE EHR template & implementation model with small group (PDSA, 3 X 10 model)

1) Review and update community resource guides to see what’s available to respond to needs

1) Plan out how/when will use data & report on progress & share data with staff and leadership—helps with buy-in

© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association.

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Example: SDOH Screening Workflow Process Map

Acknowledgement: Winters Healthcare

20© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association.

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Example: SDOH Screening Workflow Process Map

Acknowledgements: Community Health Care Association of New York State (CHCANYS) and HRHCare

21PDF: https://files.constantcontact.com/b6bde37a401/88fa3464-eed6-4898-8a63-0e4ad81aa8bf.pdf

© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association.

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Preview of Oregon PCA Workflow Builder

© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 22

OPCA Workflow Builder - MS Excel Document

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Breakout Groups & Discussion Guide

© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 23

Breakout Group #1Facilitators: Albert• Discussion Guide (click here)

Breakout Group #2Facilitators: Joe• Discussion Guide (click here)

• Messaging and Engaging Key Stakeholders Around SDOH (20 minutes)○ Access the Google Document, share your ideas, and discuss!

• Large Group Reflection (10 minutes)

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Learning Objective #2Promote empathic inquiry & patient-centered approaches for collecting SDOH data

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Empathic Inquiry: What is it?

© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 25

• Data collection - the process of gathering and measuring information on variables of interest, in an established systematic fashion that enables one to answer questions and evaluate outcomes

• Assessment -an evaluation of the health status of an individual by performing an examination and/or asking questions. The depth of investigation and frequency vary.

• Empathic Inquiry – the act of asking for information with the intent of understanding the patient’s experiences, concerns and perspectives, combined with a capacity to compassionately communicate this understanding for the purpose of creating human connection between patients and professionals.

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Why does empathic inquiry matter?

© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 26

• A review of 25 randomized trials stated, ‘‘One relatively consistent finding is that physicians who adopt a warm, friendly, and reassuring manner are more effective than those who keep consultations formal and do not offer reassurance’’ (Di Blasi et al, 2001)

• “A retrospective analysis of psychiatrists treating patients with depression reported that practitioners who created a bond had better results in treating depression with placebo than did psychiatrists who used active drug but did not form a bond.” (McKay et al, 2006)

• In a randomized controlled trial studying subjective and objective markers of the severity and duration of infection with a common cold, patients were randomized to three groups: 1) no practitioner interaction, 2) practitioner interaction with effort to limit relationship formation through brevity, lack of eye contact and touch, 3) practitioner interaction enhanced by PEECE:(P) Positive prognosis, (E) Empathy, (E) Empowerment, (C) Connection and (E) Education, as well as a few more minutes of time, eye contact and touch. (Rakel et al, 2010)

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Empathic inquiry: Key Elements

© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 27

• Reflective Listening • Affirmations • Autonomy support – “is it ok to review this with you?”

“at any point, you can let me know you’d like to stop.” • Noting strengths of individual • Asking about patient priorities and preferences • Connecting to resources where are appropriate and/or

available

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Oregon PCA’s Emptathic Inquiry

© 2020. National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, Oregon Primary Care Association. 28https://youtu.be/9rfmfsMMeEU

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Learning Objective #3Practice cultural humility when screening patients for SDOH needs

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“Integrated patterns of human behavior that includes the language, thoughts, communications, actions, customs, beliefs, values, and institutions of racial, ethnic, religious, or social groups.”

Source: HHS Office of Minority Health, 2002; Graves, 2011

Defining “Culture”

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Defining Cultural Competency

“Cultural and linguistic competence is a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross-cultural situations.”

Sources: Alameda County Public Health Department, California; The National Standards for Culturally and Linguistically Appropriate Services in Health Care, adapted from Cross T, Basron B, Dennis K, Issacs M (1989)

Defining Cultural Humility

“Does not require mastery of lists of different cultures and particular health beliefs and behaviors. Entails developing a respectful partnership with diverse individuals, groups, and communities.”

Cultural Competency and Cultural Humility

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Source: Tervalon and Murray-Garcia, 1998

Cultural Humility Values

Openness Appreciation Acceptance Flexibility

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Cultural Humility Framework

Lifelong learning and critical self-

reflection

Recognizing and changing

power imbalances

Developing institutional

accountability

Source: Tervalon and Murray-Garcia, 1998

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Cultural Humility Strategies - Sample

• Motivational Interviewing• Empathy Effect

Lifelong learning and critical self-reflection

• Recognition of Power and Privilege• Patient-Centered Care / Patient as

Expert

Recognizing and changing power

imbalances

• Training and Hiring for Diversity• Adopting National CLAS Standards

Developing institutional accountability

Sources: Tervalon and Murray-Garcia, 1998; AAPCHO, 2021

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Respond to Needs

Q&A

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Thank you for joining us!

Joe Lee, [email protected]

Albert Ayson, Jr., [email protected]

Twitter: @prapare_sdoh

Join our Listserv Email: [email protected]

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Closing Remarks & Session Evaluation

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See you next week!Session #4 | Supporting Implementation Strategies: Workflows and Communication Techniques to Collect and Use SDOH Data (continued)May 28, 2021 | 1:00 – 2:00 pm CT

Learning Objectives:1. Develop workflow models for collecting SDOH data and selecting

population(s) of focus2. Promote empathic inquiry & patient-centered approaches for collecting

SDOH date3. Practice cultural humility when screening patients for SDOH needs

Click here to register for the SDOH webinar series