Maximizing Pt-Provider Commun 12-22-20 Pt-Provider... · Sweetest sound to patients: Their own...

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Tools to Maximize

Virtual and Live

Patient Learning

and Behavior Change

and Provider

Communications

12-22-20

DSMES Learning Series

Mary Ann Hodorowicz

RDN, MBA,

CDCES, CEC

(Certified

Endocrinology

Coder)

Mary Ann Hodorowicz, RDN, MBA, CDCES CEC, is a registered dietitian nutritionist and certified diabetes educator and earned her MBA with a concentration in marketing. She is also a certified endocrinology coder and owns a private practice specializing in corporate clients in Palos Heights, IL. She is a consultant, professional speaker, trainer, and author for the health, food, and pharmaceutical industries in nutrition, wellness, diabetes, and Medicare and private insurance reimbursement. Her clients include healthcare entities, professional membership associations, pharmacies, government agencies, food and pharmaceutical companies, academia, and employer groups. Mary Ann is on the faculty of the LifeScan Diabetes Institute. She served on the Board of Directors of the Association of Diabetes Care and Education Specialists from 2013 – 2015, was the Chair of the Advanced Practice Community of Interest in 2016 and was nominated for the Award in Excellent Practice of the Weight Management Practice Group of the Academy of Nutrition and Dietetics (AND) 2016. She has served on numerous committees and work groups of ADCES and AND.

Mary Ann Hodorowicz Consulting, LLC

[email protected] 708-359-3864

www.maryannhodorowicz.com

Twitter: @mahodorowicz

I have no financial relationships to disclose.

Learning Objectives

1. Explain the key differences between compliance counseling and motivational interviewing.

2. Name at least 6 of the 24 motivational interviewing tools to maximize patient behavior change that are summarized in the word “A.D.O.P.T.E.E.S.”

3. Name the K.I.I.S.S.S.S.S.S.S. tools to enhance patient learning and retention.

4. Define the 7 “P’s” of a marketing plan for a service…including DSMES services.

5. List the 2 primary goals of promoting/communicating with providers relative to DSMES programs.

6. Give examples of promotions/communications to increase provider referrals to DSMES program.

7. Name the 6 types of outcome measures to be monitored in DSMES programs and explain the order in which patients may achieve them (domino effect).

8. Explain the relationship between positive patient outcomes and the value of the DSMES services from the perspective of referring providers.

9. State what the “3 S” format is for making a recommendation to referring providers on the patient progress report and explain why this can increase referrals.

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1) Tools to Maximize

Virtual and Live

Patient Learning

and

Behavior Change

To Maximize Virtual and Live Patient Learning, Use

Motivational Interviewing Tools.

They Spell

A.D.O.P.T.E.E.S.

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• WHY do we want to make our patients our A.D.O.P.T.E.E.S. ?

o 2 BIG Reasons:

Patient’s chronic disease will CHANGE

Patient’s “I.V.’s”…Issues and Variables… will CHANGE

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The one constant in life is change!

#1 Reason Patients NOT Empowered to Change Behaviors

Use of less effective, inpatient acute care

COMPLIANCE COUNSELING TOOLS

to try to get pts to behavior.

In direct contrast to use of

effective outpatient chronic care

MOTIVATIONAL INTERVIEWING TOOLS

for changing behaviors!

Motivational Interviewing Tools…

Do NOT promote wrestling with

your patient as an opponent….

this increases resistance to change

Do lead to dancing with your patient

as a partner…this reduces resistance

to change and helps build a strong

patient-clinician relationship

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COMPLIANCE COUNSELING MOTIVATIONAL INTERVIEWING

Coach Is sage on the stage.

Acts as parent, boss, expert.

Is guide on the side.

Acts as partner, facilitator, negotiator.

Topics Coach selects, per agenda Patient selects, per needTalking & Listening Coach does most of talking Coach does most of listening

Decisions and

Goal Setting

Coach makes all decisions

and sets goals for patient

Patient makes own decisions and

sets own goals

Coach Mindset Pessimistic Optimistic

Coach Emphasizes What’s wrong.

What has NOT been achieved.

What’s right.

What HAS been achieved.

Motivational Interviewing….

Do NOT ask:

“What is the matter with my patient?”

Do ask: “What matters most to my

patient?”

Let’s start the tools in MI Tools that Spell “A.D.O.P.T.E.E.S.”

A = Act as a partner and negotiator,

and never as the expert or boss!

Never look down on anyone unless you will help them up!

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A = Allow time at each visit for patient to select own topics, needs,

problems to discuss (what matters to the patient!)

Why? Increases motivation to change!

I know me best,

Especially my needs.

So today’s topic to discuss,

May I select it, please?

Give patients a fun list of diabetes topics!

• GROUP class, tell patients:

o First half: dedicated to topics HCP needs to review….but whole group will

contribute

o Second half: totally dedicated to what PATIENTS WANT TO TALK ABOUT!

Say to patients before break:

Just write down the questions you’d like answered today

on these sticky notes during our break.

A = Allow patients to be the FIRST to:

• Answer

• Act

• Analyze

• Add their own information

• Agree or disagree

• Arrive at their own behavior goal

• Aid in developing their own treatment plan

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Example: Conversation between Mark and HCP:

Mark: Why does everyone keep telling me that I have to test my blood sugar with this meter?

HCP: Why do YOU think they are telling you this?

Mark: I really don’t know…no one explains it to me.

HCP: How do you feel about using the test results to better control your sugar on a daily basis?

Mark: Yeh, I would think about that, if it would help.

HCP: If you don’t mind, can you share with me your thoughts on how you might use a test result

before dinner to better control your after‐dinner blood sugar?

A = Abide by the 80—20 talking rule

20% of

Timethe

HCP Talks!

80% of

Time

the

Patient

Talks!

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Sweetest sound to patients:

Their own VOICE

Sweetest word to patients:

Their own NAME

Sweetest topic to patients:

Their own STORY

80--20 Talking Rule:

HCP Talks Only 20% of Time!

• OPEN ENDED QUESTIONS

• TELLING….but ask permission FIRST

• ANSWERING pt’s questions….but only if pt cannot

• SUMMARIZING what pt said about every 10 minutes

• ASKING pt to summarize back to you important info

• PLANNING topics, needs, concerns for next visit

Sign over clock in HCP’s counseling office:

Why Am I Talking?

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A = Always remember what it means to be human….

• It means we are not rational in our decision making

• It means that rational approaches to problems can NOT always be expected to work

• BUT: do we often use rational approach to get patients to change behaviors? Ugh!

How is this working for you? Likely not so much!

Irrational Behaviors!

Swim with sharks?Coffee by computer?

Rational?

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A = Accept patient’s ambivalence toward behavior change….and work

with it

….to be human is to be ambivalent

Should I or shouldn’t I

get off the fence?

Our job is to help patients slowly motivate themselves off the fence in direction of change, but only when they’re ready, willing and able.

A = Always roll with resistance

Resistance often reflects disturbance…a good thing!!

Disturbance often is patient’s way of saying:

“I need to understand this better.”

How HCP Can Better Roll with Resistance…

1. Try to understand what is behind pt’s resistance

2. Invite patient to openly discuss his/her resistance

• Create free, friendly, safe environment for talking

• No matter what pt says…good, bad, ugly…always:

o Be gracious, non‐judgmental, accepting

o Be very careful about your body language when patient says something you find a bit “off”

3. Reinforce patient’s role as a problem‐solver

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A = Assist patient in “SAYING” the key, core message(s) via open‐ended

questions (OEQs)

Example:

“I’m sure that my high A1c and 10 pound weight gain is related to the 6

plus carb servings I eat at nearly every meal.”

• Use “Strike 3 Rule” so you’re not there all day to accomplish this!

Strike 3 Rule:

Ask patient 3 different types of OEQs

to get him to say the key, core message(s).

If not successful, then TELL patient,

but only if you ask permission.

Why ask permission?

Open‐Ended Questions (OEQs)

• In today’s visit, what topic would you like to discuss?

• From this checklist on topic, what would you like to discuss?

• Tell me what you have heard or read about weight and blood pressure?

• What will you lose if you reduce salty foods?

• What will you gain?

• What have you tried before to reduce salt and salty foods?

• Tell me what you feel about testing your blood sugar more regularly? What do you think the benefitsmight be?

• What would you like to eat in the café that would be tasty and yet lower in fat and cholesterol?

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A = Always use the K.I.I.S.S.S.S.S.S.S. tools to enhance patient learning and retention

Keep It

Interactive…so patients are “doing” which increases learning; do use:

● Wuzzles (word-picture puzzles)

• Group discussion with “Let’s Just Talk” Handout

• Games (Diabetes Bingo)

• Story telling

Short: 30-60 minutes only for individual visits and <2 hour group visits

Spotlighted on only 1 key message at a time; no fire hosing!

th

Sensory: use fun, 3-Dimensional (3D) teaching aids

Supplied with “graphic/picture-centric” handouts instead of printed word

Supplied with memory aids (acronyms and mnemonics)

Self-created by patients (Square Care Plans)

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Because Adults Learn and Retain:

20% of what they HEAR

30% of what they SEE

50% of what they SEE and HEAR

70% of what they personally explain or SAY

90% of what they SAY and DO

LEARNING by

DOING and SAYING is key!

Remember:

Learning/Knowledge Outcome precedes all other patient

outcomes in a “chain reaction”.

What I hear,

I forget;

What I see,

I remember;

but what I do,

I understand.~ Confucius, 451 B.C

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UseSquare Care Plans

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Keep It


● Wuzzles (word and picture puzzles)

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fats that came from

A __ __ M __ __ S

fats that came from

V __ __ G __ __ __ __ __ S

E __ __ R __ __ __ E

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Keep It


● Group discussion with “Let’s Just Talk” Handout

Let’s Just

TALK

with Our Patients

to Find Out What

MATTERS TO THEM!

LET’S JUST TALK! Instructor’s HEALTHY EATING Questions to

Patients to Start the Conversation

Patients,

Jot Down Your Thoughts Here

1 ReasonHow does healthy eating affect blood glucose?

How does it affect the complications of diabetes?

2 DescriptionWhat does healthy eating consist of?

3 FrequencyHow often should a healthy meal plan be followed?

4 Sharing ExperiencesWhat are some tips to make healthy eating easier?

5 Getting StartedWhat would you like to do as a first step to eating healthy?

6 BarriersWhat barriers, if any, will make it challenging to get started with this first step? What are some ways to reduce them?

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Keep It


● Games (Diabetes Bingo)

56https://bingobaker.com/view/1520318

57

http://www.bingocardtemplate.org/diabetic‐terms‐bingo

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Keep It

Short: 30 to 60 minutes only for individual visits

Why?

Adults start to “zone out” after 20 minutes!

60

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Keep It

Spotlighted on only 1 key message at a time; no fire hosing!

“Fire Hosing” and “Dumping In” Information (I) into Patient for

Behavior Change s Ineffective to Motivate Behavior Change!

. .

I I I I I I I I I

I I I I I I I I I

Do you have the “fire hosing” or “dumping syndrome”?

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Dumping and Fire hosing

can make patient feel overwhelmed…

and then perhaps even stupid!

Ugh!

REMEMBER:

People will forget much of what you DO,

They will forget much of what you SAY,

BUT they will NEVER, EVER

forget how you made them FEEL!

Keep It

Simple: <5th grade language (oral and written)

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WHY verbal words and printed words to be at <5th grade level?

Patients’ HEALTH literacy tends to be low…

despite their age, race, education,

income or career field!

Examples of simple language:

• Testing blood sugar regularly helps you to make healthier eating &

exercise decisions on daily basis

• High salt intake often increases blood pressure

• Type 1 diabetes means you don’t have any insulin

• Exercise is great tool to lower high blood pressure

• You only have to floss the teeth you want to keep!

Sensory: use fun, 3-Dimensional (3D) teaching aids

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3-Dimensional (3D)

Teaching Aids

https://www.choosemyplate.gov/eathealthy/dietary-guidelines

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THE MORE FEET, THE MORE FAT AND CHOLESTEROL!

A1C IS MEASURE OF “SUGAR COATING” ON RED BLOOD CELLS

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5% 6% 7% 8% 9% 10%

11% 12% 13% 14% 15% 16%

AMOUNT OF SUGAR (GLUCOSE) IN BLOOD:

LEFT is NORMAL LEVEL: BLOOD FLOWS WELL.

RIGHT is HIGH LEVEL: BLOOD THICK LIKE SYRUP

Supplied with “graphic/picture-centric” handouts instead of printed word

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Least effective communication: Printed word

Better communication: Pictures

BEST communication: Fun, 3-D Objects

Conversation Maps™ for Diabetes

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Supplied with memory aids (acronyms and mnemonics)

S.W.E.E.T.S. is WHAT YOU NEED TO DO TO CONTROL BLOOD SUGAR!

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S.W.E.E.T.S. for L.I.F.E. with DIABETES

S = Stress ControlW = Weight ControlE = Eat HealthyE = Exercise T = Take Diabetes Meds, If RequiredS = Self‐monitor blood glucoseforL = Learn to Reduce RisksI = Invest in Long‐Term SupportF = Fix Your ProblemsE = Enjoy Adequate Sleep

D I A B E T E S

Do Monitor Your Blood

Glucose (BG) Regularly

Involve Family

and Friends

Acquire Ongoing Support

Bring BG Values to

Healthcare Visits

Exercise Regularly

Take Medication as

Prescribed

Ease into Behavior Changes Slowly

See a Diabetes Educator Regularly

DIABETES CARE CLINIC Memorial Hospital and Health Care Center

21 Any St., Any Town, Any State www.diabetescareclinic-mh.com Phone: 123-456-7890

LEARN HOW TO CARE FOR YOUR DIABETES WITH OUR

D.I.A.B.E.T.E.S. L.I.F.E.S.A.V.E.R.S. Program

L I F E S A V E R S + ? Lose

Excess Weight

Identify Healthy Coping

Strategies

Fix Your

Problems

Eat Healthy

Sleep Well Every Night

Acquire Sick Day & Travel

Kit

Visit Your

Doctor Regularly

Enjoy Rewards for All You Do

Reduce Risks

of Complications

Set SMART

Goals

Topics and Questions of

YOUR Choice

D.I.A.B.E.T.E.S. L.I.F.E.S.A.V.E.R.S.

D Do monitor your BG regularly

I Involve family and friends in your diabetes care

A Acquire ongoing support

B Bring blood glucose values to healthcare visits

E Exercise regularly

T Take medication as prescribed

E Ease into behavior changes slowly

S See a diabetes educator regularly

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D.I.A.B.E.T.E.S. L.I.F.E.S.A.V.E.R.S.

L Lose excess weight

I Identify healthy coping strategies

F Fix your problems

E Eat healthy

S Sleep well every night

A Assemble sick day and travel diabetes care kit

V Visit your doctor regularly

E Enjoy rewards for all you do

R Reduce risks of diabetes complications

S Set S.M.A.R.T. goals

S Select Your Own Stress Reduction and Coping Strategies

W Whittle Away Your Excess Body Weight

E Eat Healthy

E Exercise Regularly

T Try to Order Healthier Foods in Restaurants and Limit Alcohol (If You Drink)

S Self‐Monitor Your Blood Glucose and How Lifestyle Choices Affect Your Numbers

F Form a Diabetes Care Plan for Sick Days and When You Travel

O Obtain Support from Your Family and Friends and Support Groups

R Reduce Your Risks of Long‐Term and Short‐Term Diabetes Complications

L Learn About Your Medications: Diabetes, OTC, Supplements, Herbs, Etc.

I Identify Technology Devices to Help You Control Your Diabetes F Fix Your Problems That Reduce Good Diabetes Control

E Enjoy Adequate Sleep Everyday

My Diabetes Education Plan = S.W.E.E.T.S. F.O.R. L.I.F.E.

Please check the diabetes self‐care behaviors you would like to learn more about in this program.

A = Arrange for a customized meal plan created for you by a Registered Dietitian

F = Flavor foods with spices and herbs instead of salt and salty ingredients

I = Increase dietary fiber

R = Read the Nutrition Facts on food labels when grocery shopping

S = Shrink sodium/salt

T = Treat yourself to lots of vegetables every day (high in fiber)

A. F.I.R.S.T. P.L.A.C.E.

M.E.A.L. P.L.A.N. for

Healthy Diabetes

Eating

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P = Portion control your protein foods

L = Limit sugary foods and drinks

A = Always limit alcoholic beverages, if you drink

C = Control carbohydrate foods

E = Enjoy lots of water and sugar‐free beverages



Healthy Diabetes

Eating



Healthy Diabetes

Eating

M = Measure your foods with measuring cups or

items around the house

E = Eat meals and snacks at regular times each day

A = Always enjoy your favorite foods…any food can

fit into your meal plan

L = Limit high fat foods (ex: fried foods, ribs,

sausage, etc.)

P = Plan your meals and snacks ahead of time

L = Limit animal fats and trans fats; select

mono‐ and polyunsaturated fats

A = Ask about over‐the‐counter dietary

supplements before taking them

N = Navigate to MyPlate® as a first step to see

what a healthy meal looks like



Healthy Diabetes

Eating

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Self-created by patients (Square Care Plans)

SQUARE CARE PLANS

to Control the A‐B‐C’s of Diabetes:

A1c….Blood Pressure….Cholesterol

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If Patients Said What They Really Feel…

“Deep down I really know the score,

But over the years, buried it more and more.

Help me to SAY, help me to DO,

As my health depends on

being fully engaged with you!”

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“Tell me things and you’re the boss,

But ask me things so our

partnership is not lost.”

“Me talk is key…….you talk, loses me!”

“Keep it simple and short,

Keep it fun and sweet…

Too much at one time,

And my goals I will not meet!”

A = Assure that main focus of any eating intervention is on what pt

CAN eat……..

rather than what pt CANNOT eat.

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B.I.G.G.E.S.T. Open‐Ended Questions for “Change Talk”

B = How would you BENEFIT if you were to test your blood sugar with a meter 1 or

2 times a day?

I = What would IMPROVE or INCREASE in your life?

What INCENTIVE would you need to start testing?

G = Who else in your life would GAIN if you did test?

G =What would you have to GIVE UP to start testing your blood sugar? How would you GAUGE the importance of testing on a 1‐10 scale?

E = What would you ENJOY about testing your blood sugar?

S = Would SOMEONE want to help you test your sugar before and after meals, or

fasting in a.m.?

T = What would TAKE to:

• Get you started with your blood sugar testing?

• Keep testing on a regular basis?

What will backfire….

• HCP trying to persuade patient to change

• HCP trying to “right” things FOR the patient

o Patient will “dig in” to protect and defend exact negative behavior you want

patient to change!

o The more people feel “pushed” to move in a certain direction, the more likely they’ll push back

…..a paradox!

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Do you have the

PERSUADING REFLEX?

RIGHTING REFLEX?

Persuading Reflex Patient Resistance

Righting Reflex Patient Resistance

It’s not OUR job to talk patients out of the woods…

it’s our job to help them talk

THEMSELVES out of the woods.

It’s NOT about putting out a fire….

It’s about igniting a flame!

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REMEMBER:

Patients have most

of the

answers

within them!

Who had the answer within her all along for how to get back to Kansas?

Thank you!

You helped

me see my

inner

strength!

111

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D = Do ask OEQs related to patient’s commitment to change

• So, what do you make of blood sugar testing now?

• What, if anything, do you plan to do with your new information on the benefits of blood sugar testing?

• If you do decide to test your blood sugar, what would your first step be?

• What, if anything, would get in your way from taking this first step?

• What can I do to help you with your decision?

O = Opt for strongest relationship with patient

#1 MOST important tool for behavior change!

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Ways To Develop Strong Relationship with Pt

S = Search for a connection….ideas?

T = Talk much less

R = Request that patient select topic(s) for each visit

Recognize big events in patient’s life

O = Obtain patient’s feelings/fears/frustrations

N = Never criticize or disagree ‐‐ instead, compliment

G = Give advice to patient (“tell”) only when asked

E = Empathize….Express kindness always

S = Simplify and shorten intervention + handouts

T = Touch patient in between visits….ideas?

WOW! Someone ‘membered my birthday!

BEST PRACTICE TIP

Treat every patient as if she/he

is your

spouse, child, mother, father,

brother or sister!

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O = Obtain and affirm patient’s negative feelings/fears/frustrations

DID YOU KNOW:

If patient does NOT have opportunity to express

and experience strong (usually negative)

feelings/fears/frustrations

about situation,

the likelihood of

sustained behavior change is SMALL !

P = Profess a “CAN DO” and “AFFIRMATIVE” attitude with patients

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1. Increase pt’s perception of self as capable person

2. Affirm positive statements and behaviors

3. Offer options….esp. when barriers identified

4. Instill hope…….esp. when problems loom large

5. Encourage consideration of role models and past successes

Can Do….Yes You Can!

T = Tell, but only if you ask patient’s permission

Then ask PATIENT to summarize what

YOU just said

to insure patient understanding.

E = Express empathy and listen reflectively

• Create free, friendly space to explore difficult issues

• Reflect back pt’s words……but with empathy!

o“I understand how difficult it is for you to exercise 15 minutes every day with your work

schedule.”

o“I also struggled with eating lower fat foods when my doctor told me my cholesterol was

too high.”

o“How do you feel about us trying to figure out a game plan that could work better for you?”

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• Builds STRONGER relationship with pt

• Helps pt feel understood

o Both proven to likelihood of behavior change

E = Explore, together with patient, patient’s behavior goal barriers

• Incorrect and irrational beliefs…can be BIGGEST

• Low importance of why, low confidence in how to

• Demographic and health barriers

• Cultural, language and religious barriers

• Health care system barriers

• Psycho‐social issues and variables:

oRelated to family/friends/coworkers

oTriggers that prompt unhealthy behaviors

Trigger foods, moods and situations

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S = Steer clear…100% of time…of criticizing, disagreeing, arguing with

patient (including “angst” body language)

Trying to persuade pt to change with argumentation never works!

Pt must persuade SELF to change.

We can help this “change talk” with OEQs!

S = Summarize every 10 to 15 minutes what you and patient have

discussed

S = Solicit patient to Summarize back to YOU the important education

you delivered!

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S = Search for achievements to praise

BUT, if patient has NOTmade any progress,

how will you do this?

S = See to it that patients feel great about themselves after ALL visits,

so as to build their confidence, and their strongest relationship

with you

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2) Tools to Maximize

Virtual and Live

Provider

Communications &

Promotions

7 P’s of Service Marketing:

Today’s focus is PROMOTION / COMMUNICATIONS TO PROVIDERS

7 Ps of “service” marketing

Products (Services)

Packaging

PROMOTION (aka, COMMUNICATIONS to providers & patients)

Place (Physical Evidence of Quality)

Processes and Procedures (Influence Target Markets in + or – Way)

Price

People (Educators, Staff) 134

1. Build PROGRAM brand…and YOUR brand…to ensure exclusive referrals

• Providers want to associate themselves with a strong brand of SUCCESS

• SUCCESS =

o Positive patient outcomes

o Excellence in service

o Clinical and technical innovation (ex, CGM, insulin pumps, etc.)

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Goals of PROMOTIONS / COMMUNICATIONS to Providers

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Providers’ need, expect, want patient OUTCOMES,

which lead to providers’ knowledge of the

VALUE

of YOU

and

your PROGRAM136

2 Big Goals of PROMOTIONS / COMMUNICATIONS to Providers

2. Prove you know each provider as unique individual: like a family member

• Prove that each promotion / communication strategy meets the individual

needs, expectations and wants of each provider

o Must identify what each provider: NEEDs, EXPECTS and WANTS

o How? Provider Survey

• Prove you understand what’s important to each provider at personal level

Bottom line for provider promotion/communication:

“You can have everything in life you want,

if you will just help other people get what they want.” Zig Zigler

2 Big Goals of PROMOTIONS / COMMUNICATIONS to Providers

Initial Outcomes

Knowledge/Learning Outcome

BehaviorChange

Outcomes

Intermediate Outcomes

ClinicalOutcomes

Post‐Intermediate Outcomes

Quality of Life

Outcomes

Long Term Outcomes

Cost‐SavingsOutcomes

Long Term Outcomes

SatisfactionOutcomes: Patient, Provider and Payer

3 P’s

Long Term Outcomes

Patient OUTCOME Quality Measures: Domino Effect

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What’s the Big Deal About DSMES Patient Outcomes?

The “Domino Effect”!

Providers’ need, expect, want patient OUTCOMES, which lead to:

Providers’ knowledge of the VALUE of program

VALUE leads to TRUST in program

TRUST leads to LOYALTY to program

LOYALTY leads to patient REFERRALS and

REFERRALS lead to increased program REVENUE

REVENUE leads to increased SUSTAINABILITY

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PROMOTION / COMMUNICATIONS

• If providers don’t know you exist, they won’t knock on your door!

• Promotion types and language must “FIT” providers’

Needs, Expectations, Wants

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141

SPECIFIC STRATEGIES TO MEET 2 PROMOTION GOALS

WHICH ULTIMATELY WILL

INCREASE PROVIDER REFERRALS

TO YOUR DSMES PROGRAM

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Create and Give to Providers

Diabetes Calendars

Create and Give to Providers

Print Promotions:

Slim Jims, Brochures, Flyers

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MONTHLY CALENDAR

DIABETES CARE CLINIC

Caring for Your Health

21 Any St., Joliet, ILph: 815-123-4567

www.diabetescareclinic.com

Monitor Your Blood Sugar Regularly

APRIL 2020

Mon Tue Wed Thu Sat

1 3

5

DSMES Class #110 -11 a

6 7

DSMES Class #17 - 8 p

8 10Diabetes

Fair8—3 p

12

DSMES Class #210 - 11 a

13

SharedMedical

Appointment9 - 10:30 a

14


15Diabetes SupportGroup7 - 8 p

17

19

MNT Class #110 - 11 a

20 21

MNT Class #17 - 8 p

22 24

26

DSMES Class #310 - 11 a

27 28


29Hot Topic Program 7 - 8 p

31

143

Tri-Fold

Double-

Sided

BROCHURE

for

DSMES

Program

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49

2-Sided

Card Stock

SLIM JIM

for

DSMES

Program

Hold a

“Ask a Diabetes Educator”

Event in Organization’s Cafeteria and

Encourage Providers to

Stop By Your Table

146

Offer

“Diabetes Friendly” Meal(s)

in Cafeteria.

Place DSME Marketing

Brochures in Cafeteria.

147

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50

Promote on Bulletin Boards in Your Organization…

Providers Will See

148

Advertise Program in

Local Newspapers

and

in Sponsoring Organization’s

Newsletter…

Which Providers

Will Read in Their Lounge

149

YOUR

DSMES

PROGRAM

AD

HERE

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Promote DSMES Program on

Organization’s

Own Website

152

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Promote Your DSMES Program on

Social Media Sites

154

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• Create branded, Medicare-compliant DSMES referral for external providers

–Paper referral (pads of 50)

– Hand deliver to providers (with lunch to incent face-to-face interaction)

– Provide several laminated copies of fully completed referral

157

– Provide wall pockets to hold referral pads for each exam room

– Fax semi-completed referral to provider for completion (with templated fax cover

letter) when patients self-refer

158

• Create electronic referral in EMR

– Imbed “auto stops” when required data fields not completed

– Add “prompts” to explain how to complete

– Hospital entities:

• Attend physician meetings to review completion requirements

159

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MARY ANN’S REFERRAL FORM

160

161

162

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163

BACK SIDE OF REFERRAL FORM (INFO FOR PATIENT)

164

WHY?

1. Is expectation of referring provider

2. Is advertising for DSMES program and you

3. Is standard of medical care

4. Is best practice procedure

Send PROGRESS REPORT

to Referring Provider After

Each and

EVERY DSMES Visit

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Send PROGRESS REPORT

to Referring Provider After

Each and

EVERY DSMES Visit

5. Opportunity to report patient’s outcomes

OUTCOMES = YOUR VALUE!

VALUE PROVIDER TRUST

PROVIDER TRUST REFERRALS

AGAIN: “DOMINO EFFECT” OF DSMES OUTCOMES








167

Send PROGRESS

REPORT to Referring

Provider After Each and

EVERY

DSMES Visit

6. Opportunity to:

-- Suggest changes to patient’s care plan

-- Show your expertise by siting specific

standard of care to support your suggestion

SEE NEXT SLIDE FOR FORMATTING IDEA

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57

3 “S” Format for Making Suggestion for Care Plan Change in Progress Note

--STATUS

“Pt is newly diagnosed with T2 diabetes and not on metformin.”

--STANDARD

“Per current ADA standards of care, all newly dx’d T2 pts to be Rx’d metformin

unless contraindicated.”

--SUGGESTION

“Please advise.”

Mary Ann’s

DSMES

PROGRAM

RECORD

AND

PROGRESS

REPORT

170

171

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172

Monitor

ALL

Patient Outcomes

and

Program Outcomes

173

Initial Outcomes


BehaviorChange

Outcomes


ClinicalOutcomes


Quality of Life

Outcomes

Long Term Outcomes


Long Term Outcomes


3 P’s

Long Term Outcomes

SPECTRUM OF DSMES OUTCOMES

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59

What’s the Big Deal About DSMES Outcomes? “Domino Effect”








175

Patient Form

for

Monitoring

Behavior

Goal

Outcomes

176

Patient Form

for

Monitoring

Clinical,

Quality of Life

and

Knowledge

Outcomes

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61

Patient Form

for

Monitoring

Cost-Savings

Outcomes

183

Patient Form

for

Monitoring

Patient

Satisfaction

Outcomes

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62

Provider Survey

for

Identifying

Provider

Satisfaction

Outcomes

and

Needs

Regularly Summarize & Report All Patient Outcomes and Program Outcomes

to:

● Referring Providers

● “Wanna Be” Referring Providers (not yet referring)

● Stakeholders:

Management of your organization

In publications of your org (ex: community newsletter)

In organization’s employee intranet, and internet website

186

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63

Initial Outcomes


BehaviorChange

Outcomes


ClinicalOutcomes


Quality of Life

Outcomes

Long Term Outcomes


Long Term Outcomes


3 P’s

Long Term Outcomes

SPECTRUM OF DSMES OUTCOMES

How to Summarize & Report Patients’ Behavior Goal Outcomes

BEHAVIOROutcome Goals

# WhoChose Goal

# Reporting Improvement

% Who ReportedImprovement

% ProgramBenchmark

Healthy Eating % %

Being Active % %

Monitoring % %

Reducing Risks % %

Taking Meds % %

Problem Solving % %

Healthy Coping % %

188

How to Summarize & Report

Patients’ Clinical Outcomes

189

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CLINICALOutcome Measures

# Who Chose Measure


% Improvement

% ProgramBenchmark

Fasting blood glucose 80 ‐ 130 mg % %

BG before lunch/dinner 80 ‐130 mg % %

Bedtime blood glucose (BG) % %

BG 2 hours after meals 180 mg or less % %

A1C Less than 7% % %

Blood pressure 140/90 or less % %

Weight % %

Total cholesterol 200 mg or less % %

LDL‐cholesterol 100 mg or less % %

HDL‐cholesterol 50 mg (F) or 40 mg (M) or more

% %

Triglycerides 150 mg or less % %

Waist circumference: Equal to or less than: 35 in. female or 40 in. male

% %

BMI 19 0 24 9

190

191

How to Summarize & Report

Patients’ Quality of Life Outcomes

QUALITY OF LIFEOutcome Measures

# Who Chose Measure


% Improvement

% ProgramBenchmark

Low energy level % %

Pain, discomfort % %

Anxiety, worry or depression due to diabetes % %

Trouble sleeping at night % %

Blurry vision % %

Thirsty % %

Urinating % %

Hungry % %

Fatigue % %

Confusion % %

Memory issues % %

Dry or itchy skin % %

Slow healing of cuts or wounds % %

Daily activities lost due to diabetes % %

Work or school days missed due to diabetes % %

Relationship issues due to diabetes % %

Financial problems due to diabetes % %192

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KNOWLEDGEOutcome Measures

# Who Chose Measure


% Improvement

% ProgramBenchmark

Healthy eating % %

Being active % %

Monitoring my blood sugar % %

Taking my medications as ordered % %

Healthy coping of my diabetes % %

Solving my diabetes problems % %

Reducing diabetes risks % %

How to Summarize & Report Patients’ Knowledge Outcomes

193

PATIENT SATISFACTIONOutcome Measures

# WhoAnswered

% Excellent

% Very Good

% Good

% Fair

% Poor

Quality of the information taught % % %

Quantity of the information taught % % %

Relevance of information taught: how important, practical, or appropriate the information is to your life

% % %

Quality of the take‐home handouts % % %

Location of the program % % %

Class times % % %

Educators’ knowledge of the subject matter % % %

Educators’ delivery/presentation of the material % % %

Educators’ knowledge of the subject matter % % %

Educators’ delivery/presentation of the material % % %

Your knowledge of diabetes and its control % % %

Your confidence in being able to control your diabetes % % %

How to Summarize & Report Patients’ Satisfaction Outcomes

194

Diabetes Prevention

Diabetes Support Groups

Renal MNT

Post‐kidney Transplant

MNT

HyperlipidemiaMNT

HypertensionMNT

Metabolic Syndrome

MNT

Consider:

• Unmet needs

• Poorly met needs

• What can you do better?

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DiabetesMNT

Weight Management

CGM

Insulin Pump Training

Insulin Injection Training / Mgmt

Pattern Management

Exercise Classes

Grocery Store Tours

Text, Email or Ask

Providers

In-Person:

“What Are Yours

or

Your Patients’

Unmet or Poorly

Met Needs?”

http://www.diabetes.org/are-you-at-risk/diabetes-risk-test/?loc=atrisk-slabnav

Give to providers the

“Type 2 Diabetes Risk Test”

to give to their patients

The End!

Thank you for the

privilege of your time.

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Can you see Friday yet?

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68

MEET YOUR APPENDIX


My smallest successes,

please do recognize,

And my faults and failures,

do not criticize.

No matter what my issues,

can you empathize?

And often, it’s

important to summarize.


Change is a journey,

It tends to ebb and flow.

I’m not in any hurry,

So please, please take it slow.

Through stages I will move,

We need to be in sync.

To keep me in the groove,

My stage, intervention and goals must link.

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Reach out and touch me when we’re not together,

As so many slippery slopes abound.

My goals, I will achieve them better,

When you make an effort to be around.

Resources by Mary Ann Hodorowicz

Turn Key Materials for ADCES DSMES Program Accreditation•DSMES Program Policy & Procedure Manual Consistent with NSDSMES (72 pages)•Medicare, Medicaid and Private Payer Reimbursement•Electronic and Copy‐Ready/Modifiable Forms & Handouts•Fun 3D Teaching Aids for ADCES7 Self‐Care Topics•Complete Business Plan

3‐D DSMES and Diabetes MNT Teaching Aids ‘How‐To‐Make’ Kit•Kit of 24 monographs describing how to make Mary Ann’s separate 3‐D teaching aids plus fun teaching points, evidence‐based guidelines and references

Money Matters in MNT and DSMES Increasing Reimbursement Success in All Practice Settings, The Complete Guide ©

Establishing a Successful MNT Clinic in Any Practice Setting©

EZ Forms for the Busy RD©: 107 total, on CD‐r; Modifiable; MS Word•Package A: Diabetes and Hyperlipidemia MNT Intervention Forms, 18 Forms•Package B: Diabetes and Hyperlipidemia MNT Chart Audit Worksheets: 5 Forms•Package C: MNT Surveys, Referrals, Flyer, Screening, Intake, Analysis and Other Business/Office and Record Keeping Forms: 84 Forms

This information is intended for educational and reference purposes only. It does not constitute legal, financial, medical or other professional advice. The information does not necessarily reflect opinions, policies and/or official positions of the Center for Medicare and Medicaid Services, private healthcare insurance companies, or other professional associations. Information contained herein is subject to change by these and other organizations at any moment, and is subject to interpretation by its legal representatives, end users and recipients. Readers/users should seek professional counsel for legal, ethical and business concerns. The information is not a replacement for the Academy of Nutrition and Dietetics’ Nutrition Practice Guidelines, the American Diabetes Association’s Standards of Medical Care in Diabetes, guidelines published by the Association of Diabetes Care and Education Specialists nor any other related guidelines. As always, the reader’s/user’s clinical judgment and expertise must be applied to all information in this document.

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REFERENCES

1. Ellen R. Glovsky, PhD, RD, LD, Gary Rose, PhD, Motivational Interviewing — A Unique Approach to Behavior Change Counseling, Today’s Dietitian Vol. 9 No. 5 P. 50, May 2007

2. Miller WR, Rollnick SR. Motivational Interviewing: Helping People Change, 2nd edition. New York: Guilford Press; 2002

3. Miller WR, Rollnick SR. Motivational Interviewing, Third Edition: Helping People Change (Applications of Motivational Interviewing), , 3rd

edition. New York: Guilford Press; 2013

4. Rose GS, Rollnick SR, Lane C. What’s Your Style? A model for helping practitioners to learn about communication and motivational

interviewing. MINUET. 2004;11:2‐4

5. Hersen M, Eisler RM, Miller PM (ed). Progress in Behavior Modification. Belmont, Calif.: Wadsworth; 1994

6. Marc Steinberg, MD, FAAP, Clinical Perspectives on Motivational Interviewing in Diabetes Care, Diabetes Spectrum, August 2011, vol. 24 no. 3, 179‐181

7. Rollnick SR, Mason P, Butler C. Health Behavior Change: A Guide for Practitioners. London: Churchill Livingstone; 1999

8. Nutrition Practice Guideline for Diabetes Mellitus Type 1/Type 2 and Hypertension, and Disorders of Lipid Metabolism Toolkit,www.andevidencelibrary.com, Academy of Nutrition and Dietetics; accessed 1‐5‐13

9. Suzanne E. Mitchell, MD, MS, Motivational Interviewing in the Management of Type 2 Diabetes: An Expert Interview With Faculty and Disclosures, CME Released: 02/07/2012, Medscape Education Diabetes & Endocrinology

10. Standards of Medical Care in Diabetes 2013, American Diabetes Association Position Statements, © 2013, Diabetes Care, Diabetes Care, Jan. 2013 vol. 36 no. Supplement 1 S4‐S10

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