Dr. Blog

OMA Quality Corner: Applying Universal Precautions to Health Communication

Universal Precautions:
Not Just for Bloodborne Diseases Anymore
Applying Universal Precautions to Health Communication

Universal precautions refers to taking specific actions that minimize risk for everyone when it is unclear which patients may be affected. What would happen if you applied this concept to health communications?

Providers don’t always know which patients have limited health literacy; health literacy is not education dependent, limited to cultural or ethnic background and is context-specific. Experts recommend that health care providers assume that everyone may have difficulty understanding and that every encounter is at risk for miscommunication.  Applying universal precautions in health communication ensures that practices are in place to minimize the risk that the patient did not understand and allows all patients to make informed decisions about their health care.

Wondering how many of your patients have limited health literacy?  Calculate your practice’s estimate using the Pfizer Prevalence Calculator.

Health Literacy Universal Precautions Toolkit

The Agency for Healthcare Research and Quality has a comprehensive Universal Precautions Toolkit that can be found at www.ahrq.gov/qual/literacy/healthliteracytoolkit.pdf.

This toolkit provides step-by-step guidance and tools for assessing your practice and making changes so you connect with patients of all literacy levels. The toolkit is set up to be implemented in manageable chunks that can be implemented over time; it includes over 20 tools in the areas of spoken communication, written communication, self-management and empowerment and supportive systems. Practice managers and staff can use the toolkit action plans, practice assessments, learning modules and easy-to-read forms to jumpstart implementation of universal precaution in health communication.

Highlights from the toolkit:

Easy-to-read materials: includes a variety of forms/materials that clinics can download and customize for their clinic (already written at the 6^th grade reading level).

Links to visual aids: includes examples of medication cards, pill charts, children’s books and adult education materials (in multiple languages).

For kids, check out Dusty the Asthma Goldfish and His Asthmas Triggers Fun Book.

HEALTH TiPS (American College of Physicians Foundation): these 4x6 cards address a variety of health conditions, come in both Spanish and English, and can be ordered/downloaded for FREE to help patients better understand their health information.

Internet resources to health literacy: includes links to videos, materials and evidence-based research as referenced in the toolkit.

Fresh from the Leadership Academy

The OMA's new President, Bud Pierce, MD, and Executive Vice President and CEO Jo Bryson, CAE, just got back from the Physicians Foundation Leadership Academy hosted by Northwest University's Kellogg School of Management in Chicago.

"This is an outstanding leadership course taught by professors who hold endowed chairs in the Kellog School of Business at Northwestern University; if you are ever asked to attend, run, don't walk to this course as it is truly outstanding in content and presentation," said Pierce.

Dr. Pierce (pictured here reading his copy of Leigh Thompson's The Truth About Negotiations from the Leadership Academy) follows in the footsteps of the last three OMA presidents, who attended the Leadership Academy with Jo in the first weeks of their presidency.

OMA Quality Corner: Patient Engagement

Patient Engagement: Just another health care buzz word?

Health care reform, both nationally and in Oregon, are seeking to deliver health care to patients in a new way: by engaging the patient in their own health care. Patient-centered primary care homes depend on an actively engaged and empowered patient population; how do we get patients to understand and increase their role in managing their care?

Researchers, health plans and providers have been developing patient engagement strategies to help increase patient education, knowledge and confidence – all of which have been shown to increase self-managed care.

Patient Activation Measure

One such strategy, known as the Patient Activation Measure (PAM) was developed by one of Oregon’s own – Judith Hibbard, Dr.P.H. at the University of Oregon. This tool measures the individual’s skill and competence in managing their health as well as gauges their beliefs about their role in managing their health. PAM uses a 13-question survey (Figure 1) and can be given by their health care team, health plan or the health care system. PAM places the patient in one of four activation levels; each level addresses a broad array of self-care behaviors that drive health activation.  

The power of this tool is in its predictive power- it gives health care providers a reliable starting point for designing specific coaching or clinical interventions that address individual needs and vulnerabilities for suboptimal care. PAM scores can also predict health care outcomes including medication adherence, ER utilization and hospitalization.

In Oregon, this tool has already been adopted by Kaiser Permanente, Providence Health Plans, CareOregon, ODS and PeaceHealth.

Interested in implementing this in your practice or learning more?

Insignia Health website: www.insigniahealth.com/solutions/patient-activation-measure 

The Commonwealth Fund, “Patients Gain Information and Skills to Improve Self-Management through Innovative Tools,” Quality Matters. Available at: www.commonwealthfund.org/Newsletters/Quality-Matters/2010/December-January-2010/In-Focus.aspx

Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers: www.ncbi.nlm.nih.gov/pmc/articles/PMC1361049

OMA Quality Corner: Adverse Event Disclosure Guide

Oregon Adverse Event Disclosure Guide:
A Resource for Physicians and Health Care Organizations

The Oregon Patient Safety Commission, working in conjunction with nearly 40 organizations including the Oregon Medical Association, developed the Oregon Adverse Event Disclosure Guide to help physicians better understand the purpose of disclosure and provide resources to help develop and improve disclosure programs in Oregon’s health care organizations.

This question and answer style guide was just released; more information and a printable copy can be found on the Oregon Patient Safety Commission website at http://oregonpatientsafety.org/healthcare-professionals/disclosure-guide.

What is “disclosure” and am I required to report?

In this guide, disclosure is defined as informing the patient of an adverse event through the use of both oral disclosure and written notification.

Required to report: If your organization participates in the Oregon Patient Safety Commission’s Patient Safety Reporting Program, you are required to report an adverse event.

The requirement to report, as a participating organization was passed by the Oregon State Legislature in 2003 and requires the physician to provide written notification in a timely manner to each patient affected by the event. This cannot be used as an admission of liability in a civil action (ORS 442.386(4)).

Oregon Patient Safety Commission recommendations regarding disclosure

1. Disclosure should be made in the form of oral disclosure followed by written notification by physicians and health care organizations faced with an adverse event.
   
   Oregon law only requires written notification; the Commission strongly feels that all patients have a right to know about adverse events and that both oral and written disclosure supports and reinforces honest communication with patients.
   
   
2. Physicians and health care organizations should consider disclosing adverse events regardless of harm level or identification of error.

For more information on adverse events and information on patient safety, please visit the Oregon Patient Safety Commission website at http://oregonpatientsafety.org; you can also receive monthly updates through their newsletter at http://oregonpatientsafety.org/news-events/newsletter.

OMA Quality Corner: A Prescription for a Healthier Lifestyle

If you would like to receive e-mail notification when new issues of Quality Corner are available, please contact Danielle Sobel, OMA Health Policy Specialist, at danielle@theOMA.org.

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A Prescription for a Healthier Lifestyle:
Resources to help your patients stay fit

The OMA General Membership meeting last weekend (April 20-21^st, 2012) featured two sessions focused on helping patients maintain healthy lifestyles by staying physically active.

Leading a Healthier Lifestyle

Patrick House, winner of The Biggest Loser, Season 10, not only shared his experience on The Biggest Loser and his weight-loss journey but talked about how he is helping kids in Mississippi overcome childhood obesity through his program, LEAN on ME (Learn, Educate, Advocate, Nullify, Obesity, Now in My Education system).

His recommended resource?
The AMA’s Weigh What Matters Program

Weigh What Matters is a family obesity prevention program that offers physicians resources to start the conversation about weight-loss for your patients. The website contains multiple resources, including an app!

App: Weigh What Matters (available on the App Store or the Android Market)


Editorial: I tested the app and found it useful for tracking my weight, food and exercise against my weight goals. It is easy to use and free; compared to other free weight tracking apps, this is an easy and useful tool to keep on one’s phone/tablet!

The website offers a variety of factsheets, including an Office Team Reference Sheet, Patient Action Plan and Brochure as well as a Physician Guide.

Find these resources and more at www.ama-assn.org/resources/weighwhatmatters/physicians.html. 

Exercise is Medicine^TM

Dr. Robert E. Sallis presented on Exercise is Medicine^TM, an initiative to improve the health and well-being of all patients through a prescription for regular physical activity. Physical activity has a powerful effect on both the treatment and prevention of virtually every chronic disease, including obesity. His goal is to make physical activity assessment and exercise prescription a standard part of the disease prevention and treatment paradigm for all patients.

When prescribing exercise, Dr. Sallis recommends you “Think FITT”:

F= Frequency (most days of the week; 5 or more days)
I= Intensity (Moderate; 50-70 percent of max heart rate)
T= Type (use large muscle groups; something enjoyable)
T= Time (30 minutes)

More about his initiative, including a Provider’s Action Guide, can be found at http://exerciseismedicine.org/physicians.htm.

OMA Quality Corner: The “Choking Game”

The “Choking Game”:
What should you be listening for from adolescent patients?

What is the “choking game”?

According to the CDC, "the choking game" is defined as: "... self-strangulation or strangulation by another person with the hands or a noose to achieve a brief euphoric state caused by cerebral hypoxia. Participants in this activity typically are youths. Serious neurologic injury or death can result if strangulation is prolonged."

Also known as: Knock Out, Space Monkey, Flatlining, The Fainting Game

How does this affect my patients?

For the first time in 2008, the Oregon Healthy Teens (OHT) survey included a question on lifetime prevalence and frequency of choking game participation. This was the first systematic assessment at the state level for awareness of and participation in strangulation activities among youth.

The 2009 OHT survey found that approximately 6.1 percent of eighth graders and 7.5 percent of eleventh-graders have participated in the choking game. Of these, 64 percent have tried it twice and 1 in 5 has done so more than five times.

Generally, males and females participate at the same rate. However, black males and Pacific Islander males and females may be participating at a higher rate than white youth. Associated risk behaviors primarily include substance abuse and sexual activity with poor nutrition, gambling and exposure to violence.

What can I do?

1. Comprehensive Adolescent Wellness Visits
    Ensure that each of your adolescent patients receives a comprehensive adolescent wellness visit and include an assessment of the youth’s risk for participation in the choking game.
2. Also Known As
   Observe the patient for physical signs of participation and remember to listen for variations of the name of the game: Knock Out, Space Monkey, Flatlining, The Fainting Game.
   
3. It’s not a Game
   Warn young people of the dangers of asphyxia games; emphasize that while the terminology used is “game”; this is not a game and participation can lead to injuries and death.
4. Oregon Health Authority Fact Sheet on the Choking Game (link below)
   Print this fact sheet and distribute to patients and/or families of the adolescent patient. This handout can be placed in patient lobbies, on bulletin boards or included in informational packets sent to patients.

Resources:

Oregon Health Authority: “The Choking Game: A fact sheet for parents and teachers” available at http://public.health.oregon.gov/HealthyPeopleFamilies/Youth/Documents/FactSheetCG.pdf

Ramowski, S.K., Nystrom, R.N., Rosenberg, K.D., Gilchrist, J., & Chaumeton, N.R. (2012) Health Risks of Oregon Eighth- Grade Participants in the “Choking Game”: Results From a Population-Based Survey. Pediatrics, 129, (5) p. 1-6. Available online at http://pediatrics.aappublications.org/content/early/2012/04/11/peds.2011-2482

CDC Morbidity and Mortality Weekly Report (January 15, 2010) “Choking Game” Awareness and Participation Among 8^th Graders –Oregon 2008. Available at www.cdc.gov/mmwr/preview/mmwrhtml/mm5901a1.htm

 

Rob Delf Honored with OMA Presidential Citation

At the Medical Society of Metropolitan Portland’s Annual Meeting on April 17, recently-retired Executive Director Rob Delf, MPA, CAE was honored by OMA President Carla McKelvey, MD, with an OMA Presidential Citation for his years of service to the medical community. Past OMA President Tom Hoggard, MD, and OMA Executive Vice President and CEO Jo Bryson, CAE, presented the award.

Rob retired in December after 30 years of dedicated service to MSMP. His work will live on in the many programs he helped create, including the DOCS program, which is now Project Access, a partnership with the Coalition of Community Health Clinics in Multnomah County that leverages charity care from physicians and other health care providers to provide low-income and uninsured patients with streamlined access to donated care, and to make it easy for the health care community to donate care.

Throughout his career, Rob clocked endless hours working on various health care committees, and in 1983, he assisted in creating The Scribe, MSMP’s award-winning newspaper that is still in circulation. His legacy of leadership and passion helped shape the organization’s focus and will ensure that MSMP continues to thrive and grow on its solid foundation of service.

CCO Forum: Hood River

Health care transformation is here, and the coordinated care organization implementation timeline is extremely fast-paced. The OMA is co-sponsoring a series of regional CCO forums around the state, hosted by CCO Oregon, to discuss what these changes mean for physicians and other health care providers, patients and communities.

The first of six CCO forums took place in Hood River on Wednesday, April 11. OMA Executive Vice President and CEO Jo Bryson was there to meet with local physicians and discuss their concerns.

The forum included a keynote address from Oregon Health Authority Director Bruce Goldberg, MD, one of the key architects of the state’s reform efforts, as well as updates from local leaders and a Q&A session for the audience.

Pictured below, Kristen Dillon, MD, a family physician from Hood River and an OMA member, answers a question from the audience as part of the panel of local leaders.

OMA Deputy Executive Vice President and COO Betsy Boyd-Flynn attended the second CCO forum, which took part in La Grande today (April 13). The OMA will also be on-hand at the following forums to answer your questions:

• Portland: April 17, 11:30 am - 2:00 pm, Double Tree Lloyd Center
  Register for Portland
• Eugene: April 19, 11:30 am - 2:00 pm, Lane Community College
  Register for Eugene
• Medford: April 24, 11:30 am - 2:00 pm, Red Lion
  Register for Medford
• Bend: May 15, 11:30 am – 2:00 pm, The Riverhouse
  Register for Bend

OMA Quality Corner: Reducing Surgical Site Infections and Adverse Events

Quality Initiatives in Oregon:
Reducing Surgical Site Infections and Adverse Events

This edition of Quality Corner highlights Oregon’s participation in two quality initiatives: Project JOINTS and Partnership for Patients. Both initiatives have multi-partner state support, offer free participation and are currently enrolling interested hospitals; find out if your hospital is participating!

This weekly column on patient safety and quality will be published every Wednesday on the OMA's blog, and new posts will be announced on our Facebook and Twitter pages. The first four issues, March 28 - April 25, will also be sent to OMA members via e-mail with a link to our blog. If you would prefer to receive this column by e-mail after April 25 or to be taken off this e-mail list, please contact Danielle Sobel, OMA Health Policy Specialist, at danielle@theOMA.org; or let Danielle know if there is a topic you would like to be included in Quality Corner.

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Project JOINTS:
The Enhanced Surgical Site Infections Prevention Bundle

Project JOINTS, an IHI initiative is a 10-state pilot aimed at reducing surgical site infections (SSIs) in hip and knee surgeries. Project JOINTS is working to accelerate the adoption of the Enhanced Surgical Bundle, a bundle of three evidence-based practices in conjunction with the two applicable Surgical Care Improvement Project (SCIP) practices:

• Use of an alcohol-containing antiseptic agent for preoperative skin preparation
• Preoperative bathing or showering with chlorhexidine gluconate (CHG) soap for at least three days before surgery
• Staphylococcus aureus screening and use of intranasal mupirocin and CHG bathing or showering to decolonize Staphylococcus aureus carriers

• Applicable SCIP practices:
  • Appropriate use of prophylactic antibiotics
  • Appropriate hair removal

Can hospitals still join?

Hospital registration is FREE, with no data obligation from the hospital. Once enrolled, the hospital and its surgeons and medical staff will have access to the Project JOINTS webinars, IHI staff assistance, and materials (including posters and media communications). The webinars/calls will have CEU credits available and are recorded and posted on the Project JOINTS website.

To sign up, hospitals can go directly to the Project JOINTS website, www.ihi.org/offerings/Initiatives/ProjectJOINTS, and submit a short, fillable form.

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Partnership for Patients:
Hospital Engagement Network

The Partnership for Patients: Better Care, Lower Cost is a public-private partnership that will help improve the quality, safety and affordability of health for all Americans. The Oregon Association of Hospitals and Health Systems (OAHHS) with the American Hospital Association and the Health Research and Educational Trust (HRET) is working to develop learning collaboratives for hospitals and provide a wide array of initiatives and activities to improve patient safety.

Harm Reduction Categories

Each Hospital Engagement Network (HEN) is responsible for identifying a set of improvement activities that are most relevant to the contracted hospital’s needs and relate to the following categories:

• Adverse drug events (ADE)
• Birth-related injuries
• Catheter-acquired urinary tract infections (CAUTI)
• Central line-associated blood stream infections (CLABSI)
• Falls
• Pressure ulcers
• Avoidable Readmissions
• Surgical infections and complications (SSI)
• Venous thrombembolisms (VTE)
• Ventilator-associated pneumonia (VAP)

For more information or to connect with OAHHS, visit www.oahhs.org/quality/initiatives/partnership-for-patients.

OMA Quality Corner: Low Back Pain

This new weekly column on patient safety and quality will be published every Wednesday on the OMA's blog, and new posts will be announced on our Facebook and Twitter pages. The first four issues, March 28 - April 25, will also be sent to OMA members via e-mail with a link to our blog. If you would prefer to receive this column by e-mail after April 25 or to be taken off this e-mail list, please contact Danielle Sobel, OMA Health Policy Specialist, at danielle@theOMA.org; let Danielle know if there is a topic you would like to be included in Quality Corner.

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Low Back Pain:
NEW resources to help patients "Get Vertical!"

The Oregon Health Care Quality Corporation recently launched a new campaign to help people with low back pain better understand safe and effective care. Their campaign, "Get Vertical: And Don't Take Low Back Pain Lying Down!" reflects the recommendations for quality patient care in the 2011 State of Oregon Evidence-Based Clinical Guideline for the Evaluation and Management of Low Back Pain.

The Quality Corp website (link below) includes a patient quiz on low back pain as well as information that can help the patient better understand what works best for the common type of low back pain caused by strain on muscles and ligaments.

How can you use this information in your clinic?

The Quality Corp booklet on Safe and Effective Care for Low Back Pain is available as a free download that can be shared with your patients.  Quality Corp does have a limited supply of printed booklets available if you would like a copy for your waiting room, doctors’ rooms or to distribute to patients. To order a booklet, please contact Quality Corp at info@q-corp.org.

Web Resources:

Quality Corp: Partner for Quality Care “Get Vertical” campaign: www.partnerforqualitycare.org/lowbackpain

Oregon Health Policy and Research, Evidence-Based Guidelines for Low Back Pain: www.oregon.gov/OHA/OHPR/HERC/Evidence-Based-Guidelines.shtml