Person-centred care -10 years of research and practice

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Slide 1Getting to person-centred careBuilding and using the evidenceHelen Crisp, Assistant Director Research1Conflicts of interest:2I am employed by the Health Foundation As such, I am paid to attend this conference and to give this talkThis presentation is based on the work of many individuals and institutions, much of it funded by the Health FoundationI will be publicising free publications and resources that the Health Foundation makes available to promote improvement science and person-centre care I have no other interests to declare 23Thanks toColleagues at the Health Foundation: Adrian SieffDarshan PatelEd McKiernan Hannah OMalleyLizzie WrobelMatt TaitNicola PowellShaun LeamonWho all contributed to the preparation of this presentation3Person-centred care as a facet ofImprovement Science4The Health Foundation is committed to building the field of Improvement Science - by which we mean:The application of a range of basic and applied sciences in order to improve the effectiveness and efficiency of efforts to improve quality of health care for patients and populations4Dimensions of quality5The Health Foundation is working to support improvements to health services so that they are:SafeEffectivePatient-centredTimelyEfficientEquitableInstitute of Medicine, 20015Dimensions of quality6The Health Foundation is working to support improvements to health services so that they are:SafeEffectivePerson-centredTimelyEfficientEquitable67Other models lots of overlap7What are the aims for person-centred care?8 Better experience of care Better clinical outcomes Better use of health care resources8What are the challenges?9 Perceptions of health care staff about person-centred careWe already do this9What are the challenges?10 Perceptions of health care staff about person-centred careWe already do thisSurveys in the NHS consistently report that over 40% inpatients would like more involvement in decisions about their care10What are the challenges?11 Perceptions of health care staff about person-centred care The changes require social and cultural changes more than technical solutionsCultureStrategy11What are the challenges?12 Perceptions of health care staff about person-centred care The changes require social and cultural changes more than technical solutions The evidence base is weak, contested and confusing- Evidence review of shared decision making found 160 different definitions - Many other studies with no definition - Same approaches have very different results12Improvement science approach to person-centred care?13Theory-based interventions using tested methods Written up using SQUIRE guidelinesOutcome measures; personal, process, clinicalRobust evaluation using a range of innovative methods 13Improvement science in action14ResearchEvidence reviewsDeveloping theoryImprovement programmesCo-Creating HealthMAGICChanging relationships projectsEvaluation: independent, qual & quant, published14A 10 year journey1515A 10 year journey1616A 10 year journey1718The Health Foundation has focussed primarily on two areas:19Self-management supportShared decision making19Health Foundation definition20Self-management support is the assistance caregivers give to patients with chronic disease in order to encourage daily decisions that improve health-related behaviours and clinical outcomes. Important to differentiate between daily self-care - people do this by themselves for 99% of the time Self-management support is about how health care professionals can work with people to help them better understand their condition and achieve outcomes hat matter to them.It can be viewed as a portfolio of techniques and tools that help patients choose healthy behaviours; and as a fundamental transformation of the patient-caregiver relationship into a collaborative partnership. The purpose of self-management support is to aid and inspire patients to become informed about their conditions and take an active role in their treatment.20Health Foundation definition21Shared decision making is a process in which clinicians and patients work together to select tests, treatments, management, or support packages, based on clinical evidence and patients informed preferences. It involves the provision of evidence-based information about options, outcomes and uncertainties, together with decision support counselling and systems for recording and implementing patients treatment preferences.Influenced by clinical practiceGrown out of informed consentFramed by bioethical valuesSeen as a middle ground between paternalist and informed patient modelsResearch aims to understand the core principles that underpin a shared decision21What do we know now?22Person-centred care is an emerging area of practiceNo common definitions of termsConcepts are contestedBased on: 18 research reports results of 3 major improvement programmesplus findings from many small-scale projects= Some confidence in what we can say22What works?23Self-management support approaches23Self-management support approaches24Counselling-oriented approach to consultations Aims to shift from medical model to one to one support that facilitates behaviour changeUsed in Co-Creating Health to train professionals a professional life-changing eventTraining in motivational interviewing described as:24Self-management support approaches25 Approach to help people more effectively manage long-term conditionsBuilds confidence by setting attainable goals that matter to the individual and step by step plans to reach themKey feature of Co-creating Health25Self-management support approaches26Short courses for groups of people with similar condition to support self-management often led by an individual who has a long term condition Im happy for starting the group when I did. Learning things, pacing, helped to sort my life. STOP! Project in Dorset: Group sessions to help people live with chronic back pain26Self-management support approaches27Group or one to one support from someone who lives with a similar condition Underpinned by key value of reciprocity Ill never be the same person I was before my diagnosis but peer support coaching has made me believe in a future where I can recover and develop the new me2Gether NHS Foundation Trust: Coaching for recovery:27Effective shared decision making28Decision aids evidence basedinclude pros and cons of each optionuse real-life examplesuse diagrams and visualsAll need skills to use and attitude trumps skill 2829Evidence basedTwo optionsFAQsOption grid breast cancer surgery2930 Decision aid sounds very posh but its not ..This was about involving people in their care, and they had never been asked beforeProject lead, Newham COPD Shine projectI probably havent involved patients as much as I thought in the past havent made them as aware of all the different options. GP, North Shields MAGIC programme30Evidence of improved clinical outcomes31Self-management supportType II diabetes Reduced HBA1cReduced fasting glucose Stroke6 studies showed improvement3 studies showed none31Benefits to patients32More confidence for better day-to-day management of healthAble to make and sustain healthy lifestyle changesHigher satisfaction with care experienceBetter adherence to treatment plans and correct medicine use32Benefits to patients33More confidence for better day-to-day management of healthAble to make and sustain healthy lifestyle changesHigher satisfaction with care experienceBetter adherence to treatment plans and correct medicine useDebate about imposition of medical model v. patient goals33Benefits for health care system 34Some evidence of:Reduced use of emergency hospital services Diabetes self-management programmeReduced number of outpatient appointmentsAyrshire & Aran Co-creating Health Choice of less invasive treatmentRight Care knee pathway projectLinks between service use and self-management are very complexCorrelation rather than causation34Benefits for health care system 35Some evidence of:Reduced use of emergency hospital services Reduced number of outpatient appointmentsNo implementation at scale to demonstrate at system level35Benefits for health care system 36Some evidence of:Reduced use of emergency hospital services Diabetes self-management programmeReduced number of outpatient appointmentsAyrshire & Aran Co-creating Health Choice of less invasive treatmentRight Care knee pathway projectLinks between service use and self-management are very complexCorrelation rather than causation3637What works to support implementation?3738What works to support implementation?3839What works to support implementation?3940Work with other sectorsWhat works to support implementation?4041Work with other sectorsFit to local contextWhat works to support implementation?4142Work with other sectorsFit to local contextWhat works to support implementation?4243Work with other sectorsClear Goals and planFit to local contextWhat works to support implementation?4344Work with other sectorsClear Goals and planFit to local contextEvaluate and sustainWhat works to support implementation?44Where next for person-centred care?4545Key areas for research:46How to measure what matters to patients?46Measurement:Surveys47Helping measure person-centred care Reviewed the evidence on measures: Overwhelmingly survey based but also:InterviewsObservations of consultationsSpreadsheet detailing 160 researched measurement tools available at:www.health.org.uk/helpingmeasurepcc Patient Activation Measure PAM Current evaluationPROMS still related to clinical outcomes not personal outcomesMove to P-COMS where an individual sets their own outcome measurePREMS important - but still about the health care system47Key areas for research:48How to measure what matters to patients?The changing role/identity for health care professionals as the patient role changesWhat is the workforce of the future?What is the contribution of community support?48Hot off the press!4949Key areas for research50How to measure what matters to patients?The changing role/identity for health care professionals as the patient role changesWhat is the workforce of the future?What is the contribution of community support?Robust studies of cost effectiveness and longer term savingsHow to commission for person-centred care?50Next steps for implementation5151For more information see: personcentredcare.health.org.uk52525353