COPD insider

3 ways to optimize quality of care by managing quality of life

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Effective communication has long been one of the most important skills you can possess in healthcare. In today’s patient-centric healthcare environment, these skills have never been more challenging to practice—or more important to master.

 

According to the Institute for Healthcare Communication, studies show a strong correlation between the communication skills of a healthcare team and a patient’s ability to follow medical instructions, self manage a chronic disease and practice recommended health behaviors.1

 

In fact, certain communication competencies can have a profound impact on patient experience, satisfaction and even clinical outcomes.1

Understanding what causes impairment of a patient’s QoL may help us implement a more personalize approach and tailor interventions to be more meaningful—and therefore more effective.”

Chris Landon, MD, FAAP, FCCP, CMD

Director of Pediatrics, Ventura County Medical Center,

Associate Medical Director of Pediatric Diagnostic Center, and CEO of Landon Pediatric Foundation

Contributors

Chris Landon

Chris Landon, MD, FAAP, FCCP, CMD

Director of Pediatrics, Ventura County Medical Center,

Associate Medical Director of Pediatric Diagnostic Center, and CEO of Landon Pediatric Foundation

Roberto Benzo

Roberto Benzo, MD, MSc

Motivational-Based Health Coach

1. Provide health coaching

Health coaching, a patient-focused intervention, is gaining significant interest in the COPD community. According to Roberto Benzo, clinician, pulmonologist, and behavioral researcher at Mayo Clinic, programs that combine individualized, patient-centered information with patient decision-making and self-management have been shown to improve outcomes for patients with chronic conditions.2,3

The proof is in the coaching

Christine Cunningham advises that you should keep care centered around your patients’ needs through motivational interviewing.

 

It’s critical to understand what motivates your patients to engage with them in a positive way. Motivating factors will be different for everyone but consider starting by asking your patients about what they desire out of treatment and out of life.

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Click here to learn more about COPD coaching and self management tools

Six essential steps to health coaching2,3

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Focus on the patient’s values and what provides meaning

Identify what patients find meaningful in their lives. When they know the “why” behind their will to live, they can tolerate any “how”
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Honor the patient’s process and experience

Have patients articulate, in their own language, what they feel they want to change or do differently
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Allow patients to make the decisions

Be ready and willing to accept that patients may not want to change, may want to change using methods that we do not like, or may even fail
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Guide the patient through listening

Use open-ended questions instead of closed questions, so you can create a different way of thinking about the situation or the problem
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Accept all outcomes

Be flexible with what happens during the process; when you relinquish control, patients have the opportunity to drive their own behavior
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Demonstrating compassion

Empty yourself of what you want to accomplish, understand what is important to the patient, and honor it
The core of health coaching is to create dialogue between the patient and clinician about what is important to the patient and what will help them sustain the life that is here and now.”

Roberto Benzo, MD, MSc

Motivational-Based Health Coach

2. Foster self-management

Self-management has been recognized as an important factor in a COPD patient’s ability to maintain QoL. Supporting self-management has therefore become a key guideline in the Chronic Care Model.5 Once limited to written action plans for early symptoms of exacerbations, the concept of self-management today includes how to guide healthy, positive behaviors. The COPD Action Plan should encourage:
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Engaging in pleasurable activities

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Remaining active

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Socializing with others

Emotions, particularly in patients with COPD, play a critical role in this. A recently published study investigated a particular skill known as emotional intelligence to determine its impact on self-management and quality of life.

 

The study, “Emotional Intelligence: A Novel Outcome Associated with Wellbeing and Self-Management in Chronic Obstructive Pulmonary Disease,” was also authored by Roberto Benzo and colleagues and published in 2016 in the Annals of the American Thoracic Society. The report indicated that emotional intelligence (EI), aka emotional quotient (EQ), is defined as:5

 

The capacity to understand and manage personal thoughts and feelings while positively influencing interpersonal communication and social well-being5

A deeper look at emotional intelligence

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Research support5

 
  • Has a significant impact on self-management abilities and on all domains of quality of life, regardless of age or disease severity
  • Can be learned and may complement existing rehabilitation efforts
  • Implementing training may help address the current gap that exists in the treatment of emotional components of COPD responsible for decreased quality of life and increased healthcare use
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Practical steps to boost emotional intelligence6

 

  • Build an emotional vocabularly by giving a label to each feeling (e.g., angry, sad, frustrated, frightened)
  • Avoid using the first person to describe an emotion, such as “I am angry.” Rather say, “I feel angry”
  • Observe emotions so you can allow them to pass through without trying to push them away
  • Identify what parts of the physical body are activated by each emotion
  • Think of emotions as neither good nor bad, but as information for the person who is experiencing them
  • Keep a diary of emotions throughout the day

3. Leverage the right technology

Self-management has been recognized as an important factor in a COPD patient’s ability to maintain QoL. Supporting self-management has therefore become a key guideline in the Chronic Care Model.5 Once limited to written action plans for early symptoms of exacerbations, the concept of self-management today includes how to guide healthy, positive behaviors. The COPD Action Plan should encourage:
The core of health coaching is to create dialogue between the patient and clinician about what is important to the patient and what will help them sustain the life that is here and now.”

Roberto Benzo, MD, MSc

Motivational-Based Health Coach
Self-management has been recognized as an important factor in a COPD patient’s ability to maintain QoL. Supporting self-management has therefore become a key guideline in the Chronic Care Model.5 Once limited to written action plans for early symptoms of exacerbations, the concept of self-management today includes how to guide healthy, positive behaviors. The COPD Action Plan should encourage:

Would your patients use mobile technology?

Results you cannot ignore

 

A poster presented at a recent CHEST conference highlighted the results of a trial involving an interactive mobile health information service. This service was designed to supplement the standard of care by supporting patient-empowerment strategies, including educating participants, encouraging behavior change, and promoting adherence.8

Through the delivery of text-based messages, patients were able to:8

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Improve their BMIs

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Reduce the incidence/severity of depression

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Go to more appointments

According to Landon, an interactive mobile health information initiative of this kind is simple and economical to implement. In addition, messages can be personalized for each individual, which can help make meaningful connections with those who may feel isolated due to their condition and restricted lifestyle. 

99091: Cracking the code

 

Landon is pleased with recent telehealth developments that will allow compensation for providers to interact with their patients in facility or non-facility settings. According to the Centers for Medicare and Medicaid Services Summary of Policies, they are finalizing separate payment for CPT code 99091, which describes certain remote patient monitoring for the calendar year 2018.

 

Landon says, “The new coding will help incentivize providers to use technologies, because they will finally be rewarded for their efforts to monitor patients beyond the clinic.9

The overwhelming rationale for connected health10

 

According to an executive summary of the Deloitte report “Accelerating the Adoption of Connected Health,” technologies are creating opportunities to:

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Facilitate self-managed care, with the help of technology-enabled solutions, in a secure environment that protects consumer privacy  

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Deliver care outside the traditional clinical setting, potentially providing better access to care at a lower cost

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Assist chronic care management and improve population health outcomes

“Lack of social interaction can be detrimental to our patients with COPD. This is another case for using technologies such as social platforms that can connect patients with COPD,” Landon explains. “There’s such a stigma surrounding COPD that being able to share your thoughts with someone else who has the very same stigma can be very powerful.”
So when treating your COPD patients, take a step back. Instead of focusing solely on general quality of care, focus on the personalization of it. This will help you tailor an individualized approach that can make all the difference.
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References

1.Brien SB, Stuart B, Dickens AP, et al. Independent determinants of disease-related quality of life in COPD—scope for nonpharmacologic interventions? Int J Chron Obstruct Pulmon Dis. 2018;13: 247–256.

2. COPD Foundation. Dr. Robert Benzo: Changing outcomes in COPD through Motivational Interviewing. https://www.copdfoundation.org/Praxis/Community/Blog/Article/598/Dr-Robert-Benzo-Changing-Outcomes-in-COPD-through-Motivational-Interviewing.aspx. Published October 17, 2016. Accessed May 25, 2018.

3.Rehman H, Karpman C, Vickers Douglas K, Benzo RP. Effect of a motivational interviewing based health coaching on quality of life in subjects with COPD. Respir Care. 2017;62(8):1043-1048.

4.Benzo R, Vickers K, Novotny PJ, et al. Health coaching and chronic obstructive pulmonary disease rehospitalizaton. A randomized study. A J Respir Crit Care Med. 2016; 194(6):672-680.

5.Benzo RP, Kirsch JL, Dulohery MM, Abascal-Bolado B. Emotional intelligence: a novel outcome associated with wellbeing and self-management in chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2016;13(1):10–16.

6.Six Seconds Emotional Intelligence Network. https://www.6seconds.org/2018/02/27/emotional-intelligence-tips-awareness/. Accessed May 30, 2018.

7.Pew Research Center. Internet and Technology. Fact sheet. http://www.pewinternet.org/fact-sheet/mobile/. Accessed May 19, 2018.

8.Landon, C. Poster: Evaluation of mHealth Intervention in COPD-CareMessage. Accessed May 30, 2018.

9.MLN Matters. Summary of Policies in the Calendar Year 2018 Medicare Physician Fee Schedule Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, and CT Modifier Reduction List. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10393.pdf

Revised March 2018. Accessed May 2018.

10.Deloitte. Accelerating the adoption of connected health. https://www2.deloitte.com/content/dam/Deloitte/us/Documents/life-sciences-health-care/us-dchs-connected-health.pdf. Accessed May 19, 2018.

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