Welcome to Patient-Centered Care, Supporting Patient-Driven Care Coordination. This is Lecture c, which will cover information-driven patient education. This unit will cover the following learning objectives. 1, explain the importance of patient-driven care coordination. 2, list ways a patient can use technology to drive care decisions. And 3, describe the concept of patient-initiated information exchange. This unit will explore the use of technology to support and enable patient-driven coordinated care. To make informed healthcare decisions, the patient must have access to information. Patient education includes materials and activities that provide information to patients to improve their health behaviors and health status. An educated patient is better prepared to participate in their care. Prevent errors, improve their outcomes, and impact the length of healthcare interventions. How can we help patients to be full partners in their healthcare? A knowledgeable and educated patient is better prepared to participate in shared decision-making. For more information on shared decision making, please see component 25, unit 7. Historically, patient education has been delivered during hospital stay, or at the end of a clinic visit. Patients have difficulty retaining information that is delivered in this way. Patients who understand their hospital discharge instructions are 30% less likely to be readmitted to the hospital. What do patients tell us about their health education wants and needs? Patients want information on demand. They want information that is proactive, personal, and interactive. And patients want to have emotional support available to them along with education. Based on patient feedback and research, we need to provide education that empowers patients. Patient empowerment allows for treatment decisions that are supported with information gained from the use of interactive technology. Interactive technology allows the patient to determine and meet their educational needs at the place and time where they can best learn. We have enough research to know that pages and pages of paper handouts given to the patient when they are least likely to retain information, do not empower self-directed healthcare. How can technology be used to improve patient education, retention of information, and empowerment? Technology used for patient education includes the television, videos, the internet, email, health education apps, EHR driven education, and patient portals. Interactive television systems are used in many inpatient settings. These systems allow patients to select and view health education of their choice during their inpatient stay. While convenient and widely used, there are downsides to this method of education. The patient may not be able to absorb and understand health information when they are in a state of decreased health. Information topics may be limited, and are not customized to each patient's needs. And patient education delivered by television relies on the patient's memory to make changes in their health behaviors based on what they viewed earlier in time. Video or DVD technology can be presented during an inpatient stay or as part of a package of information provided to the patient with a new diagnosis or treatment plan. Video technology allows the patient to view and review information when they are ready to learn. But the technology relies on patient memory to initiate and sustain behavior change. The information delivered by video or DVD is not customized to the patient needs. In addition, the patient must possess the video or DVD technology so they can view information. There is a wealth of health information on the Internet. This information can be used either independently by the patient to research their health condition. Or the patient can be linked or directed to health information on the Internet by their healthcare provider. As with video-based patient education, Internet-based patient education allows the patient to view and review information when they are ready to learn. Internet patient education may also contain interactivity that measures and reinforces learning comprehension and intention to act. In order to use internet-based patient education, the patient must have access to the Internet and possess a device that can connect to the Internet and allow for viewing and interaction. Vendors are working on email based products that will allow care providers to send health information or links to resources to patients based on specific criteria. An example of this would be sending regular scheduled emails to a newly diagnosed diabetic with helpful information that can be viewed when the patient is ready to learn. This technology provides a greater degree of personalization and may allow the healthcare provider to see what the patient has viewed. In order to use this technology the patient must have an email address and a device that allows them to receive email. More physicians and healthcare providers are prescribing or recommending health apps to patients as an educational and behavioral change technology. Health apps are mobile technology allowing the patient to learn at any place or time. Health apps can contain interactive elements that allow the patient to measure their own understanding of information, reinforce learning, and provide opportunities for repeated practice. Less than 25% of physicians currently prescribe mobile health apps, but it is estimated that many physicians will incorporate this technology into their practice within the next five years. Again, the patient must possess mobile technology that facilities use of mobile health apps and may need some assistance to understand how to use these apps. Cutting edge EHR technology now enables nurses and physicians to order patient education topics within the EHR. That is then sent to an associated patient entertainment system in the hospital room. The health topics are listed on the individual patient television, or viewing device, where they can view the information when they are able. Completed educational topics are reflected in the patient EHR. Signaling the nurse or other healthcare provider to further discuss the topic with the patient to assess and reinforce learning. This technology is fairly new and requires specific technology, setup, and equipment to initiate. Many patient portals are designed so that specific education, relevant to an in-patient, or ambulatory care episode, is available through the portal when the patient is ready to view or share with others. In addition, many patient portals provide links to an extensive list of health care topics. So the patients and families can browse and research health information. Many technologies exist or are emerging to support the goal of interactive and on-demand patient education. However, there are barriers that decrease the ability of the patient to manage their own health education needs. Barriers include, patient health literacy, language, culture, and technology. Health literacy is defined within the Institute of Medicine report, as quote, the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions, end quote. This can include the skills that are necessary to navigate within health systems in the Untied States and to communicate adequately with healthcare providers. The majority of the population in the United States possesses an intermediate level of health literacy, including the ability to locate and utilize e-health resources. Language poses an additional barrier to delivery and consumption of patient health information. Limited English proficiency impacts the patient and family's comprehension of patient education delivered through technology. Studies have shown a statistically significant difference and adherence to provider supplied health promotion behaviors based on the level of English proficiency. Those with lower levels of English proficiency demonstrated less adherence to recommended health behaviors. Information-driven patient education can only be successful if cultural factors support acquisition and use of health information. The healthcare culture must align with the partnership based care model so that the patient is empowered to locate, view and implement new knowledge into their behaviors. The environmental culture must support both the presence of technology that can be used to obtain health information and then support the patient in their efforts to use health information to make changes in their health behaviors. Technology presents an additional barrier to acquisition, comprehension and utilization of health information. At the minimum, a patient needs access to the Internet, an email address and mobile technology to increase the options for obtaining, retaining and using health information to change behaviors and improve health status. This concludes lecture C of supporting patient-driven care coordination. To summarize, a knowledgeable and educated patient is better prepared to participate in shared decision making. Technology can be used to improve the delivery of health information so that the patient can view information at the time and place where they are readiest to learn. Although barriers such as health literacy, limited English proficiency, and culture exist, there are many types of technology. That have been designed to empower patients to gain the knowledge needed to successfully manage their own health.
