FDN2_ClinicalMedicine Flashcards
What are the components of a complete medical history?
- Past Medical
- Surgical
- Gynecologic
- Psychiatric
- Medications
- Allergies
- Family History
- Review of Systems
What fraction of all americans live with a chronic condition?
>50%
What percentage of all US healthcare costs can be attributed to care of chronic conditions?
80%
What is the ultimate goal for chronic care?
Proactive, planned care for the activated patient
What is the difference between…
a) Medicare’s traditional payment model for chronic care
and
b) The innovative Medicare chronic care payment model
a) The traditional model focuses on acute, episodic care. The status of 3 chronic conditions can be substituted for 1 acute episode in a visit
b) The innovate model allows patients with 2+ chronic conditions to enroll in CCM (chronic care management) that provides an extra $40/month for care outside of office visit context. This can include preventative care, self management, phychiatric assessment, care transitions, and others for functional and psychological needs
What is an accountable care organization?
Receives money from Medicare if they can provide high quality, coordinated care to >5000 medicare beneficiearies
What percentage of total healthcare costs are attributed to the healthiest 50% of the american population?
3%
What are the basic principles of the chronic care model?
The Community: Resources adn policies, self-management support
Health systems: Delivery system design, decision support, clinical information systems
Community + health systems collaborate to achieve productive interactions betwen the informed, activated patient and the prepared, proactive practice team to improve outcomes.
Goal: lower cost, better care, better health, lower physician burnout -> an overall more sustainable system
What are the comonents of the Patient-Centered Medical Home?
- Personal physician for each patient
- Physician-directed medical practice
- Whole-person orientation
- Care is coordinated/integrated (healthcare system and community: Information exchange, regestries)
- Quality and safety
- Enhanced access to care
- Payement: recognizes value added to patients who have a patient-centered medical home (need to fund teams instead of the fee for service model)
What is an “activated patient?”
A patient with the knowledge, skill, and confidence to manage their health and healthcare
What is the ultimate goal of the chronic care model?
Improved outcomes!
lower cost, better care, better health, lower physician burnout -> an overall more sustainable system
What techniques facilitate effective information sharing with patients?
Ask - Tell - Ask
Ask - Patient’s baseline knowledge, to talk further about a topic
Tell - Anticipate what patients will fear, acknowledge uncertainty, anticpate barriers, attend to privacy
Ask - Request teach back, what questions do you have?
What kinds of patients would benefit most from motivational interviewing?
Patients who are ambivalent about changing an unhealthy behavior
What are the readiness rulers?
When is the most effective time to use them in a patient encounter?
The two readiness rules are scales to help gauge how a patient is viewing a proposed plan: On a scale of 1-10, how important is this change? On a scale of 1-10, how confident are you that you can make this change?
They are best used when you’ve discussed a potential plan with a patient, rather than right at the beginning of the interveiw
What is the goal of shared decision making?
When is it useful?
To empower patients to participate as active partners in their health care decisions.
Useful in preference-sensitive conditiosn when there is more than 1 medically appropriate choice for therapy, and the best choice depends on patient preferences, concerns, and goals
(Mincer et. al)
