Strategies for identifying, sharing, disseminating and implementing best practices in the care of patients with multiple chronic conditions and end-of-life care needs
Methods: Medical groups working with SCAN Health Plan received a survey followed by semi-structured interviews to identify promising interventions. A set of criteria was developed to judge the best practices on addressing an identified need, demonstrating evidence of achieving the triple aim, scalability and sustainability. The selected best practices were presented in a Summit, where attendees selected one of the practices, worked with experienced physician coaches to draft an action plan with specific, measurable, achievable, realistic and timely goals and a timeline to implement their selected innovation using quality improvement principles. Following the Summit, coaches met with their teams every two weeks to guide implementation.
Results: The five best practices included outpatient palliative care, palliative nurse training, advanced care planning for high-risk patients, complex care management and a virtual care team. Each one of the best practices was selected by at least one medical group in the Summit. Preliminary results indicate that 64% of the participating groups carried out implementation activities.
Conclusions: Preliminary results indicate that structured action planning and coaching improves adoption of innovations. Further study of long-term outcomes, patient satisfaction, utilization, sustainability and scalability is needed.
Learning Areas:Administration, management, leadership
Chronic disease management and prevention
Planning of health education strategies, interventions, and programs
Public health or related nursing
Public health or related research
Assess effectiveness of action planning through targeted coaching of implementation teams Identify necessary organizational components leading to successful implementation of these five best practices in other medical groups
Keyword(s): Quality Improvement, Chronic Disease Management and Care
Qualified on the content I am responsible for because: I am the primary investigator for the SCAN|UCLA Best Practices project which collected the data for this abstract. I lead the Multicampus Program in Geriatric Medicine and Gerontology, a group committed to research and education on aging. Additionally, I am an Assistant Adjunct Professor of Medicine, Division of Geriatrics in the David Geffen School of Medicine at UCLA and Assistant Adjunct Professor, UCLA Fielding School of Public Health
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.