Chronic pain is at epidemic levels and has become the highest-cost condition in health care. This course uses evidence-based science with creative and experiential learning to better understand chronic pain conditions and how they can be prevented through self-management in our cognitive, behavioral, physical, emotional, spiritual, social, and environmental realms. The goal of this course is to blend creative, experiential, and evidence-based teaching strategies to help participants understand chronic pain conditions and how a human systems approach can be applied to self-management strategies to reduce risk factors, enhance protective factors, and prevent chronic pain. There are four major objectives to the course; 1. Describe the prevalence, personal impact, and health care dilemma associated with chronic pain. 2. Recognize the clinical characteristics and underlying etiology of several common pain conditions and the peripheral, central, and genetic mechanisms of chronic pain 3. Based on the literature associated with risk and protective factors in the seven realms of our lives, learn specific strategies in each realm that can be employed daily to prevent chronic pain and enhance wellness. 4. Appreciate the value of a human systems approach to health care and how it can provide a basis for integrative, interdisciplinary, and individualized care to preventing pain and enhancing wellness. CONTINUING EDUCATION CREDIT OPTION Accreditation Statement: University of Minnesota, Interprofessional Continuing Education is accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. American Medical Association (AMA) The University of Minnesota, Interprofessional Continuing Education designates this enduring material for a maximum of 24.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. American Nurses Credentialing Center (ANCC) This activity is awarded up to 24.0 ANCC contact hours. Other Health Care Professionals Other health care professionals who participate in this CE activity may submit this certificate statement of participation to their appropriate accrediting organizations or state boards for consideration of credit. The participant is responsible for determining whether this activity meets the requirements for acceptable continuing education. Registration and disclosure information is available here at http://z.umn.edu/chronicpain and pay the additional fee. Then, email your Coursera certificate statement of completion to cme@umn.edu.
3 Transforming our health care system
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Del curso dictado por University of Minnesota
Preventing Chronic Pain: A Human Systems Approach
89 calificaciones
De la lección
Implementing Transformative Care (Week 10)
Conoce a los instructores
Dr. James Fricton, DDS, MSProfessor and Pain Specialist
University of Minnesota, HealthPartners Institute, and Minnesota Head and Neck Pain Clinic
Hi this is James Fricton again and
this is the third part of the module on transforming the healthcare system.
And the, this lecture is about what are the steps that we can take to
really make changes in our healthcare system?
It's, I do not believe we cannot overcome the barriers that we talked about.
And address the problems.
And, and there are some simple steps that we can take to make those changes.
But we need to get to the root of the problem.
We have to really change all the way from our model of
care to our paradigms that we,
we have with regard to our care, to what are the care strategies that we use?
As well as, how do we deliver those strategies?
And so every aspect of the system needs to change or tweaked a little bit.
We don't want to throw out the good stuff that we have.
But we really want to be able to, make substantial changes on
how we understand health and illness and how that plays a role in healthcare.
So these are slides that I presented in module 19.
Also that we've talked about, a broader model of care.
And so I'm going to reiterate some of this just to emphasize how important it
is to make these kind of changes.
So we need to learn a new, broader model of care and
this whole course is about a human systems approach.
And so we need to basically ring out the old and ring in the new.
With a new approach where we not only identify the diseases, the conditions,
that are causing the pain or other symptoms.
But also those contributing factors, those risk factors and protective factors that
play a role either in increasing or delay in recovery, increase in illness.
Or in protecting us from an illness.
We need to be holistic,
we need to establish these long term relationships with our patients.
Need to be more processed versus procedure oriented and
finally we really need to look at broad based outcomes not just symptom reduction.
And pathology reduction but
also how does it impact our life and our function and quality of life.
So once we understand that a new model of care and we begin to think about illness
and patients and health and wellness we then need to shift our paradigms.
That's the language that we use when we talk to patients.
Or patients in what we understand how the, how illness and health and wellness work.
So here's some of the paradigms and
we've discussed this throughout the entire course.
But let me just summarize again.
We have to assume that everybody's multidimensional.
That we all have these seven realms and we have risk factors and protective factors.
And we have to address, address and identify all of those factors.
And by, and that helps us understand the whole person.
And then we need to focus on self responsibility,
patients need to know that they are responsible for their health.
That we can certainly provide treatments that will help have an impact on
reducing illness and improving health, but really most of the, the impact that
a person has on their health and illness is based on the patient.
And thus, as a result they need to engage in self-care.
We, as health professionals, need to provide the training and
education of patients, as well as part of our routine care.
80% of a patient's success is based on what they do,
20% is based on the evidence based treatments.
We need to provide that 80%.
And then we need to create these long-term sustainable changes, when patients
realize that change is not a quick fix, but it takes six months to a year,
really restore health from a illness, because, lifestyle changes, relationship
changes changes in the pathophysiology of a condition, just take time.
And with, and with regard to the care strategies,
we really need to focus on these multi-level care strategies.
I know it gets more complicated when we do that, and it's hard to ju,
just change our workflow.
We have to work as a team.
But it's not impossible.
In fact, it's a, can be a very, pleasurable experience in the care.
So, we want to continue to provide our medical or
dental interventions but we really need to focus on these three things first.
We need to teach patients about daily personal wellness,
prevention of chronic pain and other illnesses.
We need to do early detection and not just detection of the condition.
But also early detection are variations in risk factors and protective factors.
We need to, again, enhance protective factors, reduce risk factors.
But also provide the medical intervention.
And this is the proportions that we need to focus.
Most of it should be on this and
then we need to provide this in the cases that are really needed.
Then these care strategies need to be integrated into a process,
a care process, and to really make this effective.
And I know I talked about this in the last lecture, the last module but, we
need to be strong partners and realistic expectations with regard to patients.
We need to be empowering and motivating a patient.
We really need to explain the fact that they have most of
the impact on their illness.
We need to help them gather social support.
We need to provide that support for patients, but
they also need to get the support from the people around them so that everybody is
really focused on how to have a good life, how to have, be healthy and happy.
And that, that everybody has that same goal of being content.
But in every case it does go up and down.
We need to measure these multidimensional outcomes that I mentioned before.
And of course in the,
in the end these changes will really result in a transforming of person's life.
One of illness, or chronic illness, to one of really health and wellness.
This is what we really want to achieve for our patients.
So transformative care I believe, is a solution to our healthcare problem.
And it's a simple solution.
It's simply integrating robust self management training in
with evidence-based treatments.
We, right now, do a great job with evidence-based treatments, in our clinics,
and all over the, the surgeries,
the medications, the therapies that we provide can be very helpful.
But, at the same time, we don't do a very good job in self-management training, so.
The four Ts of transformative care.
Test to identify not only the diagnosis but the risk and
protective factors through these personal assessments.
We need to train patients in reducing these risk factors and
enhancing protective factors.
We need to treat with evidence based treatments, medications, rehab,
surgery if indicated.
And it takes a team to do that.
Whether it's a physical therapist, a health educator, a clinical psychologist
a health coach integrated in with our medical or dental treatment.
I think is really important.
But transformative care is always going to have to occur with
in a health care delivery system.
So, we need to focus on a new model for
providing care, particularly outpatient care.
And that's the three I's of changing our care delivery.
We need to be interdisciplinary, integrative, and individualized.
Interdisciplinary means that we have to work on a team as I just mentioned.
And we need to integrate somebody who's going to train the patient.
A health coach, therapist, psychologist,
to train the patient on what they need to do as well as integrate with physicians,
dentists, and other health professionals to provide that evidence-based care.
Integrative really means that we need to integrate different models,
care models as well as treatment strategies together within a program.
We understand that for
instance, certain treatments all work in different, with different mechanisms.
And by adding those treatments together they are Ssynergistic.
In other words they can all have a bigger impact on reducing the illness, but
then when you add that on top of what the patient can do.
Whether it's working on posture, reducing strain, reducing stress and sleeping
better, eating well, losing weight, whatever those lifestyle factors are.
By integrating those changes with the treatment you're going to have
a much better success.
And it needs to be individualized.
Every patient that comes to my clinic is completely different in terms of
the risk factors and protective factors.
I do an assessment and
develop and individual treatment plan based on their characteristics.
And, we follow them over time based on their needs, their goals.
What do they want to change?
And we understand that not everybody's going to be able to change everything
right away.
It's a process that you go through and
that's what's important about the relationships.
But, with any care delivery system,
it's really the economics, as I talked about with regard to the barriers.
The economics need to change.
There's no question about that.
Our health care system's very expensive, 5% of the gross national product.
And we need to focus on how do we achieve better health with less spending?
And here are a couple of characteristics that are recommended.
One is, of course, transparency.
Patients need to know how much it's going to cost for me to get care for
this condition.
Bundling of fees is one way to really do that, and to open the book on fees.
Well, you say, well, I don't know what my fees are going to be.
Well, predict it.
When you integrate a care model like transformative care,
you will see the patient for six months and you can predict
the total services that are involved in that and bundle it together.
Health plans should be open to the possibility of doing this.
We need to reward consumers, whether it's reducing health plan fees or
deductibles for positive behaviors, being involved working with the health coach,
improving lifestyle factors.
We also need to reward healthcare providers.
In other words, we need, healthcare professionals, need to be reimbursed for
this risk assessment, and the time and self-management training.
And there are codes that can do that now, and
I'm happy to share that on a handout as a part of this course.
And so, we also, need to be paid for outcomes.
If we're successful in achieving, a transformation, a reduction in pain, so
that the patient has now, for the rest of their life,
control over their pain conditions.
That saves an enormous amount of cost.
And so by doing that we need to really make sure that we
collect this type of data as part of routine care.
And then share in the profits, so that, that accountable care organization concept
is something that's useful not only for hospitals but perhaps for
all health professionals and as I mentioned, also covering bundled care.
So, with this approach, I believe that you will overcome both financial barriers,
work flow barriers.
Training barriers are going to be a little more difficult but
we need to bring this knowledge into academic health centers.
And finally consumer barriers.
And healthcare will be transformed.
This will be a triple win which is pretty unique.
By making it successful for health plans and industry.
By providers, clinics, and hospitals, so
that they don't go bankrupt, so they're able to pay their bills, and, of course,
the most important thing is the patient, gains by improving their condition and
control, long term, as a result of self-management.
So thank you for your attention.
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