Care Coordination for the Burmese Population Marjeta Daja and Mina - - PowerPoint PPT Presentation

Care Coordination for the Burmese Population

Burmese Care Coordination | DiversityRx 2013 Conference | March 11 - 14, 2013

Marjeta Daja and Mina Kini. Diversity and Inclusion

Discussion Focus:

• Texas Health

Resources as the system of care

• Mission, Vision &

Values

• Our Burmese

Community in Dallas

Organizational Context

• Defining Project

Objectives and Outcomes

• Project Process
• Coordination of

Care for Burmese Patients

Project Description

• Lessons Learned
• Next Steps and

Advancing the Strategy

Outcomes

Today’s Journey – 30 minutes

Geography

Refugee Arrival Data - Burmese

1000 2000 3000 4000 5000 6000 7000 2007 2008 2009 2010 2011 2012 TOTAL Series1 668 854 1,541 1,373 1,140 1,153 6729

Burmese Arrival Data/ Dallas Fort Worth Areas

Where in the world is BURMA

Burma is located in South-East ASIA

USA

The Burmese Population

REFUGEES - Different ethnicities: language, culture, experiences

Kachin Chin Karen Mon Kayah

The Expressed Need

Started with Language Issues

• Accessing a Burmese

interpreter

• Identifying the right

dialect

• Time to explain and

seek understanding

• f the care process

Other Related Issues

• CULTURAL Issues
• Access to care and

Understanding the Western Medicine model and care expectations

• Medication Adherence
• Preventive Care

processes

Connecting the dots: Recognizing Disparities Factors

• Social Determinants
• Economic Factors
• Environmental Factors
• Primary Dimensions

Barriers to Care

Image Source: Texas Health Resources 2012 Multicultural Calendar

Discussion Focus:

• Texas Health

Resources as the system of care

• Mission, Vision &

Values

• Our Burmese

Community in Dallas

Organizational Context

• Defining Project

Objectives and Outcomes

• Project Process
• Coordination of

Care for Burmese Patients

Project Description

• Lessons Learned
• Next Steps and

Advancing the Strategy

Outcomes

Today’s Journey – 30 minutes

LEAN Process – Multidisciplinary Team

Project Sponsor : Dale Leach, Mina Kini (THR) EE Leader: Jazz Patterson, Clint Abernathy Nursing: Debra DuBois, Erin Smith, Melissa Morton, Shanna Brown Kendra Henderson, Molly Montgomery, Julie Anderson, Patti Marks, Chris Brooks, Krisi Ingram, Jean Tan, Rosa Belgard, Kelli Raibick, Shawna Gonzalez, Myesha Bryant WHC, ED, L&D, OB/GYN, Post Partum, Nursery/NICU, Pedi Clinic, Education Operations: Teresa Cannon (ITS), Marjeta Daja (THR),John Engelhard (Pastoral Care), Nancy Hetherington (Admissions), Ruby Manuel (Patient Services), Sandra Pinkerton (THRE), Elsa Phelan (Community Health) Community Members: Luke Saw, Wilma Montz, Kari Brasselero, Julie

Access to Care Getting Treatment (In Patient) Discharge & Prevention

Patient Centric Process Design

Problem Identification Team & Stakeholder Identification Team Charter & Objectives Definition Key Focus Areas

Issues Articulated: Interpretation Needs & Cultural Issues Using Patient/Family Journey Flow: – Clinical, Operations & Community Partners

• Using LEAN &

CAP approaches

• Patient

Throughput Analysis

• Identified by

Clinical Area Needs MULTIDISCIPLINARY WORK -TEAM

Challenges for Clinicians

• Basic communication challenges
• Informed consent (concept unknown)
• Deliver quality care in an appropriate and safe

manner

• Prepare patients for transfer to the Margot

Perot Center

• Educate staff about effective care practices
• Resource Considerations: Time, Budget, etc

Patient Arrives at the WHC or Physicians Office Patient Calls WHC or Physicians Off. For an Appt. Patient Care Given Patient Returns for F/U Patient Presents at L & D Admitting Patient Registers and is Directed to Location of Delivery Patient Fills Out Consent Forms and Gets Initial Teaching Patient Receives Care from L & D Patient(s) Transported and Admitted to New Area Patient Gets Initial Teaching Patient Receives Care Patient Receives Care Teaching Patient Receives Discharge Teaching Patient Arrives at Emergency Room

Process Map

Patient Arrives at the WHC or Physicians Office Patient Calls WHC or Physicians

• Off. For an

Appt. Staff Gives Literacy Test Staff Informs Depts of Patient Status (L& D, NICU, PP, Gyn, High Risk, Special Care, Newborn) Patient Care Given Patient Tour Scheduled Patient Returns for F/U and goes on Tour Staff Uses Check Sheet to Document Understanding Patient Presents at L & D Admitting Patient Registers and is Directed to Location of Delivery Patient Fills Out Consent Forms and Gets Initial Teaching Patient Receives Care from L & D Patient(s) Transported and Admitted to New Area Patient Gets Initial Teaching Patient Receives Care Patient Receives Care Teaching Patient Receives Discharge Teaching Staff Uses Check Sheet to Document Understanding Patient Arrives at Emergency Room Patient Education Graphics/ Interpretation No Planned Change Department Coordinat. ER Path Only

Project Core Focus Areas

Interpretation Services Education Graphical & Instruction Tools Community Outreach Care Coordination Team

Coordinating Care: Process, Tools and Structure

Interpretation Services

Top2 Language Line Groups

Language Monitoring Language Identification tools

Effective Communication

Language Assistant @ WHC

Burmese Interpreter (employee)

Effective Communication

Education: Patient Tours

WHC – L&D – Newborn Nursery – Post Partum – Pedi Clinic - Pharmacy

Care Coordination Tour

Patient Tours: Patient Understanding Check

Sheets – Bilingual Translated Forms

Educational Modules

Clinician Education – Cultural Competence

Cultural Intelligence - For Healthcare Providers to provide Culturally Competent Care

Patient Education tools/Materials

Care Tools –Focus on Health Literacy

• Focus on Health

Literacy & Patient Materials

• Graphic

Explanation & Accuracy of Technical

• Exploring various

methods of graphical representation

Patient Education tools/Materials

Care Tools –Focus on Health Literacy

I Speak Card

Patient Language Identification Tool

Care Tools –Focus on Health Literacy

Community Outreach

Partnership with Community Organizations resettling refugees Exploratory Care Models: Care Navigation Partnership for Action Research

• n Social

Organization

Community Engagement .

IRC Language Assistance Card

Care Coordination through EHR -

Patient Information Tool – Patient History for WHC

Process, Systems and Department Coordination

ED and Inpatient documentation of Primary Language and Interpreter needed, can be found in the Professional Exchange Report.

Care Connect Standardization

Translation and Interpreter Services SharePoint Site @ THD

Process, Systems and Department Coordination

Discussion Focus:

• Texas Health

Resources as the system of care

• Mission, Vision &

Values

• Our Burmese

Community in Dallas

Organizational Context

• Defining Project

Objectives and Outcomes

• Project Process
• Coordination of

Care for Burmese Patients

Project Description

• Lessons Learned
• Next Steps and

Advancing the Strategy

Outcomes

Today’s Journey – 30 minutes

Tracking Data 2009-2011

• 88 Total Vaginal Deliveries
• 14 Total Caesarian Deliveries
• 90% of patients returned for a Post Partum Visit
• 95% of patients chose contraception

Patient Tours

• Started tours May 2010
• 75 Families Toured

Interpretation

• 625 Patients encounters

Clinical Outcome Interpreting Encounters Cultural & Emerging Needs

Improve Health & Wellbeing

Marjeta Daja

Diversity Consultant

Mina Kini

Director Diversity and Inclusion Texas Health Resources www.texashealth.org/diversityandinclusion