The Partnership for Innovation:
2011 Grant Projects

Improving Patient Understanding of Medications at Skilled Nursing Facility Discharge

Project Leads: Carol Hartley, MD, Internal Medicine, and Jan Von Lehe, RN, MSN, Nursing Home Services

Award: $63,009 (August 2011)

Challenge: Improve patient/caregiver understanding of medications at the time of Skilled Nursing Facility (SNF) discharge.

Innovation: Using Lean principles, three facilities will be selected to evaluate the discharge process and medication instruction. We will design improvements in the process and pilot test the innovation. Measurement of performance includes targeted improvement in patient satisfaction survey results regarding their understanding of medications at the time of SNF discharge.

Potential benefits:

• Improved patient satisfaction
• Decreased hospital readmissions and/or emergency room visits post discharge

Diabetes Self-Management Program Pilot

Project Lead: Kim Wicklund, MPH, Clinical Improvement and Prevention

Award: $28,217 (August 2011)

Challenge: For the past few years, Group Health patients and staff have been advocating for diabetes self-management support in a group format.

Innovation: In 2012, Health Information & Promotion will pilot the Diabetes Self-Management Program (DSMP) in three to five clinics. The DSMP was developed at Stanford University and is modeled after the Chronic Disease Self-Management Program (Living Well with Chronic Conditions). This highly interactive, six-week workshop series is facilitated by specially trained leaders who have personal experience with diabetes or other chronic conditions.

The curriculum addresses topics related to self-management, such as nutrition and healthy eating, preventing low blood glucose and complications, fitness and exercise, and stress management. The goal is to reach up to 140 patients who have HbA1c levels of eight or higher, and to evaluate the program's impact on HbAlc levels and other measures of diabetes control.

Potential benefits:

• Improved outcomes for patients with diabetes
• Increased patient and staff satisfaction

Home Phototherapy for Psoriasis

Project Leads: Andrew Shors, MD, MPH, and Lisa Williams, MD, MS, Dermatology

Award: $89,296 (August 2011)

Challenge: Psoriasis is a common chronic skin illness. Severe psoriasis is often treated with oral or injectable medications, which are expensive and can have serious side effects. Phototherapy is an inexpensive and safe alternative to these medications.

Innovation: Currently, Group Health patients travel to regional phototherapy centers up to three times a week to receive office-based phototherapy. There are many potential barriers to office-based phototherapy, including inadequate access (only three of six Group Health dermatology centers offer phototherapy), long travel distances, limited hours of operation, parking and travel costs, difficulty obtaining childcare, lost work hours and wages, and sometimes copays.

These barriers can influence many patients to choose expensive and more dangerous systemic medications over office-based phototherapy. A recent trial demonstrated that home phototherapy is cost-effective, less burdensome, and more satisfying. A team at the Capitol Hill Campus dermatology clinic will develop and test a protocol for home phototherapy treatment of psoriasis.

Potential benefits:

• Home phototherapy has the potential to provide a safe, inexpensive, and convenient alternative for the treatment of severe psoriasis in Group Health patients.

Countdown to Healthy Living, Phase II

Project Leads: Nalini Gupta, MD, and Cicely White, MD, Pediatrics

Award: $120,429 (August 2011)

Challenge: Provide effective treatment of pediatric obesity in patients ages 6 to 11 with a body mass index (BMI) greater than 85 percent.

Innovation: Addresses the needs in the treatment of pediatric obesity in the medical home model at Group Health. The program combines medical home tools along with chronic disease management principles to provide evidence-based treatment for pediatric obesity.

Phase one of the program aims at testing feasibility of integrating evidence-based pediatric obesity treatment in the medical home model. Phase two will build on the infrastructure developed in phase one by adding additional cohorts, utilizing community resources for a six-month follow up, increasing identification of children with BMIs greater than the 85th percentile, as well as evaluating and improving the work flow processes based on the lessons learned from the first phase.

Potential benefits:

• Effective behavior modification in enrolled families
• Integrated care for patients with pediatric obesity within the existing Group Health medical home and chronic disease care model

Centering Pregnancy: Group Health Prenatal Care

Project Leads: Midwifery groups at Group Health Medical Centers Bellevue, Capitol Hill Campus, Olympia, and Tacoma. Karen McConnell, CNM; Emalee Danforth, CNM; Sara Fahey, CNM; and Susan Hodgson, CNM

Award: $60,620 (October 2011)

Challenge: A primary objective is to empower women to choose health-promoting behaviors for themselves and their families in an environment that can not be recreated in an exam room.

Innovation: Centering pregnancy is a model of group prenatal care that integrates health assessment, education, and support. With the centering model, 8 to 12 women with similar expected delivery dates meet with a certified nurse-midwife or physician and a second facilitator for 10 two-hour sessions to learn about pregnancy, childbirth, parenting, self-care, family planning, diet, exercise, and more. Group sessions help normalize the pregnancy experience as women share their concerns and their coping mechanisms. Group leaders use facilitative leadership techniques rather than lectures to guide the discussions. Women who participate develop relationships with their co-participants, gain confidence in their problem-solving ability, and are engaged in a learning atmosphere impossible to recreate in an exam room. Each session includes a self-assessment, supervision by nursing staff, and an individual health and physical assessment by a midwife or MD.

Potential benefits:

• Increase access (slightly), improve on-time scheduling, and free up exam room space.
• Improve perinatal outcomes, as well as patient and staff satisfaction.