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Download PDF File Here Welcome “ALL HANDS TOGETHER” SHARED HAEMODIALYSIS CARE EVENT 22 JANUARY 2019 : The Marriott LEEDS Programme Supported By Today is about… • Celebrate the SHAREHD programme achievements • Understand the shared care “why” • Hear & see different shared care experiences • Review early SHAREHD results • Explore the shared care broader renal context • Acknowledge and thank all SHAREHD contributions Please feel free to tweet as we go along @sharemydialysis #sharehd #whyidosharedcare Shared Haemodialysis Care "The objective of Shared Haemodialysis Care is for all people who receive dialysis at centres to have the opportunity, choice and information to participate in aspects of their treatment and thereby improve their experience and their outcomes. This requires a collaborative approach between health care professionals and patients : “without patient involvement at every level it would be misdirected and irrelevant". Small Steps (tasks) within shared care provides a framework to unlock potential Which of the following dialysis related tasks would 4 you like to try? PAM Score 1-4 Blood pressure Weight 3 Hand and access hygiene Prepare pack Set-up machine Insert needles / Connect 2 access Program machine Commence dialysis 1 Discontinue dialysis Disconnect access / remove needles Strip down machine and clear away Problem solving Administering medications Scaling Up to 19 trusts Lead Wave TRUST Shared Haemodialysis Care Central Dr Sandip Mitra 2 Manchester Dr Saeed Ahmed 1 Sunderland Dr Praveen Jeevaratnam 1 E&N Hertfordshire Dr Nicola Kumar 2 Guys & St Thomas Dr Jyoti Baharani 2 Heart of England Dr Elizabeth Garthwaite 2 Leeds Dr Albert Power 2 North Bristol Dr Alastair Ferraro 1 Nottingham Dr Veena Reddy 1 Sheffield Dr Babu Ramakrishna 1 Wolverhampton Dr Mark Lambie 1 North Midlands Dr Paul Laboi 2 York Dr Asheesh Sharma 3 Liverpool Dr Veshal Dey 3 Ayrshire & Arran Dr Ying Kuan 3 Western Trust Dr Jennifer Hanko 3 Belfast Dr Phil Evans Salford Royal Dr Didem Tez 3 South Tees Dr Clara Day 3 QE Birmingham Collaborative Power Action Period “patients & staff Team to “turning reflective Calls A Shared working Team learning into Vision together sharing Support action” ownership & control” Patient focus Sharing Group resources Sustainability Co Plans Production Toolkits and Quality “making Shared Roadmaps Improvement Care everyone’s responsibility” “real world Teams of HCP Learning co-production” and Patients events Transforming Participation in Chronic Kidney Disease – Report Findings • HD patients significantly more likely to have lowest activation scores • Patients living in deprived areas significantly more likely to have lower activation scores • Workforce training needed to enable better support for low activation levels Rachel Gair et al 2019 Patient reported Experience of Kidney Care in England and Wales 2017 • Analysis by age, sex, ethnicity, stage of disease showed no significant difference in experience based on those characteristics Fiona Loud Policy Director Kidney Care UK The NHS Long Term Plan People will get more control over their own health and more personalised care when they need it • better support for patients, carers and volunteers to enhance ‘supported self-management’ particularly of long-term health conditions Stronger NHS action on health inequalities • every local area across England will be required to set out specific measurable goals and mechanisms to narrow health inequalities over the next 5/10 years. www.longtermplan.nhs.uk Jan 2019 Session 1 Why do Shared Haemodialysis Care ? Chair : Fiona Loud Key Note Speech: “Why Bother with Shared Care - Particularly in the Renal Donal O’Donoghue Unit ?” The Joy of Supported independence Tara Bashford SHAREHD Research Findings so far …. Steve Ariss & Expert Panel Discussion James Fotheringham “ALL HANDS TOGETHER” SHARED HAEMODIALYSIS CARE EVENT Programme Supported By Why bother with shared care, particularly in the renal unit? Professor Donal O’Donoghue Registrar, Royal College of Physicians 22 January 2019 Shana Alexander, LIFE magazine, 9 November 1962 FigureFigure 2: Description of PAM Levels FFigure 3: Median PAM score by age Figure 5: PAM levels by deprivation Figure 6: PAM levels by symptoms (POS-S renal) Figure 7: PAM levels by quality of life (EQ-5D-5L) Figure 10: Haemoglobin by PAM level by Modality Figure 4: PAM levels by treatment Figure 8: Median PAM score by renal unit Table 1: RAG assessment of participating units Figure 1: Knowledge, skills and confidence cube Figure 9: Overall distribution of the difference in PAM score between first and second PAM surveys Patient Involvement: a Paradigm Shift Old method New Method What is performance? Outcomes! CLINICAL FUNCTIONAL PATIENT VALUE = QUALITY OUTCOME EXPERIENCE (COMS) (PROMS) (PREMS) COST • Clinical quality includes outcomes and safety • Functional outcome as measured by PROMs • Patient experience includes access and satisfaction measures “ALL HANDS TOGETHER” SHARED HAEMODIALYSIS CARE EVENT Programme Supported By The Joy of supported independence Tara Bashford – Liverpool Royal My dialysis journey Flexibility Support Confidence Friendship Why Shared Care? 10 months of Shared care “ALL HANDS TOGETHER” SHARED HAEMODIALYSIS CARE EVENT Programme Supported By SHAREHD Evaluation Findings Please note some slides have been removed as they are subject to further analysis in readiness for formal publication Dr Steve Ariss & Dr James Fotheringham Evaluation Work-packages • Realist/Developmental Evaluation (Developing, refining and testing theories) • Controlled Trial: Stepped wedge (Numbers of tasks & HHD) • Principal Component Analysis (How patient characteristics relate to tasks) • Linkage to HES data (Hospital service use) • Health Economics (Cost per QALY, compare activity costs, cost for additional tasks/HHD) Programme Theory Share HD Trust intervention Main/ Learning events: QI Shared Sustained Acute unit methods, Networking, competency, Care opportunity Peer support, Sharing and motivation Satellite Staff ideas and materials, of staff Discussing problems and Increased Satellite Consistent & solutions, Presenting involvement equal Patients experiences, Check- in Care opportunities for patients points & ways to Context: measure progress Wider range Ongoing -Relationships of patients monitoring between units Introduce Website: Sharing ideas and materials involved and -Leadership Changes adjustment -Budget (training, Action period calls: equipment, Shared care is Discussing problems and More materials) resilience business as -Stability of staff solutions usual/ has high profile -Patients’ needs/ Site-specific Changes have an effect on: circumstances -Service history working practices/ environment/ -Built environment opportunities/ motivation/ capability/ Variable & -Working processes organisational readiness etc. Some low volume Shared Care shared No External Intervention care Quantitative Data: The Stepped Wedge Testing if the SHARE-HD Intervention works Tasks HHD Interest Your Health Survey Rationale and design for SHAREHD: a quality improvement collaborative to scale up Shared Haemodialysis Care for patients on centre based haemodialysis. BMC Nephrology: 10.1186/s12882-017- 0748-6 Quantitative Data: Our Endpoint - 5 Tasks or more First four task are easy? Happen away from the dialysis space? Number Patients of Tasks (n) 0 64 1 83 Patient Preparation 2 104 Machine Preparation & Dialysis Initiation 3 85 4 57 During and after dialysis 5-9 130 10-15 58 Overall 581 What did we learn about patients and tasks Some things you can’t change Overall Less than 5 Tasks More than Five (n=581) (n=188) Tasks (393) Mean Age (Years) 62.3 64.9 57.4 Male Sex (%) 61.7 62.4 60.3 Ethnicity (%) White 81.3 81.3 81.3 Non-White 18.7 18.7 18.7 Dialysis Access (%) AVF/AVG 73.2 67.2 84.1 Tunnelled Line 18.6 23.4 10.0 Self Needling (%) Doing 12.4 2.2 29.7 Maybe + 21.8 21.3 22.8 Health Literacy: Trouble with forms (%) Quite Confident + 58.1 52.2 68.8 Interest In HHD (%) Yes 14.9 12.1 20.9 No 70.7 75.3 61.0 Unsure 14.4 12.6 18.1 EQ5D-5L QoL 0.698 0.669 0.751 Moderate Difficulty In Mobility (%) 35.3 43.2 27.8 Mean Tasks (N) 4.0 2.0 8.2 Baseline Patient Activation and Tasks (cross-sectional) THE RELATIONSHIP BETWEEN PATIENT ACTIVATION LEVEL AND SELF-PERFORMED TREATMENT RELATED TASKS AMONG PATIENTS RECEIVING IN-CENTRE HAEMODIALYSIS: THE SHAREHD COHORT STUDY. UKKW 2018 Qualitative Analysis Patient Activation Developmental model of activation involving 4 stages: 1. believing the active patient role is important, 2. having the confidence and knowledge necessary to take action, 3. actually taking action to maintain and improve one's health, and 4. staying the course even under stress (Hibbard et al, 2004) Increase PAM through motivational interviewing and health coaching. Patients with lowest levels of activation make the most gains. Patient Stages of Change ‘levels of motivational readiness’ 1. Pre-contemplation, 2. Contemplation, 3. Preparation, 4. Action, and 5. Maintenance/Relapse (Prochaska et al, 2005) N.B. Some patients are doing SHD but don’t consider this to be shared care(mostly basic tasks: handwashing, weight, BP, Temperature, compressing etc.) . When tasks become business as usual ‘motivational readiness’ becomes a redundant theory and social practice models more relevant, motivation becomes moral compliance with social norms. Patient Involvement Models 1) All or 2) Route to 3) Segre- 4) 5) Integrated 6) Business 7) Rehab Nothing HHD gated Transient ‘doing as usual approach shared care’ HHD Shared care in Self care separate bays
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