Скачать презентацию Healthcare Can Change From Within A Sustainable Model Скачать презентацию Healthcare Can Change From Within A Sustainable Model

9560db16afd264a074686fbae443099f.ppt

  • Количество слайдов: 22

Healthcare Can Change From Within: A Sustainable Model for Intimate Partner Violence Intervention and Healthcare Can Change From Within: A Sustainable Model for Intimate Partner Violence Intervention and Prevention Medical College of Wisconsin Bruce Ambuel, Ph. D. , L. Kevin Hamberger, Ph. D. , Amy Kistner, MS & Clare Guse, MS c Bruce Ambuel & L. Kevin Hamberger

Partners Funding Partners Healthier Wisconsin Partnership Program CDC Wisconsin Office of Justice Assistance—VAWA Community Partners Funding Partners Healthier Wisconsin Partnership Program CDC Wisconsin Office of Justice Assistance—VAWA Community Partners The Women’s Center, Waukesha, WI Sojourner Truth House, Milwaukee, WI Clinic Partners Racine Family Medicine Center, Wheaton Franciscan Healthcare All Saints Waukesha Family Medicine Center, Waukesha Memorial Hospital Foundation, Pro. Health Care Downtown Health Center, Dept of Pediatrics, Medical College of Wisconsin Emergency Department, Froedtert Memorial Lutheran Hospital c Bruce Ambuel & L. Kevin Hamberger

Intimate Partner Violence Preventable morbidity & mortality Women victims at increased risk physical injury Intimate Partner Violence Preventable morbidity & mortality Women victims at increased risk physical injury disability depression, suicide attempts, PTSD hospitalization less preventive care more episodic care death c Bruce Ambuel & L. Kevin Hamberger

Primary care clinics and EDs Women IPV victims present to primary care clinics & Primary care clinics and EDs Women IPV victims present to primary care clinics & EDs Women patients want physicians to ask Physicians can identify IPV victims Patients benefit from IPV screening and referral Many organizations recommend screening & intervention: AMA, ACEP, ACOG, AAFP, AAP c Bruce Ambuel & L. Kevin Hamberger

Training is not enough Training MDs & RNs increases ↑ Knowledge ↑ Attitudes ↑ Training is not enough Training MDs & RNs increases ↑ Knowledge ↑ Attitudes ↑ Clinical Skills But, clinical practice does not change ~ Screening ~ Intervention ~ Identification ~ Prevention c Bruce Ambuel & L. Kevin Hamberger

Health Care Can Change from Within Model CHANGE THE CULTURE in the Primary Care Health Care Can Change from Within Model CHANGE THE CULTURE in the Primary Care Clinic & Emergency Department c Bruce Ambuel & L. Kevin Hamberger

Create Local Champions Select & train 2 Health Care Advocates at each clinical site Create Local Champions Select & train 2 Health Care Advocates at each clinical site 20 -hour training IPV basics Impact on health IPV identification, intervention, prevention Leadership; catalyst for change c Bruce Ambuel & L. Kevin Hamberger

Saturation Training Train EACH employee with patient contact: physicians Nurses Social work MAs PAs Saturation Training Train EACH employee with patient contact: physicians Nurses Social work MAs PAs Med Techs Reception business office c Bruce Ambuel & L. Kevin Hamberger

Change The System Evaluate and change Policies & Procedures Define IPV as a health Change The System Evaluate and change Policies & Procedures Define IPV as a health care problem Define staff roles & responsibilities Describe workflow; communication Primary prevention—promote healthy relationships Posters, brochures, discussion Secondary prevention: Screen, Identify, Intervene Posters, brochures Valid & reliable screening methods Offer continuing education programs CQI: Define indicators of quality, measure, improve c Bruce Ambuel & L. Kevin Hamberger

Connect to the Community Local health care IPV experts Women’s advocacy organizations— Emergency shelter Connect to the Community Local health care IPV experts Women’s advocacy organizations— Emergency shelter Transitional living Legal advocacy Employment programs Support groups Consultation c Bruce Ambuel & L. Kevin Hamberger

Multi-level Evaluation Healthcare workers: Improved knowledge, attitudes, clinical behavior, self-efficacy Clinic & ED Culture: Multi-level Evaluation Healthcare workers: Improved knowledge, attitudes, clinical behavior, self-efficacy Clinic & ED Culture: Environmental audit Physical environment Policies and procedures Post-visit patient survey Patient recall of discussions re. IPV and healthy relationship Importance of these topics to patient Chart audit Screening Documentation Intervention c Bruce Ambuel & L. Kevin Hamberger

IPV Posters & brochures c Bruce Ambuel & L. Kevin Hamberger IPV Posters & brochures c Bruce Ambuel & L. Kevin Hamberger

IPV Referral Information c Bruce Ambuel & L. Kevin Hamberger IPV Referral Information c Bruce Ambuel & L. Kevin Hamberger

Other Environmental Changes OBJECTIVE BEFORE AFTER Spanish Brochures & Posters 0 4 Community Collaboration Other Environmental Changes OBJECTIVE BEFORE AFTER Spanish Brochures & Posters 0 4 Community Collaboration 1 3 Written IPV Policy 1 3 c Bruce Ambuel & L. Kevin Hamberger

New P&Ps at 2 FM Clinics Define staff responsible for IPV prevention Mandate routine New P&Ps at 2 FM Clinics Define staff responsible for IPV prevention Mandate routine screening of specific patient groups Define acceptable documentation Screening History taking Intervention Describe appropriate referral for victims c Bruce Ambuel & L. Kevin Hamberger

Barriers @ Pediatrics Clinic Developed IPV prevention policy Physicians did not agree on universal Barriers @ Pediatrics Clinic Developed IPV prevention policy Physicians did not agree on universal screening Policy not implemented Clinic did offer dating violence groups for teen girls c Bruce Ambuel & L. Kevin Hamberger

Barriers @ Emergency Department 180 nurses 3 shifts “A week” & “B week” Multiple Barriers @ Emergency Department 180 nurses 3 shifts “A week” & “B week” Multiple trainings offered Training is time intensive and costly c Bruce Ambuel & L. Kevin Hamberger

Sustaining Health Advocate Role At on FM clinic, one original advocate resigned; the second Sustaining Health Advocate Role At on FM clinic, one original advocate resigned; the second reduced hours following pregnancy FM clinic has appointed 2 new health advocates c Bruce Ambuel & L. Kevin Hamberger

Integration in EHR c Bruce Ambuel & L. Kevin Hamberger Integration in EHR c Bruce Ambuel & L. Kevin Hamberger

Radiating Change @ ED 1. IPV prevention policy adopted by ED 2. ED Social Radiating Change @ ED 1. IPV prevention policy adopted by ED 2. ED Social Worker proposed social work department adopt IPV prevention policy system-wide, but was rebuffed 3. Later, ED Social Worker invited to help hospital develop new system-wide IPV prevention policy c Bruce Ambuel & L. Kevin Hamberger

Questions & Discussion Our Academic Partners: Marlene Melzer-Lange, MD Mary Beth Phelan, MD Alicia Questions & Discussion Our Academic Partners: Marlene Melzer-Lange, MD Mary Beth Phelan, MD Alicia Stratman, MSW Marie Wolff, Ph. D Collaborating Departments: Family & Community Medicine Pediatrics Emergency Medicine Injury Research Center c Bruce Ambuel & L. Kevin Hamberger

The end Dr. Bruce Ambuel bruce. ambuel@phci. org Amy Kistner, MS amy. kistner@phci. org The end Dr. Bruce Ambuel bruce. [email protected] org Amy Kistner, MS amy. [email protected] org Dr. Kevin Hamberger [email protected] edu c Bruce Ambuel & L. Kevin Hamberger