Section 6.4 Optimize
Optimization Strategies for Client Education,
Engagement, and Self-Management
When local public health (LPH) care includes visits to clients’ homes there is an opportunity to
enhance patient education, engagement, and access to information about self-care and how their
health status compares to norms for improvement. This tool demonstrates how electronic health
records (EHR), health information exchange (HIE), and other health information technology (HIT)
can support these goals.
Time needed: 4 hours
Suggested other tools: NA
Introduction
A number of studies1 have demonstrated that when chronically ill patients have access to their vital
data—by whatever means—they are in a much better position to monitor their environment,
behavior, diet, and compliance with medication.
How to Use
1. Distinguish usefulness between public reporting and generic reference material, as well as
personalized report cards, tailored education, and self-management tools.
2. Acquire and utilize strategies to optimize adoption of EHR, HIE, and HIT to support all
forms of patient engagement and self-management.
3. Evaluate the impact of HIT on patient self-management and plan for continuous
improvement.
Comparison of Patient Support Materials and Usability within EHR, HIE, and other
HIT
Form of Patient Support
Advantages and disadvantages
Generic reference material – home health
agencies and many other providers subscribe
to services that provide health education
content suitable for:
- Brochures, pamphlets, or other
handout material
- Adopting as content for the
organization’s Web site
Advantages: Generic reference material acquired from
a company that specializes in its development and
acquisition is an important first step in making health
education available to your patients. The material is
generally written specifically for the target audience, in
“lay language,” with suitable illustrations and generic
advice.
Disadvantages: Generic reference material may not
have been written with public health in mind.
Generic reference material does not directly enable
comparison with the educational content and specific
patient’s condition.
1
Richardson, J. et al. 2012 Monitoring Physical Functioning as the Sixth Vital Sign, BMC Family Practice,
www.medscape.com/viewarticle/767764
Section 6 Optimize—Optimization Strategies for Client Education, Engagement, and Self-Management- 1
Form of Patient Support
Customizable educational material is available
as a utility in some EHR systems.
- Some systems enable the public
health nurse to select specific
educational material and have it print
with the patient’s name, photo,
language spoken, and even large
font.
- Some systems enable the public
health nurse to combine educational
material on multiple conditions for a
single client or family so one unique
packet of information can be provided
to the patient.
- Some systems pre-populate
educational material selected by the
public health nurse with patientspecific information, further
customizing the material to the
specific patient.
Client-specific report cards and diaries
(sometimes referred to as “participatory
medicine”) are intended to motivate the client
to partner with the public health nurse in
improving his or her health, take an active role
in self-management, participate in decisionmaking, and assume responsibility for making
agreed-upon changes in behavior.
Advantages and disadvantages
Generic reference material—when distributed by a
public health nurse—may require more explanation
than customizable material.
Advantages: Educational materials customizable
through the EHR provide a closer bond between the
material and the client, as well as specific guidance. To
the extent that the client’s own information can be
incorporated, the materials are more beneficial. The
public health nurse can spend time focusing on specific
messages rather than filling in client-specific
information.
Advantages: Client-specific diaries provide very
specific, clear messages about the client’s health status
and can be generated by some EHRs, especially when
linked to an HIE organization (HIO) where multiple
providers can contribute data (e.g., medications from
pharmacy, lab results from commercial or public health
lab, vital signs from public health nurse).
Disadvantages: Client diaries may not include specific
instructions for improvement. They must be explained
to the client and/or family in a supportive, partnering
manner. These should not be introduced as “grades” in
school. The public health nurse using the diaries must
be skilled in using them.
See also: http://www.jopm.org/evidence/casestudies/2011/04/04/creating-a-participatory-officepractice-for-diabetes-care/attachment/shahady-table-1/
Motivational interviewing is a non-judgmental
approach to increasing a patient’s awareness of the
potential problems caused, consequences
experienced, and risks faced as a result of a
health-related behavior – especially those that
contribute to chronic disease (e.g., diet, exercise)
and behavioral disorders (e.g., drinking, isolation).
Steps include involving client in talking about
issues and establishing rapport, focusing on
specific things the client wants to change, and
allowing client to plan the specific steps to
implement the desired change so that the client
feels empowered to actuate the change.
See also:
Section 6 Optimize—Optimization Strategies for Client Education, Engagement, and Self-Management - 2
Form of Patient Support
Advantages and disadvantages
http://www.motivationalinterview.org/
Shared decision making tools involve a
collaborative process that allows clients and
providers to make health care decisions
together, taking into account the best scientific
evidence available as well as the patient’s
values and preferences. This honors both the
provider’s expert knowledge and the client’s
right to be fully informed of all care options
and potential harms and benefits. It is most
applicable to major clinical decisions, such as
whether to have a particular surgery, but is
also effective for lifestyle changes. See also:
http://www.informedmedicaldecisions.org/what
-is-shared-decision-making/
Patient self-management/patient engagement
tools
Patient self-management/patient engagement
tools often refer to technology used by a client
or informal caregiver to manage health
problems outside formal institutions. These
tools can be accessed independently by a
client, and can be provided by a public health
nurse who also uses motivational interviewing
and shared decision making to help clients
address barriers to achieving their health
goals (e.g., lose weight, stop smoking). Some
EHRs offer templates to build a client’s selfmanagement plan of care. Patient education,
diaries, and report cards are also helpful
adjuncts. Increasingly, patient selfmanagement is being linked to the broader
scope of care coordination in the chronic care
model.
See also:
http://www.chcf.org/~/media/MEDIA%20LIBR
ARY%20Files/PDF/P/PDF%20PatientSelfMan
agementToolsOverview.pdf
http://informedmedicaldecisions.org/wpcontent/uploads/2012/04/Patient_Engagement
_What_Works_.3.pdf
http://www.google.com/url?sa=t&rct=j&q=&esr
c=s&frm=1&source=web&cd=4&ved=0CEkQF
jAD&url=http%3A%2F%2Fwww.lphi.org%2FL
PHIadmin%2Fuploads%2FPt-Engage-SelfMgt-Knox24859.ppt&ei=EXlxUsDNL8qQyAHWk4CYAg
&usg=AFQjCNFsUt3qW7U12kKNVefKwvNDig4wQ&sig2=ahJt
3bYrA23Y1n5mUrWxnA
http://healthinsight.org/Internal/events/05-2312/megalan_talk.pdf
Section 6 Optimize—Optimization Strategies for Client Education, Engagement, and Self-Management - 3
Adoption and Evaluation of Patient Self-Management Results
1. Consider using a tool to plan and track how you aid client education and self-management.
2. At a minimum, list self-management techniques that your LPH department has or can readily
acquire/develop. Provide training and encourage staff members to use these techniques.
3. Ideally, document for each patient what self-management technique was applied when.
(Techniques may need to be reinforced with discussions, and some techniques may need to
be repeated.)
4. Although it is unlikely that only one technique will be effective when there is a specific
opportunity for improvement, it can be helpful to focus on a specific goal and document
results.
5. Two examples—for different patients—are provided below. Add your own focus areas and
techniques.
SelfManagement
Technique
Date
Initiated
Baseline
Data
Results
after __
Time
Specific
Instructions
to Patient
Results
after __
Time
Report Card
May 2
Uncontrolled
diabetes; goal:
Hg A1c = 8 in 3
months
Aug 5:
Hg A1c = 8.2
Nov 3:
Hg A1c = 7.4
May 8
PHQ = 9
(Has
fluctuated
between 7
and 9)
Jun 12
PHQ = 8
-Use structured
diabetic diary to
record diet and
blood sugars
-Track Hg A1c
values through
PHR
-Have
client
develop a
self-care
plan
Diabetic diary
PHR to receive
lab results
Depression
Self-Care
Action Plan
Copyright © 2014 Stratis Health.
Aug 14
PHQ = 7
Updated 01-01-14
Section 6 Optimize—Optimization Strategies for Client Education, Engagement, and Self-Management - 4