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Enhance education by teaching at home
The best setting for patient education is not within the walls of a medical facility but at home, contends Stacey Bateman, RN, BSN, director of program development for Flagship Healthcare in Miami Lakes, FL.
"We don’t treat our diseased population from behind ivory doors. We send our home care nurses out into the community," she explains.
At Flagship, educational programs to impact a particular patient group are designed to be taught within the home, not the classroom. This form of teaching gives the educator the opportunity to see if patients are applying their knowledge.
For example, the educator can see where patients keep their medications and how they take them. Also, multiple educational sessions tailored to a patient’s needs have more of an impact on lifestyles, says Bateman.
The educational programs target major health problems in South Florida to attract managed care contracts. Total Heart Wellness is the health care company’s latest program. "We saw that a great portion of the cardiac population were poorly educated on the disease, and as a result, they were going back to the hospital and physician’s office and missing work. Their whole family dynamics were interrupted because no one ever really taught them how to manage cardiac disease. They just treated them for whatever problem they were having at the time," she says.
Each HMO that contracts with Flagship to manage its cardiac population determines which patients participate in the program and which do not. Once the patient enters the program, a Flagship cardiac nurse completes an evaluation in conjunction with a conference with the patient’s physician. This determines the number of educational visits each patient will receive.
The number of visits is usually based on the stage of the disease, with stage one being minor symptoms and stage four being symptoms so severe that the patient cannot get out of a chair without shortness of breath.
The staging is based on the New York Classification Staging Process, a nationally recognized guideline for staging cardiac disease. When targeting managed care companies, it is important to use national guidelines to obtain contracts, explains Bateman. (For information on accreditation standards affecting education programs for HMOs, see article on p. 13.)
During the first visit, the cardiac nurse sets up an educational goal with the patient that is adjusted at every visit. For example, a patient may need to learn how to follow a low-sodium diet. The goals are taken from a critical pathway, and there is a pathway for every cardiac condition, such as congestive heart failure. "The cardiac nurse uses the pathway to set a goal and key plan of care," says Bateman.
Also to aid education, the cardiac nurse follows an educational calendar listing the topics that need to be covered in a certain number of visits, according to the patient’s learning needs. For example, visit two might cover diet, exercise, and cardiac dietetics. Material from the past visit is reviewed each time, and one new topic is added to build upon the education.
While the cardiac nurse does the basic teaching, other disciplines are called in as needed. These disciplines might include social workers, dietitians, cardiac rehabilitation therapists, and respiratory therapists.
During the education process, patients can call their case manager with questions or call a 24-hour hotline. These services help patients determine when they should visit the emergency department or see their physician, and when the symptom can be handled at home.
"The telephonic network is key, because the object of our program is not only to educate people about their disease, but also to keep them from making unnecessary visits to the ER and physician," she says. When patients have a medical problem, such as retaining fluid, the patient is treated, and then the cardiac nurse helps them determine what led to the problem in an effort to change behaviors that cause such episodes.
Although Total Heart Wellness has only been in place since September 1998, Flagship is tracking outcomes to prove to HMOs that it is effective. Having the numbers to show that the program kept a stage two cardiac patient out of the emergency department and taught them how to properly take medications in 20.1 visits vs. the competition’s 45 visits is very important, says Bateman. "You want to be able to manage that patient’s dollar more effectively," she explains.
For more information on the Total Heart Wellness program, contact:
• Stacey Bateman, RN, BSN, Director of Program Development, Flagship Healthcare, 8000 Governors Square Blvd., Suite 300, Miami Lakes, FL 33016. Telephone: (305) 822-3200. Fax: (305) 820-1063.