0
View Post
Michigan Cardiac Rehab Network Spring Meeting Recap

Michigan Cardiac Rehab Network Spring Meeting Recap

Earlier this spring, the Michigan Cardiac Rehab Network (MiCR) hosted its virtual spring meeting with 74 attendees joining from cardiac rehab programs and hospitals across the state. MiCR was glad to host two guest presenters for the meeting, including Alexis Beatty, MD, MAS, Co-Director of the UCSF Cardiac Rehab and Wellness Center, and Brett Reynolds, MPH, ACSM, CEP, Supervisor of Cardiology for Corewell Health East. The primary goal of MiCR meetings is to support shared learning, practice sharing, and networking among professionals working with cardiac rehabilitation programs across Michigan.

The meeting began with MiCR team updates provided by Co-Director Mike Thompson, PhD – most notably the introduction of Dr. Jessie Golbus, MD, MS, as the new co-director of MiCR (see Figure 1). Dr. Golbus is an Assistant Professor of Internal Medicine in the Division of Cardiovascular Medicine at Michigan Medicine.

Figure 1.

Graphic depicting MiCR updates including leadership change and grant received

Dr. Thompson also announced a new grant from the University of Michigan's Frankel Cardiovascular Center awarded to Healthy Behavior Optimization for Michigan (HBOM) and MiCR for their new Heart-to-Heart initiative. Heart-to-Heart is a new initiative aiming to amplify the real, diverse voices of Michigan patients who have experienced cardiac rehabilitation. Patient stories told through compelling audio, visual, and written storytelling will foster broader conversations about the life-changing impact of cardiac rehabilitation and inspire those considering attendance. HBOM and MiCR previously partnered on the development of NewBeat materials. Following the virtual meeting, BMC2 published a blog introducing the new Heart-to-Heart initiative.

Dr. Thompson then provided insights into improvements in cardiac rehabilitation utilization in Michigan since the inception of MiCR. The network is committed to boosting enrollment to 40% across all eligible conditions except heart failure, for which it has a lower target of 10% enrollment. Dr. Thompson noted encouraging trends observed since 2020, with overall enrollment rising to 35% from just under 25%. Although heart failure patient enrollment remains low at approximately 4%, efforts are under way to improve enrollment in this population in the future.

Dr. Alexis Beatty, MD, MAS, co-director of the UCSF Cardiac Rehab and Wellness Center, delivered the first guest presentation on the transformative potential of telehealth in cardiac rehabilitation. She highlighted the advantages and potential of integrating telehealth and hybrid models with traditional center-based programming to increase accessibility and participation (see Figure 2). Since adopting a hybrid model during the COVID-19 pandemic, UCSF reported substantially improved completion rates in virtual and hybrid programs compared to exclusively in-person sessions. Furthermore, patient outcomes related to exercise capacity, risk factor management, and quality of life were consistent across all formats.

Figure 2.

Graphic depicting current in-person cardiac rehab enrollment of 29% of eligible people compared to future in-person and virtual cardiac rehab enrollment goal of 70% of eligible people

Dr. Beatty also introduced an online delivery model toolkit (available at UCSF Cardiac Rehab Toolkit), crafted using human-centered design methods to aid in telehealth program development. This toolkit includes adaptable templates for exercises and safety and is already utilized by clinics in Michigan and beyond, allowing for flexibility to meet local patient needs. Dr. Beatty’s full slide presentation is available online.

In the second presentation, Brett Reynolds, MPH, ACSM, CEP, supervisor of cardiology at Corewell Health East, showcased their "Weight of Heart Failure" quality improvement initiative. Funded by a MiCR mini grant, the project sought to improve engagement and outcomes for heart failure patients. This initiative was a response to declining cardiac rehabilitation enrollments among heart failure patients. Grant funds were used to purchase 100 Corewell Health-branded scales for daily weight monitoring, accompanied by educational materials to aid in health management. The project also included follow-up calls two weeks post-discharge to verify if patients were monitoring their weight and had scheduled follow-up appointments.

Reynolds reported that of the 156 heart failure patients reached, 110 follow-up calls were completed, with 65% consistently tracking their weight and 83% scheduling follow-up appointments. This proactive approach seemed to have contributed to an increase in participation.

Despite the success, Reynolds acknowledged persistent challenges, such as referral system barriers and limited physician awareness regarding cardiac rehabilitation eligibility for heart failure. However, the initiative's efficacy in enhancing follow-up care and patient involvement highlighted the potential impact of targeted interventions in heart failure management. The full Corewell Health slide presentation is available online.

The webinar concluded with announcements of upcoming opportunities to engage with the network and collaborate to improve cardiac rehabilitation care in Michigan. Most notable among these opportunities is MiCR’s upcoming in-person fall meeting, which is set to take place on Thurs., Nov. 13 at Corewell Health Troy. Those interested in attending can register now.

0
View Post
Using Human-Centered Design Thinking to Improve Healthcare

Using Human-Centered Design Thinking to Improve Healthcare

At its foundation, healthcare quality improvement is a process of systematically improving care to better meet the needs of patients. Similarly, the concept of human-centered design thinking asks us to put people at the center of processes meant to address problems and improve outcomes. Although people have leveraged the concept of design to develop innovative solutions for centuries, “human-centered design thinking” is a relatively new approach in healthcare settings that is gaining in popularity.

One leader in this space is IDEO, a global design and innovation company; they launched a series of resources and toolkits to implement design thinking into tangible projects and emphasized the mindset behind the theory—the notion that how one thinks about design directly affects the impact of the solution. Through their design kit, IDEO suggests a three-step guide to cultivate a practical and repeatable approach to arriving at innovative solutions: inspiration, ideation, and implementation. IDEO urges professionals to connect with the population they wish to serve to ensure a project’s goals align with the needs of the intended community, and then to generate tangible ideas and solutions to address identified issues. This connection to a specific community puts the individuals they are designing for in the spotlight.

As the use of human-centered design thinking continues to grow, innovators continue to generate different visualizations of the process. Similar to IDEO’s three steps, another popular approach has been the Design Council’s double diamond model. Created to convey the process of design to designers and non-designers alike, this model (Figure 1) highlights a balance between big-picture thinking and detail-oriented refinements while translating ideas into action. This double diamond model was the guiding framework for the development of the Michigan Cardiac Rehabilitation network (MiCR) NewBeat materials – a partnership effort between MVC, BMC2, and HBOM (Figure 2). Strategically understanding the perspectives and needs of patients after undergoing a major cardiovascular event was pivotal to the success of the project.

Figure 1.

Figure 2.

Leading the NewBeat project was Larrea Young, who works as a multimedia and human-centered design project manager at MCT2D and HBOM. In reflecting back on the success of the cardiac rehab NewBeat project, she said, “One of the first questions we ask people when we talk about design is, what does it mean to design? People’s answers often focus on aesthetics; design makes things pretty or more accessible. While aesthetics is an important aspect of design, it is only one small part. We define design as envisioning and building a preferred future. This is the essence of the human-centered design process, an approach that examines challenges through lenses of aesthetics, culture, society, technology, and economics to define what something should be. In this process, we gain a deep understanding of people’s lived experiences, challenge conventional norms, and pilot innovative solutions. In the realm of healthcare, this process helps us build solutions that contribute holistically to the health and well-being of our providers and patients.”

Further evidence of the value of design thinking can be found in the quality improvement projects that placed critical importance on understanding the population they wished to serve. Many of these also have a heightened focus on patient-centered in the context of social drivers of health. Taking this into account, a number of healthcare initiatives are now incorporating a design thinking framework to ensure the circumstances, needs, and desires of patient populations are understood; and the results are promising.

In another recent study published in JAMA Network, Dr. Alex Peahl and colleagues wanted to determine how prenatal care could be redesigned to improve access and quality for Black pregnant people with low income. Utilizing human-centered design thinking, they interviewed 19 patients and 19 healthcare workers at prenatal care clinics in Detroit, Michigan, focusing on the first two phases of IDEO’s process: inspiration and ideation. In conducting this series of personalized interviews, Dr. Peahl and colleagues not only collected data to prove that current care failed to meet patient needs, but they also gathered ideas from the patient population of ways to redesign prenatal care for pregnant people in the community. By placing the individuals affected by the redesign at the center of a project, the team ensured the solutions they developed would lead to improved outcomes and experiences (Figure 3).

Figure 3.

Recently, Dr. Alex Peahl, MD, MSc, Assistant Professor in Obstetrics and Gynecology at the University of Michigan, led the MVC Coordinating Center through a workshop on design thinking. Dr. Peahl outlined its principles, provided personal and professional examples from her work, and facilitated a space for MVC teammates to collaborate and practice design thinking with one another.

As the MVC Coordinating Center looks ahead, design thinking will be incorporated more frequently to improve the quality and impact of MVC offerings. If your team has successfully adopted human-centered design thinking or other patient-centered frameworks that can be shared with peers across the state, please contact MVC.

0
View Post
HBOM Resources Help CQIs, Providers Reduce Smoking

HBOM Resources Help CQIs, Providers Reduce Smoking

Today, the leading preventable cause of death, disease, and disability in the United States is tobacco use. National studies show that 70% of smokers want to quit, but in Michigan only about 15% receive treatment. This critical gap is the current focus of one of the newest population health Collaborative Quality Initiatives (CQIs) in the Blue Cross Blue Shield of Michigan (BCBSM) Value Partnerships portfolio. The Healthy Behavior Optimization for Michigan (HBOM) CQI aims to ensure that all smokers who are interested in quitting receive the support and resources they need to be successful.

HBOM’s mission is to make “the healthy choice the easy choice,” which is accomplished in this case by providing tobacco cessation support throughout the state of Michigan through value-based reimbursement (VBR). In 2022, nine CQIs committed to working with HBOM to provide targeted, just-in-time tobacco cessation support to seize on their “teachable moment.” This approach draws on evidence-based behavior change strategies that leverage unique shifts in patient motivation around major health events, when they may find new motivation to commit to positive health behaviors like smoking cessation.

HBOM works with hospitals, clinics, and care teams across the state of Michigan through its partner CQIs to promote healthy behaviors among patients. They also provide partner CQIs and their respective members with the infrastructure and metrics to measure the impact of these changes. Although HBOM is primarily concerned with three health behaviors (smoking cessation, healthy eating, and physical activity), smoking cessation is their current focal point.

HBOM’s smoking cessation tools and resources are available in both paper and electronic formats to ensure equitable access, and are being shared widely at the patient, physician, and organization levels. Clinicians can share these materials with patients to increase access, awareness, and utilization of smoking cessation opportunities. One example includes a “Tap for Support” near-field communication (NFC) badge (see Figure 1) that clinicians and healthcare staff can wear for patients to scan with their phone, providing them with instantaneous online smoking cessation tools and resources.

Figure 1.

Another example is the Tobacco Cessation Box that HBOM tailored to meet the needs of those wishing to quit smoking. In addition to the badges, it includes HBOM’s Quit Smoking Resource Guide Tear Off Pad (see Figure 2), which providers can use as a discussion tool for Nicotine Replacement Therapy options. The box also includes a reference guide containing a high-level overview of tobacco cessation prescription medication options and HBOM’s VBR toolkit.

Figure 2.

When CQIs and their members wish to learn more or provide support beyond the resources mentioned above, they can connect with HBOM to discuss state-wide smoking cessation metrics, best practices, challenges, and collaboration opportunities. The HBOM collaborative meets regularly with participants and partnering CQIs to address challenges and improve population health. The team is also closely connected with the Michigan Tobacco Quitline and resource recommendations delivered by text message for anyone who wishes to quit smoking.

The MVC and HBOM teams have discussed plans to include HBOM resources in future relevant MVC report communications, such as those chronic conditions that are related to tobacco use. In the meantime, hospitals and physicians can request their own tobacco cessation boxes (see Figure 3).

Figure 3.

For more information on HBOM, visit their website.

As the Michigan Value Collaborative (MVC) continues to build its offerings for members, the Coordinating Center is cognizant that many other CQIs also partner with hospitals and providers throughout Michigan. Throughout 2022, MVC will post a series of blogs about some of its peer CQIs to showcase their activities and highlight collaborations with MVC. Please reach out to the MVC Coordinating Center with any suggestions or questions.