3. TEAMcare Program: Patients w/Complex Disease & Depression - Dr. Paul Ciechanowski (Univ. of WA)

TEACH THE PATIENT HOW TO PROBLEM SOLVE
In order to address barriers to change in highly complex chronic disease cases, Group Health Cooperative's TEAMCare program uses specially-trained nurse care managers to coach patients on motivation, skill-building and overall activation. According to Dr. Paul Ciechanowski, one of TEAMcare's architects, a key is to use Motivational Interviewing (MI) to uncover and dialogue on what the patient says are the costs of changing current behavior as well as the benefits of sticking with it, however unhealthy the status quo might be. We're not going to make any progress until we have had that discussion, described Ciechanowski, and it helps us understand how to work with a specific person differently.

Another tactic is to work on increasing problem-solving skills. We have a structured way of working with patients to get them to brainstorm, think of solutions, explained Ciechanowksi, and then we'll go over the pros and cons afterwards. Added Ciechanowksi, that makes all the difference...because depressed people rule out everything before they even start to talk about it.

TEAMCare's patients represent a growing segment of more than 75 million U.S. adults with two or more chronic diseases and accompanying mental health issues. We are in the era of the multi-condition patient, warned Ciechanowski, and we have to adjust and just accept the fact that when we are treating people, we have to be treating a number of conditions at once.

TEAMCare's pilot programs have been successful in reducing A1C, blood pressure, cholesterol and depression. But behavioral empowerment is just one component of TEAMCare's patient-centric approach. Nurse care managers are part of a collaborative team that includes a primary care physician and psychiatrist and medical doctor case reviewers. In addition to weekly reviews, the team uses a registry to track progress of the entire patient population over time. We had significantly more medication adjustments in the group, again because there was a team approach, there was treat-to-target, a review of symptoms and parameters on ongoing basis, and people didn't fall through the cracks, explained Ciechanowski.

Ciechanowkski's talk was given at Consumer-Centric Health: MODELS FOR CHANGE '11, a conference that featured more than 20 presentations on all facets of health behavior change. The presenters represented diverse fields of medicine, employer health, mobile technology, health insurance, gaming, public health, research, and anthropology. The 1½ day conference, held at Seattle University in Seattle, Washington, began with an opening keynote on Oct 12, with the main sessions on Oct 13, divided into three sections (1) WHAT'S WORKING IN BEHAVIOR CHANGE; (2) HOW TO SCALE BEHAVIOR CHANGE; and (3) WHAT ELSE IS NEEDED TO MAKE BEHAVIOR CHANGE MORE EFFECTIVE AND SUSTAINABLE.

Models for Change '11 was convened by Health Innoventions with support from Bastyr University's Center for Health Policy & Leadership and Seattle University's Organization Systems Renewal Program.

Health Innoventions ( is a non profit that serves the public good by promoting the translation and dissemination of actionable consumer-centric information to support health-enhancing programs, technology and policy.