EPIC Podcast: Rachel Lohbrunner

Join Yessi Cubillo, a Quality Insights ESRD Network 3 Patient Engagement Specialist, and Rachel Lohbrunner, a Social Worker with DaVita in New Jersey, as they discuss Network 3's Patient to Patient Mentoring Program.

Learn more about Quality Insights End-Stage Renal Disease (ESRD) Network 3.
Learn more about the Patient to Patient Mentoring Program.

This material was prepared by Quality Insights Renal Network 3, an End Stage Renal Disease (ESRD) Network under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services (HHS). Views expressed in this material do not necessarily reflect the official views or policy of CMS or HHS, and any reference to a specific product or entity herein does not constitute endorsement of that product or entity by CMS or HHS. Publication No. ESRD3-101023-GK

Transcript

hello everyone welcome to the fourth

episode of the empowering partners for

improved care epic podcast in each

episode you'll hear informative

interviews about patient family and

staff engagement initiatives including

barriers anden practices that may impact

your own interventions I yesi kuo uh

your patient engagement specialist for

ESRD Network 3 will be your host and

today I have the honor of welcoming Our

Guest Rachel runer got that right right

Perfect all right hi she is a Reno

social worker covering multiple DEA

dialysis facilities in New Jersey and

together we're going to talk about her

team's implementation of the network 3

and dialysis facilities patient to me uh

to Patient patient-to-patient mentoring

Pro program um and so hi Rachel thank

you for joining me today and welcome to

today's podcast thank you for having me

oh it's an honor Rachel could you start

by sharing a little a little bit with

the audience in regards to your

experience as a renal social worker and

um what you've done in the past few

years um that way we get to know you a

little better of course so I started out

fresh out a grad school in Pittsburgh

and I was Arenal social worker in

Pittsburgh then North Philadelphia and

now in New Jersey and then when I was in

North Philadelphia I was also on the

board for the council nephology social

workers and the Eastern pH after and

then I took a little bit of a break I

actually lived in Germany for the last

couple years and now I am back here

doing renal social work in New Jersey

wow that is a wealth of experience and

you travel the world too like and now we

have you here uh so should we do this

presentation in German uh I don't know

any words in German I do know Spanish so

maybe we could go back and forth German

and Spanish and see where it goes sounds

good my German is not great though okay

let's stick to English then and I'll

speak I'll speak some Spanglish here and

there perfect I can work with that all

right so um thank you I'm I'm very

excited to have you in today's podcast

you and I were having a discussion

recently about um the work that you're

doing with the patient mentoring program

and the and the one thing that I noticed

in my conversation with you and I

highlighted as I was looking at my

records I realized that I was speaking

to the one person who is my highest

referrals you have provided me with the

highest referral number of patient

mentees to the program so you are very

active in your facilities you're

promoting the program and so I thought

what a better way to bring that

knowledge to bring that experience that

you have uh imparted into patients and

that patients have been able to benefit

from benefit from and bring that to to

the world to hear but maybe not the

whole world but maybe like the 10

listeners that we have uh being a part

of this uh podcast but uh I thought it

would be a great idea to kind of share

your initiatives and and have you talk

about that a little bit uh so today

we're going to cover three areas we're

gonna kind of focus on those three areas

but it's going to be an open discussion

uh about yours and the interdisciplinary

teams and the patients first impression

of the Patient to Patient mentoring

program uh your facilities plan of

action to promote the program as well as

lessons learn from from those

experiences all right so let's start

with let's talk about what was your

initial impression of the program when

you first came across the program where

you were introduced how did you come

across the program um and and that first

impression of yours of course so first

hi to all the listeners welcome um I

remember so again since I have been away

the last couple years uh when I came

back to Dita I remember seeing one of

your emails and getting very

enthusiastic about it I just think it's

a really good program and I wanted to

take that opportunity to advocate for

the P for our patients I should say um I

was very I'm happy to hear about it I

think that it can make a big difference

a lot of times you know we can talk to

people until we're blue in the face but

without having that firsthand experience

I think it can be difficult for us to

really relate to patients in certain

aspects and I want people to always feel

comfortable so for me it's just about

giving people extra support and making

sure being on dialysis is really

difficult

very overwhelming and I just want people

to have additional support yeah so you

mentioned you were excited about the

program when you first saw my email U

and I bet it's because these are some

these are things that are happening at

the facility patient connections is

something that's happening but to

actually have a program that you could

have as as a reference and say hey

rather than just saying to the patient

would you like to connect with the

patient that may be at our facility or

may be available to speak with you uh or

someone someone that's kind of like that

leader in your facility that patient

leader um that's how it has been working

in the past where you know you have that

or family member even and say we can

connect you to that person if you like

or in the lobby that's how those patient

engagement connections have happened

they're sitting in the lobby and they're

just talking to one another and sharing

that that that support with one another

but to actually see that there is a

program geared towards connecting the

patient to a mentor a mentor who has

taken courses to be at in the role that

their and and have gone through the

process I think that that's one of the

exciting parts of of of having such a

program right um so you were excited

about how was your team uh what was your

team's take on the program when when you

presented to them everybody was on board

we really advocate for our patients and

we want everybody to just know

everything that's out there so all of

our everybody in our team has been very

supportive and also had the same type of

enthusiasm that I've had MH so we're

we're all on board with it and we just

will we always tell patients you know we

are here for you and we will always

advocate for you but if you need

additional support we want to make sure

that they have it and so our our team

has been very involved and supportive as

well great great so I'm gonna kind of go

a little bit maybe now that you both on

board you and your team are on board to

promote the program um what was the plan

of action how did you guys decide this

is how we're going to go about it

because my email basically gave you guys

the resources and I gave you some some

pointers as to maybe create a bulletin

board and put the information up um but

what was your personal take on and your

teams take on promoting the program and

the approach that you have with the

patients of course so what I find to be

really helpful is I have a flyer in the

lobby that talks about the program but a

lot of people don't read the Flyers so

what I like to do is I go around to

patients and I let them know about what

the program is and then I always I tell

them about it I talk about the network

and everything that you all do and then

I ask people if they're computer savvy I

myself am not so sometimes it can be

nice to have someone show you the tools

so what my plan is is we're lucky that

we have an iPad that we can use in the

center for education so I um I show the

Network's website where they have the

list of the different peer mentors and

then I tell our patients all that I am

asking is because not everybody is going

to have a connection with each person so

I want you to look through the different

profiles and tell me who you feel will

be a good fit for you and then I give

them the iPad I have everything set up

and then in the meantime I go get our

the Hippa consent and then that

application give them some time to look

it over answer any questions questions

go back if they're interested then I

refer them all right so let me quick

that that way those uh those who are

watching this video and the listeners as

well can have an idea of what you're

referring to I'm going to share my my

screen um that way they can be able to

see exactly what you're talking about

and I think those are some some of the

more impactful uh interventions not just

giving the patient a flyer oft times I

did create the flyer because some

patients are visuals I need to be able

to have something tangible and something

I can refer to um but then going that

step further and now you have the iPad

and you're saying hey I know you you're

interested in home dialysis you're

interested in transplant or you're a

brand new patient to the facility or

you're struggling with X Y and Z I think

this this there's a group of patients

that you can connect with and help you

with what you're going through right now

can help you make the connections that

you're going through right now is that

is that basically what your take has

been yes yes so I have a whole Spiel

that I do okay all right tell me before

I jump all right before I jump into the

whole website tell me your what is that

whole Spiel that you and I like the fact

you started with them by telling them

about the network so you give them like

a brief intro of who the network is what

the purpose of the network is I guess

and then you kind of jump in into but I

I'll let you kind of talk about it go

ahead tell me tell me what your Spiel

is exactly so I like again I I always

let people know everything that's out

there my whole philosophy is to give as

much education as possible and then

people tell me where they're at so a lot

of times when I'm meeting with somebody

and if they're telling me they're

feeling overwhelmed or they're scared

and they're nervous and that they're

interested in transplant but they're not

really sure what to expect or they're

having a hard time adjusting to dialysis

or they're going to switch to a

different modality I just talked to them

about again the renal Network and then I

say the renal network has a program

called peer mentors where you can be

mentored with a patient who's just like

you who's been on dialysis for several

years or who's had a transplant or has

switched modalities they go through

training that they become a patient

mentor and they're a really good

resource just so you can have some

additional support alleviate some of

those symptoms of anxiety per se so I

tell them all about it and then I gauge

how people are feeling some patients

aren't receptive where other people

would like more information and for

people who aren't receptive which is

perf L fine I let them know that it's

always available for them if they ever

need it and I always remind people that

we have our flyer posted in the lobby as

well yeah so the flyer is basically like

a reminder if if right now you're not

ready you haven't made up your mind

about whether you want to connect or not

um it's that constant reminder that this

is available to you and it's something

that that they can they can reach out to

the social work or any staff at the

facility and say can you make help me

make that connection um and and that's

great that's it's great to hear that

you're not going to have you know I

don't want facilities to also think that

oh we have to give it to every patient

and every patient is is going to be

referred to the to the program that's

not the goal of the program the program

the goal is that just like you did you

identify those patients who maybe are

dealing with some

anxieties and you're not able to make

progress with those patients because of

that anxiety that they're dealing with

connecting them to a mentor easing those

anxieties then opens the doors to talk

about transplant to talk about home

dialysis to talk about different

modalities or to talk about vaccinations

or anything else that comes with those

follow-up questions having that patient

Mentor that as you said connecting them

to to the mentor might ease those those

uh anties on those concerns that they

may have so I think that's that's a

great take on on on on the way that you

sell the program to the to the uh to the

patients and like I said you are my

number one uh uh number of referrals and

if we were a car dealership I think we

will be doing really good with you

you'll be our top salesperson we're not

making any money with this but you'll be

our top

salesperson um so I I appreciate that as

you were as you were talking about that

let me um kind of show and then you can

kind of talk a about the process as I'm

as I'm showing my screen let me do this

here real quick um and that way people

can see exactly what you were talking

about so if you go to our website

qir oh hold on

let me see here we are qrn

3.org and I already have it

automatically in there you're able to

come to our main website and under

ongoing projects you just click on

ongoing projects and scroll down to

where it says pure mentoring right there

is going to take you to our very first

introduction page and right here

patients are able to select whether

they're interested in connecting with

the patient Mentor or becoming a patient

Mentor themselves

and the Flyers Rachel the ones that you

making reference to these other flyers

right here correct let me I have it open

right here on this other screen so these

are the Flyers that you have posted in

the in the lobby and that you share with

uh with those patients correct exactly

yeah do they give you any questions do

they present any questions to you when

you give them this

flyer um so the flyer I actually just

typically hang in the lobby and more of

my conversation I would I would say is I

I just kind of go over with them and

then I showed them the

website I find it for my experience I

have more of a response when I just have

that conversation as opposed to passing

out a flyer got it and then what what

you show to them is this page right here

the Patient to Patient mentoring program

connecting with the patient Mentor

exactly yeah right here and this is

where you're able to then select the

topics right here on the top you select

the topics that are of interest to the

patient um and you say look navigate

these uh this these profiles there's a

profile for each one of the patients

some of them are bilingual as well so if

you have bilingual Spanish speaking uh

patients they can also connect to those

patients so I'm going to open I already

open this one just so that we could have

a ready and this is uh one of our

mentors um and he shares about her

experience so I'm guessing tell me a

little bit do you when when you show

them the profile do you go over this

stuff with them as well so typically

what I do is one I either so again I

either have them use the iPad or they

use their phone whatever they prefer and

then I just give them time to really

think about it and for them to kind of

decide on their own because I I never

want anyone to feel pressured yeah so

that's my Approach um I let them kind of

navigate at their own pace give them

time and if they have any questions then

I address it but typically they do this

on their own and then I give them some

time and then they let me know whenever

they've made a

decision got it yeah and and it takes

time it's a it's a way of them seeing

these different faces and these are old

patients like themselves um and just

being able to look at their profile

that's probably what they they do and

look at their experiences look at their

hobbies and interest something that's

personal to them and then when they

click in here they can also watch their

introduction video that's on YouTube and

he gives them each each Mentor created a

a video specifically so that they can be

able to to connect with with the mentor

and that's where they probably spend

time when you leave that iPad with them

they're spending time watching those

videos and watching these profiles um

that that they can uh then identify a

patient to make a connection with um and

then take it from there that's great all

right I'm going to stop sharing my

screen so we can come back to us um so

with that being said like what are some

of the benefits you foresee coming out

of I know this is like the early stages

that you and your team are implementing

these connections but what are some of

the foreseeable benefits that you

foresee um uh from these connections

happening so I'm an

optimist uh what I see is I I think just

having that additional support could

hopefully alleviate symptoms of anxiety

alleviate symptoms of

depression uh hopefully improving

treatment adherence letting patients

know when talking to another patient how

important it is to come to their

treatments and then long-term benefit

hopefully reducing Hospital

ations that's kind of what I'm hoping

and I just think having a lot of our

patients who might mistreatment because

they're you know they're anxious or they

don't want to come to treatment and then

talking to a pure Mentor who can kind of

give you that little push about the

importance of it push for transplant my

hope is really just to help people just

get that support and talk about what's

going on and then having another Mentor

say I felt this way too and then this is

what's been really helpful for me and

just kind of making that connection yeah

that's yeah that's definitely important

because often times we kind of focus on

the bigger picture and thinking the

bigger picture is reaching those goals

that that we have you know the facility

goals or where there be that patient

goal could be um I want to be able to

achieve that transplant I want to be

able to make the transition to home but

if you are dealing with anxiety if

you're dealing with other things that

are impeding you from being successful

in your in Center treatment then you're

not going to be able to make those

Transitions and for example you talked

about the perfect example which I've

seen with a lot of a lot of the patient

cases that I've received is cutting

treatments and and they try to make that

connection and say to a mentor what the

importance of those treatments are if

you really want to be able to achieve

home dialysis you want to be able to uh

achieve that transplant um not cutting

your treatments it's an important

component of that and avoiding those

hospitalizations are the steps to to

then achieving the future goals that you

have and it doesn't have to be just

necessarily home or or or transplant it

could be something personal to them

something that they themselves identify

as being um of importance to them and

that's another topic that's the my

dialysis plan which I've done another

podcast for that and talking about those

goals and setting those goals but there

is all of this connects and and being

able to set a foundation for identifying

those um immediate needs of the patient

to then reach those later goals for the

patient and I think your your strategy

is one that's effective thank you yeah

yeah um so I mean I did have a

conversation with you as well about so

you're doing great with the mentees

what's going on with the mentors are you

not able to identify you did refer one

of the mentors to us uh as well and

let's talk about some of those

challenges because those are challenges

facilities are also encountering with

the mentors can you share a little bit

about that I would be happy to so I

would say I have

more I I have more patients that are

receptive to being mentees and the

mentors so typically for patients that I

feel would be excellent mentors or

patients that even express a little bit

of Interest after speaking with them

they'll say I'm not ready right now I

have a lot going on in my personal life

maybe one day but I'm not there yet I've

had other patients that have been my

patients I think are typically very

honest with me that they'll say um this

is a goal that I want to have but I'm

not ready yet so it's really just too

many things going on in their personal

life not wanting to have additional

responsibility I would say because they

have so many responsibilities right now

busy with their dialysis schedule and

everything else going on I I have a lot

more I would say more of our patients

are receptive to being the mentees just

because they they're new to dialysis

they're overwhelmed they're want to get

a transplant but they really just want

someone to talk to I think it's more

reception in that aspect if this is

making sense no definitely yeah I bring

it up a lot I talk about it a lot and I

always follow up but I think a lot of

our patients just have so many things

going on yeah yeah I I uh I had a

conversation with another staff just

actually today and she asked me a

question and her question she thought it

was like not a big deal of a not a big

deal but not a big question and her

question was does the patient have to be

a Mente before they can become a mentor

and I said to her that is a big question

that's an important question to ask I

mean if if that's the the con the the

the understanding that you're thinking

that patients need to be a m before they

can be be a mentor then that's another

kind of barrier that you're putting for

the patient to become a mentor and

that's not the case patients don't have

to be mes before they become mentors um

so I said to them I I I'll work with you

guys uh with the staff in in completing

the courses that the patients need to

complete to become mentors you talk

talked about technology being a big um

hindrance for patients and being able to

make um you know accessibility to these

resources that we have available for

them and you yourself having that iPad

and giving it to them kind of uh uh uh

helps overcome that barrier of the

technology barrier and iPads are so much

easier to kind of just open the website

and and just you're right there

navigating it uh so the same thing is

for mentors there are many mentors who

say I want to be a mentor and I think

that's what happens with one of the two

the mentors that you refer to us I want

to be a mentor but then when it comes

down to the technology part when it

comes down to the health part those are

barriers that every patient is going to

deal with and they that I trying to work

with them I can work too much with the

health component because there that's

something that they themselves are

dealing with and it'll delay the process

but the technology component I'm able to

help them uh with the courses I'm able

to get them uh register for the kidy

learning hope where they're going to

complete the courses taking the test and

on everything that comes with that I

helped them along the way and I've been

I've been successful uh in doing that

for other providers but um I wanted to

take the time today to talk about those

those exciting connections that that are

happening in your Center any feedback

that you've heard uh today I know it's

early on but have you heard any feedback

from your patients um in those

connections I have so our patients that

have already been paired with the mentor

have reported that it's been very

helpful for them they're pretty

enthusiastic and they'll talk about how

oh this Mentor has similar interest as I

do and they said that it's been great

that's the the the basic outcome sorry

the typical response I hear is that it's

been very great for them you know they

feel like they can't talk to family they

can't talk to their friends they don't

have that support So then getting this

Mentor I think it's making a very big

difference nice nice and I think the the

bigger component here too is that um

these patients are sensitive to whatever

that patient is going through and and

they are able to come down to that level

and help them through the process

through through those feelings through

those emotions that they're going

through so it's not just talking about a

specific topic but it's helping them

navigate those those emotions that

they're dealing with especially as a new

patient like you said um uh that that

it's it's new to them and it's it's a

lot of information all at once and

having that support helps out all right

Rachel anything else you like to

highlight maybe I missed something

important that you want to bring up to

to everyone's knowledge

I think you covered everything I think

the biggest thing is just talking about

the barriers and how we can address them

and then making sure patients know

what's out there and how other patients

uh find it to be as far as helpful or

you know any concerns that they have but

I think it's a really good program I'm

very passionate about it I think it can

be really helpful for our patients and I

yeah recommend it thank you so much

thank you so much for that that uh

recommendation and keep keep doing those

referrals keep connecting your the

patients when you send me those

applications I take care of making those

connections one thing I forgot to

mention actually is every time I receive

an application say from you or any other

facility for m i touch base with the

Mente first which is your patient

because I want to be able to make sure

that this is a patient that's answering

their phone that I've actually

introduced myself to them before I

introduced The MENTOR um I want to be

able to say hey um do you have the

information that you need are you aware

of what's going to happen and kind of

set the foundation now for that

connection so that I receive the

application make those phone calls reach

out to the Mente once I have established

connection with the Mente I kind of

asked them get a feel for what is it

exactly that they want to um talk about

or they would like to to receive support

on and then I then identify if they have

an identify Mentor I then reach out to

our mentor and say I have a patient

who's interested in connecting with you

or I've identified a patient that

matches with your criteria and I'm able

to connect with connect that me patient

to you are you available and then

they'll give me the yes or no and then

I'll make I I'll facilitate that then my

next step is making sure that both of

them know that this connection is going

to happen send both of them an email I

include the facility staff as well so

that you guys are are aware uh and

you've received these emails from me in

the past as well with they contact

information to the mentor they contact

information to the mentee and their

emails as well so they're if there's any

exchange of emails it happens with the

knowledge of of the staff and it happens

with the knowledge of the of the network

as well and I think I had a Facility Who

basically asked me at one point and said

do we really need to um go through the

network to make these connections and I

I said ideally you would want to be able

to go through us because it gives you

that um Foundation that I I have a

process in place and it helps you as

well with making that connection that

it's not just left up in the air but at

the same time it it's a um an

established process that the the mentor

and the mentee both feel secure in a

connection that is not just a complete

stranger that they're connecting with

that they are other professionals paying

attention to what's going on so it's not

just a random patient connecting to

another random patient and we're just

letting them be on their own and not M

now you know you know where I'm going

like anything can happen in those

connections so we want to make sure that

it's a safe environment and a safe

connection for the two of them and H

having them know that the social worker

and the network are both paying

attention to what's going on provides

for a more uh safer grounds if you want

to call it right um and and provides

that sense of security for both the

mentor and the mentee in those exchanges

of uh contacts and and exchanges of of

support um so yeah thank you thank you

uh and and like I said I look forward to

to hearing more in the future as you uh

mentioned short-term goals and the

long-term goals that you foresee

happening it will be interesting to see

some of those uh some of those outcome

so well Rachel thank you so much this is

our time for today I I know we could

speak more if we wanted to uh but this

is such value information I always

appreciate hearing directly from staff

like yourself and from patients as well

uh and learn from your unique

experiences because I think every

facility is going to have a unique

experience so I look forward maybe to

even have future provide other other

staff and and mentors themselves and

mentees be a part of this discussion and

kind of share their own experiences but

um for now we we'll we'll take the fact

that uh you are my number

one uh refer number of referrals and and

hopefully you can hold that title for

for a little longer uh before others now

see this video and hear this podcast and

and uh they themselves take the

initiative to start promoting the

program so to our listeners out there if

you have any specific topics of Interest

or you want to hear more about this you

specific questions about this don't

hesitate to reach out to me um or if you

want to hear something else in the

future podcast send me an email as well

at yo quality insight.org thank you all

for listening to today's podcast and

stay tuned for future episodes thank you

Rachel thank you