Promote Self-management in Usual Care

To help patients self-manage their care, incorporate culturally and linguistically tailored evidence-based techniques for promoting self-management into usual care, and provide patients with tools and resources for self-management. Examples of evidence-based techniques to use in usual care include: goal setting with structured follow-up, Teach-back methods, action planning, assessment of need for self-management (for example, the Patient Activation Measure), and motivational interviewing. Examples of tools and resources to provide patients directly or through community organizations include: peer-led support for selfmanagement, condition-specific chronic disease or substance use disorder selfmanagement programs, and self-management materials.

Documented use of culturally and linguistically tailored evidence-based techniques to promote self-management into usual care. Include both of the following elements:

1) Patient literacy and language capture – Documentation of patient literacy level and/or anguage preference captured in the medical record (e.g., screenshot, electronic health record [EHR] report); AND

2) Provision of appropriate self-management care techniques – Documented use of evidence-based techniques to promote self-management into usual care (e.g., eligible clinicians' completed office visit checklist, electronic health record report of completed checklist, copies of goal-setting tools or techniques, motivational interviewing script/questions, action planning tool with patient feedback, record of condition-specific self-management coaching). Materials must be provided in a format appropriate for the patient's literacy and/or language preference.