Clinical Innovation Network April 2015 Webinar: Practice Transformation in Residency Education
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Transcript of Clinical Innovation Network April 2015 Webinar: Practice Transformation in Residency Education
Collaboration and Practice Transformation in Residency
EducationWilliam Warning, MD, Crozer Keystone Health System
Bonnie Jortberg, PhD, University of Colorado
Aimee English, MD, University of Colorado
Andrew Ellner, MD, Harvard Medical School
April 6, 2015
5 pm PDT / 8 pm EDT
Focus on innovations in care delivery and training
Insight into design and implementation of innovations
A community of students, innovators, and leaders in primary care
Peter MeyersPCP Clinical Innovation Network Content Fellow
University of Minnesota
Welcome!Enjoying the webinar?
Tweet about it! #CINWebinar
Residency Training Program
PCMH Collaboratives
the PA Story and beyond…
William Warning, MD, FAAFPChair, PAFP Residency Program PCMH Collaborative
Co-Director, PCPCC Education & Training Task Force
Program Director, Crozer-Keystone Family Medicine Residency
Springfield, PA
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PAFP Residency Program & Community Health Center Collaboratives
Largest single state collaborative of its kind in the country
Two Groups: RPC started June 2010 with:
27 FM Residency programs
CHC started June 2011 with: 21 Community Health Centers
Heavy focus on the Chronic Care Model Full range of services: data, education, support from
faculty Focused on safety net providers More than 19,000 patients
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Team Participants & Requirements
Minimum 3 members (5 is ideal): Physician (usually the Medical Director)
PGY2 Resident
Clinical Supervisor-Nurse/MA/Others
Practice Manager
IT Support
Requirements Attend live learning sessions (2x/year)
Participate in monthly team calls
Report monthly data
Work with a physician mentor (faculty)
Apply for NCQA PCMH Recognition#CINWebinar
State CollaborativesSPREAD OUT
InitiallyI3= NC, SC, VAColoradoPA
Then……The Academic Collaborative!…The Collaborative OF THE Collaboratives! #CINWebinar
Benefits of Collaborative Participation Improved patient care/outcomes – “Good
Work” Sustained Change – FINALLY! Improved physician-patient (and staff)
relationships Improved physician, staff and patient
satisfaction—decrease burnout Improved recruitment of medical students Enhanced prestige of Family Medicine within
each institution
Competition -> Collaboration!#CINWebinar
Resident Learning Opportunity Expand to require a PGY2 and a PGY3 “PCMH
Resident” Population Management experience Leadership, Change Management experience Registry usage and quality of care documentation “Prove” Quality of Care to outside stakeholders
Resident Curriculum Piloting an innovative PCMH Residency
Curriculum Fulfillment of Management of Health Systems
curricular goals Resident ABFM Part IV MOC requirements
Resident Competencies PBLI and SBP fulfillment
Medical Students PCMH Pipeline development
Benefits of Collaborative Participation
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Colorado PCMH Residency Training Collaborative
Perry Dickinson, MD1
Bonnie T Jortberg, PhD, RD, CDE1
Doug Fernald, MA1
Emilie Buscaj, MPH2
1University of Colorado School of Medicine,Department of Family Medicine
2HealthTeamWorks, Lakewood, Colorado
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• Objectives– Transform 9 FM and 1 IM residency practices into PCMHs via practice/curriculum redesign
• Background– Project started in January 2009– Funded by the Colorado Health Foundation– Collaborative effort w/ UC Department of Family Medicine, HealthTeamWorks, and Colorado
Association of Family Medicine Residencies
• Data Collected– Field notes, interviews, collaborative learning session notes, and online surveys
• Project components– Practice improvement coaching– Quality improvement teams & team-based care– Leadership alignment for the PCMH– NCQA PPC-PCMH recognition support– PCMH curriculum redesign consultation– PCMH curriculum modules – Bi-annual Learning Collaborative Sessions
Colorado Family Medicine Residency PCMH Project
C O L O R A D O
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Colorado Family Medicine Residency PCMH Project
• Key Accomplishments– NCQA PCC-PCMH Level III Recognition for all programs– Developed PCMH e-Learning Modules that have been
licensed to the American Board of Family Medicine– Integration of quality improvement teams– Focus on patient engagement/advisory boards– Focus on training and “coaching” internal PCMH
champions
Team Re-
design*
Pt. Centered* SMS* Info. Systems*0
10
20
30
40
50
60
70
80
90
100
BaselineMidEnd
PCMH-Clinician Assessment:All Practices
*p < 0.0001
Change Culture *Work Environment ** Chaos0
10
20
30
40
50
60
70
80
90
100
BaselineMidEnd
Practice Culture Assessment
*p < 0.0001**p = 0.0088
Colorado Family Medicine Residency PCMH Project
• Graduate Survey– Completed by outgoing residents at end of
residency, 2011- 2014– Asked about future practice– Specific questions about
• importance of PCMH principles • influence of their PCMH Residency Project experience
on future practice
How much did the PCMH Residency project experience influence your choice of practice?
2011 2012 2013 20140.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
No influenceSome influenceA lot of influence
How valuable was the PCMH Residency project in preparing for your new practice?
2011 2012 2013 20140.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Not valuableSomewhat valuableValuableVery valuable
• What is needed going forward?– Better payment models:
• Interactions and patient care outside of exam room/clinic
– Data access and more functional data systems– Allow for flexible roles/duties, especially for staff– QI position titles, defined roles, and job descriptions
(e.g., care managers, data/IT manager, team leaders)– Recognize progress and successes
Colorado Family Medicine Residency PCMH Project
Awareness of the Collaborative in Residency
• Worked closely with our health coaches• PCMH curriculums across residencies• Biannual learning collaboratives!
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Learning Collaboratives
• Key feature for practices to understand the statewide initiative
• Fostered knowledge sharing– Regardless of role– Likely increase in widespread transformation– Platform for resident presentations– Residency-specific projects
• Networking
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Learning Collaboratives, cont’d• Communal wins
– Often shared common markers of progress• Communal grievances
– EMR transitions• A bit of healthy competition
– Despite no data sharing• Safe to assume
everyone “speaks PCMH”
• 20 primary care teaching practices • 275,000+ patients • Student & residents• Expert consultation• External evaluation
Academic Innovations Collaborative (AIC)
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Change Concepts for Practice Transformation
Wagner EH, Coleman K, Reid RJ, Phillips K, Abrams MK, Sugarman JR. The Changes Involved in Patient-Centered Medical Home Transformation. Primary Care: Clinics in Office Practice. 2012; 39:241-259.
201620152014
LS5
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LS1
Oct Dec Feb April
June Aug Oct
Prevention of Missed and Delayed Dx:Colorectal Cancer (Adult)
Developmental Delays (Pediatric)
PDS
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AIC CARES Timeline
Dec
Feb April June
PDS
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Improve Outcomes for Patients with Complex Care Needs
Prevention of Missed and Delayed Dx: Breast Cancer (Adult)
TBD (Pediatric)
Estimated transition
Estimated transition
AIC “In Their Words”
“Primary Care is fun again.”
“The biggest changes has been elevating the MA role to become the
major point of contact with the patient, with the MA now taking
ownership for the patient experience.”
“I am able to spend more time with my patients because others have been
able to help with things that I didn’t need to be doing.”
“Quality is not extra, it’s what we do.”#CINWebinar
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