TEACHING HEALTH CENTER CONSORTIUM Comparative Analysis
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TEACHING HEALTH CENTER
CONSORTIUM COMPARATIVE
ANALYSISLinda Thomas-Hemak MD
December 2013
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UNDERSTANDING OF PCMH
PRINCIPLES
Comparative Analysis
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CORE PCMH PRINCIPLES Team Approach Information System Support Quality Improvement Population Management Treatment of Mental Health issues Self-Management Support Use of Guidelines Coordination of Care Patient centered care
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THC-1 VS. TRADITIONAL-1 THC-1
better thanTraditional-1
THC-1 Similar to
Traditional-1
THC-1 Worse than Traditional-1
November 2011
Team ApproachInformation System SupportQuality ImprovementPopulation ManagementTreatment of Mental Health issuesOVERALL ASSESSMENT
Self-Management SupportUse of Guidelines
Coordination of CarePatient centered care
May 2012 Team ApproachInformation System SupportSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation ManagementCoordination of CareTreatment of Mental Health issuesOVERALL ASSESSMENT
Patient centered care
November 2012
Team ApproachInformation System SupportSelf-Management SupportPopulation ManagementPatient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT
Use of GuidelinesQuality ImprovementCoordination of Care
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THC-1 better than
Traditional-2
THC-1 Similar to
Traditional-2
THC-1 Worse than Traditional-2
November 2011 Quality ImprovementTreatment of Mental Health issues
Team ApproachInformation System SupportSelf-Management SupportUse of GuidelinesPopulation ManagementCoordination of CarePatient centered careOVERALL ASSESSMENT
May 2012 Team ApproachSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation ManagementTreatment of Mental Health issues
Information System SupportCoordination of CarePatient centered careOVERALL ASSESSMENT
November 2012 Team ApproachInformation System SupportSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation ManagementPatient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT
Coordination of Care
THC-1 VS. TRADITIONAL-2
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THC-1 VS. TRADITIONAL-3THC-1
better thanTraditional-3
THC-1 Similar to
Traditional-3
THC-1 Worse than Traditional-3
November 2011 Quality ImprovementPatient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT
Team ApproachInformation System SupportSelf-Management SupportUse of GuidelinesPopulation ManagementCoordination of Care
May 2012 Team Approach Information System SupportSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation Management Coordination of Care Patient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT
November 2012 N/A as the Traditional-3 surveyed in Nov 2011 and May 2012 had graduated from the program
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2012 THC-1 VS. 2011 THC-1
2012 THC-1 better than2011 THC-1
2012 THC-1 Similar to
2011 THC-1
2012 THC-1Worse than2011 THC-1
Nov 2012 Team Approach Self-Management SupportUse of GuidelinesQuality ImprovementCoordination of Care Patient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT
Information System SupportPopulation Management
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2012 THC-1 VS. THC-22012 THC-1 better than
THC-2
2012 THC-1 Similar to
THC-2
2012 THC-1Worse than
THC-2Nov 2012 Coordination of Care
Patient centered careTeam Approach Information System SupportSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation Management Treatment of Mental Health issuesOVERALL ASSESSMENT
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Nov 2011 – May 2012 Nov 2011 – Nov 2012
Team Approach THC +19% +19%Traditional +15% +14%
Info System Support THC +10% +13%Traditional +8% +8%
Self-Management Support
THC +11% +14%Traditional +4% +9%
Use of Guidelines THC +7% +5%Traditional +4% +6%
Quality Improvement THC +6% +9%Traditional +8% +18%
Population Management
THC +21% +19%Traditional +10% +13%
Coordination of Care THC +14% +6%Traditional -1% +7%
Patient-Centered Care
THC -1% +6%Traditional 2% -1%
Mental Health Issues THC +11% +7%Traditional +11% +10%
Overall Average THC +10% +11%Traditional +6% +8%
COMPARISON ACROSS TIME: PERCENT CHANGE
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Team
App
roac
h
Info
Sys
tem
Sup
port
Self
-Man
agem
ent
Supp
ort
Use
of
Gui
delin
es
Qua
lity
Impr
ovem
ent
Popu
lati
on M
anag
emen
t
Coor
dina
tion
of
Care
Pati
ent-
Cent
ered
Car
e
Men
tal H
ealt
h Is
sues
Ove
rall
Ave
rage
-5%
0%
5%
10%
15%
20%
25%
19%
10%11%
7%6%
21%
14%
-1%
11%10%
15%
8%
4% 4%
8%10%
-1%
2%
11%
6%
Percentage Change over 6 months
THCTraditional
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Team
App
roac
h
Info
Sys
tem
Sup
port
Self
-Man
agem
ent
Supp
ort
Use
of
Gui
delin
es
Qua
lity
Impr
ovem
ent
Popu
lati
on M
anag
emen
t
Coor
dina
tion
of
Care
Pati
ent-
Cent
ered
Car
e
Men
tal H
ealt
h Is
sues
Ove
rall
Ave
rage
-5%
0%
5%
10%
15%
20%
25%
19%
13% 14%
5%
9%
19%
6% 6% 7%
11%
14%
8% 9%
6%
18%
13%
7%
-1%
10%8%
Percentage Change over 12 months THCTraditional
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Team Approa
ch
Information
System Support
Self Manage
ment Support
Use of Guideli
nes
Quality
Initiative
Population Manageme
nt
Co-ordination
of care
Patient
Centered
Care
Treatment of
Mental Health Issues
Overall
Jermyn - Wayne residents
4.60 4.14 4.88 4.83 4.92 4.55 4.94 4.80 5.00 4.74
Jermyn - VA residents 4.10 3.25 4.38 4.50 4.00 3.50 4.50 4.30 4.50 4.11
Jermyn - Susquehanna 4.40 3.55 4.47 4.61 4.33 4.07 4.58 4.67 4.83 4.39
Jermyn - Scranton Primary
3.60 3.14 4.00 4.00 3.67 3.20 4.00 3.80 4.00 3.71
Clarks Summit- Scranton Primary
3.85 2.89 4.29 4.17 4.25 3.00 4.38 4.20 4.25 3.92
Jermyn - Wayne residents: PGY2
4.50 4.07 4.42 4.28 4.78 4.70 4.50 4.40 5.00 4.52
Scranton - Scranton Primary: PGY2
4.57 3.79 4.72 4.61 4.33 4.30 4.13 4.03 4.50 4.33
COMPARISON ACROSS TRAINING VENUES FOR THC TRACK RESIDENTS
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CORRELATION ANALYSIS OF PCMH SURVEY RESULTS
Comparative Analysis
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November2012
Team Approac
h
Information
System Support
Self Manage
ment Support
Use of Guidelin
esQI Pop
MngtCoord of
carePatient Centered Care
Treatment of
Mental Health Issues
Overall Score
Days in Jermyn
Team Approach 1
Information System Support
0.685 1 Self Management Support 0.580 0.622 1
Use of Guidelines0.675 0.582 0.736 1
QI0.528 0.693 0.695 0.451 1
Pop Mngt0.710 0.942 0.459 0.505 0.598 1
Coord of care0.640 0.497 0.587 0.754 0.658 0.438 1
Patient Centered Care0.447 0.497 0.470 0.671 0.568 0.492 0.819 1
Treatment of Mental Health Issues
0.551 0.653 0.443 0.469 0.452 0.581 0.469 0.432 1
Overall Score0.808 0.873 0.761 0.806 0.785 0.818 0.812 0.762 0.717 1
Days in Jermyn -0.031 0.141 -0.014 0.022 0.005 0.120 0.198 0.185 0.177 0.122 1
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Self
Man
agem
ent
Supp
ortTeam
Ap
proa
ch
Qua
lity
Init
iati
ves
Use
of
Gui
delin
esPo
pula
tion
M
anag
emen
t
Info
rmat
ion
Syst
em
Supp
ort
Ove
rall
Scor
e
Trea
t M
enta
l Hea
lth
Issu
es
Pati
ent
Cent
ered
Car
e
Coor
dina
tion
of C
are
-1 +10
Positive CorrelationNegative Correlation
CORRELATION BETWEEN TIME SPENT AT JERMYN AND MEDICAL HOME COMPETENCY
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November 2011
Team Approac
h
Information
System Support
Self Manage
ment Support
Use of Guidelin
esQI Pop
MngtCoord of
carePatient Centered Care
Treatment of
Mental Health Issues
Overall Score
Days in Jermyn
Team Approach 1.000
Information System Support
0.714 1.000Self Management Support 0.438 0.621 1.000
Use of Guidelines0.593 0.635 0.852 1.000
QI0.036 0.311 -0.053 0.061 1.000
Pop Mngt0.741 0.924 0.452 0.465 0.275 1.000
Coord of care0.675 0.631 0.400 0.621 0.272 0.580 1.000
Patient Centered Care0.396 0.512 0.658 0.709 0.012 0.348 0.522 1.000
Treatment of Mental Health Issues
0.158 0.160 -0.193 -0.058 0.168 0.149 0.260 0.229 1.000
Overall Score0.761 0.879 0.683 0.802 0.333 0.779 0.813 0.734 0.336 1.000
Days in Jermyn -0.010 -0.276 -0.140 -0.058 0.052 -0.313 0.204 -0.287 0.305 -0.060 1.000
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Self
Man
agem
ent
Supp
ort
Team
Ap
proa
ch
Qua
lity
Init
iati
ves
Use
of
Gui
delin
es
Popu
lati
on
Man
agem
ent
Info
rmat
ion
Syst
em
Supp
ort
Ove
rall
Scor
e
Trea
t M
enta
l Hea
lth
Issu
es
Pati
ent
Cent
ered
Car
e
Coor
dina
tion
of C
are
-1 +10
Positive CorrelationNegative Correlation
CORRELATION BETWEEN TIME SPENT AT JERMYN AND MEDICAL HOME
COMPETENCYNOVEMBER 2011
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QUALITY AND PATIENT SAFETY SURVEYS
Comparative Analysis
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QUALITY AND SAFETY SURVEYS We conducted a survey to assess the
understanding of Quality and Patient safety amongst the first year residents that included both THC and Traditional track residents in September 2011
The data was aggregate and did not look at differentiating the THC vs. Traditional track residents
The same survey was re-administered in September 2012 to the same group of residents who had transitioned to Year-2 of their training
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RESULTS: QUALITY AND SAFETY SURVEY The comparison showed an
improvement of 8% over time. The limitation of these results being that the results do not allow us to compare the effectiveness of THC vs. Traditional tracks
The researchers have identified this limitation and will focus on this during the next surveys
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CONSORTIUM MODELS FOR THC IMPLEMENTATION
Comparative Analysis
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The Wright Center for Graduate Medical
Education:A 501(c )3 not-for-profit ACGME/AOA Accredited
Sponsoring GME Institution/Consortium50 FTE IM Residency
ProgramGroup A
Group B
Mercy hospital
Community Medical Center Moses Taylor
Medicare GME Fund
39 Hospital Funded FTE
Wayne Memorial
Community Health Center
FQHC*
Wright Center Primary Care Mid-Valley**
The Wright Center Medical
Group
Veteran Administration Hospital GME Fund
2 FTE 2 FTE
4FTE
1 FTE
1 FTE
10.7FTE 11 FTE 10.3FTE
5 VA Funded FTE
Scranton Primary Health
Center*
13 FTE 13 FTE13 FTE
Hospital Participating Institutional Affiliates
HRSA Teaching Health Center
Fund
6 THC Funded FTE/year
Wright Center Primary Care Scranton**
* NEW FQHC Based Learning Environments**Established Internal Medicine Learning Environments
WCGME THC Consortium – Initial Development 2011
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Medicare GME Fund
10.7FTE 8.5 FTE 10.3FTE
Regional Hospital
Community Medical Center Moses Taylor
43 Hospital Funded FTE (4
FTE > FY2011)
16 FTE 13.5 FTE13.5 FTE
Total Participating Hospital Affiliates’ Funded FTE Slots
The Wright Center for Graduate Medical Education,
a 501(c)3, not-for-profit ACGME/AOA Accredited
Sponsoring Institution and GME Consortium: 2012 Projection of
64 FTE IM Residency Program
Veteran Administration Hospital GME Fund
5 VA Funded FTE
HRSA Teaching Health
Center Fund
Established 12 THC FTE
4 FTE THC Expansion
1/3 FTE Female Health
Maternal and Family Health
Services (M&FHS)***
The Wright Center
Medical Group, P
* Established WCMG Internal
Medicine Learning Environments
** 2011 Established THC FQHC-Based Learning Environments
*** New 2012 FQHC and M&FHS Based Learning Environments in the Planned THC Expansion• Continuity Groups A-D defined as
groups of individual THC residents having Ambulatory Continuity Training Education in 2:1 ratio between a designated WCPC and FQHC site
• 2011 Established Continuity Groups• 2012 Proposed Expansion Continuity
Groups The combined venues for curriculum expansion to benefit all THC track residents = 1 Expansion FTE = 2 Individual THC track Residents with Ambulatory Continuity experience defined as Group D
2011 Established THC site FY2012 FTEs2012 Proposed Expansion THC site FTEs
Resident Group D
Resident Group B
Resident Group C
Resident Group A
Chart 1: WCGME THC Consortium Resident FTE Cost Center Funding Relationships for 2012 with Teaching Health Center Expansion Year 1
4 FTEWright Center Primary Care
Scranton*(WCPC-S)
1 FTENortheast PA Community
Health Center FQHC***
(NEPACHC)
2 FTEWayne Memorial
Community Health Center
FQHC**(WMCHC)
The Wright Center
Medical Group, PC(WCMG)
Wright Center Primary Care Mid-
Valley*(WCPC-M)
4 FTE
2 FTEScranton
Primary Health Center** (SPHCC)
1/3 FTE Oral Hygiene*** 1/3 FTE Primary
Care Psych***
2 FTE
Continuity Group B
Continuity Group D Continuity
Group A
Continuity Group C
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WCGME THC Consortium 2012 Training Model
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WCGME THC Consortium – Regional Family Medicine 2013
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WCGME THC Consortium – National Network for Family Medicine Residency Training 2013
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WCGME THC Consortium – Interdisciplinary Model for All Regional Residency Training