Post on 23-Feb-2016
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December 4, 2012Michael Toboni and Brian Chou with Dr. Brian Prestwich
Executive Board Members: Emily Levy, Joseph Li, Natane Runningfox, Sadia Quidwai, Megan Chen, Yvonne Hoang, Mena Alrais
Who We Are
200+ Student Volunteers25+ Preceptors
4 Health ProfessionsMedicineOccupational TherapyPharmacyPhysician Assistant
2 Clinic SitesLAC + USC Urgent CareEisner + USC Med Center
Who We AreWe are students working
together in interprofessional care
teams to help deliver comprehensive care to the chronically ill and underserved population
of Los Angeles.
Care Team1 Clinic Coordinator2 Medical Students2 Pharmacy Students1 OT Student1 PA StudentSupervising Faculty
Patient ServicesPreventative ScreeningLifestyle ModificationMedical AssessmentMedication Therapy MgmtMedical Home Linkage
Cycle Time70 Min per Patient
What We Do
Primary Care Project at USC+ Eisner Family Medicine Center
Urgent Care Project at LAC+USC Urgent Care Center
The Clinic Protocol
Medicine
Pre-Clinical Medical StudentsVital SignsPreventative ServicesPatient EducationMedical HistoryPhysical Exam
Clinical Medical StudentsAssessment & PlanningTeaching and SupervisionCharting
Physician Assistant
Medical HistoryPhysical Exam
Treatment PlanningPatient Education
Verbal Case ReportsCharting
Pharmacy
Medication Therapy ManagementMedication HistoryMedication ReconciliationDrug Assessment
Appropriateness
Effectiveness Safety
Design new medication regimen Patient Education
Occupational Therapy
Increase patient engagement in chronic condition self-management and preventative health behaviors.Collaborate with team to create an individualized wellness action plan.
The Lifestyle Redesign® Approach.The process of acquiring health-promoting habits and routines in daily life. Patient education Daily activity analysis Goal setting
Students are exposed to other
disciplines, work as a clinical team, and adopt an analytical, case-based approach to
patient care…as early as their first
year of school.
All Participants
Clinical TrainingChartingCase PresentationProcedural SkillsInterviewing SkillsCultural Sensitivity
Policy TrainingMedical Home ModelChallenges to AccessCollaborative Solutions
Other Projects
Inter-Professional Health Symposium
Inter-Professional Health Fairs
Research
Questions?uscstudentrunclinic@gmail.com
Michael Toboni, Co-PresidentBrian Chou, Co-President
Brian Prestwich, Medical Director
The Phillips Neighborhood Clinic
Brian Sick, MD – Medical DirectorAnna Berglund, MS2 – Board Co-ChairAutumn Chmielewski, MHA2 – Board Co-Chair
Where are we? - The Phillips Neighborhood
• South Minneapolis
• Urban
• Diverse - 31.3% foreign
born residents
• Impoverished - 34.4% below
poverty level
• Accessible - metro transit
buses - lightrail system
• Active Neighborhood
- many non-profits - large employers
Where are we? – The Phillips Neighborhood Clinic (PNC)
PNC is located in the heart of the Phillips Neighborhood and operates from the basement of Oliver Presbyterian Church.Picture is of: 2647 Bloomington Avenue SouthMinneapolis, MN 55407
2647 Bloomington Avenue SouthMinneapolis, MN 55407
PNC is located in the heart of the Phillips Neighborhood and operates
from the basement of Oliver Presbyterian Church.
Who are we? – Our Two-part
Mission
Patient Centered
To provide accessible, culturally appropriate,
interdisciplinary health care services and education in
order to reduce the burdens of poor medical access and raise the quality of life for
our patients.
Who are we? Our Two-part
Mission
Student Centered
To provide health professional students with
the skills they need to effectively and
compassionately serve people who are
underinsured and/or unstably housed.
Who do we serve? – Our Patients
• Approximately 1,200 patient visits annually• All services are free and provided to anyone in need
• Patients are served on a first-come-first-served basis two nights per week
Uninsured 77%
Public16% Private
7%
0%10%20%30%40%50%60%70%80%90%
Type of Insurance
Who do we serve? – Our Patients
38%
21%13%
9%
8%8% 2% 1%
PNC Patient Ethnicity
Hispanic or LatinoUnknown/Choose not to answerWhite/CaucasianAsianAfrican African AmericanOtherAmerican Inidan
What services do we offer?
Physical Exams Pediatrics Well Child Visits Sports Physicals Women’s Health
Dermatology Foot Care Contraception /Birth Control
Dispensing Pharmacy Pharmacy Care
Diabetic Treatment Physical Therapy Nutrition Mental Health
Counseling Lab Tests
Blood Pressure Checks
Cholesterol, Blood, and Urine
TestsPregnancy Tests
and ReferralsSTI & HIV
Testing and Counseling
Health Insurance Application Assistance
How do we do it? – Our Structure
How do we do it? – Our Volunteers
328 Student Volunteers100 Medical72 Pharmacy
55 Public Health*40 Nursing
38 Physical Therapy15 Social Work
8 Undergraduate
* Includes Nutrition & Master of Healthcare
Administration
How do we do it? – Volunteer Commitment328 Student Volunteers
•Sign contract for 2 years of 2 semesters per year (summer optional)•Hours per semester = 35•3-4 clinic shifts x 5 hours each = 20 hours•3 outreach activities x 3 hours each = 9 hours•4 meetings x 1 hour each = 4 hours•1 cultural awareness event = 2 hours
Value of time student volunteers commit to the clinic per year = $496,395
How do we do it? – Our Preceptors
86 Volunteer Preceptors
MedicalNursingNutrition
Physical TherapyPharmacy
ResidentsMed/Ped’s
Family Medicine
How do we do it? – Our Expenses
• Total annual operating expenses are approximately $40,000• Includes the cost to provide free labs & medications for 1,200+ patient visits
per year, building rent, utilities, training materials, & fundraising costs• The average cost to serve each patient = $31.00
How do we do it? – Our Income & SupportUniversity of Minnesota Physicians: UMP helps manage clinic operations by working with PNC leadership to determine medical supplies, computers, EMR, and sign facility leaseUniversity of Minnesota: Medical school administration develops an annual budget with PNC officials with the understanding that PNC raises funds to cover as much of the budget as possibleMinnesota Medical Foundation: UMN approved foundation for Health Sciences. PNC can receive donations and gifts through the foundation, which is a 501 (c) 3 organizationPhillips Neighborhood Clinic: PNC is classified as a campus life program. All financial transactions are processed through the University.
• Income comes from a variety of sources including fundraising, donations, & grants
• Significant in-kind support is provided by supporting organizations
University of Minnesota Physicians
UMP helps manage clinic operations by working with PNC
leadership to determine medical
supplies, computers, EMR, and sign facility
lease
University of Minnesota
Medical school administration
develops an annual budget with PNC officials with the
understanding that PNC raises funds to cover as much of the budget as possible
Minnesota Medical FoundationUMN approved foundation for
Health Sciences. PNC can receive
donations and gifts through the
foundation, which is a 501 (c) 3
organization
Phillips Neighborhood Clinic
PNC is classified as a campus life program. All financial transactions
are processed through the University.
What else makes us unique? –
Community Outreach
• Student volunteers commit to 6 community outreach activities per year• Activities include tutoring, diabetes education, blood pressure & blood sugar checks,
health fairs, legislative advocacy, meal service, etc…• We can only see so many patients in clinic, but we can help many more outside of the clinic
Community
Outreach
Understand where our patients
come from
Connect with the
community
Create partnerships with other organization
s
Increase awareness of the PNC as a health resource
What else makes us unique? –
Interdisciplinary Approach
• 6 different schools are represented at PNC (medical, nursing, pharmacy, physical therapy, public health, & social work)
• Clinic “huddles” draw on insights and expertise from each profession to diagnose patients and create care plans
• Students learn firsthand that collaborative care is best for the patients
Neighborhood Phillips Neighborhood Clinic: Providing culturally
competent care and cultivating caring future
healthcare leaders
Crimson Care Collaboratives (CCC)
Harvard Medical School Student-Faculty
Collaborative Practices
Presented by Rebecca Berman MD, Juwarat Kadiri & Jessica O’Brien
CCC – Overview5 Evening Clinics, planning began fall of 2009
• CCC- MGH Internal Medicine Associates (CCC-IMA), October 2010
• CCC- MGH Chelsea, October 2011• CCC- Beth Israel Deaconess (CCC-BIDMC), January 2012• CCC- MGH Revere, October 2012• CCC- Cambridge, November 2011
Student-Faculty Collaborative practicesHMS MD, DMD students• MGH Institute for Health Professions – NP students
– clinical and nonclinical roles since summer 2011• Harvard Undergraduates
– nonclinical roles since summer 2010• HMS faculty
Needs Assessment Post Massachusetts Health-
Reform• Long wait times for new PCP
appointments
• Only 44% of IM practices accepting new patients (down from 66% pre-Health reform)
• 45% of adults using the ER for non-emergent reasons unable to get a PCP appointment
MMS Physician Workforce Study 2009,2008 Massachusetts Health Reform Survey (Long and Masi, Health Affairs 28 May 2009)
Needs & Ethical Concerns• Need for acute access to primary care
services
• Need for meaningful student experiences in primary care
• Ethical concerns met by:– Faculty partnership, supervision, and
mentorship– High quality benchmarks– Student-faculty collaborative practices
• Student-driven initiative w/close faculty support
• Student exposure to & participation in primary care in a multidisciplinary approach
• Strong social mission by increasing access to care or addressing social needs
• Commitment to quality through stringent attending-level supervision
• Development of innovative solutions to community or organizational problems
Overriding Themes
CCC – MGH IMA• Primary care and urgent care services, social services,
embedded research team
• 50% Bridge-to-Care Patients– Do not have PCP, frequent fliers to ER (MGH primary care
closed to new patients otherwise)– Patients transitioned to a long-term PCP through social
service center
• 50% Urgent Care Patients– Urgent care visits from patients who have a PCP at MGH
Internal Medicine Associates– Addresses Ethical Concerns
• 2012: Inter-professional teams of medical and NP students, interchangeable roles
CCC – MGH CHELSEA• Primary care services, social services, mental health
services, embedded research team
• Patients who have just been released from prison– Highly vulnerable population
• Patients frequently seeking care at Chelsea HealthCare Center’s Urgent Care Clinic– Predominantly immigrants/refugees– Lack access to primary care
• 2012: Interprofessional teams of medical and NP students, interchangeable roles
CCC – BIDMC• Needs assessment revealed BIDMC had access
available in their resident clinic, need for chronic disease management
• Chronic Disease Co-Management Model– Diabetes, hypertension, COPD– Focus on motivational interviewing, patient education– Titrate meds, check labs as indicated– Embedded research team
• Urgent Care
• Future direction of more team-based care– Non-physician health professionals – have run into
political difficulties getting NP/PA students involved 2/2 multiple different NP programs at BIDMC
CCC – MGH Revere (pediatrics)
• Needs assessment– Pediatricians have openings– Need for expanded hours and obesity co-
management– Difficult for students to get exposure to pediatrics
• Pediatric patients– Well child and after hours urgent care– Group visit model being piloted surrounding healthy
eating/weight management in obese patients not eligible for other services
• Inter-professional team of medical and NP students, interchangeable roles
• Community health center– Ethnically diverse, predominantly low SES
CCC – Cambridge• Located in YWCA• Women in transitional housing (residents have
history of physical, psychosocial or financial trauma)
• Initial plan was monthly outreach to bridge patients to a PCP
• Many residents have PCPs but don’t go to them due to multiple psycho-social barriers
• Students as patient navigators– Health screening, including mental health and
social services needs, help make PCP appointments and go with patients
Statistics• Each clinic sees between 6-12 patients per night,
total monthly capacity ~ 100 patients
• Clinic lasts ~3 hours, volunteers must come at least monthly
• Board members work ~ 5-10 hours per week on CCC-related planning
• 473 student volunteers to date
• This semester: 180 HMS/HSDM, 24 NP, 32 Harvard College, 3 post-baccalaureate/graduate students
Clinic Sustainability• Average annual cost to operate a clinic =
100K
• Funding Sources– Insurance accepted post health reform (wRVUs)– In-kind support from participating practices– Teaching dollars from Harvard Medical School– Grants including MGH Stoeckle Center for Primary
Care Innovation, Yawkey II Foundation, HMS Center for Primary Care
Q&A
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