“ARE WE THERE YET?” · • Project Director, WPC Community Teaching Site FM-Westview, FM...
Transcript of “ARE WE THERE YET?” · • Project Director, WPC Community Teaching Site FM-Westview, FM...
TRANSFORMING THE FAMILY PRACTICE
INTO THE PATIENT’S MEDICAL HOME
Annual Scientific Assembly Banff 2017
“ARE WE THERE YET?”
MOE, Grace, BPT, MSc, PCMH-CCE BAILEY, Allan L., MD, CCFP
Faculty/Presenter Disclosure:Faculty/Presenters:
Grace Moe, BPT, MSc, PCMH-CCE• Executive Director, Strategic Planning & Special Projects
Westview PCN/Westview Physician Collaborative• Project Director, WPC Community Teaching Site
FM-Westview, FM Residency Program, Department of FM, U of A
Allan L. Bailey, MD, CCFPFamily Physician, Westgrove Clinic, Spruce Grove
Director, Innovation, Research & Evaluation, Westview PCN/Westview Physician Collaborative
Site Director, Family Medicine – Westview, FM Residency ProgramClinical Professor, Department of Family Medicine, U of A
• no conflict of interest to disclose•no relationships with any commercial interests•no grants/research support from any agency
Diffusion of Innovation
Hype Cycle
Patient-Centered Medical Home Assessment (PCMH-A)
• developed by the US-Safety Net Medical Home Initiative 1
• modified only to reflect a publicly funded health system
_____________________________________________________________________________
1Safety Net Medical Home Initiative.
The Patient-Centered Medical Home Assessment Version 3.1.
The MacColl Center for Health Care Innovation at Group Health Research Institute and Qualis Health; Seattle, WA
May 2013.
What Does It Mean?
Score Level D C B APoints in scale 1 2 3 4 5 6 7 8 9 10 11 12
Interpretation reflect absent or minimal implementation of the key change addressed by the item.
suggest that the first stage of implementing a key change may be in place, but thatimportant fundamentalchanges have yet to be made.
typically seen when the basic elements of the key change have been implemented, although the practice still has significant opportunities to make progress with regard to one or more important aspects of the key change.
most or all of the critical aspect of the key change addressed by the item are well established in the practice.
PCMH-A ResultsClinic 5
2014 - 2015 - 2016
9.0 8.8 9.19.7
8.8
6.2
8.0
6.1
8.2
9.3 9.29.8 9.6 9.6
7.9
9.28.6
9.39.8
9.2
10.49.7 9.8
8.89.4
8.79.5
0.0
2.0
4.0
6.0
8.0
10.0
12.0
Sco
re
Clinic 5 2014 Clinic 5 2015 Clinic 5 2016
PCMH-A ResultsClinic 5
Interpretation
• “top performer”/early adopter?
• ANOVA year-to-year (statistically significant):• Patient-centeredness • Care Coordination • PCMH-A Overall
• Post-hoc Fisher’s Least Significant Difference:
• Patient-centeredness (2014 – 2016 only)
• Care Coordination (NOT 2015-2016)
• PCMH-A Overall (NOT 2015-2016)
PCMH-A ResultsPCN Wide
2014 - 2015 - 2016
8.1 8.08.5
9.9
8.6
7.38.1
7.48.28.2 8.2 8.5
9.1 9.1
7.88.6 8.5 8.58.5 8.2
8.79.3 9.0 8.7 8.8 8.7 8.7
0
2
4
6
8
10
12
Sco
re
PCN Average 2014 PCN Average 2015 PCN Average 2016
PCMH-A ResultsPCN Wide
Interpretation
• ANOVA year-to-year (statistically significant):• Patient-centeredness • Care Coordination • NO significant difference in PCMH-A Overall
• Post-hoc Fisher’s Least Significant Difference:
• Patient-centeredness (2015-2016 but NOT 2014 –2015)
• Care Coordination (2014-2015 but NOT 2015 - 2016)
• PCMH-A Overall (NO significant difference)
PCMH –A Overall Score
2014
2014 2015 2016
C1 1 8 7
C2 4 5 4
C3 5 15 11
C5 7 18 13
C6 3 17 18
C10 1 7 10
Number of Respondents
PCMH –A Overall Score
2015
2014 2015 2016
C1 1 8 7
C2 4 5 4
C3 5 15 11
C5 7 18 13
C6 3 17 18
C10 1 7 10
Number of Respondents
PCMH –A Overall Score
2016
Number of Respondents
2014 2015 2016
C1 1 8 7
C2 4 5 4
C3 5 15 11
C5 7 18 13
C6 3 17 18
C10 1 7 10
PCMH-A Overall Score 2014 - 2016
Clinic 5 PCN-Wide (n=6 FP clinics)
Per Capita Funding for “TEAM”and
PCN-Wide PCMH-A Scores 2014 – 2016
13.49
38.8737.78
40.69
46.69
56.92
59.86
51.44
54.81
49.55
8.24 8.60 8.73
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
Per Capita CICP $ PCMH-A Score
Per Capita Funding for “TEAM”)and
TEAM (FTE):MD Ratio
Per Capita CICP $ PCMH-A Score2007 13.492008 38.872009 37.782010 40.692011 46.692012 56.922013 59.862014 51.44 8.242015 54.81 8.602016 49.55 8.73
Year TEAM:MD Ratio2007 0.26
2008
2009
2010 0.35
2011
2012
2013 1.06
2014
2015
2016 1.22
Conclusions
• Are we there yet? NO, not even for the “early adopters” – at best a B+.
• There can be wide variance of performance between clinics even within a single PCN.
• Not all key aspects of performance improve at the same rate.
• Are the “early adopters” “plateauing” – WHY?
• The PCMH-A tool may be useful if used over time: is it something we should encourage for the “early and late majority”?