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

William Warning

Bonnie Jortberg

Andy Ellner

Aimee English

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

william.warning@crozer.org

#CINWebinar

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

#CINWebinar

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

#CINWebinar

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

#CINWebinar

• 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

#CINWebinar

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!

#CINWebinar

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

#CINWebinar

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)

#CINWebinar

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

LS6

LS4

LS3

LS2

LS1

Oct Dec Feb April

June Aug Oct

Prevention of Missed and Delayed Dx:Colorectal Cancer (Adult)

Developmental Delays (Pediatric)

PDS

A PDS

A PDS

A PDS

A PDS

A PDS

A

AIC CARES Timeline

Dec

Feb April June

PDS

A PDS

A PDS

A PDS

A PDS

A PDS

A PDS

A PDS

A PDS

A

Improve Outcomes for Patients with Complex Care Needs

Prevention of Missed and Delayed Dx: Breast Cancer (Adult)

TBD (Pediatric)

Estimated transition

Estimated transition

AIC Evaluation

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

Questions & Answers

Tweet them using

#CINWebinar

Use the Question function

on Go-To-Webinar

On The PCP Forum

3 Ways to ask your questions:

primarycareprogress.org/connect/forums

Thank you!

• Clinical Innovation Network Website & Mailing List

• Webinar recording

• Connect on Facebook and Twitter (#CINwebinar)

• Ideas or questions? Get in touch:clinicalinnovation@primarycareprogress.org

• Survey after the webinar

• Discussion NOW on the Primary Care Progress website http://primarycareprogress.org/connect/forums

Stay connected!