Continuity Clinics as Medical Home

Hawaii Dyson Initiative

Louise Iwaishi, MD

March 5, 2005

Hawaii Dyson Initiative

Faculty Development

Faculty workshop on the Medical Home elements– Video training vignettes– Performance checklist– Training on giving feedback

Educational strategies– Community Ped Preceptor Prompt card– Medical Home Posters for clinic rooms– Resident Medical Home Best Practice Noon Conferences

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Curricular Tools

Practice-based learning tools– Web based, self-directed training module

MH content and case scenarios Performance Checklist-self assessment Chart reviews-Quality Improvement, community contacts Medical Home Model Practice-patient panel

Portfolio assessment– Pre and Post module knowledge assessment– Confidence Survey/MH Attitudinal Scale– Performance checklist– Chart review checklist– Self reflective narrative MH best practice

Hawaii Dyson Initiative

Web-based Curriculum

http://www.hawaii.edu/dyson/Intro%20medical%20home.htm

Pre and Post module knowledge test

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Preceptor Prompt Card

Did the resident identify access, continuity and comprehensive care issues for this patient?

Did the resident know the community resources for the child’s care, family support or coordination needs?

Did the resident identify any cultural aspects or concerns?

How family/patient centered was the resident’s communication?

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Medical Home Attitudinal Scale

I understand the concept of the Medical Home. I feel confident describing the 7 principles of the MH. I apply the principles of the MH in daily patient practice. The majority of my patients identify me as their primary care

pediatrician. My preceptors encourage me to apply the MH principles in

daily patient practice. My preceptors routinely provide me with feedback regarding my

clinical performance in continuity clinic. The level of teaching in continuity clinic is optimal.

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Medical Home Performance Checklist

I. PATIENT CARE Family Centered Care

– Ask open-ended questions to identify patient and or family concerns and address concerns effectively

– Consider patient and or family members in the decision making process for management and treatment

Accessibility– Inform the patient/family how to access me as their primary care

provider4. Offer a plan for after hours care to ensure accessibility to my patient’s healthcare needs

Coordinated Care– Review correspondence from ancillary health care documents with

the patient and family6. Review plans with consultants, agencies, and or organizations involved in the patient’s care

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Medical Home Performance Checklist

II. INTERPERSONAL COMMUNICATION Compassion

– Ask questions to encourage understanding– Demonstrate compassion by using appropriate verbal and non-verbal communication

to ensure all questions are addressed or answered

III. SYSTEMS BASED PRACTICE Comprehensive

– Consider financial and social needs in my patient’s management plan to improve access to care and follow-up

– Enlist appropriate community resources for infant, child, and adolescent health needs

IV. PROFESSIONALISM Culturally Effective Care

– Explain the medical rationale for plan of care in understandable language to the child and family

– Acknowledge differences of opinion related to cultural and religious practices

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Medical Home Posters in Clinic

Faculty: Use as Visual education tool

Residents: Reinforce the Medical Home principles

Clinic staff and patient families: Promote a shared language and knowledge of the Medical Home principles of care

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Medical Home Resident Noon Conference

Medical Home Noon Conferences

Resident/CCP faculty MH best practice case presentation and discussion with feedback

– Parent Faculty from Family Voices – Community Pediatrician involved with AAP Hawaii

Chapter MH Implementation Project

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Study

A Web-based Curriculum and Portfolio Assessment to Demonstrate Medical Home Practice-Based Learning in Resident Continuity Clinics

OBJECTIVE: To determine if a web-based training curriculum using portfolios as a Practice Based Learning (PBL) assessment tool would result in increased resident knowledge, confidence, and demonstration of PBL competence.

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Study Design

Web-based training module for residents in CCP – independently study MH concepts, – perform chart reviews, – write a case-based self-reflective narrative of their application of MH principles to patient care.

A one-group pretest-post test design compared mean scores on MH knowledge and confidence using paired sample t-tests.

Competence was measured through the use of portfolios – written exams, – confidence surveys, – chart review checklists, – self-reflective narrative

Portfolio content were qualitatively analyzed. Frequencies were measured from resident course evaluation data to determine resident satisfaction of training.

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Study Results

Residents (n = 24, response rate = 71%) showed improvement in their knowledge (p<.01), confidence (p<.001), and utilization in daily practice (p< .001).

Portfolio narratives revealed resident-patient relationships often not appreciated in usual preceptor-resident training interactions.

Residents found this to be an instructive training

method that enabled them to apply principles to practice and improved teaching in clinic.

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Conclusion

Our findings suggest that a web-based training module and portfolio assessment can be an effective PBL tool for teaching and evaluating resident understanding and use of MH principles.

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Aloha!! Louisei@kapiolani.org