Patient Centered Medical Home VITL Summit September 8 th , 2010 Cyrus Jordan Medical Director VPQHC
Essential Functions of a Patient-Centered Medical Home* <ul><li>Provide each patient with an ongoing relationship with a p...
Prospects for Widespread Adoption of Patient Centered Medical Home* <ul><li>Study data and methods </li></ul><ul><ul><li>3...
Small Practices - The National Demonstration Project <ul><li>Proof of concept initiative to generate transferable knowledg...
Change is difficult at all levels <ul><li>Front-line care givers need adequate resources/time to transform their practices...
Stronger QI support structure – Importance of Peer to Peer Learning <ul><ul><li>Improving Performance in Practices, Americ...
…  And Another Issue <ul><li>Cardiologists </li></ul><ul><li>OB-GYN practitioners </li></ul><ul><li>Psychiatrists </li></u...
Meaningful Use and Medical Home are mutually supportive enablers of better care <ul><li>Provide each patient with an ongoi...
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Patient Centered Medical Home VITL Summit

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  • The first of the Report’s Three Themes 1) IOM highlighted the central importance of a QI Infrastructure for the future of rural health care The IOM also highlighted the importance of Collaboration and peer to peer learning 2) “VPQ gets it…they are not going to be able to change by themselves… they don’t have the skills or knowledge 3) The importance of Peer-to-Peer Learning! - segue to next slide
  • The importance of a QI Infrastructure as well as the importance of peer-to-peer learning in the support of transforming rural health care is becoming appreciated around the country I’ve highlighted the opinions of some of the pre-eminent leaders in promoting better primary care in the country, all of which reinforce the experience we’ve had here in the Northeast.
  • Patient Centered Medical Home VITL Summit

    1. 1. Patient Centered Medical Home VITL Summit September 8 th , 2010 Cyrus Jordan Medical Director VPQHC
    2. 2. Essential Functions of a Patient-Centered Medical Home* <ul><li>Provide each patient with an ongoing relationship with a personal physician who is trained to provide first-contact, continuous, and comprehensive care. </li></ul><ul><li>Provide care for acute and chronic conditions, preventive services, and end-of-life care, or arrange for other professionals to provide these services. </li></ul><ul><li>Coordinate care across all elements of the health care system, with coordination facilitated by the use of registries and information technology. </li></ul><ul><li>Provide enhanced access to care through systems such as open scheduling, expanded hours, and new options for communication between patients and the practice's physicians and staff. </li></ul><ul><li>*Adapted from the Joint principles of the patient-centered medical home. American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association, 2007 1 </li></ul>1 Specialist Physician Practices as Patient-Centered Medical Homes, Casalino et al. 10.1056/NEJMp1001232, April 21, 2010NEJM.org.
    3. 3. Prospects for Widespread Adoption of Patient Centered Medical Home* <ul><li>Study data and methods </li></ul><ul><ul><li>30 minute phone interview </li></ul></ul><ul><ul><li>20 or greater physicians per organization </li></ul></ul><ul><ul><li>538 organizations (60 % response rate) </li></ul></ul><ul><li>“ Largest of the large medical practices have the highest levels of medical home infrastructure, but adoption is slow” </li></ul><ul><li>“… the model has a long way to go….” </li></ul>* Measuring the Medical Home Infrastructure in Large Medical Groups , Rittenhouse et al, Health Affairs 27, no.5 (2008)
    4. 4. Small Practices - The National Demonstration Project <ul><li>Proof of concept initiative to generate transferable knowledge about practice transformation (Future of Family Medicine) </li></ul><ul><li>36 practices randomized into control and intervention group - June ’06 - April ’08 </li></ul><ul><li>Complex practice change interventions must combine flexibility in the intervention model, implementation strategy, and the evaluation, in order to maximize ongoing learning </li></ul><ul><li>Financial support </li></ul><ul><li>Organizational Improvement and Quality Improvement Facilitation </li></ul><ul><li>Peer to Peer Learning </li></ul>Implementing the Patient-Centered Medical Home: Observation and Description of the National Demonstration Project, Elizabeth E. Stewart, PhD et al, Annals of Family Medicine 8:S21-S32 (2010)
    5. 5. Change is difficult at all levels <ul><li>Front-line care givers need adequate resources/time to transform their practices </li></ul><ul><ul><li>What do they need? What have we learned in the past 10 years? </li></ul></ul><ul><ul><li>What works best? Here in Vermont? Elsewhere? </li></ul></ul><ul><ul><li>The importance of Peer-to-Peer Learning! </li></ul></ul><ul><li>Quality Through Collaboration: </li></ul><ul><li>The Future of Rural Health Care </li></ul><ul><li>Institute of Medicine (2005) </li></ul><ul><li>5 pronged strategy: </li></ul><ul><ul><li>Integrated, prioritized approach </li></ul></ul><ul><ul><li>Stronger QI support structure </li></ul></ul><ul><ul><li>Human resource capacity </li></ul></ul><ul><ul><li>Financial stability </li></ul></ul><ul><ul><li>Invest in an IT infrastructure </li></ul></ul>
    6. 6. Stronger QI support structure – Importance of Peer to Peer Learning <ul><ul><li>Improving Performance in Practices, American Board of Medical Specialties </li></ul></ul><ul><ul><li>RWJF state initiatives in CO, MI, MN, NC, PA, WA, WI </li></ul></ul><ul><ul><li>Sophia Chang, MD, MPH, Director Better Chronic Disease Care, CA Health Care Foundation </li></ul></ul>“ We know that “health care is local” and part of the investment opportunity is to create that local culture of sharing/improving that sustains itself.  It’s the opportunity to not only renew the practices, but really improve the health in their communities—which I think is what it’s all about!” &quot;It was during this second learning session that we observed an early evolution of practice learning. Although the agenda at this second learning session still included national-level consultants, an explosion of crosstalk among the practices permanently shifted the NDP learning environment from didactic to interactive, prompting one practice leader to note, &quot;We are the experts in practice change ... we have to learn from each other.&quot; <ul><li>“ Big believers in peer-to-peer learning” </li></ul><ul><ul><li>Ed Wagner’s team at Group Health Research Institute </li></ul></ul><ul><ul><li>Implementing the Patient-Centered Medical Home: Observation and Description of the National Demonstration Project, ANNALS OF FAMILY MEDICINE VOL. 8, SUPPLEMENT 1, 2010 </li></ul></ul>
    7. 7. … And Another Issue <ul><li>Cardiologists </li></ul><ul><li>OB-GYN practitioners </li></ul><ul><li>Psychiatrists </li></ul><ul><li>Nephrologists </li></ul>“ The broader issue is how to improve primary care–specialist collaboration. We agree … that such collaboration will be essential if PCMHs are to provide high-quality, cost-effective care. We also agree that policymakers should make more effort to align specialist and primary care incentives. This alignment can occur in multispecialty medical groups and may occur within accountable care organizations, if these are created…”
    8. 8. Meaningful Use and Medical Home are mutually supportive enablers of better care <ul><li>Provide each patient with an ongoing relationship with a personal physician who is trained to provide first-contact, continuous, and comprehensive care. </li></ul><ul><li>Provide care for acute and chronic conditions, preventive services, and end-of-life care, or arrange for other professionals to provide these services. </li></ul><ul><li>Coordinate care across all elements of the health care system, with coordination facilitated by the use of registries and information technology. </li></ul><ul><li>Provide enhanced access to care through systems such as open scheduling, expanded hours, and new options for communication between patients and the practice's physicians and staff. </li></ul><ul><li>*Adapted from the Joint principles of the patient-centered medical home. American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association, 2007 1 </li></ul>1 Specialist Physician Practices as Patient-Centered Medical Homes, Casalino et al. 10.1056/NEJMp1001232, April 21, 2010NEJM.org.

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