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Collaboration and Practice
Transformation in Residency
Education
William 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 Meyers
PCP 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, FAAFP
Chair, 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 Collaboratives
SPREAD OUT
Initially
I3= NC, SC, VA
Colorado
PA
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
0
10
20
30
40
50
60
70
80
90
100
Team Redesign* Pt. Centered* SMS* Info. Systems*
Baseline
Mid
End
PCMH-Clinician Assessment:
All Practices
*p < 0.0001
0
10
20
30
40
50
60
70
80
90
100
Change Culture * Work Environment
**
Chaos
Baseline
Mid
End
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?
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
2011 2012 2013 2014
No influence
Some influence
A lot of influence
How valuable was the PCMH Residency project
in preparing for your new practice?
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
2011 2012 2013 2014
Not valuable
Somewhat valuable
Valuable
Very 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
L
S
5
L
S
6
L
S
4
L
S
3
L
S
2
L
S
1
Oct Dec Feb April
June Aug Oct
Prevention of Missed and Delayed Dx:
Colorectal Cancer (Adult)
Developmental Delays (Pediatric)
AIC CARES Timeline
Dec
Feb April June
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
AIM 1. Describe tactics practices are using to implement important
elements of AIC
AIM 2. Evaluate primary care work life, professional satisfaction,
and career intentions of attendings and trainees
AIM 3. Examine degrees of improvement in healthcare quality,
spending, and patient experience
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/c
onnect/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!

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Clinical Innovation Network April 2015 Webinar: Practice Transformation in Residency Education

  • 1. Collaboration and Practice Transformation in Residency Education William 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
  • 2. 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 Meyers PCP Clinical Innovation Network Content Fellow University of Minnesota Welcome! Enjoying the webinar? Tweet about it! #CINWebinar
  • 4. Residency Training Program PCMH Collaboratives the PA Story and beyond… William Warning, MD, FAAFP Chair, 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
  • 5. 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
  • 6. 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
  • 7. State Collaboratives SPREAD OUT Initially I3= NC, SC, VA Colorado PA Then… …The Academic Collaborative! …The Collaborative OF THE Collaboratives! #CINWebinar
  • 8. 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
  • 9.  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
  • 10. 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
  • 11. • 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
  • 12. 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
  • 13. 0 10 20 30 40 50 60 70 80 90 100 Team Redesign* Pt. Centered* SMS* Info. Systems* Baseline Mid End PCMH-Clinician Assessment: All Practices *p < 0.0001
  • 14. 0 10 20 30 40 50 60 70 80 90 100 Change Culture * Work Environment ** Chaos Baseline Mid End Practice Culture Assessment *p < 0.0001 **p = 0.0088
  • 15. 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
  • 16. How much did the PCMH Residency project experience influence your choice of practice? 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 2011 2012 2013 2014 No influence Some influence A lot of influence
  • 17. How valuable was the PCMH Residency project in preparing for your new practice? 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 2011 2012 2013 2014 Not valuable Somewhat valuable Valuable Very valuable
  • 18. • 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
  • 19. Awareness of the Collaborative in Residency • Worked closely with our health coaches • PCMH curriculums across residencies • Biannual learning collaboratives! #CINWebinar
  • 20. 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
  • 21. 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”
  • 22.
  • 23. • 20 primary care teaching practices • 275,000+ patients • Student & residents • Expert consultation • External evaluation Academic Innovations Collaborative (AIC) #CINWebinar
  • 24. 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.
  • 25. 201620152014 L S 5 L S 6 L S 4 L S 3 L S 2 L S 1 Oct Dec Feb April June Aug Oct Prevention of Missed and Delayed Dx: Colorectal Cancer (Adult) Developmental Delays (Pediatric) AIC CARES Timeline Dec Feb April June Improve Outcomes for Patients with Complex Care Needs Prevention of Missed and Delayed Dx: Breast Cancer (Adult) TBD (Pediatric) Estimated transition Estimated transition
  • 26. AIC Evaluation AIM 1. Describe tactics practices are using to implement important elements of AIC AIM 2. Evaluate primary care work life, professional satisfaction, and career intentions of attendings and trainees AIM 3. Examine degrees of improvement in healthcare quality, spending, and patient experience
  • 27. 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
  • 28. 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/c onnect/forums
  • 30. • 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!

Editor's Notes

  1. DOUG: through QUALITATIVE Slides
  2. -- worked closely with HCs but may not realize they cross into other practices -- know other residencies are teaching PCMH, but maybe to different extents and in definitely in different formats
  3. Regardless of role – our nurse manager learned from another clinic’s care mgr about waiting room rounding and initiated it in our clinic; in that way, ideas spread empowerment Resident presentations – PAC presentations  key component of fellowship Residency specific projects – could be inpatient, hospital to home transitions, transitioning resident empaneled patients, how to facilitate longitudinal QI projects on a resident schedule, etc. PAC conference call with Bruner – bruner pt advisors working on paper with me.
  4. Wins – patient engagement piece across practices at the last collaborative Competition – proud of your practice and want to stay ahead of the curve Speaks PCMH – noted at chief retreats