Transcript Panel Management, Applying Population Health and Best Evidence

Panel Management, Applying
Population Health and Best
Evidence
Paige Hatcher, MD
- Diplomate, ABFM
- Preventive Medicine Resident, OHSU
- MPH Candidate, PSU
- Health Policy Fellow, OHA
What is Panel Management?
• Addresses population health through the lens of primary
care
• Evidence-based protocols and to provide selfmanagement support
• Systems to standardize care using a team-based
approach
• Designing a system that “remembers” and prevents
errors of forgetting
Neuwirth, E. B., Schmittdiel, J. A., Tallman, K., & Bellows,
J. (2007). Understanding Panel Management: A
Comparative Study of an Emerging Approach to Population
Care. The Permanente Journal, 11(3), 12-20.
What is Panel Management?
• Dedicated physician time for directing clinical
decision making
• Dedicated staff members or staff time to support
physicians and conduct outreach
• Information-technology tools to identify care
gaps
• Structured work processes completed on a
routine basis
Experience at KP
• Patients mostly like it
• Mostly implemented without new funding (some
require resource shift)
• Wide-scale dissemination through entire
facility/area
• Focused on a particular disease or high-risk
group
• 45-180 min PCP time reserved per provider per
month
Change to Standard Practice
• Requires a shift in thinking
• “It doesn’t make my day easier, but it makes my day
better”.
• “Giving me hope that some of my more difficult
patients might actually turn around their health
status”.
• Biggest change to MA and support staff roles, but
they welcomed the opportunity for job growth.
• Less face to face time can be dissatisfying.
• Patients worry decisions aren’t being made by their
doctors
Managing Change
• Physicians feel like they are losing control
• Imperative to respond with demonstration of
performance improvement
• Champions
• Warm handoffs
“Topic” Selection
• Often incentivized by a performance payment
opportunity
• Should be evidence-based, simple, and clear
• Aim for incremental improvement
Creating a Registry
• Identification of patients with particular need
• Review of list generated for appropriateness for
inclusion
• Treatment decision
• Follow up communication with patient
Example: I want all my patients to be upto-date on cervical cancer screening
• Generate First List
• Women 21-29 with an intact cervix and no pap
result for the last 3 years
• Women 30-65 years with an intact cervix and no
HPV result for the last 5 years*
*This should be tailored to your practice, if you
haven’t been doing mandatory HPV testing, then it
will be “no pap result for the last 3 years”1
Next Steps
• PCP Reviews list for appropriateness of
inclusion
• Outreach to schedule patients, correcting chart
where needed if Pap has been done somewhere
else
• Run the list again (time interval TBD) and
compare N, report results as appropriate
• PCP reviews the list again
▫ Then, start outreach to new group, adjust tactic,
etc.
Best Sources for Evidence
National Guideline
Clearinghouse
http://www.guidelines.
gov/
Best Sources for Evidence
US Preventive Services Task Force (USPSTF)
http://www.ahrq.gov/clinic/uspstfix.htm
Best Sources for Evidence
National Institute for
Health and Clinical
Evidence (NICE)
(England and Wales)
http://www.nice.org.u
k/
Patient Information
Choosing Wisely®
campaign
http://choosingwisel
y.org/
Asking your question (PICO)
• Patient- children or adults, pregnant women,
patients with a specific chronic disease or
problem
• Intervention- prevention, diagnosis, treatment
• Comparison- standard practice, placebo,
alternative therapy
• Outcome- acute or chronic
http://libguides.ohsu.edu/content.php?pid=25570
9&sid=2879578
PubMed MESH search
If you search for “pap smear” and “screening”
in PubMed, you get 15515 results.
Using MESH search Terms
Other Benefits
• ABFM MC-FP Part IV modules are Performance
in Practice Modules (PPMs), which are designed
as a Quality Improvement activity which takes
place over a one week period
Additional References
1. Saslow, D., Solomon, D., Lawson, H. W.,
Killackey, M., Kulasingam, S. L., Cain, J., ... Myers,
E. R. (2012). American Cancer Society, American
Society for Colposcopy and Cervical Pathology, and
American Society for Clinical Pathology Screening
Guidelines for the Prevention and Early Detection
of Cervical Cancer. Journal of Lower Genital Tract
Disease, 16(3), 00-00.