Transcript Patient Centered Medical Home Quality Patient Care In The

2011 Patient Centered
Medical Home
Monthly Webinar Series
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Best Practice: Access to Care
& Communication
Gretchen Geist, RN; BSN
Brad Meyers, MD
Objectives
• Identify the concepts of open access (OA)
• Understand the application of OA to PCMH
• Identify strategies for integrating
communications among staff
• Identify strategies for implementing improved
access and communications with patients
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What is Open Access?
Same-day scheduling, also called advanced
access or open access, is a method of
scheduling in which all patients can receive an
appointment slot on the day they call, almost
always with their personal physician. (AHRQ)
The goal is to reduce or eliminate wait times both
for appointments and at the time of the
appointment.
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Do Today’s Work Today
Mark Murray, MD
BALANCE
Supply (clinicians’ time)
=
Demand (appointment visits)
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Why improve access?
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Increased productivity
Greater patient satisfaction
Better care/continuity/clinical outcomes
More efficient predictable work flows
Physician/staff well-being
PCMH 2011 NCQA Standards & CAHPS
New payment models
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NCQA-PCMH 2011 Standards
1)
2)
3)
4)
Enhance Access and Continuity
Identify and Manage Patient populations
Plan and Manage Care
Provide Self-Care Support and
Community resources
5) Track and Coordinate Care
6) Measure and Improve Performance
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PCMH1: Enhance Access and Continuity
A.
B.
C.
D.
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F.
Access during office hours** CF
After-hours access CF
Electronic access MU
Continuity
Medical Home responsibilities
Culturally and linguistically appropriate
services (CLAS)
G. Practice Team CF
**Must Pass Element
CF=Critical Factor
MU=Meaningful Use
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PCMH1A: Access During Office Hours—
Must Pass
Practice has written process/standards and
demonstrates that it monitors performance
against the standards to:
1. Provide same-day appointments--CRITICAL
FACTOR
2. Provide timely advice by telephone
3. Provide timely advice by electronic message
4. Document clinical advice
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How to improve access?
1) Improvement Discipline
2) Principles for Same-Day
Scheduling
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Improvement Discipline*
Take action using closed loop feedback
process with these or similar steps:
1) Define the problem
2) Assemble a team
3) Set an aim or goal (measurable)
*Adapted from six sigma DMAIC steps
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Improvement* cont’d
4) Develop data collection tools; collect
data from different sources to determine
magnitude of problem
5) Create solutions and implement action
(mini-testing cycles to find best fit)
6) Monitor and measure outcomes
*Adapted from six sigma DMAIC steps
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Principles for Same-Day
Scheduling
A principle is the beginning of an action.
1) Understand, measure and achieve a
balance between supply and demand
2) Recalibrate the system (reduce the
backlog)
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Principles cont’d
3) Reduce the number of queues
4) Create contingency plans for times of
↑ Demand or ↓ Supply
5) Influence the Demand
6) Manage the constraints/bottlenecks
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Achieving Access at Rockwood
• Established “no-waiting” as fundamental
expression of respect for patients—shared
value
• Designed office, exam rooms for efficient
work flow
• Placed physician’s office near front for
quick access to staff—communication
• Modified-wave scheduling balances supply
and demand hourly
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Access at Rockwood cont’d
• Recall list (monthly) for chronic disease
management (planned care) and
preventive screenings—influence demand
• Three types of appointments plus
procedures
• Chart review day before all visits, both lab
and return (RN, CMA, Billing, Scheduler)
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Access cont’d
• Annual chart review of all active files
• Regular staff meetings—scheduling on
agenda every time—all staff except office
manager and physician rotated chair
role/responsibilities
CHALLENGES
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…places that function most like a system
are most successful. By system I mean that
the diverse people actually work together to
direct their specialized capabilities toward
common goals for patients.
They are coordinated by design.
They are pit crews.
To function this way, however, you must
cultivate certain skills which are uncommon
in practice and not often taught.
~Atul Gawande, MD from commencement address, Harvard Medical School
May 2011
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The Pit Crew
PCMH1
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PCMH1G: The Practice Team
Practice provides patient care services by:
1) Defining roles for clinical/non-clinical team members
2) Holding regular team meetings-Critical Factor
3) Using standing orders
4) Training and assigning care team to coordinate care
5) Training on self-management, self-efficacy and
behavior change
6) Training on patient population management
7) Training on communication skills
8) Care team involvement in performance evaluation and
QI (quality improvement)
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Healthcare Teams—Interprofessional
Collaborative Practice Competencies
Domain 1: Values/Ethics. Work with individuals
of other professions to maintain a climate of
mutual respect and shared values.
Domain 2: Roles/Responsibilities. Use the
knowledge of one’s own role and those of other
professions to appropriately assess and address
the healthcare needs of the patients and
populations served.
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Healthcare Teams—Interprofessional
Collaborative Practice Competencies
Domain 3: Communication. Communicate with
patients, families, communities, and other health
professionals in a responsive and responsible
manner that supports a team approach to the
maintenance of health and treatment of disease.
Domain 4: Teams and Teamwork. Apply
relationship-building values and the principles of
team dynamics to perform effectively in different
team roles to plan and deliver patient/population-centered care that is safe, timely,
efficient, effective, and equitable.
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Teams-Teamwork-Team-based Care
Communication
Take the time to do it well
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Clarity “My role is…”
Complexity “How can we begin…”
Consensus “We all value…”
Conflict “I see your point…”
Continuous Quality Improvement “We can do…better”
Coordination “I care…you care…we care…”
Cooperation “I can help with…”
Commitment “Yes, and…”
Teach others by example
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Who is Driving the Car?
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References
Agency for Healthcare Quality and Research.
http://www.cahps.ahrq.gov/QIguide/content/interventions/OpenAccessSchedulingforR
outineandUrgentAppointments
Green, L., & Savin, S. (2008). Reducing delays for medical appointments: A queuing
approach. Operations Research, 56(6), 1526-1538.
Institute for Healthcare Improvement (IHI). Primary care access. Retrieved from
http://www.ihi.org/IHI/Topics/OfficePractices/Access/
Interprofessional Education Collaborative Expert Panel (2011). Core competencies for IP
collaborative practice: Report of an expert panel. Washington, DC: Interprofessional
Education Collaborative.
Murray, M. (2005). Answers to your questions about same-day scheduling. Family
Practice Management, 12(3), 59-64. Retrieved from http://www.aafp.org/fpm
National Committee for Quality Assurance (NCQA, n.d.). Patient Centered Medical Home
Standards Workshop 2011. Retrieved from http://www.ncqa.org/
Rose, K., Ross, J., & Horwitz, L. (2011). Advanced access scheduling outcomes.
Archives of Internal Medicine (online version) doi:10.1001/archinternmed.2011.168
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