Transcript Colorado Family Medicine Residency Patient

Practice and Curricula
Transformation in Residency
Practices: Are We Homes Yet?
Bonnie Jortberg, MS,RD,CDE
University of Colorado Denver
Department of Family Medicine
Nicole Deaner, MSW
Colorado Clinical Guidelines Collaborative
Who is Involved?
• Funded by The Colorado Health Foundation
• University of Colorado Dept of Family Medicine
– Perry Dickinson MD: Project Director
– Bonnie Jortberg: Project Coordinator,
Curriculum Redesign
– Doug Fernald, Evaluation
– Frank deGruy MD
– Larry Green MD
Who is Involved?
• Colorado Clinical Guidelines Collaborative
(CCGC)
–
–
–
–
Nicole Deaner: Practice Improvement Coach
Caitlin O’Neill: Practice Improvement Coach
Julie Schilz: Manager, IPIP and PCMH
Marjie Harbrecht : CCGC Executive Medical Director
• Colorado Association of Family Medicine
Residencies
– Nine Family Medicine Residencies + one track
– 10 residency practices
– Tony Prado-Gutierrez: Director
What is Involved?
Planning Phase
• Preparation for practice and curricular
redesign
• Assistance with IT issues
• Start working on forming improvement team
• Practice/program discussions of PCMH
• Sponsoring organization – look for support,
try to remove barriers
• Prepare for cultural transformation
Practice Coaching
• Active coaching period – approximately 14
months
• Assessment with feedback – 2 months
• Active coaching with practice improvement
team(s) – 12 months (or more)
• Continued team meetings for PCMH
changes, other practice improvement with
coach “boosters”
Collaboratives
• Meetings of representatives of all practices
and programs
• Planning, sharing, educational – highly
interactive
• Two collaboratives per year
– First one May 2009 – 105 people from the
practices
– Second in October – over 130 from practices
What’s Provided?
• Assistance with orientation to PCMH, initial
planning, working with hospital leadership
• Coaching team provided
• IT consultation resources
• PCMH consultation and support
• NCQA PPC-PCMH certification paid for
• Direct funding for the programs
Curricular Redesign Objectives
• Facilitation and consultation for PCMHrelated curriculum changes
• Changes to free up residents to participate
in PCMH and QI efforts
• Shared resource development across
programs (lectures, modules, etc)
• Active involvement of residents in practice
redesign process
• PCMH practices for residents to experience
Practice Outcomes
• Achieve NCQA PPC-PCMH certification –
hopefully at least level 2
• Improve level of medical homeness:
– NCQA PCMH assessment
– PCMH Clinician Assessment
– Practice Staff Questionnaire
• Improve quality measures in two clinically
important areas to be chosen by the
practices
Curricular Outcomes
• Improved resident achievement of PCMH
competencies
• Improved resident use of PCMH elements as
assessed by PCMH clinician assessment
• Revision of residency curricula to allow resident
participation in PCMH and QI efforts
• Implementation of PCMH curricular elements
• Will follow resident In-training Exam and Board
Exam scores, but may not show up there
Two Parts of Project—Practice and
Curriculum Redesign
Curricular Redesign
PCMH Residency Practice
Practice Improvement
Practice PCMH Transformation
NCQA Certification
Iterative Practice Redesign
Cultural Transformation
Baseline Assessment Process –
Practice Improvement
•
•
•
•
NCQA Self-Assessment – group or individual
Key Informant Interviews
Cycle Time Report
Online surveys using survey monkey:
o PCMH - Clinician Assessment (PCMH-CA)
o Practice Staff Questionnaire (PSQ)
Baseline Assessment Report
• Structure:
– Narrative explanation and assessment on 7 core
elements
– Data tables for responses to NCQA Self-Assessment
& responses to PSQ & PCMH-CA
– Recommendation section
– Approximately 10 pages long
– Appendix:
• PCMH-CA & PSQ graphic data (previous slides) with
narrative explanation
• NCQA Self-Assessment Report
Practice Redesign Lessons
Learned
• Leadership buy-in prior to project launch critical.
• High-functioning teams build foundation for project.
• Clinic flow - first entrée into working on teams & teaching
QI principles.
• QI teams big cultural shift for existing leadership
structure; largest source of resistance.
• Building communication infrastructure for all staff
inclusion a local and important process.
• Current: choosing clinically important conditions &
registries
• Next steps: Patient Involvement and Reporting & Posting
Measures
Curriculum Redesign
• Challenges and Opportunities
– No organized, comprehensive PCMH
curriculum or materials
– No developed curriculum competencies
– No tools to assess PCMH curricular activities
or resident competency
Curriculum Redesign
• Started with developing competencies
(see handout)
• Curriculum Assessment:
– Developed Residency Curriculum SemiStructured Interview Template to determine
current PCMH curricular activities; identify
gaps; set goals and establish plan
Curriculum Assessment
• Competencies:
– Who, what, where, when, how for each
• Summary Questions:
– Strengths/weaknesses of curriculum
– What do they need the most help with for the
curriculum?
– Resource for other programs
– How do they characterize their sponsor’s interest and
support for this project?
– Resident’s interest and support (scale 1-5)
– Staff and faculty support
Resident PCMH Curriculum
Competency Survey
• Developed to assess resident baseline
competence (See handout)
Results and Lessons Learned
• Interview completed with 3 programs so far
• Emerging Themes:
– Interview process is an “intervention” for the program
• Makes them take comprehensive look at what they are
teaching
• “We want to go from reactive teaching to intentional teaching”
– Revealing that they are teaching many of the
elements of the PCMH, just not in an organized
manner
– Resident participation on the QI teams an important
curricular component
Results and Lessons Learned
• Common areas meeting competencies (through
resident involvement in QI teams)
–
–
–
–
Team approach
Integrated and coordinated care
Quality Improvement
Leadership skills
• Common areas not meeting competencies
–
–
–
–
Population management
Access to care
Information systems to support PCMH
Self-management support
Results and Lessons Learned
• Time-consuming process
• Great qualitative data
• Quantitative data still to be determined
Curriculum Redesign: Next Steps
• Review feedback report
• Goal setting for each practice
• Actively developing curricular modules and
tools
• Integration of curricular modules and tools
• Continuous evaluation
Questions?
• Contact Information:
– Bonnie Jortberg:
[email protected]
– Nicole Deaner:
[email protected]