Transcript Document

Group Medical Visits
For Specialists
www.pspbc.ca
Group Medical Visits
Aim
 Improve patient access to and increase efficiency of care and
follow-up through shared medical appointments, a time-efficient
method of treatment
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Focus on
 Identify suitable patient populations and best suited practice
approach
 Plan, implement and evaluate shared medical appointments
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SMA Aims
 Improve access (decrease waiting time)
 Improve efficiency
 Integrate health services – ‘wrap the services around the patient’
 Improve patient and provider satisfaction
 Improve health outcomes
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What are the best patient populations for SMAs?
 Baseline data
 Endoscopy: Approximately 300 scopes per year
 Individual consult appointments
 Average wait time for consult – 8 weeks
 Average wait time for scope 6-8 weeks
 Procedure appointments booked by hospital staff via phone calls
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Scenario – Defining the Measures
 TIME 1 – referral letter to group visit
 TIME 2 – group visit to scope procedure
 Number of patients seen
 Physician and staff work hours
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Scenario – The Plan
 Establish the team – including hospital staff
 Determine objectives
 Formulate a process
 Set a date, time and location
 Initiated group consults June 25 2008
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Scenario – Summary of Measures
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TIME 1 to 4 weeks (50% reduction)
TIME 2 to 4 - 6 weeks (30% reduction)
consult time by 52%
number of patients seen by 29%
hospital staff booking time by 64%
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How do we know we have achieved
positive sustainable change?
 Met objectives and measures
 Group visits held twice a month
 Process embedded in the clinic
 Cross-training of clinic staff
 Hospital staff continue to be involved
 Lead physician promoting group visits with other physicians
 Patient satisfaction
 Provider and staff satisfaction
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Group Medical Visit Benefits
 Decreased wait time
 Improved health maintenance
 Enhanced services and quality of care
 Improved patient and physician relationships
 Improved patient and provider satisfaction
 Cost savings
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Group Medical Visits Roles
 Specialist
 MOA
 PSP Coordinator
 RNs/other health care providers
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Specialist Role
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1 to 1 Specialist/patient appointment done in a Group
Share patient clinical data (flip chart, overhead)
Charting during the group meeting
Order lab/diagnostics
Prescriptions
Chart notes
Patients that need to be seen privately can do so at the end
Arrive on time
Leave on time
Participates in short debriefing at the end of GMV
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MOA or office staff
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Organize the group space
Working with the Specialist to ID good time and how often GMVs will be held
Overbook by 25% (stats show 81% of pre-registered actually show up)
Telephone bookings and patient invite and/or send out invitation letter
Make a patient information package
› Confidentiality form
› Evaluation form
› Flow sheets
› Handouts doctor wants
 Track data/narrative reports/measures i.e. module measurements, completion
and target rates
 As patients arrive assist with BP, weight, etc. and document
 Participates in short debriefing at the end of GMV
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Coordinator role
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Facilitates learnings for GMV for each team member
Encourages role maximizing, and role expansion training
Assists with finding a suitable behaviourist
Attends GMVs until independent
Facilitates team debrief after each GMV
Continues to keep in touch for support
Facilitates model for improvement testing and evaluating
Writes PDSA
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Physicals Shared Medical Appointments
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Shared physicals appointment
They reduce repetitive information
8-12 patients
90 minutes long
First half of the session is a private physical exam by doctor while other group members are sharing & learning with
behaviourist
 Second half is doctor patient interactions in a group
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Aim Statement: Increased access, capacity and
efficiency in specialty practice
 The care of patients requiring specialty services will be
redesigned to increase access, capacity and efficiency in
specialty practices.
 Advanced Access, Efficiency change packages, including Group
Medical Visits will be used to decrease the wait time of patients
for and at appointments in specialty practices.
 Change will be evidenced by improved 3rd next available
appointment, or improved cycle time, or the implementation of a
minimum of two Group Medical Visits.
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The Model for Improvement
 What are we trying to accomplish?
› Aim
 How do we know a change is an
improvement?
› Measures
 What changes can we make that will
result in an improvement?
› Are the small test of changes showing improvement?
Source: The Improvement Guide (Langley, Nolan, Nolan, Norman, and Provost, Jossey-Bass, 1996).
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The PDSA cycle
Act
Plan
• What changes
• Objective
• Questions and
are to be made?
• Next cycle?
• Plan to carry out
• Complete the
Study
analysis of the data
• Compare data to
predictions
• Summarize what
was learned
predictions (why)
the cycle (who,
what, where, when)
Do
• Carry out the plan
• Document problems
and unexpected
observations
• Begin analysis
of the data
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Repeated use of the PDSA cycle
Changes that result in
improvement
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P
S
D
Implementation of change
Wide-scale tests of
change
Hunches
theories ideas
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P
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Follow-up tests
Very small scale
test
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Improved access =
better patient
outcomes
Specialty: Improving access
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P
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D
Cycle3: Group Medical Visit 2 X per month to
work down backlog
A P
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Cycle 2: Work 1 hour later each day to work down backlog
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Cycle 1: Measure 3
rd
Next Available
Reduce backlog: Goal is 5
days
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Kelowna’s Aim: Reduce use of Foley catheters
following joint arthroplasty surgery
Standing orders do
not include
catheters
Idea:
Don’t insert at all or else
remove catheters Day 1
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P
S
D
Cycle3: Second surgeon trials no Foley and
in and out PRN
A P
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Cycle 2: Dr. O’C trials no Foley insertion on pt. with no hx of
urinary problems. In and out catheter if unable to void
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Cycle 1: On male pt. of Dr. O’C’s, with no hx of urinary problems, Foley is
d/c’d POD1 with order to perform in and out catheter if unable to void
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Characteristics of the Model for Improvement
Action-oriented – “What are you going to test next Tuesday?”
Rapid-cycle testing of changes
Evaluation and revision of all changes before implementation
Testing and implementing the changes in small populations, then
spreading to the larger population
 Impact evaluated using annotated run charts
 Monthly reporting of tests and outcomes
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Planning for Action Period
“Fail to plan, plan to fail.”
Carl W. Buechner
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For more information
Practice Support Program
115 - 1665 West Broadway
Vancouver, BC V6J 5A4
Tel: 604 736-5551
www.pspbc.ca
www.pspbc.ca