facilitating primary care practice transformation nursing research symposium november 12, 2011...
TRANSCRIPT
Facilitating Primary Care Practice Transformation
Nursing Research Symposium
November 12, 2011 Sandra M. Robinson, MS, RN, Practice Facilitator
Nancy H. Abernathey, MSW, LICSW, Practice Facilitator
Laura Carleu, RN, MS, MPH, Practice Facilitator
Theresa Fortner, RN, Practice Facilitator
Elise McKenna, RN, MPH, MSEd., Practice Facilitator
Miriam Sheehey, RN, Practice Facilitator
Facilitating Primary Care Practice Transformation
Blueprint ExpansionLegislative mandate (Act 128)
Vermont Act 128 of 2010 requires Commissioner of Vermont Health Access to expand the Blueprint for Health to at least two primary care practices in very hospital service area no later than July 1, 2011 and no later than October 1, 2013 to primary care practices statewide whose owners wish to participate (Multi-payer Advanced Primary Care Practice Demonstration Project application, 8/11/2010)
Facilitating Primary Care Practice Transformation
Blueprint Expansion 545 physicians and 239 APRNs, CNMs and PA-Cs
in 220 primary care practices in Vermont 12 practice facilitators deployed throughout state
with “caseload” of 4-10 practices each; work with practice 6-12 months
46 practices scored in last 12 months since facilitators began work in 11/10.
Adding approximately 6 practices per month to those recognized as patient-centered medical homes; another 90 practices are scheduled to be scored/recognized in 2012. (Multi-payer Advanced Primary Care Practice Demonstration Project application, 8/11/2010)
Facilitating Primary Care Practice Transformation
Blueprint Assumptions/Principles Advanced Model of Primary Care can result in better
health outcomes and reduced expenses for costly ED and hospital visits
Foundation of primary care is a long-term relationship with one provider (for continuity and consistency)
Team-based approach to primary care utilizes all team members in a patient-centered approach, engaging patient to participate and/or direct his/her care (self-management)
Facilitating Primary Care Practice Transformation
Blueprint Assumptions/Principles Managing a panel or population of patients is an
organized, systematic approach to primary care that measures success:
Process measures (eg Asthma panel: # patients who do not have an asthma action plan)
Outcomes measures (eg Asthma panel: # patients who had ED visit in a defined time period)
“Care gaps” are addressed by improving processes for care
Facilitating Primary Care Practice Transformation
CHANGE
“It is not the strongest of the species that survives, nor the most intelligent that survives, it is the one that is the most adaptable to change.”
Charles Darwin
Facilitating Primary Care Practice Transformation
Characteristics of effective change championsResponsive to data
Encourage open exchange of ideas
Not always the “expert” – ask for help
Organized
Available/visible
Action-oriented
Approachable
Reliable Source: HealthTeamWorks
Facilitating Primary Care Practice Transformation
Statewide revolution of grass-roots, local process improvement workSmall businessesSmall staffSmall/No budgetBig ambitionHuge commitmentSpectacular results
Facilitating Primary Care Practice Transformation
Facilitator role is an opportunity to be part of this “moment in time,” “grand experiment”
Challenge/opportunity requires: Commitment to making primary care better for all Vermonters High tolerance for ambiguity Confidence and humility (insight to know when to show which) Generosity and team spirit (share everything you know and do with
everyone!) Sense of humor
Facilitating Primary Care Practice Transformation
What do we do? Assess the practice
Clinical microsystems – how does the system work? Visit cycle time Through the Eyes of Patients Patient Satisfaction Staff Satisfaction Core process assessment
Facilitating Primary Care Practice Transformation
Assess the practice NCQA Standards
Access and Continuity Panel Management Focus on chronic conditions important to practice
Evidenced-based guidelines Self-management
Test/referral tracking and follow-up Coordination of care/transitions Performance Improvement/measurement
Facilitating Primary Care Practice Transformation
What do we do? Identify gaps
Facilitating Primary Care Practice Transformation
What do we do? Plan improvements
Access Data integrity Care coordination Panel/population management Self-management
Facilitating Primary Care Practice Transformation
What do we do? Examples of improvements
Evidence-based guidelines in EHR visit templates – improved adherence to guidelines
Panel management improvements: Mammograms Hgb A1Cs for patients with diabetes
Installation of kiosk for registration to free up time staff time for telephones
Facilitating Primary Care Practice Transformation
What do we do? Measure success
Waterbury Medical Associates
Goal: to increase the % of diabetic patients with documented data on 4 core variables to 85% during the pilot period
The Intervention:• Decision to measure heights on all patients at non-acute visits•Review documentation rules (where each measure should be documented in the EMR)•Patient “flow sheet” printed out for all patients with a dx of diabetes the evening before the visit for the provider to review. The flow sheet contains longitudinal data from the last 5 visits
Waterbury Medical AssociatesResults
Provider 1: Phase I (n=10) Provider 2: Phase II (n=15)
St. Albans Primary CareKiosk check-in Improvement Plan
AIM:
Free up one front desk person to focus on timely answering of phones so as to put patients/callers on hold less. Kiosk installed for patients to use to check in independently so that one less person is needed to at front desk.
St. Albans Primary CareKiosk check-in Improvement Plan
Results
St. Albans Primary CareKiosk check-in Improvement Plan
Results
Facilitating Primary Care Practice Transformation
Where do we work? Hospital-owned practices
Facilitating Primary Care Practice Transformation
Where do we work? Small, independent practices
Facilitating Primary Care Practice Transformation
Where do we work? Federally-qualified health centers
Facilitating Primary Care Practice Transformation
Where do we work? Multi-practice corporations with sites throughout
state
Facilitating Primary Care Practice Transformation
Nursing skills required: Knowledge of evidenced-based guidelines Understanding of IT and how EHRs work Data management Creativity/ingenuity
Are practice facilitators making a difference? Sustainability – building capacity in practices
What is the future role for facilitators? Consultant to primary care practices for ongoing process
improvement support Support future Blueprint Expansion
Thank you!