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Disease Management in a Multi-Specialty Group Practice

Disease Management in a Multi-Specialty Group Practice. Terrigal Burn, MD. Palo Alto Medical Foundation: Palo Alto Division. Education Division Research Institute Health Care Division: 2002 Year End Data 227 FTE Physicians 999 Staff 868,943 patient visits Surgecenter 6,718 surgeries

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Disease Management in a Multi-Specialty Group Practice

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  1. Disease Management in a Multi-Specialty Group Practice TerrigalBurn, MD

  2. Palo Alto Medical Foundation: Palo Alto Division • Education Division • Research Institute • Health Care Division: 2002 Year End Data • 227 FTE Physicians • 999 Staff • 868,943 patient visits • Surgecenter 6,718 surgeries • Main Campus in Palo Alto with satellite offices in Fremont, Los Altos, Portola Valley, and Redwood Shores

  3. Palo Alto Medical Foundation: Palo Alto Division Locations Connected Through Epic

  4. What is Disease Management? • Interventions designed for groups of patients: populations • Interventions to supplement or even replace the 1 to 1 face to face encounter in the exam room

  5. Evidence Based Medicine--Haven’t we always done that? • Role of mentors • Training emphasizes self reliance • Every patient is unique

  6. Keeping up with the Science • Pharyngitis (sore throat) • 5240 articles in MedLine • 2345 articles in last 2 years • 20 articles per day, 365 days per year

  7. How to search the medical literature Understand hierarchies of evidence When is there good data, when not? How to apply the evidence to the particular clinical situation Use evidence to develop best practices Monitor how well we do this Applying EBM

  8. Medication BPAs: Alternative Medications

  9. Harnessing the Power oftheElectronic Medical Record • Case of an elderly patient taking a Non-Steroidal Anti-Inflammatory Drug (NSAID) who developed kidney failure was referred to Care Review • Variation existed in monitoring kidney function of patients receiving high-risk medications • A Best Practice Alert was developed • Measurable, durable improvement in monitoring of kidney function was the result

  10. Clinical Decision Support (CDS): Current Best Practice Alerts • Health Maintenance Alerts • Influenza and Pneumococcal Vaccine • Diabetes • Pap Smear • Well child • Medication Alerts • Allergies • Drug Interactions • Food/Alcohol Reactions • Alternative medication for formulary restrictions

  11. Guidelines • Epidural steroid injections in back pain • Shock wave treatment of plantar fasciitis • How to evaluate rectal bleeding in younger individuals

  12. Disease Management • Congestive Heart Failure • Diabetes • Antibiotic use in upper respiratory infection • Preventive Health Care • Seniors at Home • Shared Medical Appointments

  13. A Suite of Tools • Rosters • Best Practice Alerts • Technology assessment • Guidelines • Group visits • Disease Management • Education about Evidence Based Medicine • Financial incentives

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