Continuity Clinics as Medical Home

1. Hawaii Dyson Initiative Continuity Clinics as Medical Home Hawaii Dyson Initiative Louise Iwaishi, MD March 5, 2005

2. Hawaii Dyson Initiative Faculty Development • Faculty workshop on the Medical Home elements • Video training vignettes • Performance checklist • Training on giving feedback • Educational strategies • Community Ped Preceptor Prompt card • Medical Home Posters for clinic rooms • Resident Medical Home Best Practice Noon Conferences

3. Hawaii Dyson Initiative Curricular Tools • Practice-based learning tools • Web based, self-directed training module • MH content and case scenarios • Performance Checklist-self assessment • Chart reviews-Quality Improvement, community contacts • Medical Home Model Practice-patient panel • Portfolio assessment • Pre and Post module knowledge assessment • Confidence Survey/MH Attitudinal Scale • Performance checklist • Chart review checklist • Self reflective narrative MH best practice

4. Hawaii Dyson Initiative Web-based Curriculum • http://www.hawaii.edu/dyson/Intro%20medical%20home.htm • Pre and Post module knowledge test

5. Hawaii Dyson Initiative Preceptor Prompt Card • Did the resident identify access, continuity and comprehensive care issues for this patient? • Did the resident know the community resources for the child’s care, family support or coordination needs? • Did the resident identify any cultural aspects or concerns? • How family/patient centered was the resident’s communication?

6. Hawaii Dyson Initiative Medical Home Attitudinal Scale • I understand the concept of the Medical Home. • I feel confident describing the 7 principles of the MH. • I apply the principles of the MH in daily patient practice. • The majority of my patients identify me as their primary care pediatrician. • My preceptors encourage me to apply the MH principles in daily patient practice. • My preceptors routinely provide me with feedback regarding my clinical performance in continuity clinic. • The level of teaching in continuity clinic is optimal.

7. Hawaii Dyson Initiative Medical Home Performance Checklist I. PATIENT CARE • Family Centered Care • Ask open-ended questions to identify patient and or family concerns and address concerns effectively • Consider patient and or family members in the decision making process for management and treatment • Accessibility • Inform the patient/family how to access me as their primary care provider4. Offer a plan for after hours care to ensure accessibility to my patient’s healthcare needs • Coordinated Care • Review correspondence from ancillary health care documents with the patient and family6. Review plans with consultants, agencies, and or organizations involved in the patient’s care

8. Hawaii Dyson Initiative Medical Home Performance Checklist II. INTERPERSONAL COMMUNICATION • Compassion • Ask questions to encourage understanding • Demonstrate compassion by using appropriate verbal and non-verbal communication to ensure all questions are addressed or answered III. SYSTEMS BASED PRACTICE • Comprehensive • Consider financial and social needs in my patient’s management plan to improve access to care and follow-up • Enlist appropriate community resources for infant, child, and adolescent health needs IV. PROFESSIONALISM • Culturally Effective Care • Explain the medical rationale for plan of care in understandable language to the child and family • Acknowledge differences of opinion related to cultural and religious practices

9. Hawaii Dyson Initiative Medical Home Posters in Clinic Faculty: Use as Visual education tool Residents: Reinforce the Medical Home principles Clinic staff and patient families: Promote a shared language and knowledge of the Medical Home principles of care

10. Hawaii Dyson Initiative Medical Home Resident Noon Conference • Medical Home Noon Conferences Resident/CCP faculty MH best practice case presentation and discussion with feedback • Parent Faculty from Family Voices • Community Pediatrician involved with AAP Hawaii Chapter MH Implementation Project

11. Hawaii Dyson Initiative Study • A Web-based Curriculum and Portfolio Assessment to Demonstrate Medical Home Practice-Based Learning in Resident Continuity Clinics • OBJECTIVE: To determine if a web-based training curriculum using portfolios as a Practice Based Learning (PBL) assessment tool would result in increased resident knowledge, confidence, and demonstration of PBL competence.

12. Hawaii Dyson Initiative Study Design • Web-based training module for residents in CCP • independently study MH concepts, • perform chart reviews, • write a case-based self-reflective narrative of their application of MH principles to patient care. • A one-group pretest-post test design compared mean scores on MH knowledge and confidence using paired sample t-tests. • Competence was measured through the use of portfolios • written exams, • confidence surveys, • chart review checklists, • self-reflective narrative • Portfolio content were qualitatively analyzed. Frequencies were measured from resident course evaluation data to determine resident satisfaction of training.

13. Hawaii Dyson Initiative Study Results • Residents (n = 24, response rate = 71%) showed improvement in their knowledge (p<.01), confidence (p<.001), and utilization in daily practice (p< .001). • Portfolio narratives revealed resident-patient relationships often not appreciated in usual preceptor-resident training interactions. • Residents found this to be an instructive training method that enabled them to apply principles to practice and improved teaching in clinic.

14. Hawaii Dyson Initiative Conclusion • Our findings suggest that a web-based training module and portfolio assessment can be an effective PBL tool for teaching and evaluating resident understanding and use of MH principles.

15. Aloha!! Louisei@kapiolani.org