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Andrew Vasey, MD University of Nebraska Medical Center September 2, 2011. Transforming a Resident Clinic into a PCMH. Disclosures. I have no financial disclosures Our resident clinic at UNMC is not NCQA certified as of yet. Objectives.
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Andrew Vasey, MD University of Nebraska Medical Center September 2, 2011 Transforming a Resident Clinic into a PCMH
Disclosures • I have no financial disclosures • Our resident clinic at UNMC is not NCQA certified as of yet
Objectives • Discuss how a resident continuity clinic can be a PCMH. • Show how the PCMH joint principles are incorporated at Midtown Clinic. • Discuss resident driven projects.
Midtown Clinic • Site for resident continuity clinic • Social worker and mental health provider • Pharmacy support • EMR • More than 10,000 patient visits annually
Resident Board • Consists of: • Ambulatory chief resident • Residents from each half day clinic • Clinic nurse manager • Faculty clinic director • UNMC-P representative • Make decisions on how the clinic works
PCMH • Seven joint principles • Personal physician • Physician directed medical practice • Whole person orientation • Coordinated and integrated care across all elements of the complex health care system • Quality and safety • Enhanced access • Payment reform
Personal Physician • Resident patient panels • Residents build their panels during training • Patient input • Teams
Whole Person Orientation • ‘Birthday’ visit • Dedicated visit to discuss health care maintenance issues, medications, advance directives, etc • Lab reminder postcard • Patient screening/intake • Proactive visits
Coordinated and Integrated Care • Nurse coordinator • Social worker/mental health provider • Diabetes registry • HgB A1C, blood pressure, LDL cholesterol, eye exam etc • Colonoscopy • Mammograms/Pap Smear
Quality and Safety • Patient Education Discharge Form • Diabetes Education Class • Medication Adherence Project
Patient Education Discharge Form • All Midtown clinic patients • Residents complete prior to discharge • Review with patient prior to leaving • Stored within the electronic record
Pre- and post-intervention 30-day hospital reutilization p<0.001
Diabetes Education Class • Held monthly at clinic • Residents, staff, pharmacist, diabetes educator, nutritionists
Medication Adherence Project • Comparing medication adherence post discharge between two resident continuity clinic sites • Patient demographics
Enhanced Access • Creation of ‘walk-in’ hospital follow up slots on day of normal clinic • Same day/acute appointments available • Contacting residents
Payment Reform • Nothing yet • Support from Dept of Internal Medicine, UNMC-P and the Nebraska Medical Center