A 3-Year Longitudinal Curriculum Designed to Teach Family Medicine Residents the Patient-Centered Medical Home W. Fred Miser, MD, MA Professor of Family Medicine Residency Director The Ohio State University

Disclosures I have no relevant financial conflicts of interest to disclose.

Presentation Objectives 3 Identify key components of the patient-centered medical home (PCMH) that should be taught to FM residents Describe our 3-year longitudinal PCMH curriculum –Web-based modules –PCMH rotation –Direct observation Provide time to share experiences gleaned from teaching FM residents PCMH concepts

It’s Been a Long Journey 4   Consultant visits  Meetings (lots)  Office meetings  PCMH HRSA grant  2011 – NCQA PCMH Level 3 (2008 criteria)  2014 – NCQA PCMH Level 3 (2011 criteria) Feb 2008 – EMR (Epic) Feb 2009 – Dept strategic planning PCMH 1 st Residency sites (2) All practices

Thanks to Our Team 1.Larry Gabel, PhD 2.Jennifer Lehman, BS 3.Pam Beavers, BA 4.Cheryl Brilmyer, BA 5.Bill Buoni, MD 6.Don Mack, MD 7.Randy Wexler, MD 8.John McConaghy, MD 9.Randy Longenecker, MD 10.Rollin Nagel, PhD 11.Meghan Parsley, BA And to our faculty, residents, staff and patients To our consultants: Carlos Jaen, MD Rich Wender, MD Paul Grundy, MD To our consultants: Carlos Jaen, MD Rich Wender, MD Paul Grundy, MD

The Patient Centered Medical Home: Adaptable Curriculum Models, Instructional Modules, and Implementation Plans Grant Number: D58HP years (September 2010 – June 2015) no cost extension December 2015

The Ohio State University Family Medicine Residency Program

OSU Rardin FPC OSU CarePoint East FPC

Patient-Centered Medical Home Model of Care – aims to transform delivery of comprehensive primary care to children, adolescents and adults. Access to a personal physician who leads the care team within a medicine practice A whole-person orientation to comprehensive care Integrated & coordinated care Focus on quality and safety Enhanced access to care AAFP 2016

Our Responsibility as Educators Prepare our residents for their future practice

Purpose of PCMH Project To plan, develop, and implement educational and training modalities that promote FM residents’ knowledge and abilities regarding the PCMH

4 Objectives 13 1.Design and configure a model 3-year PCMH curriculum that melds core primary care principles, relationship-centered care, new IT, and chronic care management 2.Develop, pilot, & refine 13 instructional modules that emphasize topics germane to the PCMH 3.Transform ambulatory care training sites of the OSU FM Residency Program into respective model PCMHs 4.Model and teach how PCMH provides comprehensive, integrated, and outcomes-based care that meets full range of patients’ health care needs, especially those with chronic disease

What We Accomplished 14 –Residency practice sites are Level 3 NCQA Certified PCMHs (2011) –Residents practice every day in a PCMH Residents looking for a job come back excited because future employers are impressed they are trained in a PCMH

What We Accomplished The 3-Year Curriculum 15 Year 1 – Introduction to PCMH concepts, patient centeredness, QA, team based care, pre-visit planning, huddles, direct observation Year 2 – Medical Management Home 4-week rotation, PCMH Modules, EMR IT, QA, direct observation, chronic care management Year 3 – Repetition of concepts, population health, registries, QA, multidisciplinary approach to care coordination, direct observation

What We Accomplished Instructional Modules 16 Written content by content experts Converted content to web-base format Revised based on consultant critique Evaluations –Pre- and Post-Tests Residents and Faculty (FM, IM, Peds) Revision #2 based on consultant critique and feedback Focus group on usability Final review and revision based on consultant critique

Preliminary Results FM, Peds and IM residents Module # Pre-Test Post-Test Score (%)

Web-Based Modules 18 Introduction to PCMH Transformed Models –Patient Experience –QA/QI –Health Info Technology –Practice Organization and Development Introduction to NCQA Enhance Access & Continuity Identify & Manage Patient Populations Plan & Manage Care Provide Self-Care Support & Community Resources Track & Coordinate Care Measure & Improve Performance Accountable Care Organizations Teaching Critical Appraisal of the PCMH – Faculty Guide OSU PCMH Website

Medical Management Home Rotation 19 –4-week block rotation – 2 nd -Year –Review PCMH modules –Readings on PCMH –Work on office QI project –Attend local PCMH meetings –Work with office manager on items related to PCMH (analyze reports, etc) –Complete Residency to Reality

Direct Observation Videoprecepting

Discussion Time to share experiences What do others do? Insights? Questions?

Summary It takes work and buy-in from lots of folks –Office staff, nurses, physicians –Residents We have implemented a seamless 3- year PCMH curriculum which includes having the residents “live in it” daily as they see their own patients On-going critique and evaluation is essential as climate constantly changing

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