Peer Physician Maternal Child Health Case Management: The Benefits and Challenges in the Patient-Centered Medical Home Abigail Love MD MPH, Reena Paul.

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Presentation transcript:

Peer Physician Maternal Child Health Case Management: The Benefits and Challenges in the Patient-Centered Medical Home Abigail Love MD MPH, Reena Paul MD, Nora Smith MD Cook County-Loyola-Provident FMRP April 26, 2010

Our Practice 5 urban CHCs >50 FM providers: attend/residents in Maternal Child Health (MCH) University affiliated Publicly funded system: “the County” Budget cuts: lack of staff for QI Higher risk patients: medically and socioeconomically

The QA process Inconsistent audit process: we have no tracking mechanism, our deliveries our dropping MCH is a key focus for our dept and QA focus for upcoming year Pilot site: Jorge Prieto FMHC 3 MD, 1 CNM 4 hour session/month Average of 16 new OB cases and 20 case follow-ups per month. Case-based peer-review using a standardized form in paper chart Electronic main database: demographics, risk stratification and f/u

Why the peer-review model? Collaborative risk stratification Evaluating the whole system of care in real-time Academic/curricular issues Rich discussion: possible “Faculty development” in MCH care Qualitative: complex issues that can’t crunched into numerical data

Mock Case Demo

Preliminary Data: 7 months 119 new OB intakes 58% retention rate of continued pregnancies Documented follow-up (active, abortion, transfers) in > 90% of cases Hard to find comparative retention rates: in PNC studies: 4-41%

Initial risk of all patients Risk Stratification Initial risk of all patients (n=81) Initial risk of retained patients (n= 57)

Systems Issues Volume not retention: We need to get more patients in the door! Appt access Pregnancy testing Shifting demographics No group visits Retention issues: Follow-up appointments: “advanced access”; resident schedules change Inconsistent approach to no-shows Lacking provider continuity

Provider Issues Common gaps in provision of prenatal care Screening and follow up of psychosocial issues e.g. IPV and MDD Medical issues eg varicella screen Adherence to policies of consultation

Summary of Model Drawbacks Benefits Time burden for physicians and midwife Training: approach and knowledge base of reviewers Requires significant nursing and clerical support Identifies systemic issues affecting patient recruitment, retention and safety Determines educational needs for resident and faculty development Identified and triaged several high-risk cases Gives us data! This is how we justify our jobs!

Moving forward Disseminate to all 5 centers Incorporate residents? Maintain practicing faculty and update “non-MCH” FM faculty

Questions to YOU! Resources? Other models? Risk stratification guideline Audit forms Contacts Other models?

Thank you Janice Benson MD, Associate Chair, Department of Family Medicine, Provident Hospital of Cook County Crystal Cash MD, Chair, Department of Family Medicine, Provident Hospital of Cook County, System-wide Bureau Chief of Family Medicine, Cook County Health and Hospital Services Mark Loafman MD