Initial Lessons Learned With Implementation of The PCMH In Family Medicine Residency Practices Nicole Deaner, MSW Colorado Clinical Guidelines Collaborative Bonnie Jortberg, MS, RD, CDE University of Colorado, Dept. of Family Medicine

The Colorado Family Medicine Residency PCMH Project 3-year grant from the Colorado Health Foundation; began in December 2008 Goal: To transform the 10 Colorado FM Residency Programs into medical homes through practice improvement and curriculum redesign

Who is Involved? University of Colorado School of Medicine, Department of Family Medicine Colorado Clinical Guidelines Collaborative Colorado Association of Family Medicine Residencies Colorado Institute for Family Medicine

Practice Coaching Assessment of current status in practice Feedback assessment and data to practice Assist in improvement team formation Initially facilitate team meetings but transition to practice taking process over Serve as connection to resources Facilitation of QI and change process Goal is to establish a sustainable change & improvement process in the practice

Curriculum Redesign Facilitation and consultation for PCMH-related curriculum changes Changes to free up residents to participate in PCMH and QI efforts Shared resource development across programs (lectures, modules, etc) Active involvement of residents in practice redesign process PCMH practices for residents to experience

Lessons Learned - Culture Leadership Shift from traditional model to more facilitative leadership– need for support & training, especially among faculty Mixed investment among practice leaders in PCMH concept Shared leadership model & QI teams require time, training and resources Change is inconsistent with slow movement forward. Resistance to registry launch – benefits understood later as data drives motivation for change. Communication is critical but challenging with many moving parts. Using simple proactive surveys can be an easy way to engage all staff in the change process.

Lessons – Project Structure & Support No established road map to the medical home at this time, especially for residencies Practices benefit from assistance but need to own and guide the process Moving toward a structured approach balanced with practice choice & creativity NCQA recognition is laborious & time-consuming but can also provide some framework for the change process. But lacks may of the key aspects of the PCMH

Lessons - Sustaining Change Areas where lack of payment reforms problematic: care management, population management, and integrated care and ongoing funding for QI teams Need for job descriptions, training, evaluation around PCMH to address staff turnover. Internal QI Team Leader training developed to lead/facilitate QI teams past coach involvement. Learning Collaboratives working well to promote sharing Project staff creating connections between programs working on similar areas Use of technology???

Lessons - Curriculum Residents are more energized and ready to change than faculty Practices are not a PCMH (yet) – hard to teach something that is not practiced Difficult but crucial to involve residents on a regular basis in the change process Developed PCMH competencies – will evolve Curriculum issues may change over time Initial need for didactics & projects in key PCMH areas Gradual shift to more experiential learning NEED MORE REGULATORY FLEXIBILITY

Questions Bonnie Jortberg Bonnie.Jortberg@ucdenver.edu Nicole Deaner ndeaner@coloradoguidelines.org