Assessment of the Patient Centered Medical Homeness in Residency Practices and Curricula: Are We Homes Yet? Perry Dickinson, MD University of Colorado Denver Department of Family Medicine Bonnie Jortberg, MS,RD,CDE Nicole Deaner, MSW Colorado Clinical Guidelines Collaborative

Who is Involved? Funded by the Colorado Health Foundation University of Colorado Dept of Family Medicine Perry Dickinson: Project Director Bonnie Jortberg: Project Coordinator, Curriculum Redesign Doug Fernald, Evaluation Frank deGruy Larry Green

Who is Involved? Colorado Clinical Guidelines Collaborative (CCGC) Nicole Deaner: Practice Improvement Coach Julie Schilz: Director, IPIP and PCMH Caitlin O’Neill, MS, RD: Practice Improvement Coach Marjie Harbrecht: CCGC Director Colorado Association of Family Medicine Residencies Nine Family Medicine Residencies + one track 10 residency practices Tony Prado-Gutierrez: Director

What is Involved? Planning Phase Preparation for practice and curricular redesign Assistance with IT issues Start working on forming improvement team Practice/program discussions of PCMH Sponsoring organization – look for support, try to remove barriers Prepare for cultural transformation

Practice Coaching Active coaching period – approximately 14 months Assessment with feedback – 2 months Active coaching with practice improvement team(s) – 12 months (or more) Continued team meetings for PCMH changes, other practice improvement with coach “boosters”

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

Collaboratives Meetings of representatives of all practices and programs Planning, sharing, educational – highly interactive Two collaboratives per year First one May 2009 – 105 people from the practices Second in October – over 130 from practices

What’s Provided? Assistance with orientation to PCMH, initial planning, working with hospital leadership Coaching team provided IT consultation resources PCMH consultation and support NCQA PPC-PCMH certification paid for Direct funding for the programs

Practice Outcomes Achieve NCQA PPC-PCMH certification – hopefully at least level 2 Improve level of medical homeness: NCQA PCMH assessment PCMH Clinician Assessment Practice Staff Questionnaire Improve quality measures in two clinically important areas to be chosen by the practices

Curricular Outcomes Improved resident achievement of PCMH competencies Improved resident use of PCMH elements as assessed by PCMH clinician assessment Revision of residency curricula to allow resident participation in PCMH and QI efforts Implementation of PCMH curricular elements Will follow resident In-training Exam and Board Exam scores, but may not show up there

Two Parts of Project—Practice and Curriculum Redesign Curricular Redesign PCMH Residency Practice Practice Improvement

Baseline Assessment Process – Practice Improvement NCQA Self-Assessment – group or individual Key Informant Interviews Cycle Time Report Online surveys using survey monkey: PCMH-CA PSQ Core & Supporting Processes

NCQA Self-Assessment Report delineates: “Must Pass” elements Pass percentage per element (50% required) Total points & # must pass elements 1. Level 1 = 25-49 points; 5/10 must pass 2. Level 2 = 50-74 points; 10/10 must pass 3. Level 3 = 75-100; 10/10 must pass

PSQ Results

PCMH-CA Results

Baseline Assessment Report Structure: Narrative explanation and assessment on 7 core elements Data tables for responses to NCQA Self-Assessment & responses to PSQ & PCMH-CA Recommendation section Approximately 10 pages long Appendix: PCMH-CA & PSQ graphic data (previous slides) with narrative explanation NCQA Self-Assessment Report

Baseline Assessment Report – Lessons Learned Baseline Report: Very helpful/insightful process for coaches initially about practice culture & leadership Practices’ baseline – major struggles with patient flow vs. NCQA process Report is conceptual, practices looking initially for “roadmap” Working on new, shorter more specific report with current report for later Report presentation lessons Core & Supporting Processes not currently used – low return rate & questionable benefit

Curriculum Redesign Challenges and Opportunities No organized, comprehensive PCMH curriculum or materials No developed curriculum competencies No tools to assess PCMH curricular activities or resident competency

Curriculum Assessment Start with developing competencies Feedback from residency programs to “map” PCMH competencies to ACGME competencies (see handout) Developed Residency Curriculum Semi-Structured Interview Template (see handout)

Curriculum Assessment Semi-Structured Template, completed with program faculty involved with curriculum: Introductory questions: Basic set up of program Process of determining the curriculum Process for making curricular changes How much time do the residents spend in clinic What makes your program a PCMH? What changes need to take place to make your program a PCMH? On a scale from 1-5, what is the current level of resident involvement with practice improvement?

Curriculum Assessment Competencies: Who, what, where, when, how for each Summary Questions: Strengths/weaknesses of curriculum What do they need the most help with for the curriculum? Resource for other programs How do they characterize their sponsor’s interest and support for this project? Resident’s interest and support (scale 1-5) Staff and faculty support

Resident PCMH Curriculum Competency Survey See handout

Results and Lessons Learned Interview completed with 3 programs so far Emerging Themes: Interview process is an “intervention” for the program Makes them take comprehensive look at what they are teaching “We want to go from reactive teaching to intentional teaching” Revealing that they are teaching many of the elements of the PCMH, just not in an organized manner Resident participation on the QI teams an important curricular component

Results and Lessons Learned Common areas meeting competencies (through resident involvement in QI teams) Team approach Integrated and coordinated care Quality Improvement Leadership skills Common areas not meeting competencies Population management Access to care Information systems to support PCMH Self-management support

Results and Lessons Learned Time-consuming process Great qualitative data Quantitative data still to be determined

Questions? Contact Information: Perry Dickinson: perry.dickinson@ucdenver.edu Bonnie Jortberg: bonnie.jortberg@ucdenver.edu Nicole Deaner: ndeaner@coloradoguidelines.org