New Hanover Regional Medical Center Residency in Family Medicine Improvement in Practice via Practice Based Learning A Residency Research Learning Model New Hanover Regional Medical Center Residency in Family Medicine Albert A. Meyer, M.D. March 6,2009

Objectives How we teach Practice Based Learning How the Improvement in Practice Initiative – became a natural outgrowth How we handle present and future challenges

New Hanover Regional Medical Center Residency in Family Medicine Community Hospital Based Tri-affiliated Residency 1. Department of Family Medicine University of North Carolina 2. South East Area Health Education Center (SEAHEC) 3. New Hanover Regional Medical Center Wilmington NC Dual Accreditation ACGME AOA

Creating A PBL Culture The Fellowship 2004 - 2005 The Expectation 2005 The Reward 2008 The Results 2006-2009

Design Faculty design curriculum and set expectations. Residents analyze practice experience based on systematic methodology The resident faculty team studies the practice and improves care

Faculty 1. Coastal Family Medicine Faculty 2. SEAHEC Research Department 3. IPIP Support 4. IT NHRMC

Research Curriculum 1. Project Development - Group 2. Protection of Human Subjects Tutorial – Individual 3. Relevant Literature Review – AHEC Digital Library 4. Analysis of Practice Experience 5. Statistical Analysis of Data

Expectations Set Relevant Skill: Locate,appraise and assimilate evidence from scientific studies related to patient’s health problems Obtain and use one’s own population of patients and the larger population from which patients are drawn 3. Apply knowledge of study design and statistical methods to the appraisal of clinical studies

What is the Improving Performance in Practice Initiative? All Primary Care Disciplines North Carolina and Colorado pilots, with focus on Diabetes, Asthma Quality improvement coaches Data systems –national measures and systems for sharing

Main Outcomes Educated 4 classes of residency trained family physicians thoroughly in an ACGME core competency (16 projects by 5/15/09) Have grown the residency’s interdependence with the SEAHEC research team, the local & statewide IPIP Quality Improvement Consultants Family Medicine Research Day Identified key barriers to improvement

Barriers Solutions to IPIP @ CFM 1. Registry function  EMR reports / research intern 2. What’s our vision? “Excellent care of each patient at CFM is my responsibility” 3. Role of MA  role of SOP in IPIP 4. Where’s the data and how to we collect it?  Cecil Sheps Center Secure Data Repository

Topic Selection 2009 Lipids (TC HDL LDL TG) Resident 1 Labs(HA1C;<7 >9; microalb/creat) Resident 2 Clinical (BP <130/80; foot; eye) Resident 3 Drugs (ASA / ACE or ARB / nicotine) Resident 4

How does 2009 look ? 95/440 patients with Diabetes QI NCQA CFM 6mo.Goal BP<130/80 25% 58% 58% HBA1C<7.0 40% 44% 44% HBA1C>9.0 15% 14% 14% EYE EXAM 60% 58% 60% FOOT EXAM 80% 58% 80% LDL< 100 36% 52% 52%

Summary How we teach PBL in Wilmington How IPIP is helping us to use our data for outcome impact The challenging road ahead

Special Thanks Faculty Development Fellowship Program Directors: Jessie Junker and Jan Beste SEAHEC Research Division