Georges Potworowski, PhD School of Public Health University at Albany Leveraging Research Evidence and Local Expertise to Transform Primary Care Georges Potworowski, PhD School of Public Health University at Albany Potworowski © 2016

Acknowledgements Lee Green, MD MPH Jodi Holtrop, PhD Michael Fetters, MD MPH Christopher Wise, PhD Jeffrey Alexander, PhD Potworowski © 2016

Does PCMH Work? SE Pennsylvania Michigan 32 practices NCQA certified, >50% lvl 3 Self-reported Minimal quality effect No hospital utilization effect No ED utilization effect Michigan 2400 practices Cognitive Task Analyses (CTA) and Normalization Process Theory in 50 Quality improvement ED and inpatient utilization reduction, specific to primary care sensitive conditions Benefit proportional to PCMH score Friedberg et al. (2014); Paustian et al., (2014) Potworowski © 2016

What Does Transformation Require? Team-based care Systems-based care Patient-centered care Transformation of leaders’ mental model of care delivery + focused and sustained effort Transformation of practice culture and routines Improved outcomes that are sustainable Wise et al., (2014) Potworowski © 2016

1. Team-Based Care Fundamental change in mental model 5 1. Team-Based Care Fundamental change in mental model Everyone working to top of license Evolving role assignment Role security Delegation + empowerment Coordination, communication, psychological safety Potworowski © 2016

2. Systems-Based Care Integration and transitions Seek data, use data 6 2. Systems-Based Care Integration and transitions Seek data, use data Do it in real time (e.g., clinical reminders) Quality improvement Role awareness, systems thinking Double-loop learning Real-time use of information systems. Point-of-care is one example, such as clinical reminders. Care managers or chronic disease managers using the registries for real-time patient contact is another. As opposed to looking at reports. Tends to be patient-specific, whereas non-real-time tends to be big-picture. Potworowski © 2016

3. Patient-Centered Care 7 3. Patient-Centered Care Not just about warm fuzzies Know your population, find your lost sheep Shared goal-setting Specific roles and services Access Potworowski © 2016

How To Transform Into a PCMH Leverage research evidence and local expertise Leverage: Build on what is known by better organizing Research evidence: Draw on all relevant evidence Local expertise: Find, unite, develop experts in region Transform: Achieve and sustain the quadruple aim Potworowski © 2016

Leveraging Research How should we think about research? What kinds of research? Who has time for research? Potworowski © 2016

Leveraging Research Get over NIH, BOPID, and “three easy steps” mentality Equifinality: More than one way to implement well Consider context intelligently: You are not unique Don’t seek “best practice,” but “best for our practice” One place to start: pcpcc.org Potworowski © 2016

Leveraging Research Use clinical, implementation, organizational research Not just EBM, but EBMgt, EBPH, EBSW… Research exists on effective teams, communication, leadership, change management, motivation, quality improvement, learning, culture change… Research evidence is only one part of the EB equation Potworowski © 2016

Evidence-based Transformation Environment and organizational context Practitioner Expertise Population characteristics, needs, values expectations Best available research evidence Satterfield et al., (2009) Potworowski © 2016

Leveraging Local Expertise Who is the practitioner in “practitioner expertise”? What relevant expertise do they have? How can we leverage local expertise? How can we develop local expertise? Potworowski © 2016

Leveraging Local Expertise Vanguard clinicians, managers, and staff Some have achieved PCMH lvl3 or APC Some of have transformed or are transforming Some of those might be willing to help Practice facilitators (PFs) Some better than others PCMH so complex, one PF cannot be expert in all facets Key part of PF expertise: Understanding your practice Don’t just reach for the fish Potworowski © 2016

Leveraging Local Expertise Researchers Clinical, implementation, organizational research expertise Can help adapt research to your context Can help generate local evidence when appropriate Can help identify meaningful data and conduct analysis Key points: Draw on all sources of expertise: None has all the answers “Best practices” from convergence of multiple sources “Best practice” must be adapted, tested, tweaked by you Adapt, innovate, generate local evidence Potworowski © 2016

Next Steps: How Can I Transform? Better question: How can we transform together? Organize into a practice network. Connect with peers Organize a PCMH knowledge management system Facilitate and incentivize practice learning and transformation Potworowski © 2016

Georges Potworowski, PhD Questions? Georges Potworowski, PhD gpotwo@albany.edu Potworowski © 2016

Evidence-based Transformation Environment and organizational context Practitioner Expertise Population characteristics, needs, values expectations Best available research evidence Satterfield et al., (2009) Potworowski © 2016

Potworowski © 2016