Panel Management, Applying Population Health and Best Evidence Paige Hatcher, MD - Diplomate, ABFM - Preventive Medicine Resident, OHSU - MPH Candidate, PSU - Health Policy Fellow, OHA

What is Panel Management? Addresses population health through the lens of primary care Evidence-based protocols and to provide self- management support Systems to standardize care using a team-based approach Designing a system that remembers and prevents errors of forgetting Neuwirth, E. B., Schmittdiel, J. A., Tallman, K., & Bellows, J. (2007). Understanding Panel Management: A Comparative Study of an Emerging Approach to Population Care. The Permanente Journal, 11(3),

What is Panel Management? Dedicated physician time for directing clinical decision making Dedicated staff members or staff time to support physicians and conduct outreach Information-technology tools to identify care gaps Structured work processes completed on a routine basis

Experience at KP Patients mostly like it Mostly implemented without new funding (some require resource shift) Wide-scale dissemination through entire facility/area Focused on a particular disease or high-risk group min PCP time reserved per provider per month

Change to Standard Practice Requires a shift in thinking It doesnt make my day easier, but it makes my day better. Giving me hope that some of my more difficult patients might actually turn around their health status. Biggest change to MA and support staff roles, but they welcomed the opportunity for job growth. Less face to face time can be dissatisfying. Patients worry decisions arent being made by their doctors

Managing Change Physicians feel like they are losing control Imperative to respond with demonstration of performance improvement Champions Warm handoffs

Topic Selection Often incentivized by a performance payment opportunity Should be evidence-based, simple, and clear Aim for incremental improvement

Creating a Registry Identification of patients with particular need Review of list generated for appropriateness for inclusion Treatment decision Follow up communication with patient

Example: I want all my patients to be up- to-date on cervical cancer screening Generate First List Women with an intact cervix and no pap result for the last 3 years Women years with an intact cervix and no HPV result for the last 5 years* *This should be tailored to your practice, if you havent been doing mandatory HPV testing, then it will be no pap result for the last 3 years 1

Next Steps PCP Reviews list for appropriateness of inclusion Outreach to schedule patients, correcting chart where needed if Pap has been done somewhere else Run the list again (time interval TBD) and compare N, report results as appropriate PCP reviews the list again Then, start outreach to new group, adjust tactic, etc.

Best Sources for Evidence National Guideline Clearinghouse gov/

Best Sources for Evidence US Preventive Services Task Force (USPSTF)

Best Sources for Evidence National Institute for Health and Clinical Evidence (NICE) (England and Wales) k/

Patient Information Choosing Wisely ® campaign y.org/

Asking your question (PICO) Patient- children or adults, pregnant women, patients with a specific chronic disease or problem Intervention- prevention, diagnosis, treatment Comparison- standard practice, placebo, alternative therapy Outcome- acute or chronic 9&sid=

PubMed MESH search If you search for pap smear and screening in PubMed, you get results.

Using MESH search Terms

Other Benefits ABFM MC-FP Part IV modules are Performance in Practice Modules (PPMs), which are designed as a Quality Improvement activity which takes place over a one week period

Additional References 1. Saslow, D., Solomon, D., Lawson, H. W., Killackey, M., Kulasingam, S. L., Cain, J.,... Myers, E. R. (2012). American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer. Journal of Lower Genital Tract Disease, 16(3),