2. 2 Forging a Path: Our Ongoing Journey Toward Building a PCMH Curriculum Maureen Mavrinac, MD Assistant Clinical Professor UCLA Department of Family Medicine May 5, 2013 46th STFM Annual Spring Conference

3. The Journey Why? How? When? What? Background Needs assessment Overview of curriculum Seminar series Group visit One-on-one tutorials Lessons and Secrets Next steps 3

4. Background “Why” My experience: Rural & Urban Settings Across the US Care Fragmentation & Burnout 4

5. The “How” Opportunity at UCLA Flow Innovations Huddles Team: Champion + Collaborator Resident Needs Assessment 5

6. Residents want to learn about PCMH 76% of residents felt knowledge of the PCMH will be important to them post residency 96% strongly agreed or agreed that resident physicians have the responsibility to learn about the PCMH model. 83% stated that they learned “way too little” or “too little” about the PCMH model during medical school When asked “How well are you able to describe a Plan Do Study Act (PDSA) rapid cycle?” 71% responded “not at all” 6

7. The “When” PGY-2 SCHEDULE ComMed OVIPS SMPeds OV Beh Sci SM Vac ER OV WH SMOB CHDerm VAIPS SMVacCHLA IPS Nite SM Elec SMSurg SM 7 PCMH

8. PGY-2 Year New PCMH Curriculum Model Integrated with Community Medicine Block Traditional Block: County Clinics New PCMH Curriculum Components: One on One Faculty Tutorials Creating Ed Half Day Series “PCMH Implementers and Leaders Workshops” Alternate template of Care: Group Diabetic Visits 8

9. Formal Requirements The What? 9 Complete Core modules online learning IHI “Open School” patient quality and safety or similar program One group visit for patients with diabetes One-on-one QI tutorial with research faculty (one hour) Lead care team huddles Learn about other organizations PCMH: i.e. Denver Health, Virginia Mason, and Clinica Family Health Services Attend conference PCMH practice improvement or Q.I. Participate patient safety or Q.I. project Collaborate with expert on Ed Day talk presentation

10. PCMH Seminar Series More What? 10 Amireh Ghorob, MPH “Sharing the Care” UCSF NEJM B. Yoshi Laing, MD, RWJ Fellow “P-D-S-A” Stephanie McCutcheon, UCLA strategic leader Robin Clarke, MD, MSHS, “Empanelment” Tanya Paz, Architect, Dr. Paul Farmer, “Design” Bonnie Jortberg, PhD, online learning PCMH Kate Neuhausen, RWJ, Advocating and Paying for PCMH David Reuben, MD PCMH and the Older Adult

11. Group visits More What? Wednesday Monthly Faculty Resident DM Group 11

12. One on One Tutorials More What? Lunchtime meeting Research Faculty on Q.I. After clinic meeting Core Faculty PCMH Overview Readings: Grumbach & Bodenheimer PCMH literature compilation 12

13. Accomplishments Residents Say: …I also feel like the curriculum has helped me understand the value of teamwork because PCMH is about more than just improving the experience that our patients have, it also improves the healthcare worker's experience …The group visit was really fantastic, and I had a wonderful experience with it and wish I could have more continuity with the groups. 13

14. LESSONS AND SECRETS What does it take? Perseverance, Courage, Vision External Wisdom: STFM, NAPCRG, et al One other faculty supporter How can it grow? Firm Up Scheduling Commitment Self and Department Get a common language across residency Disseminate to Faculty 14

15. Next steps 15 Asynchronous online learning Study literature Resident Experts Faculty Development. “Alice came to a fork in the road. 'Which road do I take?' she asked.”

16. Acknowledgements Gerardo Moreno, MD, MSHS Lacey Wyatt, MD, MPH Denise K.C. Sur, MD Patrick Dowling, MD, MPH Lourdes Guerrero, Ed.D. Indi, the cat & Spouse “Traveler, there is no path. The path is made by walking”. Antonio Machado 16

17. HANDOUTS AVAILABLE “Putting patients at the center of primary care: A Course for PCMH Implementers and Leaders” Course Alignment with Joint Principles and ACGME Competencies Resident Needs Assessment mmavrinac@mednet.ucla.edu 17