1. The Inter-professional Team: Who, Why, and What do they do in the Patient-Centered Medical Home? Gillian S. Stephens, MD, MS 1, F. David Schneider, MD, MSPH 1, Natalie A. Brooks, PharmD, BC-ADM 1,2, Sherry Muir, MOT, OTR/L 1, Rabia Rahman, MS, RD, LD 1, Ellen Gruszczynski, MPH, BSN, RN 1, and William T. Manard, MD 1 1 Saint Louis University, 2 St. Louis College of Pharmacy DISCUSSION BACKGROUND OBJECTIVES RESULTS Saint Louis University (SLU) is self-insured for the healthcare of its 5,000 employees and their dependents. In order to decrease healthcare costs, the university has shifted its focus toward wellness. Part of this new focus was the establishment of the Saint Louis University Patient-Centered Medical Home (SLU PCMH) 1, a family medicine practice, in January 2010. All patients in the SLU PCMH are SLU employees or their dependents. 1.To describe the formative process of the SLU PCMH team for adaptation in other settings. 2.To reveal team members' perceptions about their contribution to the SLU PCMH concepts and operations. 3.To describe patient utilization of SLU PCMH member services. Team formation began 9 months prior to opening of SLU PCMH, with the family and community medicine (FCM) chair appointing a medical director – a faculty family physician. FCM chair met with deans and chairs of SLU’s schools of allied health, nursing, public health, and affiliated Saint Louis College of Pharmacy, who nominated members of the team from their faculty. 2 Goal was to hand-pick an inquisitive, creative, patient-centered team of faculty and staff who would be innovative with respect to patient care and education and be able to document their success. FCM chair and medical director met with each prospective team member. Some chose not to be part of the team after the mission of the SLU PCMH was explained and others were “not a good fit” and were excluded. Some of the limitations above will be resolved when the SLU PCMH acquires its own space in January 2011. Other limitations will require health care and reimbursement reform. In an academic setting, an ideal opportunity exists for developing a broad spectrum inter-professional team for a PCMH. Many members were unfamiliar with the PCMH model and yet exhibited enthusiasm and willingness to participate. As a result, a cohesive, collaborative, and innovative inter-professional team has developed. Not only does this improve the care of SLU PCMH patients, but students from multiple disciplines see true inter-professional collaboration in practice. METHODS 1. Joint Principles of the PCMH (AAFP) 2. What is Interprofessional Health? Interprofessional Health @ UW-Madison 3. Diman MA, Simmons LA,Snyderman R. Commentary: Personalized health planning and the patient protection and affordable care act: an opportunity for Academic Medicine to Lead Health Care Reform. Acad. Med. 2010 Healthy Lifestyles 6 week “jump start” program to improve health in an interactive group setting with information on weight loss, nutrition, exercise, stress management, and balance. Diabetes Lunch & Learn 6 week, 45 minute lunch program to discuss diagnosis, risk factors, pharmacotherapy, monitoring, physical activity, goals, and stress management. Balancing Life & Work 7 weekly sessions to help patients identify stressors in their work and home life. The patients are taught stress reduction methods. In the SLU PCMH, the medical director, a family physician, leads an inter-professional team which meets weekly to discuss individual patient needs, develop group visits and educational programs. Members of the team see patients one-on-one in the clinical setting, lead and participate in group visits and educational programs, and communicate with patients through the patient portal in the electronic medical record and by telephone. They also give presentations about the SLU PCMH to other employees and assist at employee health fairs. TEAM MEMBER PERCEPTIONS Depending on the needs of enrolled employees, the inter-professional team develops and facilitates free group education for patients with similar health issues. Nurse Care Manager Social Worker Medical Assistant Business Manager Nurse Practitioner Outcomes Researcher Physician Assistant Public Health Occupational Therapist Registered Dietician Department Chair Physical Therapist Clinical Lab Scientist Family Physician Medical Director Billing Representative Pharmacist Group Education and Support Care Guidance Team Approach FACTORS LIMITING TEAM UTILIZATION Clinical psychologist needed for behavioral medicine Health Informatics decided not to participate Only 6% of patients have attended group visits, programs Lack of reimbursement for some disciplines 3 Space limitations for treatment by multiple health care providers Time restriction of faculty participation due to teaching obligations Patients not signing up for the internet patient portal within EMR Space limitation for group visits and teaching sessions Offices and meeting rooms not in close proximity to each other Through participation, team members have clearer concept of principles of PCMH model of care. Few team members had previous inter-professional experience with such a broad spectrum of disciplines. Members have new understanding of function and training of other disciplines. Team members prioritize attendance at weekly meetings, led by medical director. Collaborative discussions result in innovative planning of group visits and educational programs. Because of their enthusiasm for the concept, team members promote the SLU PCMH to colleagues and new SLU employees, provide screening at employee health fairs. Team members’ concept of contribution to the PCMH has expanded to include office visits, small group visits, educational programs, and patient portal within electronic medical record (EMR).