1. Integrating the Personal Medical Home into a Nursing Home Curriculum
Huey Lin, MD
Assistant Professor
UC Davis Family and Community Medicine
STFM Annual Spring Conference

2. Goals Establish a longitudinal nursing home rotation
Assessments of needs and concerns / assets and barriers of all involved parties
Create and grow a relationship between myself, the residents, and the skilled nursing facility that will facilitate excellent patient care and resident education
Educational experience that consists of care of at least two patients over a minimum of two years.

3. Assets Enthusiasm by myself and Emerald Gardens
Support from Program Director and Curriculum Director
Current nursing home physician was considering retirement – relatively quickly build a patient panel
SHARED VISION with Director of Nursing and the Administrator

4. Me /Me / Me / Me Myself Residents Emerald Gardens Faculty
How do I have everyone meet eye-to-eye?
Too busy; where is the time?
Is this going to be more work for staff?
Where can time be carved out for this?
How do I not get overworked?
It’s depressing; what’s the value?
What is our financial incentive?
Can this be done without other faculty involvement?
Will patient care be affected?
Will this be of any additional cost?

5. Goals -> GOAL
Bring as many aspects of the patient-centered medical home to the nursing home curriculum

6. Patient-Centered Medical Home

7. Principles of Personal Medical Home already in place at Emerald Gardens
Quality and Safety – patient safety focus, medication management, evidence-based outcome analysis, quality improvement, risk management, regulatory compliance
Team Based Care – IDT meetings, physician leadership, collaborative staff, shared vision
Information System – computers and high speed Internet access

8. PDSA: Phone Calls – 2005-2006 BEFORE AFTER All calls to me
PMD to take calls during day
Flowsheet

9. PDSA: Phone Calls – 2006-2007 BEFORE AFTER
PMD to take calls during day
Flowsheet
AFTER
Calls to PMD – day, night float - night
Flowsheet

10. PDSA: Phone Calls – 2007-2008 AFTER BEFORE
Flowsheet
Resident education on phone triage
Signout list
Reminder notice to Emerald Gardens’ staff
BEFORE
Calls to PMD – day, night float – night
Flowsheet

11. PDSA: Phone Calls – 2008-2009 BEFORE AFTER
Calls to PMD – day, night float – night
Flowsheet
Resident education on phone triage
Signout list
Reminder notice to Emerald Gardens’ staff
AFTER
EHR Shared List
Routine reminders with new staff

12. PCMH – Practice- Based Care via Communication
Phone calls protocol established. Agreed upon by residents and Emerald Gardens staff. Mutual understanding that ongoing feedback is necessary.

13. PCMH – Continuity of Care / Access to Care
Resident “buddies” work together to care for a pair of patients. Reinforce personal medical home when patients come to or are discharged from Emerald Gardens.
Based on the resident buddy system that we have established in clinic for coverage when away on particularly hard rotations or vacation. Always a junior and senior resident. Learn from each other.
Pair of nursing home patients – important to

14. PCMH – Continuity of Care
Scheduled visits during weekly half-day resident didactics. Approved by Program Director and Curriculum Director.
Changes to schedule need to be approved.
Residents encouraged to attend important IDT meetings.
Online and also posted in didactic conference room.

15. PCMH – Health Information Technology via ELECTRONIC HEALTH RECORD
Visit documentation and billing
Shared patient list
Correspondence between night float and “buddies”
Group decision making
Resident education
Referrals; continuity if hospitalized

16. PCMH – Practice-Based Care, Care Management, Quality and Safety
Large and small group meetings on importance of nursing home care
Quarterly meetings at Emerald Gardens
Annual and “on-the-fly” feedback

17. PCMH – Place to Call “Home”
FOOD!
“Get togethers” at Emerald Gardens
Desktop and laptop stations
Constant support and thanks of each other

18. Summary
Integrating the personal medical home into a nursing home curriculum is achievable, but does take time.
Implementation of PDSA cycles to your nursing home curriculum can yield fruitful results.
If possible, incorporate an EHR in your nursing home curriculum. Some of the results have exceeded our expectations.
Keep the curriculum dynamic and strive for ongoing collaborations.

19. On the Horizon Improve wireless access for potential WOWs
Moving our physician workplace to a central location accessible by patients and staff
Patient and/or family be able to communicate with us electronically
Expand on a culture of collaboration and collegiality