1. Palmetto Health/University of South Carolina PACER Team - Our Journey Nicole Bookstaver, Scott Carney, Renee Connolly, Christopher Goodman, Jocelyn Harmon, Mark Humphrey, Matthew Orr, Jennifer Porth, Donna Ray, Kathryn Stephenson, Gregg Talente, & Cynthia Winston
Our Mission: The Palmetto Health/University of South Carolina (PH/USC) PACER Team will work to improve resident training & delivery of care in our three PH/USC PACER sites Family Medicine, Internal Medicine & Pediatric (Children’s Hospital Outpatient) Clinics – to be increasingly patient oriented and integrated in our care delivery.
Our Vision: To be a learning lab for patient centered medical care
Educational Transformation
Recognizing that the “Clinic is the curriculum”
Interpersonal Medicine – Accelerating Patient Activation & Practitioner Wellbeing
Inter-professional faculty development sessions in motivational interviewing (MI) completed to include our PACER team members, Pediatrics and Family Medicine faculty and 60% of our general Internal Medicine faculty
Residents from all 3 residency programs are completing initial MI training which also included pharmacy residents
Certified medical assistants (CMA’s) joining PH/USC Medical Group now have MI training as part of their on-boarding, 12 have completed.
Care managers at PH also are being trained in motivational interviewing
Assessments post training include follow up at multiple intervals and direct observation tools have been modified to verify utilization and coach for MI
Quotes from Resident’s change plans for implementation of motivational interviewing:
“ I want to develop my listening skills when working with patients’ families to understand what they are saying.“
“…consistently reflecting on what my patients tell me.”
“ When taking a patient history, I am going to ask more open-ended questions.”
Culinary Medicine Curriculum from Tulane – will be implemented as part of our SC FoodShare clinical collaboration project
Joint PH/USC PACER Grand Rounds
October 2016 PACER – an overview of the national program & local efforts
January 2017 Improving Care through Patient Empowerment (Session delivered with our Coach Steve Crane)
Future - Optimizing Partnerships with Pharmacists, and more…
Pilot of PCMH Criteria Workshop (Family Medicine) as part of practice management series
“QuEST” IPE Pilot – medical & pharmacy students recruited through USC IHI Open School Chapter in an elective experience doing quality improvement work at Palmetto Health; faculty represents multiple professions
Clinical Transformation
Family Medicine Center
Recertified as NCQA – PCMH
Readmission/Emergency Department Utilization Project
Re-established Patient Council
Pediatric Clinic - CHOC
QTIP National Collaborative
USC School of Law
Medicolegal partnership
Carolina Collaborative
In SC/NC for SDOH
Pediatrics
Internal Medicine
Family
Medicine
I3 Value Collaborative (Regional)
Quadruple Aim focus of metrics
Diabetes Mellitus care
Smoking cessation screening & counseling
NQF #
Measure
Descriptor
Domain
Population: Active patients with at least 2 visits in previous 24 months
CLINICAL QUALITY
RECOMMENDED
0059
Comprehensive Diabetes Care
The percentage of patients years of age with diabetes (type 1 and type 2) whose most recent HbA1c level during the measurement year was greater than 9.0% (poor control) or was missing a result, or if an HbA1c test was not done during the measurement year
Clinical Quality
0028
Preventive Care Screening: Tobacco Use: Screening and Cessation
The percentage of patients aged 18 years of age and older who were screened for tobacco use at least once during the two year measurement period AND who received cessation counseling intervention if identified as a tobacco user
PATIENT EXPERIENCE
N/A
TNA (Access)
Average number of days to third next available appointment for an office visit
Patient Experience
Usual Primary Care (UPC) Continuity of care measure
Average UPC for all active patients
PHYSICIAN & STAFF EXPERIENCE
RECOMMENDED – COMING SOON
MA/staff turnover
The percentage of medical assistant staff who left their position in the previous 12 months
Provider & Staff Experience
Clinical Team Satisfaction
Faces scale
UTILIZATION/COST
1789
Hospital Readmissions
Total # of 30-day readmissions for active patients during the measurement year
Utilization
ED Visits
Total # of ED visits by active patients during the measurement year
Patient Engagement Project
Collaboration with USC Education department, graduate class for
customized survey process
Internal Medicine Clinic
Clinic Improvement Team reinvigorated
Weekly Case management Conference
Team-based special population care
Joint Clinical Initiatives (across all three clinical sites)
Resident Incentive Program, Optional Goal – Quality Improvement Projects
Sponsored by Palmetto Health Graduate Medical Education
6 residency programs completed for added incentive payments in 2017
New cycle in progress, PH/USC PACER team provides peer review & coaching
Interpersonal Medicine – Accelerating Patient Activation & Practitioner Well-Being
These “process groups” are detailed further under educational transformation; We are
integrating motivational interviewing into the clinical training for multiple professions and
exploring potential for team training with simulation in the future.
SC FoodShare Collaboration – Building on pilot work in Pediatrics, all three clinics will screen for food insecurity using FDA 2-question screen, share resources with patients and families and enroll appropriate patients/families in FoodShare study (measure health impacts); Grant application under review.
Clinic walk-through visits for patient-centered care using a tool developed from Palmetto Health (PH) Patient Centered Medical Home handbook, the Patient Centered Environmental Audit Tool, the Interprofessional Education Collaborative (IPEC) and the Institute for Family Centered Care, as well as the PACER PCMH Monitor Survey.
Early stage of collaboration with Palmetto Health “Patient Experience” leadership and the PH Patient & Family Advisory Council (PFAC) to align Clinic PFACs with overall system initiatives.
A Few Challenges:
Change of team member for Pediatrics, but warm hand-off to help onboard new member
EMR upgrade anticipated 2016 was delayed significantly, affected data retrieval for QI
Scheduling joint resident education has been challenging; requiring more “parallel play”
Next Steps:
Dissemination – continued efforts to spread to other residencies within the system and to rural programs near us & connected through Palmetto Health or USC School of Medicine
Collaborative efforts - Eastern Virginia Medical School & I3 for regional growth of patient-centered care and interprofessional education and care delivery
Continue to gather data for assessment of our learners and overall program evaluation
Adolescent to Adult transitions of care for all 3 clinics
Expand group visit model, including follow up for newborn care for participants who had been involved in group visit models during pregnancy
Continue to promote PACER concepts and invite others to join in transformational efforts
Explore funding mechanisms to support ongoing change efforts locally and regionally
Our sincere thanks to the Oregon Health & Science University for leading the charge and to the sponsors.