1. Initial Lessons Learned With Implementation of The PCMH In Family Medicine Residency Practices
Nicole Deaner, MSW
Colorado Clinical Guidelines Collaborative
Bonnie Jortberg, MS, RD, CDE
University of Colorado, Dept. of Family Medicine

2. The Colorado Family Medicine Residency PCMH Project
3-year grant from the Colorado Health Foundation; began in December 2008
Goal: To transform the 10 Colorado FM Residency Programs into medical homes through practice improvement and curriculum redesign

3. Who is Involved?
University of Colorado School of Medicine, Department of Family Medicine
Colorado Clinical Guidelines Collaborative
Colorado Association of Family Medicine Residencies
Colorado Institute for Family Medicine

4. Practice Coaching Assessment of current status in practice
Feedback assessment and data to practice
Assist in improvement team formation
Initially facilitate team meetings but transition to practice taking process over
Serve as connection to resources
Facilitation of QI and change process
Goal is to establish a sustainable change & improvement process in the practice

5. Curriculum Redesign
Facilitation and consultation for PCMH-related curriculum changes
Changes to free up residents to participate in PCMH and QI efforts
Shared resource development across programs (lectures, modules, etc)
Active involvement of residents in practice redesign process
PCMH practices for residents to experience

6. Lessons Learned - Culture
Leadership
Shift from traditional model to more facilitative leadership– need for support & training, especially among faculty
Mixed investment among practice leaders in PCMH concept
Shared leadership model & QI teams require time, training and resources
Change is inconsistent with slow movement forward.
Resistance to registry launch – benefits understood later as data drives motivation for change.
Communication is critical but challenging with many moving parts.
Using simple proactive surveys can be an easy way to engage all staff in the change process.

7. Lessons – Project Structure & Support
No established road map to the medical home at this time, especially for residencies
Practices benefit from assistance but need to own and guide the process
Moving toward a structured approach balanced with practice choice & creativity
NCQA recognition is laborious & time-consuming but can also provide some framework for the change process.
But lacks may of the key aspects of the PCMH

8. Lessons - Sustaining Change
Areas where lack of payment reforms problematic: care management, population management, and integrated care and ongoing funding for QI teams
Need for job descriptions, training, evaluation around PCMH to address staff turnover.
Internal QI Team Leader training developed to lead/facilitate QI teams past coach involvement.
Learning Collaboratives working well to promote sharing
Project staff creating connections between programs working on similar areas
Use of technology???

9. Lessons - Curriculum
Residents are more energized and ready to change than faculty
Practices are not a PCMH (yet) – hard to teach something that is not practiced
Difficult but crucial to involve residents on a regular basis in the change process
Developed PCMH competencies – will evolve
Curriculum issues may change over time
Initial need for didactics & projects in key PCMH areas
Gradual shift to more experiential learning
NEED MORE REGULATORY FLEXIBILITY

10. Questions Bonnie Jortberg Bonnie.Jortberg@ucdenver.edu
Nicole Deaner