1. Practice and Curricula Transformation in Residency Practices: Are We Homes Yet?
Bonnie Jortberg, MS,RD,CDE
University of Colorado Denver
Department of Family Medicine
Nicole Deaner, MSW
Colorado Clinical Guidelines Collaborative

2. Who is Involved? Funded by The Colorado Health Foundation
University of Colorado Dept of Family Medicine
Perry Dickinson MD: Project Director
Bonnie Jortberg: Project Coordinator, Curriculum Redesign
Doug Fernald, Evaluation
Frank deGruy MD
Larry Green MD

3. Who is Involved? Colorado Clinical Guidelines Collaborative (CCGC)
Nicole Deaner: Practice Improvement Coach
Caitlin O’Neill: Practice Improvement Coach
Julie Schilz: Manager, IPIP and PCMH
Marjie Harbrecht : CCGC Executive Medical Director
Colorado Association of Family Medicine Residencies
Nine Family Medicine Residencies + one track
10 residency practices
Tony Prado-Gutierrez: Director

4. What is Involved? Planning Phase
Preparation for practice and curricular redesign
Assistance with IT issues
Start working on forming improvement team
Practice/program discussions of PCMH
Sponsoring organization – look for support, try to remove barriers
Prepare for cultural transformation

5. Practice Coaching Active coaching period – approximately 14 months
Assessment with feedback – 2 months
Active coaching with practice improvement team(s) – 12 months (or more)
Continued team meetings for PCMH changes, other practice improvement with coach “boosters”

6. Collaboratives
Meetings of representatives of all practices and programs
Planning, sharing, educational – highly interactive
Two collaboratives per year
First one May 2009 – 105 people from the practices
Second in October – over 130 from practices

7. What’s Provided?
Assistance with orientation to PCMH, initial planning, working with hospital leadership
Coaching team provided
IT consultation resources
PCMH consultation and support
NCQA PPC-PCMH certification paid for
Direct funding for the programs

8. Curricular Redesign Objectives
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

9. Practice Outcomes
Achieve NCQA PPC-PCMH certification – hopefully at least level 2
Improve level of medical homeness:
NCQA PCMH assessment
PCMH Clinician Assessment
Practice Staff Questionnaire
Improve quality measures in two clinically important areas to be chosen by the practices

10. Curricular Outcomes Improved resident achievement of PCMH competencies
Improved resident use of PCMH elements as assessed by PCMH clinician assessment
Revision of residency curricula to allow resident participation in PCMH and QI efforts
Implementation of PCMH curricular elements
Will follow resident In-training Exam and Board Exam scores, but may not show up there

11. Two Parts of Project—Practice and Curriculum Redesign
Curricular Redesign
PCMH Residency Practice
Practice Improvement

12. Practice PCMH Transformation
NCQA Certification
Iterative Practice Redesign
Cultural Transformation

13. Baseline Assessment Process – Practice Improvement
NCQA Self-Assessment – group or individual
Key Informant Interviews
Cycle Time Report
Online surveys using survey monkey:
PCMH - Clinician Assessment (PCMH-CA)
Practice Staff Questionnaire (PSQ)

14. Baseline Assessment Report
Structure:
Narrative explanation and assessment on 7 core elements
Data tables for responses to NCQA Self-Assessment & responses to PSQ & PCMH-CA
Recommendation section
Approximately 10 pages long
Appendix:
PCMH-CA & PSQ graphic data (previous slides) with narrative explanation
NCQA Self-Assessment Report

15. Practice Redesign Lessons Learned
Leadership buy-in prior to project launch critical.
High-functioning teams build foundation for project.
Clinic flow - first entrée into working on teams & teaching QI principles.
QI teams big cultural shift for existing leadership structure; largest source of resistance.
Building communication infrastructure for all staff inclusion a local and important process.
Current: choosing clinically important conditions & registries
Next steps: Patient Involvement and Reporting & Posting Measures

16. Curriculum Redesign Challenges and Opportunities
No organized, comprehensive PCMH curriculum or materials
No developed curriculum competencies
No tools to assess PCMH curricular activities or resident competency

17. Curriculum Redesign Started with developing competencies
(see handout)
Curriculum Assessment:
Developed Residency Curriculum Semi-Structured Interview Template to determine current PCMH curricular activities; identify gaps; set goals and establish plan

18. Curriculum Assessment
Competencies:
Who, what, where, when, how for each
Summary Questions:
Strengths/weaknesses of curriculum
What do they need the most help with for the curriculum?
Resource for other programs
How do they characterize their sponsor’s interest and support for this project?
Resident’s interest and support (scale 1-5)
Staff and faculty support

19. Resident PCMH Curriculum Competency Survey
Developed to assess resident baseline competence (See handout)

20. Results and Lessons Learned
Interview completed with 3 programs so far
Emerging Themes:
Interview process is an “intervention” for the program
Makes them take comprehensive look at what they are teaching
“We want to go from reactive teaching to intentional teaching”
Revealing that they are teaching many of the elements of the PCMH, just not in an organized manner
Resident participation on the QI teams an important curricular component

21. Results and Lessons Learned
Common areas meeting competencies (through resident involvement in QI teams)
Team approach
Integrated and coordinated care
Quality Improvement
Leadership skills
Common areas not meeting competencies
Population management
Access to care
Information systems to support PCMH
Self-management support

22. Results and Lessons Learned
Time-consuming process
Great qualitative data
Quantitative data still to be determined

23. Curriculum Redesign: Next Steps
Review feedback report
Goal setting for each practice
Actively developing curricular modules and tools
Integration of curricular modules and tools
Continuous evaluation

24. Questions?
Contact Information:
Bonnie Jortberg:
Nicole Deaner: