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Advancing Integrated Primary Care Education in the VA Medical System Kendra Campbell, Ph.D. Assistant Professor of Psychology University of Alaska Fairbanks.

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Presentation on theme: "Advancing Integrated Primary Care Education in the VA Medical System Kendra Campbell, Ph.D. Assistant Professor of Psychology University of Alaska Fairbanks."— Presentation transcript:

1 Advancing Integrated Primary Care Education in the VA Medical System Kendra Campbell, Ph.D. Assistant Professor of Psychology University of Alaska Fairbanks Daniel Baughn, Ph.D. Staff Psychologist, PCMHI James A. Haley Veterans’ Hospital Rebecca Shunk, M.D. Co-Director, Center of Excellence in Primary Care Education, Associate Director of PRIME Program, UCSF Internal Medicine Residency Eleni Romano, Ph.D. Primary Care Psychology Fellow San Francisco VA Medical Center

2 Objectives for Today Provide overview of EdPACT Educational domains Report preliminary outcomes Challenges/Next Steps Discussion/Q&A

3 Patient Aligned Care Teams (PACT) Team-based patient-centered model of care 1200 patients per team Teamlet- Primary Care Provider, Registered Nurse, Licensed Vocational Nurse and Clerical Associate Practice Changes Panel Management Pre-visit planning Huddles Shared Medical Appointments/Group Clinics Walk-in appointments Telephone appointments Secure Messaging Health Coaching

4 Diabetes Shared Medical Appointments

5 VA Centers of Excellence (COE) Criteria: Transformative, generalizable, sustainable, and interprofessional primary care training Must include MD & NP trainees COE awards: Up to $1 M/yr x 5 years, exclusive of any new trainee positions 5 COEs Cleveland, San Francisco, West Haven, Boise, and Seattle

6 Mission of EdPACT: To develop and implement an inspirational model of patient-centered, interprofessional education that will advance primary care within and beyond the VA Joint effort with: UCSF School of Nursing UCSF School of Medicine Office of Medical Education

7 Structure Primary care training in a team-based, PCMH model Practice partnership model Each trainee has his/her own panel and cross-covers partners’ patients Interprofessional trainees support multiple trainee teamlets Teamlet Dietetics Social Work Psychiatry Pharmacy NP student Medicine R2 Psychology Health Professions Trainees

8 EdPACT Participants Core EdPACT trainee teams: Internal Medicine residents (two PGY-2 partners) Adult NP students from UCSF (1 per pair of MD partners) Additional interprofessional trainees: Clinical pharmacy, social work, psychology fellows, podiatry, nutrition, medical students, optometry, audiology, psychiatry Teamlets: LVN, RN, Clerk Preceptors & Educators: Longitudinal MD & NP preceptors Clinical psychology faculty & fellows Experts in communication, teamwork, performance improvement Additional health professionals– podiatry, social work, pharmacy, nutrition

9 Educational Domains of EdPACT Shared Decision-Making Sustained Relationships Interprofessional Collaboration Performance Improvement

10 Curricular Content: Interprofessional Collaboration Interactive small group seminars: Handoff communication Debriefing Huddling Feedback Conflict Resolution Daylong retreat: Team building Practice key communication skills Workplace reinforcement: 1) Preceptors reinforce skills and provide feedback during teamlet huddles 2) Teams engage in formative assessment processes Interactive small group seminars: Handoff communication Debriefing Huddling Feedback Conflict Resolution Daylong retreat: Team building Practice key communication skills Workplace reinforcement: 1) Preceptors reinforce skills and provide feedback during teamlet huddles 2) Teams engage in formative assessment processes Didactics Interactive small group seminars: Huddling Team Members Roles Handoff communication Feedback Conflict Resolution Debriefing Workplace reinforcement: Huddling Huddle Coaches Preceptors reinforce skills and provide feedback during huddles Teams engage in formative assessment processes Reflection Half-day retreat: Team building Opportunities to reflect Identifying similarities and differences

11 Nuts & Bolts of MH Integration Didactics Shared Decision Making Motivational Interviewing Case Conferences Diabetes Board Collaborative Care Conference Physical Proximity Huddles/Huddle Checklist Shared Medical Appointments Team Development Retreat Groups (Stress Management, Pain, Tobacco)

12 Interprofessional Communication -Huddles

13

14 Barriers to PC-MH Integration Limited facility space Increasing MH trainees/staff contact in exam room Staff turnover and scheduling complexity Cross discipline/specialty MH understanding of integrated care Culture change/ paradigm shifts

15 Measuring Outcomes Program ComponentData Source Curriculum Session evaluations Learners Learner Perception Survey (LPS-PC) Interviews Patient-Provider Continuity Faculty / Preceptors Interviews Mid & End of year surveys Staff Maslach Burnout Inventory (MBI) Teams Team Development Measure Interviews Huddle Observations Team-Patient Continuity Patients Patient Surveys (CAHPS) Interviews Systems QI project status

16 Team Development Results: Years 1 & 2 STAGESCORECOMPONENTS SOLIDIFICATION Pre-team0-36None to Building 11-46Cohesiveness In Place 247-54Communication 355-57Role Clarity 458-63Goals-means Clarity 564-69Cohesiveness Firmly In Place 670-77Communication 778-80Role Clarity 881-86Goals-means Clarity Fully Developed87-100Everything www.peacehealth.org/about-peacehealth/medical-professionals/eugene-springfield-cottage- grove/team-measure/Pages/Default.aspx Last Accessed 1/12/2012. Fall (Aug/Sept) Spring (Mar/Apr) Yr 1 - Trainee Teams: 59.4 Yr 1 - Trainee Teams: 64.6 Yr 2 - Trainee Teams: 62.2 Yr2 - Trainee Teams: 70.3

17 Team Development Scores by Team Fall 2012 to Spring 2013

18 Outcomes: Patient Satisfaction, 2011-12 R2sNP Students SFVA Outpatient Clinic FY12 YTD Qtrs1-3 N % Usually or Always N N How often did this provider explain things in a way that was easy to understand? 24195%7397%30489.1% How often did this provider listen carefully to you? 24194%73100%30490.0% How often did this provider show respect for what you had to say? 24296%72100%29991.7% How often did this provider seem to know the important information about your medical history? 23894%7294% Surveys returned by 244 R2 patients and 73 NP student patients 18% Response Rate, on average, for R2s and NP students

19 Outcomes: Patient Satisfaction, 2011-12 R2sNP Students SFVA Outpatient Clinic FY12 YTD Qtrs1-3 N% 9 or 10N N Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider? 24273%7476%31068.1% N % Definitely Yes N Would you recommend this provider to your family and friends? 24279%7489%

20 Next Steps Dissemination of our work/ Demonstrating benefit of EdPACT and PCMHI overall Implementation of PCMHI to VA Community- Based Clinics Americorps participants- health behavior coaches Increasing motivational interviewing/shared decision making/ other behavioral health topics into curriculum

21 Discussion Implementing change in primary care/ integrated health education within and outside of VA medical system Setting-based differences Directions for future growth/applications of current model

22 Thank You

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