Challenges and Solutions in Adopting Electronic Patient Registries in Privately Owned Primary Care Practices Serving Minority Patients

Transcription

1 Challenges and Solutions in Adopting Electronic Patient Registries in Privately Owned Primary Care Practices Serving Minority Patients Thomas J. Van Hoof, MD, EdD Associate Professor University of Connecticut Schools of Nursing & Medicine & Clinical Advisor, Qualidigm

2 Preliminary Findings: Themes and Lessons Learned Barriers to recruitment Nature of changing clinical practice Concept of cultural humility

3 The Equity and Quality (EQual) Health Care Project Study: 2-year descriptive study in Connecticut Practices: private, primary care, very small, low-tech, >25% minority patients Measures: diabetes, prevention and chronic care Incentives: free registry, QI support, monetary, CME, and other Interventions: multifaceted, including use of a patient registry

4 Collaborators Funding: Connecticut Health Foundation Evaluation: Community Science Implementation: Qualidigm and the University of Connecticut

5 Barriers to Recruitment Too much work or change Too busy/workflow concerns Other projects Inadequate financial incentive Retiring soon Patient non-adherence perceived as issue

6 Lessons Learned from Recruitment Examine incentives to participation Allocate more time for recruitment Work with larger practices Assess readiness for HIT, QI, and cultural competency training Require some experience with QI Use peer clinicians to recruit

7 Changing Clinical Practice Time to develop rapport and assess office culture Importance of needs assessment Many changes at once: QI, HIT, cultural competence, and practice culture Balancing recruitment with expectations Face time and communication

8 Lessons Learned from Changing Clinical Practice Allocate more time for orientation to the project Consider context: Office culture, workflow, and leadership Consider standardized/validated tools for needs assessment Carefully sequence intervention strategy Have a reliable contact mechanism Recruit for project phases

9 Concept of Cultural Humility Experience as a barrier to humility Importance of practice-specific data to frame issue Opportunities for improvement: Clinician vs. patient

10 Lessons Learned about Cultural Humility Allocate more time when trying to change attitudes Practice-specific race/ethnicity data may be helpful earlier in the project Highlight what clinicians can do despite access and other challenges Model reflection about language and culture (local physician champion)

11 Summary of Major Points Small (1-2 clinician), low-technology, primary care private practices represent a challenging context in which to conduct quality improvement Recruitment requires one to generate enthusiasm but establish expectations, a difficult balance to strike when proposing new ideas to new providers Changes in clinical practice that involve QI, HIT, and cultural humility (or any similar combination) require a complex and carefully sequenced intervention Cultural humility is different from cultural competence but essential to patient-centered care, a new paradigm for many clinicians

12 References Cited 1. Meehan TP et al. (2006). Improving the quality of preventive cardiovascular care provided by primary care physicians. International Journal for Quality in Health Care 18(3): Meehan TP et al. (submitted). Challenges in Recruiting Minority-Serving Primary Care Physicians in Private Practice to a Quality Improvement Project. 3. Tervalon M, Murray-Garcia J. (1998). Cultural humility versus cultural competence: A critical distinction. Journal of Health Care for the Poor and Underserved 9(2): Van Hoof TJ et al. (2010). The Equity and Quality (EQual) Health Care Project: A Connecticut Health Foundation Initiative with Qualidigm. Connecticut Medicine 74(5): Weinick RM et al. (2010). Reducing disparities and improving quality. Ethnicity & Disease 20(1):58-63.

13 Contact Information Thomas J. Van Hoof, MD, EdD University of Connecticut 231 Glenbrook Road, Unit 2026 Storrs, CT Phone: (860)