March 27, 2012 Practice Facilitators - Catalyst for Medical Home Transformation Lyndee Knox, PhD, Vanessa Nguyen, MPH, & Diana Traje, MPH
Who we are 2 LA Net a Primary Care Practice Based Research & Resource Network in Los Angeles (AHRQ) 23 FQHC, CHC and small practices = 116 practice sites Mission: Strengthen the safety-net, reduce health disparities Methods: Support practice improvement w/ Practice Facilitators Support clinician led research that matters to them Innovation pipeline LA Net is a petri dish for primary care Practice Facilitation, LA Net 3/27/12
From a High School Math Quiz 3 Practice Facilitation, LA Net 3/27/12
Effective Implementation of Innovations in Primary Care 4 Literature and Exemplar Methods Academic Detailing Performance Feedback Facilitation IT Support Practice Enhancement Assistant Local Learning Collaboratives Practice Facilitation, LA Net 3/27/12
What are Practice Facilitators (QI coaches)? 5 Practice facilitators are specially trained individuals who assist primary care practices to make positive changes in their care and processes. They have expertise in: Quality improvement People and project management Accessing & using data and IT to drive care and change Core competencies of PCMH/Care Model They develop long-term relationships with providers and practices; and are available on an PRN basis. E.g. A metric of success = They have the key/combo to the back door
Who are they? LA Net s PFs 6 Zoe- Anne Fitzhugh, RN, MS, CCRN, CHES June Levine, RN Aminah Ofumbi, MSW Vanessa Nguyen, MPH Diana Traje, MPH Chris@ne Edwards, PhD
7 Evidence supporting PF 2012 Meta-analysis of research on PF Facilitated practices are 3 times more likely to adopt evidence-based guidelines than non-facilitated practices Baskerville, Liddy, and Hogg. 2012. "Systematic Review and Meta-Analysis of Practice Facilitation Within Primary Care Settings." Annals of Family Medicine 10(1):63-74.
Evidence 8 Cost-consequence analysis of PF in Canadian context ROI on intervention: 40% Savings: $3600/MD, $63,000/PF Hogg, Baskerville, and Lemelin. 2005. Cost saving associated with improving appropriate and reducing inappropriate preventive care: cost consequences analysis. BMC Health Services Research 5(20): 1-15.
9 Type of PFs Location of facilitators: Internal External General agreement: Internal is generally less effective. Internal facilitators get pulled away from facilitation role by competing demands, and often lack the distance they need to drive change. Possible exception to this is IPA or other type organization, where facilitator is internal to organization but not to individual practice.
LA Net s PF program 10 Long Term relationship Provide on-site support ½ day a week Set up QI systems Do audit and feedback Train on core PCMH concepts Optimize HIT Executive coaching An extra set of hand Build capacity of the pratices Cost: Est. $8000/practice for 6-month active intervention 2012
California San Francisco, Los Angeles Oregon ORPRN PBRN Washington Washington Academy Colorado HealthTeam Works, U of Colorado Vermont State Health Department Oklahoma State Health Department & OKPRN New York Primary Care Development Corporation, UNYNet North Carolina Statewide AHEC Pennsylvania U of Pennsylvania & AHEC program Maine State Health Department/ Maine Counts Clinical Microsystems TransforMed IHI training program Etc. Practice Facilitation, LA Net 11 PF Programs in the U.S. 3/27/12
National Primary Care Extension Program 12 The goal is to create a national network of facilitators for small and medium sized practices Analogous to the agricultural extension service Created by the Affordable Care Act but unfunded AHRQ is funding a 4 state pilot: IMPACT (Pennsylvania, North Carolina, Oklahoma, New Mexico) Nidus: HI TECH RECs AHECs PBRNs Other Practice Facilitation, LA Net 3/27/12
13 Diana Traje, LA Net Practice Facilitator Practice Facilitation, LA Net 3/27/12
14 Vanessa Nguyen, LA Net Practice Facilitator Practice Facilitation, LA Net 3/27/12
15 Stories from the field Using HIT to support population management Background Chronic Kidney Disease (CKD) Guideline Implementation project Leverage practice s existing resources i2itracks: stand-alone registry Create a CKD registry
16 Stories from the field Using HIT to support population management What was the process? 1. Identified functions of the registry that could support CKD care 2. Assessed the impact of registry on workflow 3. Mapped a preliminary workflow 4. Created the CKD registry 5. Populated registry 6. Tested workflow and made adjustments 7. Finalized workflow with providers/staff feedback 8. Introduced new care process
17 Stories from the field Using HIT to support population management What did PF do? Facilitate the process Research best practices Assisted with workflow mapping and analysis PDSA cycles What did practice staff do? Set up CKD registry Submitted enhancement request to vendor Mapped workflow Clinician champion provided training to peers; lead MA provided training to peers
18 Stories from the field Using HIT to support population management What were the outcomes in the practice? Practice can now manage panel of CKD patients Standardized care for CKD patients Practice engaging in preventive care for CKD patients Increased capacity for interpreting data and reports Increased capacity to practice evidence-based medicine
19 Stories from the field Using HIT to support population management Spreading best practices This was such a great project! How do we spread this to other community health centers? --Provider PF set up clinician-to-clinician learning sessions on setting up a CKD track in i2i with 2 other practices in the area
20 Stories from the field Empanelling to improve the continuity of care Background Clinic sought to improve the continuity of care for its patients Empanelment Clinic staff were sent to train Still unsuccessful with the Empanelment process Reasons: Constant shift in lead champion Additional staff training Gap in communication between providers and staff
21 Stories from the field Empanelling to improve the continuity of care Clinic s Project Objectives 1. Establish a workgroup and regularly scheduled meetings 2. Calculate panel sizes 3. Develop Panel Policies and Procedures 4. Develop a Panel reporting and tracking tool 5. Develop a system for maintaining panels
22 Stories from the field Empanelling to improve the continuity of care Practice Facilitation Process to Assist Clinic in completing Objectives Initial assessment: an evaluation of clinic s past efforts Finalize policies and procedures Train staff on new script and policies & procedures Identify barriers and provide the clinic feedback Begin the empanelment process Facilitate the formation of a workgroup and generate timeline Review and revisit the empanelment process
23 Stories from the field Empanelling to improve the continuity of care Outcomes Panel teams established Building capacity for change: Automated reporting system that provides staff with pre-calculated panel sizes Produced a set of policies and procedure for calculating and maintaining panels Clinic an Nurse Managers at each site were trained in policies and procedures
24 Stories from the field Empanelling to improve the continuity of care Outcomes (cont.) Spreading best practice: Provide front staff and call center with script on the process for providing change Established regularly scheduled panel meetings Process for providing letters to patients notifying them of change in provider Patient assignment to panel is reviewed on a monthly basis
Questions 25 What has been the most surprising to you about working with practices around PCMH transformation? Other questions? Practice Facilitation, LA Net 3/27/12
How do you find more information on PF? A How-To Guide on Developing and Running a Practice Facilitation Program Available on the AHRQ PCMH web site or at: http://pcmh.ahrq.gov/portal/server.pt/community/ pcmh home/1483/ pcmh_implementing_the_pcmh practice_facilitation_v2 AHRQ s PF listserv: send an email to PCPF-request@LIST.AHRQ.GOV and include subscribe in the subject heading 26 AHRQ s PCMH website: http://pcmh.ahrq.gov
Useful websites 27 Some websites: LA Net - lanetpbrn.net Safety net initiative - http:// www.safetynetmedicalhome.org/ Healthteam works - http://www.healthteamworks.org/ TransforMed - http://www.transformed.com/ Clinical Microsystems http://www.clinicalmicrosystem.org/ IMPACT BD - http://www.impactbc.ca/ IHI - http://www.ihi.org/pages/default.aspx Practice Facilitation, LA Net 3/27/12
Thank you! 28 Lyndee.knox@lanetpbrn.net Practice Facilitation, LA Net 3/27/12