National Primary Care Extension Program in the United States: A Learning Network International Forum on Quality & Safety in Healthcare 2015, London England 21-24 April 2015 Robert A. Gabbay, MD, PhD, FACP Joslin Diabetes Center, Harvard Medical School; Boston, MA Alan M. Adelman, MD, MS Penn State University College of Medicine; Hershey, PA
Disclosures The speakers have no disclosures.
Learning Objectives 1. Identify features of a national learning network that can be utilized to spread and disseminate best practices among primary care practices. 2. Identify services that a Primary Care Extension Program can offer to help improve primary care.
Background PA SPREAD (Pennsylvania Spreading Primary Care Enhanced Delivery Infrastructure) funded by the Agency for Healthcare Research and Quality (AHRQ) in 2012 for an IMPaCT award Infrastructure for Maintaining Primary Care Transformation Via Patient Protection and Affordable Care Act, 2010. Most significant health care overhaul since the implementation of Medicare and Medicaid in 1965. GOAL: develop infrastructure for supporting/spreading primary care transformation Create a Primary Care Extension Program (PCEP)
Model for National Primary Care Extension Program Based on the Agricultural Cooperative Extension Model Most successful innovation spread program in U.S. 1914 Collaboration of federal, state, county governments, land grant universities Helped famers adopt best practices Network of local change agents
National Primary Care Extension Program Establish state hubs and local primary care extension agents (practice facilitation) Community based services but central administration Fundamentally an organized mechanism to spread new care models and innovations One size may not fit all Learning collaboratives Convener Shared resources Community health workers Tension between focus on primary care social determinant health
ACA: Sec. 5404 Primary Care Extension Programs (PCEPs) PCEP shall provide support and assistance to primary care providers to educate providers about preventive medicine, health promotion, chronic disease management, mental and behavioral health services (including substance abuse prevention and treatment services), and evidence-based and evidence-informed therapies and techniques, in order to enable providers to incorporate such matters into their practice and to improve community health by working with community-based health connectors
National Primary Care Extension Program (PCEP)
The Chronic Care Model Community Resources and Policies Self- Management Support Health System Health Care Organization Delivery System Design Decision Support Clinical Info Systems Informed and Activated Patient Productive Interactions Prepared and Proactive Practice Team Improved Outcomes
The Medical Home
Transformation/Paradigm Shift Population Management - shift from treating one patient at a time to managing populations of patients Continuum of care - shift from defining a single medical encounter as a complete entity to viewing it as one point on a continuum of care Team-based care - shift from the physician providing care alone to coordinated, physician-led interprofessional team care.
Methods of Transformation Data review Practice facilitation Learning collaboratives
What do Providers Want from a PCEP- Survey Results Top 5 Rated Services 1. Identifying and coordinating referrals to mental health services. 2. Improving office efficiency (workflow). 3. Increasing overall revenues. 4. Strategies to help Implement evidence-based clinical guidelines. 5. Helping patients set self-management goals. Parisi LM, Gabbay RA. What Providers Want From the Primary Care Extension Service to Facilitate Practice Transformation. Fam Med (in press).
Provider Survey Results Bottom 5 Rated Services 1. Implementing e-prescribing. 2. Implementing an electronic medical record (EMR) system. 3. Implementing group visits. 4. Recruiting new patients (marketing). 5. Implementing open or advanced access scheduling. Parisi LM, Gabbay RA. What Providers Want From the Primary Care Extension Service to Facilitate Practice Transformation. Fam Med (in press).
Provider Survey Results 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Time Spend Monthly on QI Time Willing to Spend Monthly on QI Missing >10 Hours 0% Time Now Time Willing Parisi LM, Gabbay RA. What Providers Want From the Primary Care Extension Service to Facilitate Practice Transformation. Fam Med (in press). 556 responses at least 1 response from every county in the state 5 to 10 Hours 3 to 5 Hours 1 to 2 Hours None
General Contractor Model
PCEP is Not One Size Fits All Based on REGIONAL and COMMUNITY needs; tailored Social Determinants of Health QI Coordination COOPERATIVE EXTENSION Share Resources/ Best Practices/ Communication Lines Data Monitoring Patient-Centered Medical Home IMPROVING PRIMARY CARE INFRASTRUCTURE
Developmental Model
Health Extension Toolkit www.healthextensiontoolkit.org Created by the University of New Mexico and network of PCEP Literature, modules, videos, etc.
Conclusion
In Conclusion Primary care practices often need technical assistance to transform A Primary Care Extension Program (PCEP) can provide a valuable role to convene local and regional resources to improve care
Questions? Thank You! Resources: www.paspread.com