Practice and curricula transformation in residency practices are we homes yet
Download
1 / 24

Practice and Curricula Transformation in Residency Practices: Are We Homes Yet? - PowerPoint PPT Presentation


  • 118 Views
  • Uploaded on

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. Who is Involved?.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Practice and Curricula Transformation in Residency Practices: Are We Homes Yet?' - ianthe


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Practice and curricula transformation in residency practices are we homes yet

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


Who is involved
Who is Involved? Practices: Are We Homes Yet?

  • 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


Who is involved1
Who is Involved? Practices: Are We Homes Yet?

  • 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


What is involved planning phase
What is Involved? Practices: Are We Homes Yet?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


Practice coaching
Practice Coaching Practices: Are We Homes Yet?

  • 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”


Collaboratives
Collaboratives Practices: Are We Homes Yet?

  • 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


What s provided
What’s Provided? Practices: Are We Homes Yet?

  • 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


Curricular redesign objectives
Curricular Redesign Objectives Practices: Are We Homes Yet?

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


Practice outcomes
Practice Outcomes Practices: Are We Homes Yet?

  • 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


Curricular outcomes
Curricular Outcomes Practices: Are We Homes Yet?

  • 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


Two parts of project practice and curriculum redesign
Two Parts of Project—Practice and Curriculum Redesign Practices: Are We Homes Yet?

Curricular Redesign

PCMH Residency Practice

Practice Improvement


Practice pcmh transformation
Practice PCMH Transformation Practices: Are We Homes Yet?

NCQA Certification

Iterative Practice Redesign

Cultural Transformation


Baseline assessment process practice improvement
Baseline Assessment Process – Practices: Are We Homes Yet?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)


Baseline assessment report
Baseline Assessment Report Practices: Are We Homes Yet?

  • 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


Practice redesign lessons learned
Practice Redesign Lessons Learned Practices: Are We Homes Yet?

  • 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


Curriculum redesign
Curriculum Redesign Practices: Are We Homes Yet?

  • Challenges and Opportunities

    • No organized, comprehensive PCMH curriculum or materials

    • No developed curriculum competencies

    • No tools to assess PCMH curricular activities or resident competency


Curriculum redesign1
Curriculum Redesign Practices: Are We Homes Yet?

  • 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


Curriculum assessment
Curriculum Assessment Practices: Are We Homes Yet?

  • 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


Resident pcmh curriculum competency survey
Resident PCMH Curriculum Competency Survey Practices: Are We Homes Yet?

  • Developed to assess resident baseline competence (See handout)


Results and lessons learned
Results and Lessons Learned Practices: Are We Homes Yet?

  • 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


Results and lessons learned1
Results and Lessons Learned Practices: Are We Homes Yet?

  • 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


Results and lessons learned2
Results and Lessons Learned Practices: Are We Homes Yet?

  • Time-consuming process

  • Great qualitative data

  • Quantitative data still to be determined


Curriculum redesign next steps
Curriculum Redesign: Next Steps Practices: Are We Homes Yet?

  • Review feedback report

  • Goal setting for each practice

  • Actively developing curricular modules and tools

  • Integration of curricular modules and tools

  • Continuous evaluation


Questions
Questions? Practices: Are We Homes Yet?

  • Contact Information:

    • Bonnie Jortberg:

      [email protected]

    • Nicole Deaner:

      [email protected]


ad