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Meet the Author Webinar May 10, 2012. Ground Rules for Webinar Participation. Actively participate and write your questions into the chat area during the presentation(s) Do not put us on hold Mute your line if you are not speaking (press *6, to unmute your line press #6) - PowerPoint PPT Presentation
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Meet the AuthorWebinar
May 10, 2012
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Ground Rules for Webinar Participation
• Actively participate and write your questions into the chat area during the presentation(s)
• Do not put us on hold• Mute your line if you are not speaking
(press *6, to unmute your line press #6)• Slides and other resources are available
on our website at incareCampaign.org• All webinars are being recorded
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Agenda
• Welcome & Introductions, 5min• Meet the Author: Dr. Amy Sitapati, 30min• Q & A Session, 20min• Campaign Next Steps, 5min
BRINGING RETENTION INTO THE HIV PATIENT CENTERED MEDICAL HOMEAmy M. Sitapati, MDAssociate Director, Owen ClinicAssociate Clinical Professor, Department of MedicineUCSD ANCHOR: A Novel Centered Home Optimizing Retention
Tell Us About Your Site – Question 1
Bibliography1. Kurt C. Stange, Paul A. Nutting, William L. Miller, Carlos R.
Jaen, Benjamin F. Crabtree, Susan A. Flocke, and James M. Gill Defining and Measuring the Patient-Centered Medical Home. J Gen Intern Med. 2010; 25(6):601-12.
2. Mallory O. Johnson. The Shifting Landscape of Health Care: Toward a Model of Health Care Empowerment. Am J Public Health. 2011;101:265-270.
3. David W. Bates and Asaf Bitton. The Future of Health Information Technology in the Patient Centered Medical Home. Health Affairs. 2010;29(4):614-21.
4. http://www.ncqa.org
Who are we? The OWEN CLINIC
Funded by California HIV/AIDS Research Program (CHRP) to serve as a pilot center for application of Patient Centered Medical Home in HIV
Site based focus to improve Retention
University of California, San Diego20 years of experience 3,000 HIV/AIDS patientsHigh proportion of Medi-Cal/ Medicare/ RW funding
Goal of presentation: To illustrate how to begin to construct the concepts of a patient centered medical home into HIV primary care retention
Some of our patchwork homes, need upgrading
maybebymonday.com/cars3
Step 1: Belief that change will helpNational Committee for Quality Assurance Patient-Centered Medical Home
“The comprehensive and coordinated care thatthe medical home promotes leads to better
health, longer lives, higher patient satisfactionand less expensive care. The question isn’twhether we should implement the medicalhome, but how. NCQA standards clearly
assess and identify effective medical homes.”
Paul Grundy, MD, IBM Global Director of HealthcareTransformation and President, Patient-CenteredPrimary Care Collaborative (PCPCC)
http://www.ncqa.org/Portals/0/PCMH%20brochure-web.pdf
David W. Bates and Asaf Bitton
The Future Of Health Information Technology In The Patient-Centered Medical Home
Health Affairs, 29, no.4 (2010):614-621
Framing the PCMH
http://www.vermonttimberworks.com/Web-Photos/Post-And-Beam/
THE MODERN MEDICAL HOME
PhysicianPatient Case
Manager
SocialWorker
Homehealth
Housingassistance
Midlevel
PhysicianColleague
Receptionist
MA
RN
Operator
Referrals
Partner
Family
Pharmacy
Dental
Insurance
Prescriptiondrug plan
Specialist
MULTIPLY PATIENT BYn= x in the medical practice
Communications multidirectional between provider-patient-and all the between.
Step 2: How to conceptualize concepts of PCMH
Core Frames of the building
• REGISTRYDefine patients with specific condition (i.e. HIV) while also specifying their disease status (6 month gap in care, poor viral control, etc.). Best practice would be to have non MD identify, communicate and track with an actionable intervention.
• CLINICAL DECISION SUPPORTComputerized system aiming to improve decision making around the diagnosis (clinical prediction), prevention and disease management (routine care reminder), and treatment.
Bates, Health Affairs, 2010.
Martin is due for his routine care… But, we didn’t recognize that he was poorly retained.CARE MANAGEMENT (evidence for q 6 mo. visit)
The database is searched using registryFor the practice, and patients with gaps of6 months are loaded into a tracking accessProgram.
A retention specialist uses TEAM CARE with tracking database for information about contact, last visit, primary provider and contacts patient.
OPEN ACCESS SCHEDULING:
• Allows for scheduling in less than 2 week notice
Tell Us About Your Site – Question 2
Patient returns to care, and provider needs electronic record to help facilitate the quality careProvider View
Manageable appointment schedule
Clinical decision support
Secure communication with patient
Priority notification of abnormal lab results
Help patient establish health care goals
Provider & health team related EMR improvements
• Decision support improvements, prevention health maintenance• Provider report card• Improved communication methodology (urgency, type)
Where we’re heading in modern POPULATION MANAGEMENT
Actionable reports in the EMR will make it possible evaluate: are my Hypertensive patients on two-drug therapy? (HIVQUAL measure)
--and generate orders per protocol --and communicate with patient (letters, phone lists or MyChart)
Step 3: Patient empowerment in the PCMHPATIENT SELF CARE SUPPORT AND RESOURCES
Health Care EmpowermentEngagedInformed
CollaborativeCommitted
Tolerant of uncertainty
“Engagement in health care has been identified as an important factor related to optimization of health outcomes.”
MO Johnson, Am J Public Health, 2011
Patient centered technology supports patient and provider
Manageable appointment schedule
Clinical decision support
Secure communication with patient
Priority notification of abnormal lab results
Help patient establish health care goals
Schedule/Reschedule appointment
Learn about support tools and programs
Ask a medical question
Learn about my condition
View my lab results
Get reminders of health care tests
Set and track my health goals
Clinic Based Web Page
MyChart / MyChart Mobile Electronic Medical Record
Offer improved patient health literacy and systems literacy
• Clinic based web page• Offer basic computer training• Enhanced computer access (care service sites)
• Enhance patient chart access MyChart:– Spanish translation– Providers strongly supporting patient initiation/use– Appt reminders– Test reminders (including specific to safety on meds)– Preventative care reminders/tracking
Tell Us About Your Site – Question 3
Step 4: Measure and Improve PerformanceDevelop, apply, test, analyze and start over“The value of … primary care…includes higher health care quality, better whole-person and population health, lower cost and reduced inequalities…”
“The transformation …is best understood as a developmental process, with stops, starts, backslides, leaps and challenges…”
This article nicely summarizes application of PCMH into primary care.
Stange, J Gen Intern Med, 2010.
PCMH Review in HIV Primary Care1. Open Access to continuity
provider2. Registry of HIV primary care
patients3. Apply poor retention as
important quality goal4. Improve patient empowerment
through knowledge, chart access, etc.
5. Track patient’s return to care and coordination
6. Use lessons learned in CQI to make process more robust
http://www.ncqa.org
Thanks to the OWEN ANCHOR TEAM:• Moira Mar-Tang• Militza Bonet-Vazquez• Barbara Berkovich• Pavel Tseytlovskiy• Susan Benson• Dorothea Northcutt• Jan Limneos• Dr. Chris Mathews• CQI committee
The California HIV/AIDS Research Program; Award number: MH10-SD-640
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Time for Questions and Answers
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Partners in+care
• Aspect of Campaign aimed at People Living with HIV and their allies• What can they do to make sure they stay in
care?• What can they do to ensure their friends and
loved ones stay in care?• Handouts, Webinars, and Bulletin Board
(coming soon)• Partners in+care website is live!
http://www.incarecampaign.net/index.cfm/77453
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Photo Drawing Prizes
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• Campaign Office Hours: Mondays & Wednesdays 4-5pm ET
• Improvement Update Submission Deadline: May 15, 2012
• Next Campaign Webinar: Retention & Youth May 31, 2012 2pm ET
• Next Partners in+care Webinar: Peer-to-Peer Retention May 24, 2012 2pm ET
• Data Collection Submission Deadline: June 1, 2012
Upcoming Events and Deadlines
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Campaign Headquarters:National Quality Center (NQC)90 Church Street, 13th floorNew York, NY 10007Phone [email protected]
incareCampaign.orgyoutube.com/incareCampaign