1. Taber Clinic Group Visits September 11, 2007 Audrey Wiebe, RN Mike Brand, Clinic Manager

2. Why Group Visits? Busy, part-time physician with a large population of elderly pts Interested physician Interested team!

3. Identifying the population for the group visit Physician panel profile > 60 y of age > 5 office visits per year From this list, the doctor selected pts he thought would benefit. 14 pts chosen Avg age 78.8 yrs # of dx 4.7 # of visits in last year 17.9!!!!!

4. Selecting the group visit content Group Starter Kit from Improving Illness Care Program in Seattle www.newhealthpartnerships.org Followed outline from the kit Topics were solicited from the group cardiac issues, sleep, depression, falls prevention, medications & side effects, community services

5. The group visit team and their roles Each team member has roles before, during and after the visit: Office Assistant RN Physician

6. Office Assistant Role Before Confirms pt attendance Gathers labs and tests for dr to review During Greets pts as they arrive Obtains vital signs Updates medication changes After Collects information from debrief Enters info into EMR Completes new physician orders Advises front desk of next appt

7. RN Role Before Coordinates time/date with MOA & dr. Recruits speakers to present content Coordinates materials and information During Greets pts Facilitates meeting Facilitates question/answer period Presents on a topic, or introduces speaker Assesses pts 1:1 during break After Debriefs with team Assists with following up Prepares for next meeting

8. Physician Role Before Reviews pt list Provides input about topics During Assesses pts 1:1 Communicates new orders to team Participates in question/answer period After Debriefs with team Suggests further topics

9. Measuring the effect of Group Visits Pt evaluation sheet # of office visits Group visit attendance

10. Hearing what staff, pts, and doctors say Staff Builds more trust among team members Pts See and hear people with similar experiences Doctors Changed the traditional roles and challenged each of us as team members in these roles

11. Experiencing Challenges Choosing relevant topics Adjusting the agenda Developing the team Focussing on group visit, not just social component Keeping physician on time

12. Celebrating Successes Great attendance Builds trust with pts in the team Positive group relationships Decrease in office visits

13. Preparing Next Steps Continue improving as we go along Add more groups

14. Sharing Resources Group visit sample pt package Agenda Pts medication list Pts labs Confidentiality sheet Consent form Group norms sheet Action plan

15. Questions & Discussion Lets hear from the participants and the faculty!