1. Michael Toboni and Brian Chou with Dr. Brian Prestwich
MT  everyone
December 4, 2012
Michael Toboni and Brian Chou with Dr. Brian Prestwich
Executive Board Members: Emily Levy, Joseph Li, Natane Runningfox,
Sadia Quidwai, Megan Chen, Yvonne Hoang, Mena Alrais

2. Who We Are 200+ Student Volunteers 25+ Preceptors 4 Health Professions
Medicine
Occupational Therapy
Pharmacy
Physician Assistant
2 Clinic Sites
LAC + USC Urgent Care
Eisner + USC Med Center
Michael
UADC: 22 clinic days, 67 patients seen 
Eisner: 17 clinic days, 93 patients seen Total clinic days: 39 Total patients seen: 160
Total number of volunteers (not unique) = 267 (130 med, 42 pharm, 60 PA, 35 OT)
Total number of student volunteer hours = 1163
Total number of unique student volunteers (unique) = 200 (99 med, 30 pharm, 47 PA, 24 OT)
Total number of unique faculty = 25
More time spent with patient between all the student healthcare providers
Each healthcare provider accomplishes specific tasks with the patient that a single clinician cannot achieve by him/her-self
Patient satisfaction has been overwhelmingly positive
Inter-professional care teams
Not just in primary care
Example: ENT Head and Neck Cancer tx involves not only the ENT, but also oncologist, speech pathologist, OT, physical therapist
Even surgical teams
 Every person on the team has specific role that need to accomplish with patient, each provider equally important to the care of the patient

3. Who We Are
We are students working together in interprofessional care teams to help deliver comprehensive care to the chronically ill and underserved population of Los Angeles.
Care Team
1 Clinic Coordinator
2 Medical Students
2 Pharmacy Students
1 OT Student
1 PA Student
Supervising Faculty
Patient Services
Preventative Screening
Lifestyle Modification
Medical Assessment
Medication Therapy Mgmt
Medical Home Linkage
Cycle Time
70 Min per Patient
Brian
More time spent with patient between all the student healthcare providers
Each healthcare provider accomplishes specific tasks with the patient that a single clinician cannot achieve by him/her-self
Patient satisfaction has been overwhelmingly positive
Inter-professional care teams
Not just in primary care
Example: ENT Head and Neck Cancer tx involves not only the ENT, but also oncologist, speech pathologist, OT, physical therapist
Even surgical teams
 Every person on the team has specific role that need to accomplish with patient, each provider equally important to the care of the patient

4. What We Do Primary Care Project at USC+ Eisner Family Medicine Center
Urgent Care Project at LAC+USC Urgent Care Center
What We Do
Joseph and Emily
More time spent with patient between all the student healthcare providers
Each healthcare provider accomplishes specific tasks with the patient that a single clinician cannot achieve by him/her-self
Patient satisfaction has been overwhelmingly positive
Inter-professional care teams
Not just in primary care
Example: ENT Head and Neck Cancer tx involves not only the ENT, but also oncologist, speech pathologist, OT, physical therapist
Even surgical teams
 Every person on the team has specific role that need to accomplish with patient, each provider equally important to the care of the patient

5. The Clinic Protocol Joseph
More time spent with patient between all the student healthcare providers
Each healthcare provider accomplishes specific tasks with the patient that a single clinician cannot achieve by him/her-self
Patient satisfaction has been overwhelmingly positive
Inter-professional care teams
Not just in primary care
Example: ENT Head and Neck Cancer tx involves not only the ENT, but also oncologist, speech pathologist, OT, physical therapist
Even surgical teams
 Every person on the team has specific role that need to accomplish with patient, each provider equally important to the care of the patient

6. Medicine Pre-Clinical Medical Students Vital Signs
Preventative Services
Patient Education
Medical History
Physical Exam
Clinical Medical Students
Assessment & Planning
Teaching and Supervision
Charting
Michael
More time spent with patient between all the student healthcare providers
Each healthcare provider accomplishes specific tasks with the patient that a single clinician cannot achieve by him/her-self
Patient satisfaction has been overwhelmingly positive
Inter-professional care teams
Not just in primary care
Example: ENT Head and Neck Cancer tx involves not only the ENT, but also oncologist, speech pathologist, OT, physical therapist
Even surgical teams
 Every person on the team has specific role that need to accomplish with patient, each provider equally important to the care of the patient

7. Physician Assistant Medical History Physical Exam Treatment Planning
Patient Education
Verbal Case Reports
Charting
Melody
More time spent with patient between all the student healthcare providers
Each healthcare provider accomplishes specific tasks with the patient that a single clinician cannot achieve by him/her-self
Patient satisfaction has been overwhelmingly positive
Inter-professional care teams
Not just in primary care
Example: ENT Head and Neck Cancer tx involves not only the ENT, but also oncologist, speech pathologist, OT, physical therapist
Even surgical teams
 Every person on the team has specific role that need to accomplish with patient, each provider equally important to the care of the patient

8. Pharmacy Medication Therapy Management Medication History
Medication Reconciliation
Drug Assessment
Appropriateness
Effectiveness
Safety
Design new medication regimen
Patient Education
Brian
More time spent with patient between all the student healthcare providers
Each healthcare provider accomplishes specific tasks with the patient that a single clinician cannot achieve by him/her-self
Patient satisfaction has been overwhelmingly positive
Inter-professional care teams
Not just in primary care
Example: ENT Head and Neck Cancer tx involves not only the ENT, but also oncologist, speech pathologist, OT, physical therapist
Even surgical teams
 Every person on the team has specific role that need to accomplish with patient, each provider equally important to the care of the patient

9. Occupational Therapy
Increase patient engagement in chronic condition self-management and preventative health behaviors.
Collaborate with team to create an individualized wellness action plan.
The Lifestyle Redesign® Approach.
The process of acquiring health-promoting habits and routines in daily life.
Patient education
Daily activity analysis
Goal setting
Yvonne
More time spent with patient between all the student healthcare providers
Each healthcare provider accomplishes specific tasks with the patient that a single clinician cannot achieve by him/her-self
Patient satisfaction has been overwhelmingly positive
Inter-professional care teams
Not just in primary care
Example: ENT Head and Neck Cancer tx involves not only the ENT, but also oncologist, speech pathologist, OT, physical therapist
Even surgical teams
 Every person on the team has specific role that need to accomplish with patient, each provider equally important to the care of the patient

10. All Participants Students are exposed to other disciplines,
work as a clinical team,
and adopt an analytical, case- based approach to patient care
…as early as their first year of school.
All Participants
Clinical Training
Charting
Case Presentation
Procedural Skills
Interviewing Skills
Cultural Sensitivity
Policy Training
Medical Home Model
Challenges to Access
Collaborative Solutions
Michael
More time spent with patient between all the student healthcare providers
Each healthcare provider accomplishes specific tasks with the patient that a single clinician cannot achieve by him/her-self
Patient satisfaction has been overwhelmingly positive
Inter-professional care teams
Not just in primary care
Example: ENT Head and Neck Cancer tx involves not only the ENT, but also oncologist, speech pathologist, OT, physical therapist
Even surgical teams
 Every person on the team has specific role that need to accomplish with patient, each provider equally important to the care of the patient

11. Other Projects Inter-Professional Health Symposium
Inter-Professional Health Fairs
Research
Other Projects
Emily
More time spent with patient between all the student healthcare providers
Each healthcare provider accomplishes specific tasks with the patient that a single clinician cannot achieve by him/her-self
Patient satisfaction has been overwhelmingly positive
Inter-professional care teams
Not just in primary care
Example: ENT Head and Neck Cancer tx involves not only the ENT, but also oncologist, speech pathologist, OT, physical therapist
Even surgical teams
 Every person on the team has specific role that need to accomplish with patient, each provider equally important to the care of the patient

12. Questions? uscstudentrunclinic@gmail.com
Michael Toboni, Co-President
Brian Chou, Co-President
Brian Prestwich, Medical Director

13. The Phillips Neighborhood Clinic
Brian Sick, MD – Medical Director
Anna Berglund, MS2 – Board Co-Chair
Autumn Chmielewski, MHA2 – Board Co-Chair

14. Where are we? - The Phillips Neighborhood
South Minneapolis
Urban
Diverse
- 31.3% foreign born residents
Impoverished
- 34.4% below poverty level
Accessible
- metro transit buses
- lightrail system
Active Neighborhood
- many non-profits
- large employers

15. 2647 Bloomington Avenue South
PNC is located in the heart of the Phillips Neighborhood and operates from the basement of Oliver Presbyterian Church.
Where are we? – The Phillips Neighborhood Clinic (PNC) PNC is located in the heart of the Phillips Neighborhood and operates from the basement of Oliver Presbyterian Church. Picture is of: 2647 Bloomington Avenue South
Minneapolis, MN 55407
2647 Bloomington Avenue South
Minneapolis, MN 55407

16. Who are we? – Our Two-part Mission
Patient Centered
To provide accessible, culturally appropriate, interdisciplinary health care services and education in order to reduce the burdens of poor medical access and raise the quality of life for our patients.

17. Who are we? Our Two-part Mission
Student Centered
To provide health professional students with the skills they need to effectively and compassionately serve people who are underinsured and/or unstably housed.

18. Who do we serve? – Our Patients
Approximately 1,200 patient visits annually
All services are free and provided to anyone in need
Patients are served on a first-come-first-served basis two nights per week

19. Who do we serve? – Our Patients

20. What services do we offer?
Physical Exams
Pediatrics
Well Child Visits
Sports Physicals
Women’s Health
Dermatology
Foot Care
Contraception /
Birth Control
Dispensing Pharmacy
Pharmacy Care
Diabetic Treatment
Physical Therapy
Nutrition
Mental Health Counseling
Lab Tests
Blood Pressure Checks
Cholesterol, Blood, and Urine Tests
Pregnancy Tests and Referrals
STI & HIV Testing and Counseling
Health Insurance Application Assistance

21. How do we do it? – Our Structure

22. How do we do it? – Our Volunteers
328 Student Volunteers
100 Medical
72 Pharmacy
55 Public Health*
40 Nursing
38 Physical Therapy
15 Social Work
8 Undergraduate
* Includes Nutrition & Master of Healthcare Administration

23. How do we do it? – Volunteer Commitment
328 Student Volunteers
Sign contract for 2 years of 2 semesters per year (summer optional)
Hours per semester = 35
3-4 clinic shifts x 5 hours each = 20 hours
3 outreach activities x 3 hours each = 9 hours
4 meetings x 1 hour each = 4 hours
1 cultural awareness event = 2 hours
Value of time student volunteers commit to the clinic per year =
$496,395

24. How do we do it? – Our Preceptors
86 Volunteer Preceptors
Medical
Nursing
Nutrition
Physical Therapy
Pharmacy
Residents
Med/Ped’s
Family Medicine

25. How do we do it? – Our Expenses
Total annual operating expenses are approximately $40,000
Includes the cost to provide free labs & medications for 1,200+ patient visits per year, building rent, utilities, training materials, & fundraising costs
The average cost to serve each patient = $31.00

26. University of Minnesota Physicians
UMP helps manage clinic operations by working with PNC leadership to determine medical supplies, computers, EMR, and sign facility lease
University of Minnesota
Medical school administration develops an annual budget with PNC officials with the understanding that PNC raises funds to cover as much of the budget as possible
Minnesota Medical Foundation
UMN approved foundation for Health Sciences. PNC can receive donations and gifts through the foundation, which is a 501 (c) 3 organization
How do we do it? – Our Income & Support University of Minnesota Physicians: UMP helps manage clinic operations by working with PNC leadership to determine medical supplies, computers, EMR, and sign facility lease University of Minnesota: Medical school administration develops an annual budget with PNC officials with the understanding that PNC raises funds to cover as much of the budget as possible
Minnesota Medical Foundation: UMN approved foundation for Health Sciences. PNC can receive donations and gifts through the foundation, which is a 501 (c) 3 organization Phillips Neighborhood Clinic: PNC is classified as a campus life program. All financial transactions are processed through the University.
Phillips Neighborhood Clinic
PNC is classified as a campus life program. All financial transactions are processed through the University.
Income comes from a variety of sources including fundraising, donations, & grants
Significant in-kind support is provided by supporting organizations

27. What else makes us unique? – Community Outreach
Understand where our patients come from
Connect with the community
Create partnerships with other organizations
Increase awareness of the PNC as a health resource
Student volunteers commit to 6 community outreach activities per year
Activities include tutoring, diabetes education, blood pressure & blood sugar checks, health fairs, legislative advocacy, meal service, etc…
We can only see so many patients in clinic, but we can help many more outside of the clinic

28. What else makes us unique? – Interdisciplinary Approach
6 different schools are represented at PNC (medical, nursing, pharmacy, physical therapy, public health, & social work)
Clinic “huddles” draw on insights and expertise from each profession to diagnose patients and create care plans
Students learn firsthand that collaborative care is best for the patients

29. Neighborhood
Phillips Neighborhood Clinic: Providing culturally competent care and cultivating caring future healthcare leaders

30. Crimson Care Collaboratives (CCC)
Harvard Medical School Student-Faculty
Collaborative Practices
Presented by Rebecca Berman MD, Juwarat Kadiri & Jessica O’Brien
Thanks for inviting us to talk about the crimson care collaborative, a project we are really excited about and have been working on since October Introductions! CCC is a planned student-faculty collaborative practice. Want to mention that throughout the presentation you will hear us refer to student run clinics which exist at other schools. We decided that a better way to describe CCC is a student faculty collaborative because we wanted to emphasize that this is really a joint endeavor between students and faculty. This will hopefully come across as we talk to you more about this exciting project.

31. CCC – Overview 5 Evening Clinics, planning began fall of 2009
CCC- MGH Internal Medicine Associates (CCC-IMA), October 2010
CCC- MGH Chelsea, October 2011
CCC- Beth Israel Deaconess (CCC-BIDMC), January 2012
CCC- MGH Revere, October 2012
CCC- Cambridge,  November 2011
Student-Faculty Collaborative practices
HMS MD, DMD students
MGH Institute for Health Professions – NP students
clinical and nonclinical roles since summer 2011
Harvard Undergraduates
nonclinical roles since summer 2010
HMS faculty
50% what we call Bridge to care. Patients without PCPs. Meeting acute need for primary care. We will see these patients for urgent and primary preventative care until our social services team can connect with a long-term PCP.
50% IMA patients. These are patients who have PCPs at IMA but need urgent care after hours. Remember from the ED stats, over 75% of patients who went to ED for a non emergency cited the need for after hours care as the reason. This also functioned to address the ethical concerns of student clinics involving subpar care for poor people. Dr. Berman wanted to create a student-faculty collaborative practice that was so high quality that you’d “refer your mother”. That’s unpractical and has its own ethical concerns, so we created a practice that was of such high quality that doctors would “refer their own patients”, meaning the IMA patients.

32. Needs Assessment Post Massachusetts Health-Reform
Long wait times for new PCP appointments
Only 44% of IM practices accepting new patients (down from 66% pre-Health reform)
45% of adults using the ER for non-emergent reasons unable to get a PCP appointment
MMS Physician Workforce Study 2009,
2008 Massachusetts Health Reform Survey (Long and Masi, Health Affairs 28 May 2009)

33. Needs & Ethical Concerns
Need for acute access to primary care services
Need for meaningful student experiences in primary care
Ethical concerns met by:
Faculty partnership, supervision, and mentorship
High quality benchmarks
Student-faculty collaborative practices

34. Overriding Themes
Student-driven initiative w/close faculty support
Student exposure to & participation in primary care in a multidisciplinary approach
Strong social mission by increasing access to care or addressing social needs
Commitment to quality through stringent attending-level supervision
Development of innovative solutions to community or organizational problems

35. CCC – MGH IMA
Primary care and urgent care services, social services, embedded research team
50% Bridge-to-Care Patients
Do not have PCP, frequent fliers to ER (MGH primary care closed to new patients otherwise)
Patients transitioned to a long-term PCP through social service center
50% Urgent Care Patients
Urgent care visits from patients who have a PCP at MGH Internal Medicine Associates
Addresses Ethical Concerns
2012: Inter-professional teams of medical and NP students, interchangeable roles
50% what we call Bridge to care. Patients without PCPs. Meeting acute need for primary care. We will see these patients for urgent and primary preventative care until our social services team can connect with a long-term PCP.
50% IMA patients. These are patients who have PCPs at IMA but need urgent care after hours. Remember from the ED stats, over 75% of patients who went to ED for a non emergency cited the need for after hours care as the reason. This also functioned to address the ethical concerns of student clinics involving subpar care for poor people. Dr. Berman wanted to create a student-faculty collaborative practice that was so high quality that you’d “refer your mother”. That’s unpractical and has its own ethical concerns, so we created a practice that was of such high quality that doctors would “refer their own patients”, meaning the IMA patients.

36. CCC – MGH CHELSEA
Primary care services, social services, mental health services, embedded research team
Patients who have just been released from prison
Highly vulnerable population
Patients frequently seeking care at Chelsea HealthCare Center’s Urgent Care Clinic
Predominantly immigrants/refugees
Lack access to primary care
2012: Interprofessional teams of medical and NP students, interchangeable roles

37. CCC – BIDMC
Needs assessment revealed BIDMC had access available in their resident clinic, need for chronic disease management
Chronic Disease Co-Management Model
Diabetes, hypertension, COPD
Focus on motivational interviewing, patient education
Titrate meds, check labs as indicated
Embedded research team
Urgent Care
Future direction of more team-based care
Non-physician health professionals – have run into political difficulties getting NP/PA students involved 2/2 multiple different NP programs at BIDMC

38. CCC – MGH Revere (pediatrics)
Needs assessment
Pediatricians have openings
Need for expanded hours and obesity co-management
Difficult for students to get exposure to pediatrics
Pediatric patients
Well child and after hours urgent care
Group visit model being piloted surrounding healthy eating/weight management in obese patients not eligible for other services
Inter-professional team of medical and NP students, interchangeable roles
Community health center
Ethnically diverse, predominantly low SES

39. CCC – Cambridge Located in YWCA
Women in transitional housing (residents have history of physical, psychosocial or financial trauma)
Initial plan was monthly outreach to bridge patients to a PCP
Many residents have PCPs but don’t go to them due to multiple psycho-social barriers
Students as patient navigators
Health screening, including mental health and social services needs, help make PCP appointments and go with patients

40. Statistics
Each clinic sees between 6-12 patients per night, total monthly capacity ~ 100 patients
Clinic lasts ~3 hours, volunteers must come at least monthly
Board members work ~ 5-10 hours per week on CCC- related planning
473 student volunteers to date
This semester: 180 HMS/HSDM, 24 NP, 32 Harvard College, 3 post-baccalaureate/graduate students

41. Clinic Sustainability
Average annual cost to operate a clinic = 100K
Funding Sources
Insurance accepted post health reform (wRVUs)
In-kind support from participating practices
Teaching dollars from Harvard Medical School
Grants including MGH Stoeckle Center for Primary Care Innovation, Yawkey II Foundation, HMS Center for Primary Care

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