Shared Medical Visits Jauch Symposium – May 17, 2014.

Slides:

Advertisements

Similar presentations

Engaging Consumers to Improve Health and Reduce Costs

Advertisements

Integrated Behavioral Health Care with Underserved Pts: The VCU PC Psychology Program Benjamin Lord, M.S. Virginia Commonwealth University.

Shared Medical Visits. What Is a Shared Medical Visit?  A shared medical visit is usually a 90-minute medical visit that is shared with 8 to 15 other.

Disease State Management The Pharmacist’s Role

Marge Koepping, MN, FNP, BC-ADM, CDE Warm Springs Model Diabetes Program Warm Springs SDPI Diabetes Prevention Program.

Texas Diabetes Education & Care Management Project Funded by Bristol-Myers Squibb Foundation Bureau of Primary Health, HRSA CDC Diabetes Prevention (in-kind.

Clinical Pharmacy II Lobna Al Juffali,MSc Fall-2009.

Chronic Care Model Donald Mack, MD, FAAFP, CMD Assistant Professor-Clinical Family Medicine.

Asthma: Shared Medical Appointments

Minimally Invasive Surgery Symposium Modest Weight Loss in T2 DM: Lessons from the Look AHEAD Trial Donna H. Ryan, MD Pennington Biomedical Research Center.

Leadership and Management Training for physicians Maria V. Gibson, MD, PhD Trident / MUSC Family Medicine Residency Program Background Practice Problem.

Heart Health Project University of Pennsylvania School of Medicine American Heart Association Pennsylvania State University Funded by the Robert Wood Johnson.

KORIN M. TRUMPIE Evidence Based Medicine Spring 2009.

Wyoming Total Population Health Management and Utilization Management Program Overview May 28, 2015.

Incentives for Medical Practice Transformation: The Bridges to Excellence Initiatives A. O’tayo Lalude, MD Louisville, Kentucky at The Third Annual HIT.

Reduction Of Hospital Readmissions Hany Salama, MD Diplomat ABIM IM Hospice and Palliative Care Sleep Medicine.

Evidence-based Checkup for Patient Education Web Sites Suzanne Austin Boren, MHA Center for Health Care Quality University of Missouri

James Schuster, MD, MBA VP, Behavioral Integration May 21, 2015 Using data to engage members with complex medical conditions.

Basma Y. Kentab MSc.. 1. Define ambulatory care 2. Describe the value of ambulatory care practices 3. Explore pharmacy services in some ambulatory care.

Health Coaching as a Strategy in the Team Practice Environment Leigh Ann Simmons, Ph.D. Assistant Professor, Medicine Senior Faculty Fellow for Clinical.

Dr. Turki AlBatti,MD. barriers in young adults with type 1 diabetes Glycemic control and adherence behaviors remain low for patients with type 1 diabetes.

An Innovative Approach to Managing Diabetes in a Large Public Health System Donna J. Calvin, PhD, FNP-BC, CNN Post Doctoral Research Associate University.

MEDication Focused Outpatient Care for Underutilization of Secondary Prevention (MEDFOCUS) Matt Arnold, PharmD Site Investigator Genesis Quad Cities Family.

Effectiveness of Depression Care Management in a Multiple Disease Care Management Model Bruce Friedman, Ph.D. Departments of Community and Preventive Medicine,

Use of Computerized Clinical Decision Support System and Registry Functions to Track and Improve Clinical Outcomes Pamela Ferrari RN Director of Performance.

Healthy Heart Initiative and the Role of the Pharmacist Alexis Beyer, PharmD, NCPS Cherokee Indian Hospital Healthy Heart Pharmacist.

Problem: Although over 80% of all physician visits by adults with type 2 diabetes are to primary care physicians, little is known about the content of.

New York State Department of Health Hospital-Medical Home Demonstration Reflections, Celebrations and Transformations.

Behavioral Health Integration

Mary Gardner, RN, MA, CCM, CDE Program Manager, High Risk Diabetes and COPD XLHealth Member Management Using The Med-eXpert System and Med-eMonitor Patient.

RIGHT CARE INITIATIVE TEAM BASED CARE: A LOCAL EXAMPLE 12/10/12 Phillip Raimondi MD Bridget Levich MSN, CDE University of California Davis Medical Center.

Impact of a Group Heart Failure Clinic on Patient Outcomes in a Veteran Population Melissa Angell, Pharm.D., CGP Adrienne Matson, Pharm.D., BCPS Kate Schmoll,

SHARED MEDICAL APPOINTMENTS Achieving Better Patient Outcomes and Organizational Efficiencies Part 1 of 2 Provided as an educational service by Pfizer.

Quality Improvement and Care Transitions in a Medical Home Maryland Learning Collaborative May 21, 2014 Stephanie Garrity, M.S., Cecil County Health Officer.

FAMILY MEDICINE AT ITS PEAK Amy Russell, MD Medical Director MAHEC/MMA Primary Care Asheville, NC FAMILY MEDICINE AT ITS PEAK Amy Russell. MD Medical Director.

Self-Management Support Strategies for Improving your Patients’ CVD Risk Bonnie Jortberg PhD, RD, CDE Robyn Wearner RD, MA Department of Family Medicine.

The Role of Health Information Technology in Implementing Disease Management Programs Donald F. Wilson, MD Medical Director Quality Insights of Pennsylvania.

Transforming Care in Patient Centered Medical Home and Accountable Care Organization Hae Mi Choe, PharmD Director, Pharmacy Innovations & Partnerships.

Do Group Visits Improve Care? Results of a Diabetes Group Visit Model in a Family Medicine Residency Authors: Josephine Agbowo MD, Grace Chen Yu, MD Location:

Seeing Patients efficiently: Teaching strategies to improve patient care Wendy Shen, MD, PhD; Jill Endres, MD; Anne Gaglioti, MD; Alison Lynch, MD; Kelly.

Falls and Fall Prevention. Prevalence of Falls in Older Adults  33% of older adults fall each year  Falls are the leading cause of fatal and nonfatal.

Improving Transitions of Care from Hospital to Home: A Health Care Reform Priority Gina Gill Glass, MD, FAAFP Barbara J. Roehl, MD, MBA, CAQ Geriatrics.

Helping Medical Students Counsel Patients With Uncontrolled Type II Diabetes: An Innovative Approach Alice Fairman Daniels, MD,MS Assistant Professor Cook.

Coordination of Care, Information Support, and Quality of Diabetes Care : A STARNet Study Michael L. Parchman, MD, MPH Raquel L. Romero, MD Jacqueline.

Community Paramedic Primary Care Project.

Nora Gimpel M.D., Florence J Dallo PhD, MPH, Barbara Foster PhD, Natalia Gutierrez-Chefchis M.D. University of Texas, Southwestern Medical Center Parkland.

References 1.Buse JB, Ginsberg HN, Bakris GL, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement.

An Inter-Professional Collaboration between a Family Medicine Center and a School of Nursing Maritza De La Rosa, MD New Jersey Family Practice Center Rutgers,

Teaching and Evaluating the Follow-up Visit: A 2-staged Patient Simulation Carol P. Motley MD Ehab Molokhia MD University of South Alabama College of Medicine.

Group Visits for Diabetes: An improved model for care Jessica McIntyre M.D.

PROGRAM PRESENTATION: BENEFITS TO THE PHYSICIAN

Peers for Progress STFM AAFP Conference December 2010 Michelle Henry, MSN, RN, VP, Clinical Program Administration Margie Gomez, BSN, RN Clinical Program.

Improving Diabetic Care through Implementing Point of Care HbA1C and Utilizing the Care Coordinator in PCMH Josh Strehle, D.O. Jen Kirstein, RN, BSN.

Using A Diabetes Registry: Lessons from Our Office Merced Faculty Associates Atwater, CA Family Medicine Summit Creating the Patient-Centered Medical Home.

Wellness Group Visits: Development and Implementation Randall T. Forsch MD MPH University of Michigan November 19, 2006.

Pharmacists’ role in a family medicine clinic: a focus on patients with diabetes Benjamin Chavez, PharmD, BCPP, BCACP Associate Professor Pacific University.

The Inter-professional Team: Who, Why, and What do they do in the Patient-Centered Medical Home? Gillian S. Stephens, MD, MS 1, F. David Schneider, MD,

Clinical Quality Improvement: Achieving BP Control

Nurse Patient Care Leadership (Nurse Team Manager) Staff Support

Cheryl Schraeder, RN, PhD, FAAN Health Systems Research Center

Office of Health Systems Collaboration

Research Questions Does integration of behavioral health and primary care services, compared to simple co-location, improve patient-centered outcomes in.

Mary McDonough RN Jeff Aalberg MD October 28, 2006 NESTFM

Michael L. Parchman, MD1 Jacqueline A. Pugh, MD2 Raquel L. Romero, MD1

Clinical Pharmacy II.

Integrative Medicine Approach to Diabetes Group Visits within a Patient Centered Medical Home Krishna Desai, MD; Scott Bragg, PharmD; Sarah Winter, PharmD;

Diabetes Self-Management Education and Support: Component of Standard Diabetes Care 1, 2 “… Ongoing patient self-management education and support are.

ICARE Trial Survey Post-Analysis

Diabetes Self-Management Education and Support: Component of Standard Diabetes Care 1, 2 “… Ongoing patient self-management education and support are.

Presentation transcript:

Shared Medical Visits Jauch Symposium – May 17, 2014

Personal information Stephen Sorensen, MD Family Physician Faculty member of Genesis Family Medicine Residency Program, Davenport, Iowa Director of Quality and Clinic Operations No financial obligations to report

Current state of medicine in the United States Problem: Significant shortage of primary care physicians AAFP projects a shortage of 150,000 physicians by 2020 HRSA projects a shortage of 65,000 PCP by 2020 Physicians are being asked to see more patients in the same amount of time Accountable Care Act – an additional strain on clinics as additional patients are seeking to establish care with PCP’s

Current patient experience: Typical office visit Present to front desk Asked to arrive early Bottle neck – 5-10 minutes of waiting Sit in waiting room Read an out-of-date magazine – minutes of waiting Brought back to exam room Wait for physician – minutes of waiting Physician in the room minutes Total time in office – 40 to 60 minutes, less than half that time is actually spent talking to the physician!

What has to occur during an office visit for Diabetes? A physician is asked to address: Blood glucose control Nutrition Physical activity Foot care Eye care Address co-morbidities: Hypertension Hyperlipidemia Cardiovascular disease Order additional lab work Review and establish goals Arrange for follow up appointment

Another way to look at this? During a typical diabetes follow-up appointment, a physician: Addresses 17 topics, questions or symptoms Writes on average 2 prescriptions Discusses nutrition and medication changes All within 17 minutes Parchman ML, et al: Encounters by patients with type 2 diabetes – complex and demanding: an observational study. Ann Fam Med 4:40-45, 2006.

One possible solution?

Shared Medical Visits Multiple names for this: Shared Medical Visits Shared Medical Appointments Group Medical Visits Group Medical Appointments Not common in the Midwest – (yet!) Much more common in areas with HMO’s Now a requirement for family medicine residency programs to teach

Shared Medical Visits Can take many different forms: Acute care visits: (i.e.: URI’s) Chronic care visits: Asthma COPD Heart Failure Type 2 Diabetes Pregnancy We have chosen to focus on conducting SMV’s with diabetic patients, now in our 8 th year.

Shared Medical Visits What do they look like 8-10 patients per visit All given the same appointment time (i.e.: 10:30 – 12:00) Each patient seen individually for 2-3 minutes on arrival by physician Very brief physical exam Ask if there are any questions they have about their care Patients gather in a conference room for remainder of visit Vast majority of the visit (60 minutes) spent on education, group discussion, visiting experts, etc. Each visit attended by a physician, an observing resident physician, behavioral scientist, nurse and health coach

Is there any evidence that these actually work?

Randomized Trials Managed Care Setting: Monthly, 2 hour SMA’s with multidisciplinary team vs.. usual care A1C’s > 8.5% Results for SMA patients: Greater reduction in A1C (1.3% to 0.2%, p < 0.001) Lower hospital admission rates (P = 0.04) Improved self efficacy in balancing food intake (P = 0.003) Improved self-treatment of hypoglycemia (P = 0.03) Improved management of glucose when ill (P = 0.001) Sadur CN, et al: Diabetes management in a health maintenance organization: efficacy of care management using cluster visits. Diabetes Care 22: , 1999

Randomized Trials Five year follow-up study, 112 patients with Type 2 DM Group appointments vs. usual care Received four educational sessions on weight control, meal planning, improved glycemic control, preventing complications Results for the group appointments: Knowledge of DM2 improved (+12.4 vs. -3.4, P =0.001) Improved problem solving ability (+5.7 vs. -2.3, P = 0.001) Improved quality of life over 5 years (-23.7 vs , P = 0.001) Improved A1C control (-0.1% vs. +1.7%, P = 0.001) Trento, M, et al: A 5 year randomized controlled study of learning, problem-solving ability, and quality of life modifications in people with type 2 diabetes managed by group care. Diabetes Care 27: , 2004.

Randomized Trials Primary Care Clinic 12 month trial, 186 patients, monthly group visits vs. usual care Results: Significantly greater concordance with ADA process of care indicators Primary Care Clinic 6 month trial, 120 patients, group medical appts vs. usual care Baseline A1C was 10.3% vs. 10.6% Results: No significant improvement in A1C Higher “trust in physician” scores (P = 0.02) More successful in meeting ADA care indicators (P = 0.001) Clancy DE, et al: Group visits: promoting adherence to diabetes guidelines. J Gen Intern Med 22: , Clancy DE, et al: Group visits in medically and economically disadvantaged patients with type 2 diabetes and their relationships to clinical outcomes. Top Health Inf Manage 24:8-14, 2003.

Nonrandomized Trials 13 month study, Hmong refugees with type 2 DM Group medical appointments Results: Improved anxiety scores (P = 0.05) No difference in A1C, BP, or lipids Synchronous PCP visits and educational sessions, 44 Hispanic patients Results: Significantly improved A1C (P = 0.001) Culhane-Pera K, et al: Group visits for Hmong adults with type 2 diabetes mellitus: a pre-post analysis. J Health Care Poor Underserved 16: , Gold R, et al: Synchronous provider visit and self-management education improves glycemic control in Hispanic patients with long-standing type 2 diabetes. Diabetes Educ 3: , 2008.

How about our data?

Family Medical Center Data collected in 2010 Pre-post evaluation of diabetic data Used resident and faculty patients Separated out patients who had been coming to group visits for less than and greater than 18 months Evaluated for changes in: Weight A1C Blood Pressure LDL

Patient satisfaction Patients uniformly enjoy shared medical visits Every patient that we surveyed stated that they would recommend these to others However, it is a self-selecting population Most difficult thing is getting them to attend the first!

Shared Medical Visits Disadvantages of shared medical visits More logistics involved Need for appropriate space to meet with a large group Need to have someone review medical record before the visit to identify opportunities for care Less “one-on-one” time spent with physician

Shared Medical Visits Benefits of shared medical visits: Systematic approach to diabetic patients May assist in meeting standards of care No special training required Offers additional support to patients Patients regularly discuss lifestyle changes with each other Structured opportunities for dieticians, pharmacists, exercise physiologists to meet with patients No additional costs involved Reimbursement is the same as regular office visits Potential for increased revenue Patients enjoy them!

Questions?