1. Mary McDonough RN Jeff Aalberg MD October 28, 2006 NESTFM
IT TAKES A TEAM THE USE OF SHARED MEDICAL APPOINTMENTS IN A FAMILY MEDICINE RESIDENCY
Mary McDonough RN
Jeff Aalberg MD
October 28, 2006
NESTFM

2. WHO WE ARE Maine Medical Center Family Medicine Residency
Portland, Maine
19,000 patients
43,000 visits
21 Residents

3. THIS PRESENTATION WILL HELP YOU…
Describe Shared medical visits
Think about basic data
Delineate the setup process
Engage residents
Identify the necessary resources
Anticipate obstacles
Start a Group Visit!

4. WHAT ARE SHARED MEDICAL APPOINTMENTS?
A visit designed for a group of patients rather than individual provider-patient appointments

5. WHY DO PEOPLE LIKE SHARED MEDICAL APPOINTMENTS?
Additional support for “me” from people like “me”
Learn new things through education and discussion
Socialize, make new friends
Get to know their doctor and care team better
It’s fun

6. THE ADVANTAGES Improved patient and provider satisfaction
Patient Centered
Peer support and shared experiences
Teaches patients how to care for themselves
Maximizes educational time
Efficient model of care
Billable service
Improved clinical outcomes

7. EVIDENCE BASED OUTCOMES
30% decrease in emergency dept use
20% decrease in hospital use
Delayed entry into nursing facilities
Decreased visits to sub-specialists
Fewer calls to nursing & providers
Decreased cost to health care system
Increased patient satisfaction

8. WHO IS APPROPRIATE? Patients with:
Diabetes
CVD risks
High risk seniors
Asthma
Well child exams
Prenatal care
Chronic Pain
Many Others

9. HOW TO GET STARTED? “Just Do It”
Assemble a team
Determine the type of group format
Develop an action plan & timeline
Find the patients (10-15 is best)
Set a time of day and date

10. OUR TEAM Faculty physician champion Residents Registered Nurse
Medical office assistant (MA)
Patient service representative (PSR)
Social Worker: some groups
(Invited community members)

11. HOW TO FIND THE RIGHT PATIENTS
Ask the team and providers
Pull from registries, billing info, Dx codes
Posters
Letter to patients signed by their PCP
Confirmation call (scripted)-always

12. DATE & TIME OF DAY -be patient centered-
Mid afternoon for seniors
Early evenings for working adults
Tuesday, Wednesday, Thursday are most popular
Saturday might work

13. FORMAT & AGENDA (ours) Welcome & Introductions The topic of the day
Action plans
Individual clinical visits
Wrap up
Total meeting time: 90 minutes

14. TOPICS Basic science of heart disease, HTN, diabetes, other Exercise
Risks & warning signs
Diet
Stress
Medications
Specialists: PT, Pharm, Optometrist, behavioralist, trainer…
Tobacco cessation
Understanding personal medical information
We have a core set, and let patients choose

15. ACTION PLAN & TIMELINE 6 months ahead: decide to do a SMV
3 months ahead: recruite patients & team
1 month ahead: solidify agenda
1 week ahead-get organized: huddle on buffing the process, team responsibilities

16. THE VISIT DAY Before (be very organized)
Materials: name tags, easels, agenda…
Be clear on duties
MA/RN
-Vital signs
-Standards: what patient needs at time of visit
Group Facilitator (may be RN/SW): talk show host strategy
Faculty physician & resident physician: share the educational topic
After: clean up, then huddle

17. DOCUMENTATION Review the patients’ charts before meeting
Vital signs and measurements
Data may vary with the measures you desire
Support the level of care
Group discussion
Personal stories/concerns
Exam
Assessment and Plan

18. DATA Office system design dictates
Select simple, patient centered measures
Think in terms of longevity of group
Control group

19. Possible outcomes CARDIAC GROUP DIABETES GROUP
Blood Pressure
Foot exam
Eye exam
Lipids
Immunizations
BMI
Lipids BP
ASA
Self management goals for all!

20. LESSONS LEARNED It takes a team, and it empowers a team
Recruitment is the most difficult part
Need to be flexible and creative: ‘let go’; allow the group process to occur
Education must be at the patient level
Plan ahead for schedule variations
Need an exit strategy
Huddles are a must

21. HANDOUTS Typical agenda Basics of a successful action plan
Problem solving steps
HIPAA notice
Confidentiality agreement
Medical waiver
Letter of invite to patients
Office visit documentation tool