1. New Hanover Regional Medical Center Residency in Family Medicine
Improvement in Practice via Practice Based Learning A Residency Research Learning Model
New Hanover Regional Medical Center
Residency in Family Medicine
Albert A. Meyer, M.D.
March 6,2009

2. Objectives How we teach Practice Based Learning
How the Improvement in Practice Initiative – became a natural outgrowth
How we handle present and future challenges

3. New Hanover Regional Medical Center Residency in Family Medicine
Community Hospital Based
Tri-affiliated Residency
1. Department of Family Medicine University of North Carolina
2. South East Area Health Education Center (SEAHEC)
3. New Hanover Regional Medical Center Wilmington NC
Dual Accreditation ACGME AOA

4. Creating A PBL Culture The Fellowship 2004 - 2005 The Expectation 2005
The Reward 2008
The Results

5. Design Faculty design curriculum and set expectations.
Residents analyze practice experience based on systematic methodology
The resident faculty team studies the practice and improves care

6. Faculty 1. Coastal Family Medicine Faculty
2. SEAHEC Research Department
3. IPIP Support
4. IT NHRMC

7. Research Curriculum 1. Project Development - Group
2. Protection of Human Subjects Tutorial – Individual
3. Relevant Literature Review – AHEC Digital Library
4. Analysis of Practice Experience
5. Statistical Analysis of Data

8. Expectations Set Relevant Skill:
Locate,appraise and assimilate evidence from scientific studies related to patient’s health problems
Obtain and use one’s own population of patients and the larger population from which patients are drawn
Apply knowledge of study design and statistical methods to the appraisal of clinical studies

9. What is the Improving Performance in Practice Initiative?
All Primary Care Disciplines
North Carolina and Colorado pilots, with focus on Diabetes, Asthma
Quality improvement coaches
Data systems –national measures and systems for sharing

10. Main Outcomes
Educated 4 classes of residency trained family physicians thoroughly in an ACGME core competency (16 projects by 5/15/09)
Have grown the residency’s interdependence with the SEAHEC research team, the local & statewide IPIP Quality Improvement Consultants
Family Medicine Research Day
Identified key barriers to improvement

11. Barriers Solutions to IPIP @ CFM
1. Registry function  EMR reports / research intern
2. What’s our vision? “Excellent care of each patient at CFM is my responsibility”
3. Role of MA  role of SOP in IPIP
4. Where’s the data and how to we collect it? 
Cecil Sheps Center Secure Data Repository

12. Topic Selection 2009 Lipids (TC HDL LDL TG) Resident 1
Labs(HA1C;<7 >9; microalb/creat) Resident 2
Clinical (BP <130/80; foot; eye) Resident 3
Drugs (ASA / ACE or ARB / nicotine) Resident 4

13. How does 2009 look ? 95/440 patients with Diabetes
QI NCQA CFM 6mo.Goal
BP<130/ % % %
HBA1C< % % %
HBA1C> % % %
EYE EXAM % % %
FOOT EXAM % % %
LDL< % % %

14. Summary How we teach PBL in Wilmington
How IPIP is helping us to use our data for outcome impact
The challenging road ahead

15. Special Thanks Faculty Development Fellowship Program Directors:
Jessie Junker and Jan Beste
SEAHEC Research Division