1. Purpose and Utilization of PEA within UNYNET PEA’s are incorporated within the Primary Care Setting for the purpose of facilitating progressive changes in: Chronic Disease Management and Patient Safety Primary Care Physicians face the daunting task of caring for patients with chronic diseases. With a population of patients with chronic disease comes the immediate task of managing their care leaving little time to implement practice changes: Barriers to change within a PCP Practice: Busy Offices Limited Staff Limited Patient-Provider Interaction time. Immediate task of managing patient care. Little time to re-organize or implement new projects. The PEA can overcome the barriers and create change by assisting in the facilitation of: The research process. Practice enhancements (implementation) Communication within and between clinical practices. What is a Practice Based Research Network (PBRN)? AHRQ defines a primary care practice-based research network, or PBRN, as a group of ambulatory practices devoted principally to the primary care of patients, and affiliated in their mission to investigate questions related to community-based practice and to improve the quality of primary care. What do PBRNs do? Involve community-based clinicians and their staff in activities designed to improve primary care. They link relevant clinical questions with rigorous research methods in community settings to produce scientific information that is externally valid, and can be assimilated more easily into everyday practice. “ Healthcare professionals who assist primary care clinicians in research and quality improvement Projects.” (Nagykaldi 2005) When did they begin? Initially developed as Practice Facilitators in Europe and Australia Introduced to North America by James Mold Director of the OKPRN. PEA Research Assistant Quality Improvement Agent Data Management Chart Audits Patient Recruitment and Interviews Attend Conferences and Workshops Develop a Relationship with the Practice. Help Provider and Staff Identify and implement Practice Changes. Identify Best Practices “Cross-fertilization.” Populations Served: Primary Care Community Population Demographics Urban and Rural Regions (e.g. Buffalo and Akron) Large and Small Practices (e.g. greater than 10,000 or less than 4,000) Underserved Communities (e.g. Low-income ) Minority and Refugee Populations UNYNET Office P.E.A. PBRN Practice Sites PEAs are the bridges between the Research and Clinical Communities. An Example of PEAs Working on a UNYNET Study 12 Randomized Practices 4 Control Sites 8 CRM Intervention Sites 4 Sites using CRM only 4 Sites Using CRM with PEA Intervention = Crew Resource Management (CRM) AHRQ Medication Safety Study: How to reduce medication errors in clinical outpatient practices? Study Objective : Comparison of Overall Quality of Care and Medication Errors between Control Site and Crew Resource Management (CRM) sites. Does the inclusion of a PEA with CRM further improve the overall quality of care and assist in reducing medication errors? PEA Success Stories What is a PEA? Let the Practice Staff Know who you are: “As soon as the staff members understood who we were and what our intentions were, they started to make changes on their practices.” S. Okazaki It is vital to involve the Practice Leader of the site. Without the leader it seemed very hard to start making changes. QI Projects Implemented with the Help of PEAs : A. B.PEA Keys to Success C.Lessons Learned Practice Enhancement Assistants (PEAs) within UNYNET Elizabeth McLean-Plunkett, Renee Kee, Kathryn Glaser, and Saburo Okazaki Family Medicine Research Institute, Department of Family Medicine, State University of New York at Buffalo Abstract Practice enhancement assistants (PEAs) have played a key role in primary care practice initiatives since the 1980’s. The concept and utilization of PEAs initially began in Europe and Australia where they participated in practice-based research and quality improvement projects. It is only within the last decade that PEAs have been introduced and incorporated into the healthcare system within the United States (Nagykaldi et. al 2005, 2006). Since their introduction in the United States the PEA position has been found to be a valuable resource for Practice Based Research Networks (PBRNs). The Oklahoma Physicians Resource/Research Network (OKPRN) was the first PBRN to utilize PEA’s and more PBRN’s (e.g. UNYNET, ORPRN, and NJFMRN) have acknowledged their usefulness and consider the PEA model an ideal approach to help improve quality of care in primary care practices. This poster focuses on the evolving PEA model. Specifically within UNYNET how PEAs have helped establish relationships with network practices for sustained periods of time; how they have helped improve practice systems and patient care utilizing a substantial array of resources from the academic medical environment as well as act as assistants in research studies. Lab monitoring reminder posters developed by PEA to ensure that proper lab work is ordered for corresponding medications prescribed. Easy-to-understand Medication Safety brochures developed by a PEA to increase patient education and compliance with medications. Medication patient assistance program lists developed for patients to increase patient compliance with medications. Cross-fertilization: Some projects implemented at PEA sites have been passed on to other cites (e.g. medication brochures and patient assistant program lists). The PEAs partner with providers to create and edit guidelines. PEAs Disseminate the Quick Reference Chronic Kidney Disease Guide to the Primary Care Physician’s. Clinicians and staff already have too much work to do. Practice changes (e.g. new electronic medical record system or new staff members) make quality improvement difficult. Practice administrative changes creates difficulties when attempting to develop relationships with the practice staff. PEAs = outsiders. A critical part of the PEA tasks is cooperation from medical staff members. Cooperation and acceptance may be a challenge. The staff are not familiar with "PEAs." Some of them are weary about allowing strangers to have access to their clinic, go into their chart system, and "pick on" the service they provide to their patients. Solution – First, try to observe as many things as possible (from office environment, communication style, flow of orders, etc.). After that, try your best to let everybody know who you are, what you want from them and what you could provide for them. Then things should start running smoothly. UNYNET Studies Utilizing PEAs: Making CKD Guidelines Work in Underserved Practices Site Survey on Asthma Guidelines Provider Survey on Asthma Guidelines. Making Asthma Guidelines Work in Primary Care Practices Cross-Sectional Study if Asthma Medication Adherence. For Comments or Questions Please contact: Elizabeth McLean-Plunkett at eamp@buffalo.edu