1. Linda Thomas-Hemak MD December 2013

2. Comparative Analysis

3.  Team Approach  Information System Support  Quality Improvement  Population Management  Treatment of Mental Health issues  Self-Management Support  Use of Guidelines  Coordination of Care  Patient centered care

4. THC-1 better than Traditional-1 THC-1 Similar to Traditional-1 THC-1 Worse than Traditional-1 November 2011 Team Approach Information System Support Quality Improvement Population Management Treatment of Mental Health issues OVERALL ASSESSMENT Self-Management Support Use of Guidelines Coordination of Care Patient centered care May 2012 Team Approach Information System Support Self-Management Support Use of Guidelines Quality Improvement Population Management Coordination of Care Treatment of Mental Health issues OVERALL ASSESSMENT Patient centered care November 2012 Team Approach Information System Support Self-Management Support Population Management Patient centered care Treatment of Mental Health issues OVERALL ASSESSMENT Use of Guidelines Quality Improvement Coordination of Care

5. THC-1 better than Traditional-2 THC-1 Similar to Traditional-2 THC-1 Worse than Traditional-2 November 2011 Quality Improvement Treatment of Mental Health issues Team Approach Information System Support Self-Management Support Use of Guidelines Population Management Coordination of Care Patient centered care OVERALL ASSESSMENT May 2012 Team Approach Self-Management Support Use of Guidelines Quality Improvement Population Management Treatment of Mental Health issues Information System Support Coordination of Care Patient centered care OVERALL ASSESSMENT November 2012Team Approach Information System Support Self-Management Support Use of Guidelines Quality Improvement Population Management Patient centered care Treatment of Mental Health issues OVERALL ASSESSMENT Coordination of Care

6. THC-1 better than Traditional-3 THC-1 Similar to Traditional-3 THC-1 Worse than Traditional-3 November 2011 Quality Improvement Patient centered care Treatment of Mental Health issues OVERALL ASSESSMENT Team Approach Information System Support Self-Management Support Use of Guidelines Population Management Coordination of Care May 2012 Team Approach Information System Support Self-Management Support Use of Guidelines Quality Improvement Population Management Coordination of Care Patient centered care Treatment of Mental Health issues OVERALL ASSESSMENT November 2012N/A as the Traditional-3 surveyed in Nov 2011 and May 2012 had graduated from the program

7. 2012 THC-1 better than 2011 THC-1 2012 THC-1 Similar to 2011 THC-1 2012 THC-1 Worse than 2011 THC-1 Nov 2012Team Approach Self-Management Support Use of Guidelines Quality Improvement Coordination of Care Patient centered care Treatment of Mental Health issues OVERALL ASSESSMENT Information System Support Population Management

8. 2012 THC-1 better than THC-2 2012 THC-1 Similar to THC-2 2012 THC-1 Worse than THC-2 Nov 2012Coordination of Care Patient centered care Team Approach Information System Support Self- Management Support Use of Guidelines Quality Improvement Population Management Treatment of Mental Health issues OVERALL ASSESSMENT

9. Nov 2011 – May 2012Nov 2011 – Nov 2012 Team ApproachTHC+19% Traditional+15%+14% Info System SupportTHC+10%+13% Traditional+8% Self-Management Support THC+11%+14% Traditional+4%+9% Use of GuidelinesTHC+7%+5% Traditional+4%+6% Quality ImprovementTHC+6%+9% Traditional+8%+18% Population Management THC+21%+19% Traditional+10%+13% Coordination of CareTHC+14%+6% Traditional-1%+7% Patient-Centered Care THC-1%+6% Traditional2%-1% Mental Health IssuesTHC+11%+7% Traditional+11%+10% Overall AverageTHC+10%+11% Traditional+6%+8%

12. Team Approach Information System Support Self Management Support Use of Guidelines Quality Initiative Population Management Co-ordination of care Patient Centered Care Treatment of Mental Health Issues Overall Jermyn - Wayne residents 4.604.144.884.834.924.554.944.805.004.74 Jermyn - VA residents 4.103.254.384.504.003.504.504.304.504.11 Jermyn - Susquehanna 4.403.554.474.614.334.074.584.674.834.39 Jermyn - Scranton Primary 3.603.144.00 3.673.204.003.804.003.71 Clarks Summit- Scranton Primary 3.852.894.294.174.253.004.384.204.253.92 Jermyn - Wayne residents: PGY2 4.504.074.424.284.784.704.504.405.004.52 Scranton - Scranton Primary: PGY2 4.573.794.724.614.334.304.134.034.504.33

13. Comparative Analysis

14. November 2012 Team Approach Information System Support Self Management Support Use of Guidelines QI Pop Mngt Coord of care Patient Centered Care Treatment of Mental Health Issues Overall Score Days in Jermyn Team Approach 1 Information System Support 0.6851 Self Management Support 0.5800.6221 Use of Guidelines 0.6750.5820.7361 QI 0.5280.6930.6950.4511 Pop Mngt 0.7100.9420.4590.5050.5981 Coord of care 0.6400.4970.5870.7540.6580.4381 Patient Centered Care 0.4470.4970.4700.6710.5680.4920.8191 Treatment of Mental Health Issues 0.5510.6530.4430.4690.4520.5810.4690.4321 Overall Score 0.8080.8730.7610.8060.7850.8180.8120.7620.7171 Days in Jermyn -0.0310.141-0.0140.0220.0050.1200.1980.1850.1770.1221

15. Self Management Support Team Approach Quality Initiatives Use of Guidelines Population Management Information System Support Overall Score Treat Mental Health Issues Patient Centered Care Coordination of Care +10 Positive CorrelationNegative Correlation

16. November 2011 Team Approach Information System Support Self Management Support Use of Guidelines QI Pop Mngt Coord of care Patient Centered Care Treatment of Mental Health Issues Overall Score Days in Jermyn Team Approach 1.000 Information System Support 0.7141.000 Self Management Support 0.4380.6211.000 Use of Guidelines 0.5930.6350.8521.000 QI 0.0360.311-0.0530.0611.000 Pop Mngt 0.7410.9240.4520.4650.2751.000 Coord of care 0.6750.6310.4000.6210.2720.5801.000 Patient Centered Care 0.3960.5120.6580.7090.0120.3480.5221.000 Treatment of Mental Health Issues 0.1580.160-0.193-0.0580.1680.1490.2600.2291.000 Overall Score 0.7610.8790.6830.8020.3330.7790.8130.7340.3361.000 Days in Jermyn -0.010-0.276-0.140-0.0580.052-0.3130.204-0.2870.305-0.0601.000

17. Self Management Support Team Approach Quality Initiatives Use of Guidelines Population Management Information System Support Overall Score Treat Mental Health Issues Patient Centered Care Coordination of Care +10 Positive CorrelationNegative Correlation

18. Comparative Analysis

19.  We conducted a survey to assess the understanding of Quality and Patient safety amongst the first year residents that included both THC and Traditional track residents in September 2011  The data was aggregate and did not look at differentiating the THC vs. Traditional track residents  The same survey was re-administered in September 2012 to the same group of residents who had transitioned to Year-2 of their training

20.  The comparison showed an improvement of 8% over time. The limitation of these results being that the results do not allow us to compare the effectiveness of THC vs. Traditional tracks  The researchers have identified this limitation and will focus on this during the next surveys

21. Comparative Analysis

22. WCGME THC Consortium – Initial Development 2011

23. Medicare GME Fund 10.7FTE8.5 FTE10.3FTE Regional Hospital Community Medical Center Moses Taylor 43 Hospital Funded FTE (4 FTE > FY2011) 16 FTE13.5 FTE Total Participating Hospital Affiliates’ Funded FTE Slots The Wright Center for Graduate Medical Education, a 501(c)3, not-for-profit ACGME/AOA Accredited Sponsoring Institution and GME Consortium: 2012 Projection of 64 FTE IM Residency Program Veteran Administration Hospital GME Fund 5 VA Funded FTE HRSA Teaching Health Center Fund Established 12 THC FTE 4 FTE THC Expansion 1/3 FTE Female Health Maternal and Family Health Services (M&FHS)*** The Wright Center Medical Group, P * Established WCMG Internal Medicine Learning Environments ** 2011 Established THC FQHC-Based Learning Environments *** New 2012 FQHC and M&FHS Based Learning Environments in the Planned THC Expansion Continuity Groups A-D defined as groups of individual THC residents having Ambulatory Continuity Training Education in 2:1 ratio between a designated WCPC and FQHC site 2011 Established Continuity Groups 2012 Proposed Expansion Continuity Groups The combined venues for curriculum expansion to benefit all THC track residents = 1 Expansion FTE = 2 Individual THC track Residents with Ambulatory Continuity experience defined as Group D 2011 Established THC site FY2012 FTEs 2012 Proposed Expansion THC site FTEs Resident Group D Resident Group B Resident Group C Resident Group A Chart 1: WCGME THC Consortium Resident FTE Cost Center Funding Relationships for 2012 with Teaching Health Center Expansion Year 1 4 FTE Wright Center Primary Care Scranton* (WCPC-S) 1 FTE Northeast PA Community Health Center FQHC*** (NEPACHC) 2 FTE Wayne Memorial Community Health Center FQHC** (WMCHC) The Wright Center Medical Group, PC (WCMG) Wright Center Primary Care Mid- Valley* (WCPC-M) 4 FTE 2 FTE Scranton Primary Health Center** (SPHCC) 1/3 FTE Oral Hygiene*** 1/3 FTE Primary Care Psych*** 2 FTE Continuity Group B Continuity Group D Continuity Group A Continuity Group C

24. WCGME THC Consortium 2012 Training Model

25. WCGME THC Consortium – Regional Family Medicine 2013

26. WCGME THC Consortium – National Network for Family Medicine Residency Training 2013

27. WCGME THC Consortium – Interdisciplinary Model for All Regional Residency Training