integration in practice; tracking the transformation perry dickinson, md stephanie kirchner, msph,...
TRANSCRIPT
Integration in Practice; Tracking the Transformation
Perry Dickinson, MD Stephanie Kirchner, MSPH, RD
Kyle Knierim, MD
Collaborative Family Healthcare Association 16th Annual ConferenceOctober 16-18, 2014 Washington, DC U.S.A.
Session # G1BOctober 17, 2014
Faculty Disclosure
• We have not had any relevant financial relationships during the past 12 months.
Learning Objectives
At the conclusion of this session, the participant will be able to:
• Describe how ongoing quality improvement and change management are crucial in supporting behavioral health integration in a primary care setting.
• Identify how the Comprehensive Primary Care Monitor could be utilized in their own settings to supporting ongoing integration efforts.
• Discuss how elements of the Comprehensive Care Monitor align with essential practice transformation and support practice self-assessment.
Bibliography / Reference
1. Davis, M, Balasubramanian, BA, Waller, E, Miller, BF, Green, LA, Cohen, DJ. Integrating Behavioral and Physical Health Care in the Real World: Early Lessons from Advancing Care Together. Journal of the American Board of Family Medicine.2013;26(5): 588-602.
2. Peek, C.J. and the National Integration Academy Council (2013). Lexicon for behavioral health and primary care integration: Concepts and definitions developed by expert consensus. AHRQ Publication No.13-IP001-EF. Rockville, (MD), Agency for Healthcare Research and Quality.
3. Kathol, RG, deGruy, F, Rollman, BL. Value-Based Financially Sustainable Behavioral Health Components in Patient-Centered Medical Homes. Annals of Family Medicine.2014;12(2): 172-175.
4. Fernald, DH, Deaner, N, O'Neill, C, Jortberg, BT, deGruy, F, Dickinson, P. Overcoming Early Barriers to PCMH Practice Improvement in Family Medicine Residencies. Family Medicine. 2011;43(7):503-509.
5. Daniel DM, Wagner EH, Coleman K, Schaefer JK, Austin BT, Abrams MK, Phillips KE, Sugarman JR. Assessing progress toward becoming a patient-centered medical home: an assessment tool for practice transformation. Health Services Research. 2013;48:1979-1897.
Learning Assessment
• A learning assessment is required for CE credit.
• A question and answer period will be conducted at the end of this presentation.
What is the PCMH Monitor?Originally developed for use in the
Colorado Family Medicine Residency PCMH project, aimed at transforming their practices and programs into medical homes
Intended to be a reflective tool for practices to assess and monitor their implementation of fairly concrete activities
Can also be used for evaluationUsed in multiple other projects across
various types of practices
Why did we develop the Monitor?
Facilitators needed a tool to measure progress and motivate practices
PCMH principles are vague – difficult to conceptualize for implementation
No tool existed to help practices evaluate progress toward goals
Monitor has evolved over time to align with AHRQ Lexicon and incorporate behavioral health integration
Let’s give it a try!
Please complete Section 11 (Behavioral Health Integration) of the Monitor:
Questions to consider:◦Which area did you rank the highest &
why?◦Which area needs the most work & why?◦Who do you need to complete the tool?◦How would you work to improve these
areas?
Group Discussion
Questions to consider:◦Which area did you rank the highest &
why?◦Which area needs the most work & why?◦Who do you need to complete the tool?◦How would you work to improve these
areas?
Team-based careWe have the person, now what?How do we work together?How do we communicate with
one another?
Professional CulturesPrimary care and mental health
professionals often have basic differences in how they view health care – may not understand each other very well◦ Differences in basic approach to health and
health care◦ Differences in rhythm of practice, time with
patients“I need my behavioral health people to
speed up and my family medicine people to slow down”
Lack of training in teamworkNeed team meetings to figure out roles,
work flow, how to work together
Looking at the DataSum of scores for all items in each
subscale normalized to number of points out of 100 total
Practice and project level trends
Practice A: Overall Summary
13
Practice B: Summary by Item
14
Project 1: Change over time
Project 1: What changed
Project 2: Growth Over Time
Lead
ersh
ip
Staff E
ngag
emen
t
QI P
roce
ss
Data
Capac
ity
Pop M
anag
emen
t
Pt & F
am E
ngag
emen
t
Team
Bas
ed C
are
Coord
inat
ion
of C
are
Cost Con
tain
men
t
Acces
s Con
tinui
ty
BH Inte
grat
ion
0
25
50
75
100
FoundationsInnovations
Project 2: Quite a Range
Leaders
hip
Staff E
ngagement
QI Pro
cess
Data C
apacity
Pop Managem
ent
Pt & F
amily
Engagem
ent
Team B
ased C
are
Coordinatio
n of C
are
Cost C
ontainm
ent
Access
& C
ontinuity
BH Inte
gratio
n
0
25
50
75
100
OutcomesMonitor confirms from a practice
perspective what we think is really going on (validates field notes, survey data)
Highlights key areas of interest, progress, and difficulties
Both the process of completing the Monitor and the results offer opportunities for reflection and prioritization.
Facilitating the MonitorCan be done in small bitesCan open up conversations that
lead to workflow redevelopment.Can make the concept of practice
transformation “real” to staff.Can be used to benchmark
progress over time.Takes some time – protect the
time.
Session Evaluation
Please complete and return theevaluation form to the classroom
monitor before leaving this session.
Thank you!