linda thomas-hemak md december 2013. comparative analysis
TRANSCRIPT
TEACHING HEALTH CENTER
CONSORTIUM COMPARATIVE
ANALYSISLinda Thomas-Hemak MD
December 2013
UNDERSTANDING OF PCMH
PRINCIPLES
Comparative Analysis
CORE PCMH PRINCIPLES 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
THC-1 VS. TRADITIONAL-1 THC-1
better thanTraditional-1
THC-1 Similar to
Traditional-1
THC-1 Worse than Traditional-1
November 2011
Team ApproachInformation System SupportQuality ImprovementPopulation ManagementTreatment of Mental Health issuesOVERALL ASSESSMENT
Self-Management SupportUse of Guidelines
Coordination of CarePatient centered care
May 2012 Team ApproachInformation System SupportSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation ManagementCoordination of CareTreatment of Mental Health issuesOVERALL ASSESSMENT
Patient centered care
November 2012
Team ApproachInformation System SupportSelf-Management SupportPopulation ManagementPatient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT
Use of GuidelinesQuality ImprovementCoordination of Care
THC-1 better than
Traditional-2
THC-1 Similar to
Traditional-2
THC-1 Worse than Traditional-2
November 2011 Quality ImprovementTreatment of Mental Health issues
Team ApproachInformation System SupportSelf-Management SupportUse of GuidelinesPopulation ManagementCoordination of CarePatient centered careOVERALL ASSESSMENT
May 2012 Team ApproachSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation ManagementTreatment of Mental Health issues
Information System SupportCoordination of CarePatient centered careOVERALL ASSESSMENT
November 2012 Team ApproachInformation System SupportSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation ManagementPatient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT
Coordination of Care
THC-1 VS. TRADITIONAL-2
THC-1 VS. TRADITIONAL-3THC-1
better thanTraditional-3
THC-1 Similar to
Traditional-3
THC-1 Worse than Traditional-3
November 2011 Quality ImprovementPatient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT
Team ApproachInformation System SupportSelf-Management SupportUse of GuidelinesPopulation ManagementCoordination of Care
May 2012 Team Approach Information System SupportSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation Management Coordination of Care Patient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT
November 2012 N/A as the Traditional-3 surveyed in Nov 2011 and May 2012 had graduated from the program
2012 THC-1 VS. 2011 THC-1
2012 THC-1 better than2011 THC-1
2012 THC-1 Similar to
2011 THC-1
2012 THC-1Worse than2011 THC-1
Nov 2012 Team Approach Self-Management SupportUse of GuidelinesQuality ImprovementCoordination of Care Patient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT
Information System SupportPopulation Management
2012 THC-1 VS. THC-2
2012 THC-1 better than
THC-2
2012 THC-1 Similar to
THC-2
2012 THC-1Worse than
THC-2Nov 2012 Coordination of Care
Patient centered careTeam Approach Information System SupportSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation Management Treatment of Mental Health issuesOVERALL ASSESSMENT
Nov 2011 – May 2012 Nov 2011 – Nov 2012
Team Approach THC +19% +19%Traditional +15% +14%
Info System Support THC +10% +13%Traditional +8% +8%
Self-Management Support
THC +11% +14%Traditional +4% +9%
Use of Guidelines THC +7% +5%Traditional +4% +6%
Quality Improvement THC +6% +9%Traditional +8% +18%
Population Management
THC +21% +19%Traditional +10% +13%
Coordination of Care THC +14% +6%Traditional -1% +7%
Patient-Centered Care
THC -1% +6%Traditional 2% -1%
Mental Health Issues THC +11% +7%Traditional +11% +10%
Overall Average THC +10% +11%Traditional +6% +8%
COMPARISON ACROSS TIME: PERCENT CHANGE
Te
am
Ap
pro
ach
Info
Syste
m S
up
po
rt
Se
lf-M
an
ag
em
en
t S
up
po
rt
Use
of
Gu
ide
lin
es
Qu
ali
ty I
mp
rove
me
nt
Po
pu
lati
on
Ma
na
ge
me
nt
Co
ord
inati
on
of
Ca
re
Pa
tie
nt-
Ce
nte
red
Ca
re
Me
nta
l H
ea
lth
Issu
es
Ove
rall
Ave
rag
e
-5%
0%
5%
10%
15%
20%
25%
19%
10%11%
7%6%
21%
14%
-1%
11%10%
15%
8%
4% 4%
8%
10%
-1%
2%
11%
6%
Percentage Change over 6 months
THC
Traditional
Te
am
Ap
pro
ach
Info
Syste
m S
up
po
rt
Se
lf-M
an
ag
em
en
t S
up
po
rt
Use
of
Gu
ide
lin
es
Qu
ali
ty I
mp
rove
me
nt
Po
pu
lati
on
Ma
na
ge
me
nt
Co
ord
inati
on
of
Ca
re
Pa
tie
nt-
Ce
nte
red
Ca
re
Me
nta
l H
ea
lth
Issu
es
Ove
rall
Ave
rag
e
-5%
0%
5%
10%
15%
20%
25%
19%
13%14%
5%
9%
19%
6% 6%7%
11%
14%
8%9%
6%
18%
13%
7%
-1%
10%
8%
Percentage Change over 12 months
THC
Traditional
Team Approa
ch
Information
System Support
Self Manage
ment Support
Use of Guideli
nes
Quality
Initiative
Population Manageme
nt
Co-ordination
of care
Patient
Centered
Care
Treatment of
Mental Health Issues
Overall
Jermyn - Wayne residents
4.60 4.14 4.88 4.83 4.92 4.55 4.94 4.80 5.00 4.74
Jermyn - VA residents 4.10 3.25 4.38 4.50 4.00 3.50 4.50 4.30 4.50 4.11
Jermyn - Susquehanna 4.40 3.55 4.47 4.61 4.33 4.07 4.58 4.67 4.83 4.39
Jermyn - Scranton Primary
3.60 3.14 4.00 4.00 3.67 3.20 4.00 3.80 4.00 3.71
Clarks Summit- Scranton Primary
3.85 2.89 4.29 4.17 4.25 3.00 4.38 4.20 4.25 3.92
Jermyn - Wayne residents: PGY2
4.50 4.07 4.42 4.28 4.78 4.70 4.50 4.40 5.00 4.52
Scranton - Scranton Primary: PGY2
4.57 3.79 4.72 4.61 4.33 4.30 4.13 4.03 4.50 4.33
COMPARISON ACROSS TRAINING VENUES FOR THC TRACK RESIDENTS
CORRELATION ANALYSIS OF PCMH SURVEY RESULTS
Comparative Analysis
November2012
Team Approac
h
Information
System Support
Self Manage
ment Support
Use of Guidelin
esQI Pop
MngtCoord of
carePatient Centered Care
Treatment of
Mental Health Issues
Overall Score
Days in Jermyn
Team Approach 1
Information System Support
0.685 1 Self Management Support 0.580 0.622 1
Use of Guidelines0.675 0.582 0.736 1
QI0.528 0.693 0.695 0.451 1
Pop Mngt0.710 0.942 0.459 0.505 0.598 1
Coord of care0.640 0.497 0.587 0.754 0.658 0.438 1
Patient Centered Care0.447 0.497 0.470 0.671 0.568 0.492 0.819 1
Treatment of Mental Health Issues
0.551 0.653 0.443 0.469 0.452 0.581 0.469 0.432 1
Overall Score0.808 0.873 0.761 0.806 0.785 0.818 0.812 0.762 0.717 1
Days in Jermyn -0.031 0.141 -0.014 0.022 0.005 0.120 0.198 0.185 0.177 0.122 1
Self
Man
ag
em
en
t S
up
portTe
am
A
pp
roach
Qu
ality
In
itia
tives
Use o
f G
uid
elin
es
Pop
ula
tion
M
an
ag
em
en
t
Info
rmati
on
Syste
m
Su
pp
ort
Overa
ll S
core
Treat
Men
tal H
ealt
h
Issu
es
Pati
en
t C
en
tere
d C
are
Coord
inati
on
of
Care
-1+1
0Positive CorrelationNegative Correlation
CORRELATION BETWEEN TIME SPENT AT JERMYN AND MEDICAL HOME COMPETENCY
November 2011
Team Approac
h
Information
System Support
Self Manage
ment Support
Use of Guidelin
esQI Pop
MngtCoord of
carePatient Centered Care
Treatment of
Mental Health Issues
Overall Score
Days in Jermyn
Team Approach 1.000
Information System Support
0.714 1.000Self Management Support 0.438 0.621 1.000
Use of Guidelines0.593 0.635 0.852 1.000
QI0.036 0.311 -0.053 0.061 1.000
Pop Mngt0.741 0.924 0.452 0.465 0.275 1.000
Coord of care0.675 0.631 0.400 0.621 0.272 0.580 1.000
Patient Centered Care0.396 0.512 0.658 0.709 0.012 0.348 0.522 1.000
Treatment of Mental Health Issues
0.158 0.160 -0.193 -0.058 0.168 0.149 0.260 0.229 1.000
Overall Score0.761 0.879 0.683 0.802 0.333 0.779 0.813 0.734 0.336 1.000
Days in Jermyn -0.010 -0.276 -0.140 -0.058 0.052 -0.313 0.204 -0.287 0.305 -0.060 1.000
Self
Man
ag
em
en
t S
up
port Te
am
A
pp
roach
Qu
ality
In
itia
tives
Use o
f G
uid
elin
es
Pop
ula
tion
M
an
ag
em
en
t
Info
rmati
on
Syste
m
Su
pp
ort
Overa
ll
Score
Treat
Men
tal H
ealt
h
Issu
es
Pati
en
t C
en
tere
d
Care
Coord
inati
on
of
Care
-1+1
0Positive CorrelationNegative Correlation
CORRELATION BETWEEN TIME SPENT AT JERMYN AND MEDICAL HOME
COMPETENCYNOVEMBER 2011
QUALITY AND PATIENT SAFETY SURVEYS
Comparative Analysis
QUALITY AND SAFETY SURVEYS 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
RESULTS: QUALITY AND SAFETY SURVEY
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
CONSORTIUM MODELS FOR THC IMPLEMENTATION
Comparative Analysis
The Wright Center for Graduate Medical
Education:A 501(c )3 not-for-profit ACGME/AOA Accredited
Sponsoring GME Institution/Consortium50 FTE IM Residency
ProgramGroup A
Group B
Mercy hospital
Community Medical Center Moses Taylor
Medicare GME Fund
39 Hospital Funded FTE
Wayne Memorial
Community Health Center
FQHC*
Wright Center Primary Care Mid-Valley**
The Wright Center Medical
Group
Veteran Administration Hospital GME Fund
2 FTE 2 FTE
4FTE
1 FTE
1 FTE
10.7FTE 11 FTE 10.3FTE
5 VA Funded FTE
Scranton Primary Health
Center*
13 FTE 13 FTE13 FTE
Hospital Participating Institutional Affiliates
HRSA Teaching Health Center
Fund
6 THC Funded FTE/year
Wright Center Primary Care Scranton**
* NEW FQHC Based Learning Environments
**Established Internal Medicine Learning Environments
WCGME THC Consortium – Initial Development 2011
Medicare GME Fund
10.7FTE 8.5 FTE 10.3FTE
Regional Hospital
Community Medical Center Moses Taylor
43 Hospital Funded FTE (4
FTE > FY2011)
16 FTE 13.5 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 FTEs2012 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 FTEWright Center Primary Care
Scranton*(WCPC-S)
1 FTENortheast PA Community
Health Center FQHC***
(NEPACHC)
2 FTEWayne Memorial
Community Health Center
FQHC**(WMCHC)
The Wright Center
Medical Group, PC(WCMG)
Wright Center Primary Care Mid-
Valley*(WCPC-M)
4 FTE
2 FTEScranton
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
WCGME THC Consortium 2012 Training Model
WCGME THC Consortium – Regional Family Medicine 2013
WCGME THC Consortium – National Network for Family Medicine Residency Training 2013
WCGME THC Consortium – Interdisciplinary Model for All Regional Residency Training