Innovations in AAFP Clinical Care Demonstrating Better Results for Patients

Transcription

1 Innovations in AAFP Clinical Care Demonstrating Better Results for Patients Perry A. Pugno, MD, MPH, FAAFP, Vice President for Education Bruce Bagley, MD, FAAFP, Medical Director, Quality Improvement Ann Karty, MD, FAAFP, Medical Director, CME Division Wilson D. Pace, MD, FAAFP, Director, National Research Network

2 Demonstrating Better Results for Patients Through Practice Level Data AAFP promotes data driven practice improvement and education for family physicians Impact practice performance and improve patient outcomes Systems-based change Education for the new practice environment Regional data used to address CME needs

3 Healthy Communities Collaborative TM Helping Communities Improve Outcomes For Patients With Chronic Illness Through Better Practice Systems And A Team Approach

4 The Super-Hero Model Is No Longer OK!

5 Knowledgeable Physicians Working On Teams In A Well Organized System Get Better Results For Patients And Populations Knowledge Base Identify gaps in knowledge Read journals Attend traditional CME Work with team to develop protocols based on evidence Engage others when limit of knowledge in near Systems of Care True team approach Registries for chronic illness care Care management and care coordination Team based patient selfmanagement support Maximize benefit of health information technology Decision support

6 Goals Of The Patient Centered Medical Home PCMH is nothing less than an extreme makeover for primary care practices, to make them: More Service Oriented for patients More Efficient for better profit and system costs More Effective for patient outcomes More Fun to go to work for all 6

7 Healthy Communities Collaborative TM Online Learning Community State Chapter Champion WebEx Learning Sessions HCC Pre-work CSQ Evaluation Component NRN Local QI Expertise METRIC Leadership Change Management PEF Longitudinal Curriculum Practice Coaches (training) 7

8 Moore s New Levels of Outcomes- Based CME Evaluation Level Outcome Definition 1 Participation Attendance 2 Satisfaction Participant satisfaction 3A 3B Learning: Declarative Learning: Procedural Knows Knows how 4 Competence Shows how; observed in ed. setting 5 Performance Change in practice performance 6 Patient Health Change in patient health status 7 Community Change in population health status Moore DE, Green JS, Gallis HA. Achieving desired results and improved outcomes: integrating planning and assessment throughout learning activities. J Continuing Educ Health Prof. 2009: 29(1):

9 There Is A Better Way! Patients and Their Problems Populations Quality Measurement 100% Items for specific patient type Increasing Reliability and Better Results Usual Care Delegate Automate Patient Activation

10 AAFP CME Activities Ann Karty, MD, FAAFP, Medical Director, CME Division

11 AAFP CME Activities Curriculum Review Educational Format Selection Clinical Needs Assessment, Gap Analysis Learning Objectives Created Outcomes Assessment

12 Newer educational models Individualized data to gear educational need Regional Multi-modal Longitudinal, layered learning Team based Research for publication

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14 AAFP National Research Network and DARTNet Institute An Update Wilson D. Pace, MD, FAAFP Director, AAFP NRN CEO, DARTNet Institute

15 Disclosure Statement Wilson D. Pace, MD, FAAFP Recent Research Funding: Genova Diagnostics RS Medical Financial Investments: Novartis, Johnson and Johnson, Teva No off label medication use will be discussed.

16 AAFP NRN - Today

17 DARTNet Institute Organizations ~ 85 EHR s = 15 States = 25 Practices >400 Clinicians > 3000 Patients ~ 5 million Male 42% Female 58% % % % 65-older 18% * Technology Partner

18 AAFP NRN/DARTNet Capabilities

19 Evaluation of Educational Activities ABFM interested in impact of MOC programs (not just theirs) Pilot study - 76 family physicians Data pulled for diabetes care

20 Power at Physician Level* Study Group # Physicians Total Patients Mean/practice DM SAM/PPM Other SAM/PPM No SAM/PPM Totals Data elements captured: age, gender, diagnoses, medications, BP, A1c, lipids, micro-albumin for 36 months * Actual results of the project are embargoed

21 Examining CVD Testing Approaches Cardiovascular testing ordered by primary care physicians Exercise treadmill (ETT) Functional/Advanced Testing* (ECHO/nucl.) Cardiac CT scans (only 3 identified dropped) Three cohorts of patients Symptom cohort New diagnosis - CVD Established diagnosis - CVD Three patient risk groups - on age, gender, comorbidities*, smoking status, BMI * HTN, DM, CKD, BP control, lipid control

22 Sample Size by Region Region # Healthcare Organizations # Patients Midwest 5 35,163 Southeast 3 57,359 Texas 6 193,719 TOTAL ,241 22

23 Symptom Cohort Stratified by Risk Region/Risk ETT ECHO/Nucl. Ratio Midwest/low Midwest/med Midwest/high Southeast/low Southeast/med Southeast/high Texas/low Texas/med Texas/high Rate: tests/ 1000 people Ratio: ETT/ECHO 23

24 Management of Skin and Soft Tissue Infections (SSTI) AHRQ Contract # HHSA Practical intervention that compared an historical cohort to an intervention cohort of patients seen for SSTI in 28 primary care practices in two health care systems.

25 Demonstrated ability to study / improve acute problems Tracked 100% of SSTIs Data: EHR, Clinician Decision Making, Chart Audit, Patient Outcomes 3112 cases observed 12 month baseline 1406 cases 8 month intervention Increased use of antibiotics that cover MRSA No increase in drainage procedures

26 Multi-faceted Research Observational CER data mining Enhanced clinical data Understanding processes of care Information to inform studies Eligibility criteria Incidence and prevalence data Best practices research PBRN interventional trials

27 Conclusions The educational needs of AAFP members have changed, but they may not know Gaps in knowledge and gaps in performance must be addressed, but often in different ways Clinical data from the electronic record will be critical to optimize patient care and to direct educational strategies

28 Questions & Discussion