4/8/2015

Chronic Pain Collaborative 2 (CPC2) Kick-Off Webinar April 9, 2015 Presenters: Noah Nesin, MD, FAAFP — Chief Medical Officer, Penobscot Community Health Care (PCHC) Daren Anderson, MD, VP/Chief Quality Officer, Community Health Center, Inc, and Director, Weitzman Institute Dora Anne Mills, MD, MPH, FAAP, Vice President of Clinical Affairs, University of New England (UNE) Sandra Seamans, RN, Director of Nursing, Harrington Family Health Center For Audio, please call: 1.866.740.1260, Access Code: 9217167# QC Webinar 04/09/15

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Today’s Webinar Agenda: 12:00 pm 12:05 pm 12:10 pm 12:20 pm 12:45 pm 12:50 pm 12:55 pm 1:00 pm

Welcome & Introductions Portraits of Pain, “Ernie” Key Lessons Learned from CPC1 Overview of Project ECHO Pain Introduction to Interprofessional Practice Lessons Learned from a CPC1 Practice Questions & Answers Adjourn

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Webinar Logistics: To minimize background noise, all lines will be muted until the presentation begins • To unmute your line, press *7 • To mute your line, press *6 To ask questions or share comments, use one of two ways: 1. Raise Your Hand button (press *7 to unmute your line) 2. Type in chat box on the lower left-hand side of the screen Please state your name and organization before asking your question or sharing your comment.

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CME Certification: • CME will be available for participants who have signed into the live webinar. If there are multiple people at one computer, please type their names and email addresses into the chat box for our attendance records. • We do not have separate nursing CEUs- but you can get a CME certificate. • A CME evaluation survey will be available when you exit the webinar and will be sent after the webinar via email. • Please complete the survey via Survey Monkey within 1 week • A CME certificate will be emailed within 1 month of completion of the survey

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Welcome Practices and Peer Consultants • • • • • •

Group A: Coaches are Elisabeth Fowlie Mock, MD, and Noah Nesin, MD MMA MICIS consultant is Dr. Mock Winterport Community Health Center (Bangor) (Dr. Mock) EMMC Family Practice Husson (Bangor) (Dr. Mock) Brewer Medical Center – PCHC (Brewer) (Dr. Mock) Maliseet Health and Wellness Center (Littleton) (Dr. Nesin) St. Joseph Internal Medicine (Bangor) (Dr. Nesin) Dover Foxcroft Family Medicine (Dover Foxcroft) (Dr. Nesin)

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Group B: Coaches are Rich Entel, MD, Rhonda Selvin, NP, and Anne Graham, NP MMA MICIS consultant is Erika Pierce, PA HealthReach Health Center – Sheepscot Valley Health Center (Coopers Mills) (Selvin/Graham) Inland Family Care (Unity) (Selvin/Graham) Swift River Family Medicine (Rumford) (Selvin/Graham) Westbrook Primary Care (Westbrook) (Dr. Entel) CMMC Family Medicine Residency Clinic (Lewiston) (Dr. Entel) MMP Family Medicine Portland/Falmouth (Portland/Falmouth) (Dr. Entel) Mark Braun, MD (Scarborough) (Dr. Entel)

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Speaker Disclosure: The speakers today do not have any relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity. The Chronic Pain Collaborative 2 Project is funded by a grant by the Pfizer Foundation’s Independent Grants for Learning and Change (IL&C). which funds the time of QC Staff and Consultants.

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Speaker Information: Dr. Noah Nesin is the Chief Medical Officer of Penobscot Community Health Care (PCHC) and a Peer Physician Consultant with the ME CPC2. Dr. Nesin is a distinguished physician leader with a state-wide reputation. He has been Medical Director of Health Access Network and a physician in the Lincoln community for almost 30 years. Dr. Nesin joined the PCHC Clinical Leadership team in March 2013, and works closely with other Quality Management Leaders and Providers to help them achieve high levels of measurable quality, and provider and patient satisfaction.

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Speaker Information: Dr. Daren Anderson is VP/Chief Quality Officer of Community Health Center, Inc. (CHC) In this role, Dr. Anderson is responsible for ensuring that CHC delivers the highest possible quality of care to its patients, developing a strong quality improvement infrastructure across CHC, promoting research and development, and supporting CHC's mission to become a nationally-recognized center of worldclass healthcare. Dr. Anderson conducts research, lectures and writes extensively in the areas of disease management, self-management/behavior change, implementation science, and health services research. He is the 2010 recipient of the Society of General Internal Medicine's Hamolsky Award for his research on disease management for diabetes in a community health center.

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Speaker Information: Dr. Dora Mills is a Maine native who was raised in Farmington, graduated from Mt. Blue High School, Bowdoin College, University of Vermont College of Medicine, Children's Hospital of Los Angeles Pediatric Internship and Residency Program, and the Harvard School of Public Health. She is a board-certified pediatrician. From 1996-2011, she served as Maine's State Health Officer, for the administrations of Governors Angus S. King and John E. Baldacci. As the Director of the Maine CDC, her priorities included: lowering Maine's tobacco addiction and obesity rates; improving health equity; developing a statewide public health infrastructure; working on health care reform to increase access to care, improve quality of health care, and reduce costs; addressing chronic diseases with comprehensive and coordinated strategies; leading the public health response to several emergencies; and reducing Maine's teen pregnancy, infant and maternal mortality rates.

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http://blog.une.edu/portraitsofpain/2013/04/03/video-portrait-ernie/

ERNIE’S PORTRAIT OF PAIN

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Maine Chronic Pain Collaborative 2 Lessons Learned April 9, 2015

Noah Nesin, MD, FAAFP Chief Medical Officer, PCHC [email protected]

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Disclosures: • I am employed by PCHC. • PCHC gets reimbursed by MQC for some of the time that I put into the MCPC (@ 2 hours/week). • MQC has funding for this initiative from Pfizer Independent Grants for Learning and Change (IL&C).

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What Did We Learn?

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Lessons Learned • Primary care providers feel overwhelmed by the challenge of managing patients with chronic pain. o Self-efficacy and knowledge o Resources and specialty support o Addiction and dependence o Trauma o Pain vs. suffering o Patient expectations/demand QC Webinar 04/09/15

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TIME!

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Details • • • • •

Who are our chronic pain patients? Who will identify them? How will we identify them? How do we change the dynamic? If we are going to change the dynamic, how do we explain it to our patients? • How do we maintain relationship? • Should I be frightened? QC Webinar 04/09/15

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Peer Support

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Agi Erickson Project ECHO Manager April 3, 2015

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Our Vision: Since 1972, Community Health Center, Inc. has been building a world-class primary health care system committed to caring for underserved and uninsured populations and focused on improving health outcomes, as well as building healthy communities.

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CHC’s Weitzman Institute

Committed to improving primary care for underserved populations by promoting research, training, education, and innovation

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Project ECHO “The mission of Project ECHO is to develop the capacity to safely and effectively treat chronic, common and complex diseases in rural and underserved areas and to monitor outcomes.” Dr. Sanjeev Arora, University of New Mexico

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Key Elements of an ECHO Session Case Presentations • 2-3 Cases per ECHO session • Co-presented by PCP and BH Provider • Complex cases • Multi-disciplinary consultation available • Valuable for discussion and teaching • Total time = 1.5 hours

Didactic Presentations • • • •

1 per session Focused and topical By expert faculty Total time < .5 hour

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Technology Infrastructure

Webcam/ Computer iPad/ Smartphone for End-Users

Video Conferencing System for ECHO Team

Cloud-based Teleconferencing Platform (Zoom©)

Recorded/ Catalogued Sessions

Streaming Sessions

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Pain Management

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Integrative Pain Center of Arizona

Bennet Davis, MD, Founder IPCA

Amy Kennedy, PharmD, BCACP

Anesthesiology, orthopedics, and Pain Medicine

Clinical Assistant Professor at the Univ. of Arizona College of Pharmacy and Clinical Pharmacist

Cela Archambault, Ph.D., Founder IPCA Clinical Psychology, Health Psychology and Pain Management

Kathy Davis, RN, ANP-C, Founder IPCA

Jennifer Schneider, MD, Ph.D.

Ancillary staff: Chinese medicine,

Internal Medicine, Addiction Medicine and Pain Management

rehabilitation/occupational medicine, nutrition

Primary care, pain management

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Our Project ECHO Philosophy Providers need specific guidance for each case: Each ECHO faculty member is taught to avoid generic “you could do this, this or this” guidance in favor of a specific suggestion for what they would do with the particular patient.

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Evidence-based Guidance for Chronic Pain Management

• Each member of the Pain ECHO expert panel is responsible for keeping up with his/her own area of specialty • ECHO expert panel members are carefully selected as leaders in their field with extensive teaching resumes and clinical experience • The expert panel always qualifies whether their recommendation is based on peer-reviewed evidence vs. consensus vs. individual opinion 27

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Integration of Medical and Behavioral Health • Primary care providers and behavioral health providers encouraged to attend sessions and co-present • Didactic lectures on medical and behavioral health topics with emphasis on how to integrate the two at the primary care level • Care plan recommendations include BH and medical recommendations

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Pain ECHO Curriculum •

Monthly core session with second optional session

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All Cases Recorded and Indexed Case Index: Details about the cases presented in each recorded session – age and gender of patient and brief synopsis of providers’ questions to expert faculty.

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Provider Expectations The ECHO Participants will be expected to: • Attend a minimum of 2/3rds of the total ECHO sessions. • Present at least one case every 3 months. • Complete pre- and post-ECHO surveys. • Watch the recorded session if you are unable to attend.

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When Can I Submit Cases? • Cases can be submitted at any time! • To be submitted by the PCP • Must be received by the ECHO team at least 48 hours before the ECHO session is scheduled • ECHO staff will send a reminder email at the beginning of each week to submit cases for ECHO

How Can I Submit Cases? • Fax or Secure Email

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What Do I Submit? • Complete the Chronic Pain Presentation Form in Word and print, or fill it out by hand • Print documents from your EHR that provide the information requested on the form • If the printed documents provide the info, you don’t need to fill out the form – ie: current meds, medical history • Assemble the case and fax to Ági Erickson: 860-638-6605

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The Case Presentation Form

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The Case Presentation Form Submit: • Question for Discussion • Patient Medical Summary • Current Medications with Dosages • Patient’s Social History • Relevant Progress Notes • Labs Results or Imaging

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What Happens to Case Materials? • Cases are de-identified by ECHO staff at Weitzman Institute and scheduled for presentation at an ECHO session • Cases are submitted to the ECHO faculty for advance review before the session • Presenters will receive a copy of the de-identified case materials the day before the ECHO session • All ECHO session attendees and faculty will receive an agenda for ECHO each week, listing the scheduled cases and didactic presentation

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How Do I Present a Case at ECHO? • During each ECHO session, 2-3 cases are discussed, on a first-come, first-serve basis • ECHO faculty will call on a scheduled presenter, and the presenting provider or team will introduce the case and ask their questions • Each case will be discussed by the faculty, presenter(s) and attendees during the ECHO session • Case discussions will be limited by the total amount of time available in the session, and will not exceed .5 hr each.

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Following the Session • CME credits are available through AAFP (American Academy of Family Physicians) • You may earn 2 credits per ECHO session • If your credentialing organization is not AAFP, check to see if AAFP credits are accepted • After presenting your case, remember to document the ECHO team’s recommendations in your electronic health record.

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Contact Information Daren Anderson, MD VP/Chief Quality Officer Director, Weitzman Institute [email protected] 860-347-6971 ext. 3740

www.quality.chc1.com

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Dora Anne Mills, MD, MPH, FAAP, Vice President of Clinical Affairs, University of New England (UNE)

INTRODUCTION TO INTERPROFESSIONAL PRACTICE QC Webinar 04/09/15

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Interprofessional Collaborative Practice Dora Anne Mills, MD, MPH, FAAP Vice President for Clinical Affairs UNE [email protected] 207-221-4621

Today’s Questions • What is interprofessional collaborative practice? • Why is it needed? • What are some tools to implement interprofessional practice?

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210,000 – 440,000

Top Causes of Death U.S. Numbers of Death, 2010 Heart Disease

600,000

Cancer

575,000

Medical Errors in Hospitals Strokes Accidents Alzheimer’s Disease Diabetes

210,000

440,000

130,000

120,000

84,000

70,000

80%

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A Team of Experts is not An Expert Team

Interprofessional Collaborative Practice (IPCP)

“When multiple health workers from different professional backgrounds work together with patients, families, caregivers, and communities to deliver the highest quality of care” (WHO, 2010)

4 IP Competencies

• Values/Ethics • Roles/Responsibilities • Communication • Teamwork

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Interprofessional Education (IPE) at UNE • Early Introduction – Common Curriculum • Shared Learning – Medicine & Nursing • Modules for Graduate Learners • Team-based Service Learning

TeamSTEPPS

Sandra Seamans, RN, Director of Nursing, Harrington Family Health Center

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Chronic Pain Collaborative 2 Up-Coming Dates: Project ECHO (via Zoom): April 16, 2015, 11a-1p April 30, 2015, 11a-1p Next CPC2 All-Practice Webinar (1.866.740.1260, Access Code: 9217167#, www.readytalk.com) May 14, 2015, 12pm -1pm Coaching Visits Prior to June: MICIS On Site Practice Training Meet with your Peer Consultant Learning Session: May 28, 2015, Maple Hill Farm, 9am-4pm QC Webinar 04/09/15

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Contact Information: CPC2 Team: Tel: 207-620-8526 Amy Belisle, MD, Interim Director [email protected], 207-847-3582 Chris Beaudette, MS, Project Manager [email protected] , ext.1027 Eric Buch, Project Coordinator [email protected] , 508-341-9787 Wendy Rodrigue, Administrative Coordinator [email protected], ext. 1004

For Audio, please call: 1.866.740.1260, Access Code: 9217167#

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