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Virtual Journal Club Collaborative Process for Improving Performance in Practice Tuesday, June 14, 2011 2:00 – 3:00 Pm ET

Supported by an educational grant from Genentech and Pfizer.

Moderator

Ronald M. Cervero, PhD Professor and Associate Dean, College of Education Co-director, Institute for Evidence-Based Health Professions Education The University of Georgia

Guest Faculty Robert A. Gabbay, MD, PhD Professor of Medicine, Director Penn State Institute for Diabetes and Obesity

Suzanne Yunghans, MMGT Executive Director Pennsylvania Chapter American Academy of Pediatrics

Patricia L. Bricker, MBA Research Coordinator Penn State Institute for Diabetes and Obesity

June 14, 2011 Suzanne Yunghans, MMgt, PA Chapter, American Academy of Pediatrics Patricia L. Bricker, MBA, Penn State Institute for Diabetes & Obesity Robert A. Gabbay, MD, PhD, Penn State College of Medicine























Primary Care Coalition – PEDS, FP, IM PEDS and FPs – partnership on public health issues with state government Jointly applied for Improving Performance in Practice (IPIP) grant

Governor’s Office of Health Care Reform Advisory Committee Multi-payer collaboration Provider group participation via IPIP

Voice in infrastructure design of learning collaborative Engagement of practices in quality improvement Negotiating practice incentives

















7 regional rollouts from May 2008-Dec 2009 300 primary care practices recruited by payers, primary care societies, Gov’s Office 155 practices selected with diversity in size, ownership, patient mix Care for almost 10% of Pennsylvania’s population 3-year commitment in payer-supported regions

Year 1 infrastructure payments ◦ 17 payers providing incentives in 4 regions ◦ Small state grant program in other 3 regions

















National Committee on Quality Assurance (NCQA) Patient Centered Medical Home recognition required in all 7 regions Payer incentives tied to NCQA PCMH Payer incentives more prescriptive as regions added: care management, shared savings (see Table 2 in JCEHP article)

Developed by Institute for Healthcare Improvement (IHI) Typically used with large organizations to improve care; Pennsylvania bringing together diverse unconnected practices Systems change focus necessitates team participation and learning First session mostly didactic, but less and less so as teams present what they are doing Main goal = sharing experiences and best practices












Practice team attendance required Quarterly learning sessions in Year 1; twice a year afterwards Monthly conference calls Monthly clinical data reporting and benchmarking Monthly narrative reporting on changes tested, implemented, spread

Model for Improvement

(PDSA cycles of Model for Improvement)


Session evaluations help tweak curriculum




Monthly written feedback to practices On-site, telephone, email support Fulfillment of resources, such as sample templates, forms, patient communications, staff training materials, etc. Networking and sharing of best practices








100

100

80

80

60

Pct of DM patients with latest BP 90% practices reporting by third month Consistent reporting: >80% practices reporting in most months Steady, consistent clinical improvement trends Reported improvements in practice teamwork, communications, relationships with patients, efficiency

Pct of DM patients with latest LDL