integration in practice; tracking the transformation perry dickinson, md stephanie kirchner, msph,...

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.

Questions??

Contact:Perry.Dickinson@ucdenver.eduKyle.Knierim@ucdenver.eduStephanie.Kirchner@ucdenver.edu

Session Evaluation

Please complete and return theevaluation form to the classroom

monitor before leaving this session.

Thank you!