panel management, applying population health and best evidence
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Panel Management, Applying Population Health and Best EvidencePaige Hatcher, MD- Diplomate, ABFM- Preventive Medicine Resident, OHSU- MPH Candidate, PSU- Health Policy Fellow, OHA
What is Panel Management?• Addresses population health through the lens of
primary care• Evidence-based protocols and to provide self-
management support• Systems to standardize care using a team-based
approach• Designing a system that “remembers” and prevents
errors of forgettingNeuwirth, E. B., Schmittdiel, J. A., Tallman, K., & Bellows, J. (2007). Understanding Panel Management: A Comparative Study of an Emerging Approach to Population Care. The Permanente Journal, 11(3), 12-20.
What is Panel Management?•Dedicated physician time for directing
clinical decision making•Dedicated staff members or staff time to
support physicians and conduct outreach•Information-technology tools to identify
care gaps•Structured work processes completed on
a routine basis
Experience at KP•Patients mostly like it•Mostly implemented without new funding
(some require resource shift)•Wide-scale dissemination through entire
facility/area•Focused on a particular disease or high-
risk group•45-180 min PCP time reserved per
provider per month
Change to Standard Practice• Requires a shift in thinking• “It doesn’t make my day easier, but it makes my
day better”.• “Giving me hope that some of my more difficult
patients might actually turn around their health status”.
• Biggest change to MA and support staff roles, but they welcomed the opportunity for job growth.
• Less face to face time can be dissatisfying.• Patients worry decisions aren’t being made by
their doctors
Managing Change•Physicians feel like they are losing control•Imperative to respond with demonstration
of performance improvement•Champions•Warm handoffs
“Topic” Selection•Often incentivized by a performance
payment opportunity•Should be evidence-based, simple, and
clear•Aim for incremental improvement
Creating a Registry•Identification of patients with particular
need•Review of list generated for
appropriateness for inclusion•Treatment decision•Follow up communication with patient
Example: I want all my patients to be up-to-date on cervical cancer screening•Generate First List•Women 21-29 with an intact cervix and no
pap result for the last 3 years•Women 30-65 years with an intact cervix
and no HPV result for the last 5 years**This should be tailored to your practice, if you haven’t been doing mandatory HPV testing, then it will be “no pap result for the last 3 years”1
Next Steps•PCP Reviews list for appropriateness of
inclusion•Outreach to schedule patients, correcting
chart where needed if Pap has been done somewhere else
•Run the list again (time interval TBD) and compare N, report results as appropriate
•PCP reviews the list again▫Then, start outreach to new group, adjust
tactic, etc.
Best Sources for Evidence
National Guideline Clearinghouse http://www.guidelines.gov/
Best Sources for EvidenceUS Preventive Services Task Force (USPSTF) http://www.ahrq.gov/clinic/uspstfix.htm
Best Sources for Evidence
National Institute for Health and Clinical Evidence (NICE) (England and Wales) http://www.nice.org.uk/
Patient InformationChoosing Wisely® campaignhttp://choosingwisely.org/
Asking your question (PICO)•Patient- children or adults, pregnant
women, patients with a specific chronic disease or problem
•Intervention- prevention, diagnosis, treatment
•Comparison- standard practice, placebo, alternative therapy
•Outcome- acute or chronichttp://libguides.ohsu.edu/content.php?pid=255709&sid=2879578
PubMed MESH search
If you search for “pap smear” and “screening” in PubMed, you get 15515 results.
Using MESH search Terms
Other Benefits•ABFM MC-FP Part IV modules are
Performance in Practice Modules (PPMs), which are designed as a Quality Improvement activity which takes place over a one week period
Additional References1. Saslow, D., Solomon, D., Lawson, H. W., Killackey, M., Kulasingam, S. L., Cain, J., ... Myers, E. R. (2012). American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer. Journal of Lower Genital Tract Disease, 16(3), 00-00.
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