CDE Role in Redesigning Primary Care: Training

MAs in the CCM

Jan Wolfram RN, MN, CDE Shari Gioimo, Medical Assistant

Providence St. Peter Hospital, Olympia, WA August 3, 2007

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PSPH Medical Assistants & Boldt Diabetes Center

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CDE’s & Medical Assistants Work Within the CCM

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Expanded Role of the Medical Assistant

• Data Registry Entry

• Goal Setting

• MA Patient Planned Visits

• Organized Patient Group Visits

• Referrals to Health Specialists (CDE’s)

• Initiate Standing Orders

• Provide Follow­Up Phone Calls to Patients

• Foot Checks

• Immunizations

• DM Education Reinforcement

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Dr. Devin Sawyer

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Primary Care Self­Management Goal Cycle

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Considerations for the MA Curriculum

• American Association of Medical Assistants

• Western Washington Area Health Education Center

• Health Care Assistant Law in the State of Washington

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More Considerations for the MA Curriculum

• Review of MA Focus Group Results

• Review of MA Curriculums from Local Technical Community Colleges

• Literature Search on MA Training for Diabetes Care

• Review of Published Diabetes Knowledge Surveys for Patients

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Medical Assistant Learner Characteristics

Characteristics of MAs in Primary Care

• 18 Medical Assistants

• Most Caucasian

• Trained locally

• Significant Family Responsibilities

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Rapid Cycle Improvement Process

Rapid Cycle Improvement Process

• MAs attended patient DM classes.

• MAs gave feedback.

• PPT slides for MA training edited.

• Classes revised

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MA Curriculum Matrix

Reporting Conditions X X Goal Setting

X X X X Long­term Complications X X X X Acute Complications X Diabetes Treatments X X X X X Pathophysioloy of Diabetes X X X X X Age, Race, Gender Awareness

X X X X

Registry Data Entry

Telephone Follow­Up

Planned Visits

Provider Visit

Group Visit

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Applied Educational Theories

• Mezirow Transformational Learning – Experience – Reflection – Discussion

• Knowles Adult Learner – Independent Learner

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Educational Methods

• Cognitive Methods: Lectures, Discussion, PPT slides

• Behavioral Methods: Role­Play, Phone Scripting, Computer Practice; Diaries for Food, Blood Glucose, & Exercise

• Kinetic Methods: Self­Blood Glucose Monitoring, Glucose Gel and Tablet Tasting, Injection of Normal Saline

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Shari Gioimo, Medical Assistant

• Active Participant in the Diabetes Initiative

• National Consultant to Clinics Expanding the MA Role

• Certified Trainer in Chronic Disease Self­ Management

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Clinical Life before the MA Expanded Role

• The MA traditionally “roomed” and “vitaled” the patient prior to the PCP visit

• The MA was dependent on the PCP direction

• The MA­Patient Relationship was not well developed

• The MA role was to perform tasks and keep the office flow moving

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Delivery System Design

• Individual “Planned Visits” with MA and Patients

• MA Organized Group Visits with PCP and Patients

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Decision Support

• Standing Orders:

– Introduce the Idea of Self­Management

– Laboratory (Tests A1c, etc.)

– Immunizations

– Foot Checks

– Referral to CDEs and specialists

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Self­Management Support

• Goal setting using the Transtheoretical Model

• Follow­up phone calls to “check­in”

• Goal Trotter’s Walking Club

• Newsletters

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Clinical Information Systems

Data Input into CDEMS Registry

– Self­Management Goals – A1c – Lab Results – Immunizations – Eye Exams – Smoking Cessations – Medications – Vital Signs

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Interaction with the Community

• Consult with local CDE’s regarding questions on diabetes.

• Consult with other community agencies and programs such as the Food Bank, YMCA, and Senior Centers.

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Health Systems Support

• MAs give administrative leaders and

doctors feedback.

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Clinical Life After the MA Training • MA­Patient relationship is better.

• MA patient care is more organized.

• MAs receive more respect from team members.

• MAs reinforce patient education.

• MA retention rate is higher.

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Percent of Patients with Self­Management Goals

Percent of Patients with Documented Self­Management Goals

6.8 9.2 12.6 12.4 12.0 11.3 11.2 12.4 10.4

18.8 16.7 19.0 20.6 18.6 19.4 19.2 20.1 21.5 21.6

24.7 25.9 25.5 27.1

36.7

46.9

57.2 58.5 61.5 61.2 62.7

66.7 68.6 72.6 73.8

76.9

0.0 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 100.0

perc

ent

Goal = 70%

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Quality of Patient Self­Management Goals

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Quality of Self­Management Goals Over Time

Clinic SMG By Date

1.0

2.0

1.0 1.0 1.5

4.2 4.2 4.0

3.4

4.0 3.6

3.2

3.8

3.1

3.6 3.5

2.6 2.9

2.4 2.0 2.0 2.0

3.4

1.6 2.0 2.0

1.3

2.0 1.5

1.0 1.0

2.0

1.0 1.0

3.0

2.0

0

1

2

3

4

5

Mar­01

May­01

Jul­01

Sep­01

Nov­01

Jan­02

Mar­02

May­02

Jul­02

Sep­02

Nov­02

Jan­03

Mar­03

May­03

Jul­03

Sep­03

Nov­03

Jan­04

Mar­04

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Opportunities • The MA Curriculum A Work in Process

• CDE’s deliver MA training in local settings.

• Business expansion with referrals.

• Expand resource base for the CDE’s and the Family Medicine Teams.

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Contacts

• Jan Wolfram RN, MN, CDE janet.wolfram@providence.org

• Shari Gioimo MA Shari.Gioimo@providence.org

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PSPH Medical Assistants & Boldt Diabetes Center