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Meet the AuthorWebinar

May 10, 2012

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Ground Rules for Webinar Participation

• Actively participate and write your questions into the chat area during the presentation(s)

• Do not put us on hold• Mute your line if you are not speaking

(press *6, to unmute your line press #6)• Slides and other resources are available

on our website at incareCampaign.org• All webinars are being recorded

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Agenda

• Welcome & Introductions, 5min• Meet the Author: Dr. Amy Sitapati, 30min• Q & A Session, 20min• Campaign Next Steps, 5min

BRINGING RETENTION INTO THE HIV PATIENT CENTERED MEDICAL HOMEAmy M. Sitapati, MDAssociate Director, Owen ClinicAssociate Clinical Professor, Department of MedicineUCSD ANCHOR: A Novel Centered Home Optimizing Retention

Tell Us About Your Site – Question 1

Bibliography1. Kurt C. Stange, Paul A. Nutting, William L. Miller, Carlos R.

Jaen, Benjamin F. Crabtree, Susan A. Flocke, and James M. Gill Defining and Measuring the Patient-Centered Medical Home. J Gen Intern Med. 2010; 25(6):601-12.

2. Mallory O. Johnson. The Shifting Landscape of Health Care: Toward a Model of Health Care Empowerment. Am J Public Health. 2011;101:265-270.

3. David W. Bates and Asaf Bitton. The Future of Health Information Technology in the Patient Centered Medical Home. Health Affairs. 2010;29(4):614-21.

4. http://www.ncqa.org

Who are we? The OWEN CLINIC

Funded by California HIV/AIDS Research Program (CHRP) to serve as a pilot center for application of Patient Centered Medical Home in HIV

Site based focus to improve Retention

University of California, San Diego20 years of experience 3,000 HIV/AIDS patientsHigh proportion of Medi-Cal/ Medicare/ RW funding

Goal of presentation: To illustrate how to begin to construct the concepts of a patient centered medical home into HIV primary care retention

Some of our patchwork homes, need upgrading

maybebymonday.com/cars3

Step 1: Belief that change will helpNational Committee for Quality Assurance Patient-Centered Medical Home

“The comprehensive and coordinated care thatthe medical home promotes leads to better

health, longer lives, higher patient satisfactionand less expensive care. The question isn’twhether we should implement the medicalhome, but how. NCQA standards clearly

assess and identify effective medical homes.”

Paul Grundy, MD, IBM Global Director of HealthcareTransformation and President, Patient-CenteredPrimary Care Collaborative (PCPCC)

http://www.ncqa.org/Portals/0/PCMH%20brochure-web.pdf

David W. Bates and Asaf Bitton

The Future Of Health Information Technology In The Patient-Centered Medical Home

Health Affairs, 29, no.4 (2010):614-621

Framing the PCMH

http://www.vermonttimberworks.com/Web-Photos/Post-And-Beam/

THE MODERN MEDICAL HOME

PhysicianPatient Case

Manager

SocialWorker

Homehealth

Housingassistance

Midlevel

PhysicianColleague

Receptionist

MA

RN

Operator

Referrals

Partner

Family

Pharmacy

Dental

Insurance

Prescriptiondrug plan

Specialist

MULTIPLY PATIENT BYn= x in the medical practice

Communications multidirectional between provider-patient-and all the between.

Step 2: How to conceptualize concepts of PCMH

Core Frames of the building

• REGISTRYDefine patients with specific condition (i.e. HIV) while also specifying their disease status (6 month gap in care, poor viral control, etc.). Best practice would be to have non MD identify, communicate and track with an actionable intervention.

• CLINICAL DECISION SUPPORTComputerized system aiming to improve decision making around the diagnosis (clinical prediction), prevention and disease management (routine care reminder), and treatment.

Bates, Health Affairs, 2010.

Martin is due for his routine care… But, we didn’t recognize that he was poorly retained.CARE MANAGEMENT (evidence for q 6 mo. visit)

The database is searched using registryFor the practice, and patients with gaps of6 months are loaded into a tracking accessProgram.

A retention specialist uses TEAM CARE with tracking database for information about contact, last visit, primary provider and contacts patient.

OPEN ACCESS SCHEDULING:

• Allows for scheduling in less than 2 week notice

Tell Us About Your Site – Question 2

Patient returns to care, and provider needs electronic record to help facilitate the quality careProvider View

Manageable appointment schedule

Clinical decision support

Secure communication with patient

Priority notification of abnormal lab results

Help patient establish health care goals

Provider & health team related EMR improvements

• Decision support improvements, prevention health maintenance• Provider report card• Improved communication methodology (urgency, type)

Where we’re heading in modern POPULATION MANAGEMENT

Actionable reports in the EMR will make it possible evaluate: are my Hypertensive patients on two-drug therapy? (HIVQUAL measure)

--and generate orders per protocol --and communicate with patient (letters, phone lists or MyChart)

Step 3: Patient empowerment in the PCMHPATIENT SELF CARE SUPPORT AND RESOURCES

Health Care EmpowermentEngagedInformed

CollaborativeCommitted

Tolerant of uncertainty

“Engagement in health care has been identified as an important factor related to optimization of health outcomes.”

MO Johnson, Am J Public Health, 2011

Patient centered technology supports patient and provider

Manageable appointment schedule

Clinical decision support

Secure communication with patient

Priority notification of abnormal lab results

Help patient establish health care goals

Schedule/Reschedule appointment

Learn about support tools and programs

Ask a medical question

Learn about my condition

View my lab results

Get reminders of health care tests

Set and track my health goals

Clinic Based Web Page

MyChart / MyChart Mobile Electronic Medical Record

Offer improved patient health literacy and systems literacy

• Clinic based web page• Offer basic computer training• Enhanced computer access (care service sites)

• Enhance patient chart access MyChart:– Spanish translation– Providers strongly supporting patient initiation/use– Appt reminders– Test reminders (including specific to safety on meds)– Preventative care reminders/tracking

Tell Us About Your Site – Question 3

Step 4: Measure and Improve PerformanceDevelop, apply, test, analyze and start over“The value of … primary care…includes higher health care quality, better whole-person and population health, lower cost and reduced inequalities…”

“The transformation …is best understood as a developmental process, with stops, starts, backslides, leaps and challenges…”

This article nicely summarizes application of PCMH into primary care.

Stange, J Gen Intern Med, 2010.

PCMH Review in HIV Primary Care1. Open Access to continuity

provider2. Registry of HIV primary care

patients3. Apply poor retention as

important quality goal4. Improve patient empowerment

through knowledge, chart access, etc.

5. Track patient’s return to care and coordination

6. Use lessons learned in CQI to make process more robust

http://www.ncqa.org

Thanks to the OWEN ANCHOR TEAM:• Moira Mar-Tang• Militza Bonet-Vazquez• Barbara Berkovich• Pavel Tseytlovskiy• Susan Benson• Dorothea Northcutt• Jan Limneos• Dr. Chris Mathews• CQI committee

The California HIV/AIDS Research Program; Award number: MH10-SD-640

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Time for Questions and Answers

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Partners in+care

• Aspect of Campaign aimed at People Living with HIV and their allies• What can they do to make sure they stay in

care?• What can they do to ensure their friends and

loved ones stay in care?• Handouts, Webinars, and Bulletin Board

(coming soon)• Partners in+care website is live!

http://www.incarecampaign.net/index.cfm/77453

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Photo Drawing Prizes

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• Campaign Office Hours: Mondays & Wednesdays 4-5pm ET

• Improvement Update Submission Deadline: May 15, 2012

• Next Campaign Webinar: Retention & Youth May 31, 2012 2pm ET

• Next Partners in+care Webinar: Peer-to-Peer Retention May 24, 2012 2pm ET

• Data Collection Submission Deadline: June 1, 2012

Upcoming Events and Deadlines

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Campaign Headquarters:National Quality Center (NQC)90 Church Street, 13th floorNew York, NY 10007Phone 212-417-4730incare@NationalQualityCenter.org

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