Center of Excellence in Primary Care Education Training a ...

Center of Excellence inPrimary Care EducationTraining a communityoriented primary careworkforceCo-Directed by:Rebecca Shunk, MDSusan Janson, PhD, RN, ANP-BC

PACT• Team-based patient-centered model of care• 1200 patients per team• Teamlet- Primary Care Provider, Registered Nurse, LicensedVocational Nurse and Clerical Associate• Practice Changes• Population Management• Panel Management• Pre-visit planning• Huddles• Shared Medical Appointments/Group Clinics• Walk-in appointments• Telephone appointments• Secure Messaging• Health Coaching

Mission of EdPACT:To develop and implement an inspirationalmodel of patient-centered, interprofessionaleducation that will advance primary carewithin and beyond the VAJoint effort with:• VA Office of Academic Affiliations• UCSF School of Nursing• UCSF School of Medicine• UCSF Office of Medical Education

ParticipantsCore EdPACT trainee teams:• Internal Medicine residents (two PGY-2 partners)• ANP students from UCSF (1 per pair of MD partners)• Additional interprofessional trainees:• Clinical pharmacy, social work, psychology fellows, podiatry,psychiatry, nutrition, medical students, NP FellowsTeamlets:• LVN, RN, ClerkPreceptors & Educators:• Longitudinal MD & NP preceptors• Clinical psychology faculty & fellows• Experts in communication, teamwork, performance improvement• Additional health professionals– podiatry, social work, pharmacy,nutrition

Core EdPACT Team DesignNP 2N=50R R 2 2N=120N=120• rotate• 潣 瑮 湩 極 祴

Educational Domains of EdPACTand Core Values of PACT• Shared Decision-Making: care is aligned with values,preferences and cultural perspective of the patient;emphasizing behavior modification / self-management• Sustained Relationships: curricula accommodatescontinuity of care and promotes longitudinal learningrelationships• Interprofessional Collaboration: care is team based,efficient and coordinated; trainees practice collaboratively• Performance Improvement: trainees learn to optimizethe health of populations and understand themethodology of process and outcome assessment andCQI

4 Design Principles for EdPACTOur innovative educational model incorporates designprinciples for optimal workplace learning• Establish a culture and supportive working relationshipsthat reinforce patient-centered approaches to care• Use experiences from clinical practice as the primarycurricular material• Activate providers/staff/trainees to take responsibility forimproving patient care• Create accountability for performance and continuouslystrive for improvement on an individual-, team-, andpopulation-level

Curricular Theme Months• Patient Communication• Interprofessional Communication• Practice Improvement 1• Advanced Communication• Shared Decision Making• Motivational Interviewing• Practice Improvement 2• Transitions in patient care

Population Based SettingsEdPACT Continuity Clinic Sites•Medical Practice Clinic SFVAMC•Community-based Outpatient Clinics• San Bruno – suburban setting• Downtown – inner city urban setting

Downtown Clinic• Demographics• Marginally housed and homeless veterans (50%)• High prevalence of mental health problems (50%)• Poly-substance abuse (38%)• Mental health and addiction disorders (61%)• Resources• Washer/dryer, shower facilities, clothes, lockers, mailboxes• On-site psychologist, psychiatrist, social work, pharmacist,lab• Key Tailored PACT Components• Intensive mental health case management• Housing referrals and prominent social work assistance• Substance abuse treatment• Homeless PACT- vulnerable patient outreach• Weekly HIV clinic• Open access appointments

Sustained Relationships and InterprofessionalCollaboration

Community Specific Components• Mental Health/ Primary Care MorningHuddle• Co-precepting Model with Mental Health,NP, MD preceptors• Practice Improvement• Improve access to HCV treatment• Groups• Smoking cessation• Chronic pain group

Training a Community Oriented PrimaryCare Workforce• Provide care in settings where patients live• Threats to health• Community resources• Tailor care• Learn population health• Community determinants of health risks• Accountability through panel management• Value of an interprofessional team• Special skills• Overlapping functions and abilities

Training a Community Oriented PrimaryCare Workforcewhen I started out as an intern, for me it was more likethis gentleman has diabetes, this gentleman hashypertension, which now, if I look at my scores I am notdoing well on [those metrics], but I feel like I may bedoing better in the other categories…like getting peoplehousing, getting people a little bit more stabilizedregards to psychiatric issues; getting more peoplestabilized to other issues that aren’t necessarilymeasured by what these numbers are anymore; …I’veshifted from a medical orientation to more social…social medicine as being problem number one onalmost all of my patients, with medicine kind of falling tonumber two. Only a handful of patients that are sociallywell-adjusted that I see can I focus on medicine beingnumber one. R2