Independent Evaluation Team Shares Second Round of Preliminary Findings From TransforMED Medical Home National Demonstration Project

FOR IMMEDIATE RELEASE   
Thursday, May 28, 2009

Contact:
Janelle Davis
TransforMED
(800) 274-2237, ext. 5222
jdavis@aafp.org

LEAWOOD, Kan. – A team of independent evaluators today released the second round of preliminary findings from the TransforMED medical home national demonstration project. The two-year pilot, undertaken by TransforMED LLC, was supported by the American Academy of Family Physicians. These most recent findings pertain to the implementation of health information technology, the use of chronic disease registries and changes in some physicians’ quality of life as a result of efforts to transform to the patient-centered medical home model of care.

Practices of all types and sizes can successfully implement health information technology, including electronic health records, Web portals and chronic disease registries.

  • Small, private practices in the NDP were enormously successful in the implementation of electronic health records. This was due largely in part to their decision making autonomy and not having to rely on the development process and priorities of a larger health system.
  • Fourteen of the 31 practices successfully implemented patient Web portals which enable patients to receive services via the Internet, such as secure e-visits and online lab results. Twelve of the 14 practices that implemented portals were small, private practices.
  • Fifteen practices successfully implemented disease registries, 10 of which were small, private practices. Larger practices, again, seemed hindered by their dependence on their larger health systems and IT departments.
  • While money and financing were important, small practices were most in need of assistance in selecting an EHR and related technology. Financial assistance alone does not appear to offer a complete solution. It also is important to remember that time physicians spend researching EHRs is time they are losing income by not seeing patients.
  • Some practices needed assistance in the ongoing implementation of an EHR. Nearly all of the NDP practices reported that implementing the EHR was tougher and more complicated and time consuming than they anticipated.
  • Some practices needed assistance in developing communication and leadership skills to better adapt to the new challenges presented by new technology. Patient flow, documentation, communication in the exam room, follow-up care, etc., all change as a result of EHR implementation.
  • Rural practices were able to successfully implement a range of health information technology, including EHRs, patient portals and disease registries.

Chronic disease registries are beneficial, but some have caveats.

  • NDP practices found great value in disease registries that allowed them to plan a population-based, proactive approach to their daily routines.
  • NDP practices said disease registries provided opportunities to more fully engage medical staff in a more team-based approach to patient care through the development of “standing orders” based on registry results.
  • Practices reported that the value of disease registries was greatly enhanced or diminished by the presence or absence of the self-populating feature.
  • While most practices were eager to implement registries, fewer were willing or able to perform the “double data entry” required with stand-alone registries that are not integrated within their EHR system.
  • Data on disease registries are somewhat limited because the practices, as a whole, did not begin taking steps toward implementation until the second year of the NDP.

Efforts to transform to the PCMH model may improve quality of life for primary care physicians.

Although the evaluation of the NDP was not designed to systematically measure the quality of life for primary care physicians as a result of PCMH implementation, interviews and transcripts from learning sessions yielded testimonies from physicians that support the notion of positive change in their professional lives.

  • Delegation and team care empowered staff and, in many cases, reduced the responsibility, stress and emotional drain on the physicians.
  • Open-access scheduling resulted in immediate positive reaction from patients, which in turn resulted in positive rewards for physicians. Almost all of the physicians agreed that nothing makes a patient happier than the ability to get a same-day appointment with their personal physician.
  • Some physicians reported that a series of small changes can result in a cumulative effect of enhancing the patient-physician relationship. For example, doctors don’t feel as rushed, and patients aren’t upset about waiting three weeks for an appointment.

Additional findings from the NDP, including outcomes data on quality measures and patient satisfaction, will be published upon completion of extensive data analysis by the NDP independent evaluation team. To view TransforMED’s “Preliminary Answers to Policy-Relevant Questions,” visit
http://www.transformed.com/evaluatorsReports/preliminaryAnswers.cfm(www.transformed.com)

The TransforMED NDP concluded in May 2008, when 31 of 36 diverse medical practices successfully completed a two-year endeavor to test and establish best practices for implementing various components of the PCMH model of care in primary care office settings. They also set out to determine empirically whether patient-centered care could deliver on its promise to improve quality of care and practice performance.


About TransforMED LLC:

The Leawood, Kan.-based TransforMED LLC is a wholly-owned subsidiary of the American Academy of Family Physicians. Established in 2008, TransforMED provides ongoing consultation and support to physicians looking to transform their practices to a new model of care that is based on the concept of a patient-centered personal medical home. TransforMED is an active member of primary care communities and recognizes and supports the unique value that primary care offers to patients and the health care system. TransforMED shares and supports the idealism and altruism of primary care physicians and the strong commitment to their communities and patients through continuing patient relationships and independent decision making. TransforMED offers practices both products and services, including consultation and advice on implementing the new model. To learn more about TransforMED, visit
www.transformed.com(www.transformed.com).

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Family physicians conduct approximately one in five office visits -- that’s 192 million visits annually or 48 percent more than the next most visited medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.

To learn more about the specialty of family medicine, the AAFP's positions(5 page PDF) on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit
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