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Family Medicine Residencies Are Incorporating Medical Home Model
P4 Programs May Be Leading Off, But Others Not Far Behind
By Barbara Bein
Middlesex Hospital Residency
According to program director Michael Stehney, M.D., the residency has worked through numerous modules, or core competency sets, that are part of TransforMED's Medical Home Implementation Quotient program. One major transition the program plans, he says, is moving from a three-year program training eight residents a year to a four-year program with six residents a year. The extra year will allow more core rotations in areas such as behavioral and developmental pediatrics, home health care, systems medicine, and practice management.
Listen to a brief audio interview with Guernsey. (1:10-minute MP3 file; About Downloading)
Stehney says he's most proud of the program's interdisciplinary quality improvement teams, which comprise physicians, nurses and other office staff. The teams identify and implement best practices for managing various health conditions, providing preventive services, and monitoring medication efficacy and safety.
"They've helped us look at education, they've taught teamwork and best practices, they've helped us improve our workflow and we've also used them to help our billing," Stehney says.
"We have our eyes on this goal of fully implementing the model of the PCMH," he adds. "We'll be there a year from now. But we already have a lot of elements in place. Our hypothesis is that our graduates will implement the features of the PCMH in their practices or choose a practice that has these features."
New residents soon learn that the program's shared EHR and other health information technology, or HIT, systems are the centerpiece of the practice environment and undergird all interactions between health care professionals and patients, says Geoff Jones, M.D., program director.
Patients can use a Web portal to book their own appointments, choose the care team member they want to see and enter information into their own charts.
At the main residency practice site, the front desk and the waiting room have been eliminated. Members of the health care team communicate with each other and with staff members via walkie-talkie. When a patient comes in, a staff person equipped with a computer and a walkie-talkie contacts the team.
Patients first go to a room outfitted with scales, a phone and a computer. There, care team members perform such tasks as recording their vital signs, ordering tests or drawing blood. Physicians and physicians-in-training access care guidelines online, where they also can get answers to an array of clinical questions.
University of Colorado Residency
First-year residents learn about PCMH concepts in three discrete skill-building blocks that focus on various aspects of care for adults, infants and children, and older patients. Cardiovascular life support, life support in obstetrics and pediatrics, ICU care, and orthopedics are among topics covered.
To hone their skills, residents may tackle a case presentation on how to help a patient quit smoking or lose weight through stage-of-change analysis, motivational interviewing and other patient-centered techniques.
As part of the program's community integration emphasis, care teams might help create a community directory of resources tailored to patients' special needs and lifestyles, says Burke. For example, patients with diabetes need to exercise. If they are affluent, they can buy a gym membership. But for patients who aren't well off or who live in dangerous neighborhoods, the directory might list a church group that offers exercise in a safe environment.
Smoky Hill Residency
The latest is the University of Kansas School of Medicine-Wichita Family Medicine Residency Program at Smoky Hill-Salina, which focuses on training family physicians to practice in rural areas. Last month, the program announced plans to establish the PCMH model of care, with technical assistance from TransforMED, according to residency director Robert Freelove, M.D.
When the transformation is completed, Smoky Hill will be among the first residency programs in the nation to offer training in a comprehensive medical home environment.
"All family medicine residency programs are doing some of the things in the patient-centered medical home, but there aren't many places doing all of it. I want to be one of those places" doing it all, says Freelove.