Harvard Medical School Takes Case Study Approach to Primary Care

May 19, 2016 02:50 pm Michael Laff

Primary care physicians typically learn about best practices by chatting with peers, attending conferences and reading specialty publications. Harvard Medical School's Center for Primary Care(primarycare.hms.harvard.edu) is working on a new resource to add to that list.

[Team of physicians discussing chargs]

Researchers at the Boston-based center are preparing comprehensive case studies to highlight best practices while illustrating how effective primary care teams are transforming practices. When the project is complete, the research will be part of the Harvard Medical School curriculum for the next generation of students.

The researchers considered more than 120 sites for possible inclusion as a case study. They are narrowing them to 10 to 15 -- or more, depending on demand -- by weighing factors such as geography, payment model, level of innovation and outcomes.

Although the Harvard Business School library has case studies about other physician specialties, Erin Sullivan, Ph.D., the center's research and curriculum director, said she knew of no case studies of this scope dedicated to primary care. She said it's important for the future of primary care that students have this type of research available.

"In order to change primary care, you have to start with students in medical school," Sullivan said. "Our cases engage students outside of their comfort zones. We ask them to read and discuss issues of management, infrastructure and leadership -- real issues that they are likely to face when they start practicing."

One study will focus on the Southern California Permanente Medical Group, which has demonstrated success in keeping hypertension rates low among its entire 3.7 million-patient population. It is an integrated system -- with primary care, a hospital and an insurer -- and has achieved the outcome on a large scale.

"That is one of the reasons why we chose to study them," Sullivan said. "They are a giant system that has done really great work in managing chronic conditions and closing the care gap by making sure patients get the care they need. When you look at their quality ratings, you can see they've had some success."

Sullivan believes measurements of such health outcomes are especially valuable for investigating how practices identify and solve health problems.

"People are publishing about outcomes and not publishing about how it was achieved," she said. "Kaiser Permanente did well on hypertension, but how did they get there? People need to know how it was done in order to effect a change in behavior or a change in their own practice."

Sullivan said the practices under study evaluated their patient populations' needs and tailored the practice to best serve these patients. For instance, the Camden Coalition of Healthcare Providers(primarycare.hms.harvard.edu)  in Camden, N.J., used electronic health records to identify patients who repeatedly visited the hospital or the ER for preventable coditions.

Then coalition care management teams used a variety of health care professionals, including registered nurses, social workers and health coaches, to engage 70 to 80 of these patients with "high-touch intervention" for an average of three months, taking on duties such as routine administrative tasks, diabetes education and lab results.

Sullivan noted that the approach allowed physicians to devote more of their time to work such as diagnosis or working with patients whose initial treatment protocol was not doing well.

"This intervention seems to work for Camden's most complex patients, which has cascading effects in terms of hospital readmission rates and health care costs in the city," Sullivan said.