Patient Centered Medical Home Elective

I.Rationale

The Patient centered medical home is a model that is currently being embraced by the U.S. to transform the health care system. It is an enhanced primary care model that provides comprehensive and timely care with appropriate reimbursement, with emphasis on the central role of team work and engagement by the recipient of care.It facilitates partnerships between individual patient, their personal physician, and patient’s family when needed.

With the current crisis facing the health care system in the United States, progressive decline in quality of care, affordability, inaccessibility to timely care and advancing cost, It has become necessary to have a transformation in the system. Hence, it is thereforenecessary and valuable for residency programs to incorporate PCMH rotation in the curricula to enable residents to get adequate and basic training in the core principles that guide creating and implementing a PCMH.

II.Competencies

Residents will be evaluated on the following six competencies, eventually achieving the expected level of a board certified family physician. Achievement of satisfactory performance levels for all six competencies will be necessary for successful completion of the rotation.

MedicalKnowledge

Goal: To have a comprehensive knowledge of the concept and the principles that guides the creation and implementation of a PCMH.

Objectives:

  1. Learn the need and principle of the medical home
  2. Learn more about cost and resources needed to fund the PCMH
  3. Challenges that face implementing the PCMH and possible solutions
  4. Review practices that have implemented the model and their achievements
  5. Enhance my knowledge on population management in a PCMH
  6. Reason Primary Care should adopt the PCMH
  7. Origin of the Medical Home

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / X / Morning Report
X / Program Director
Review / In-Training Exam / X / Faculty Supervision and Feedback
360 ᵒ evaluation / Videotape Review / X / Quarterly Review

Patient Care

Goal: Review and improve patient care process as seen from a system based care perspective.

Objectives:

  1. Evaluate patient’s satisfaction in the delivery of care.
  2. Inquire on easy accessibility to practice staff in scheduling appointment.
  3. Patients will be asked to answer a 10- item questionnaire on satisfaction of care. Results will be reviewed and recommendations given.

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / Morning Report
X / Program Director
Review / In-Training Exam / X / Faculty Supervision and Feedback
360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

Professionalism and Interpersonal skills

Goal: Observe level of professionalism and commitment to patient care in a compassionate, quality and culturally appropriate manner.

Objectives:

  1. Dress professionally
  2. Interact with staff in a courteous manner
  3. Punctuality and availability of providers and members of the care team
  4. Motivation for excellence
  5. Sensitivity to culture/age/gender/disability

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / Morning Report
X / Program Director
Review / In-Training Exam / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

Systems-based Practice and Practice based learning

Goal: Review and evaluate the processes at EFMDC.

Objectives:

  1. Evaluate our triaging system
  2. Methods of scheduling
  3. Timely response to phone messaging and prescription request
  4. System of giving lab results; is it timely and efficient?
  5. Is patient care evidenced based?
  6. Up to date on preventive screening
  7. Measured change and recommendations to be implemented in our clinic.

Learning Activities
Attending Rounds / Research Conference / X / Outpatient Clinics
Multidisciplinary Rounds / Ethics/Comm Conference / X / Direct Patient care
Grand Rounds / Specialty Conference / Resident Seminar
Sub-Specialty Conference / Noon Conference / Journal Club
Morning Report / X / Faculty Supervision / X / Readings
X / Didactics / Procedures
Other
Evaluation Methods
X / Attending Evaluation / Directly Supervised Procedures / Morning Report
X / Program Director
Review / In-Training Exam / X / Faculty Supervision and Feedback
X / 360 ᵒ evaluation / Videotape Review / X / Quarterly Review
Other

IV.Instructional Strategies (see above)

This is a four-week elective and should be attended by the resident for a minimum of 5-6 half days per week. The other 4-5 half days per week will be spent in the resident’s continuity clinic and in didactics. Readings can be obtained from Section VI and should also be solicited from the Clinic Medical Director and team.

The resident and rotation supervisor can choose to perform 30 patient’s charts review on specific criteria or value to be measured and present results and recommendations. (This may be presented in a didactics format to give a summary of attained goals during the rotation.)

Alternatively,

The resident can choose to perform a fine tooth comb review of 3 charts of patients with chronic diseases (e.g. Diabetes mellitus, heart failure, morbid obesity, hypertension, tobacco abuse) and see what we have been doing in the past as a practice and how the PCMH model will improve the quality of care delivered.

V.Evaluation Strategies (see above)

  1. Observation of the resident by the PCMH rotation advisor.
  2. End of rotation evaluation.
  3. Take the Medical Home IQ for our clinic and review the results with preceptor(s). Turn in results to Sandra Price to documentcompletion.
  4. Visit TransforMed online and take some of the PCMH quizzes/info.

VI.Implementation Methods

This medical elective consists of 6 ½ day sessions per week of PCMH in a clinical setting of the, for a total of 4 weeks.

Location: Emory Family Medicine at Dunwoody

Contact: Dr. Toyosi Morgan

Family Practice Center: 4500 N. Shallowford Road, Atlanta, GA 30338

Call/Vacation: Call taken at EUHM. Vacation allowed.

Supervision: Residents will be supervised by Dr. Toyosi Morgan.

Conferences: The resident is expected to attend Family Medicine Didactics Conferences.

VI.Suggested Readings/Resources

  1. Patient Centered medical home: what, why and how by Jim Adams et al (IBM Global business services)
  1. The Patient Centered Medical Home – History, Seven Core Features, Evidence and Transformation Change by Robert Graham Center : November 2007
  1. Medical home demo reports some positive outcomes --with caveats - by Chris Silva, amednews.com June 21, 2010
  1. "Evaluation of the American Academy of Family Physicians' Patient-Centered Medical Home National Demonstration Project. Annals of Family Medicine.

Last Updated April 19, 2013