Family Doctors and the Commonweal

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Family Doctors and the Commonweal

• STFM NE Regional
• Baltimore

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Getting unstuck..
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Factors that affect health McKnight

• Personal behavior
• Social relationships
• Physical environment
• Socioeconomic status
• Access to care

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Principles of Community Responsive Practice

• The ability to describe the practice population
  and the communities in which they live
• Socio demographics of practice
• Practice registries and co morbidity registries
• Community level data

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Practice population

• African-American   2,468   19.5 American
  Indian/Eskimo 624     4.9Asian   660
      5.2Caucasian/White      5,738
    45.3Hawaiian/Pacific Islander    27
   0.2Latino       2,543
    20.1Unknown   594     4.7
• 11, 197

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Listen to stories in the context of lives

• Change our gaze to beyond the patient
• Create processes for listening to groups, not
  individuals
• Bus routes, not clinics

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Think of our practices as taking care of neighbors

• Participate in the community in which our
  patients live
• Or live in the community with them
• Practice boundary crossing

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Scale facilities to neighborhoods and place them
where they are most helpful

• Walk to the doctor
• 3 FTE practices
• Built to meet community needs not that of systems
  or hospitals

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Create patient committees for organized feedback
for all practices

• Meet regularly, reports from managers,
  physicians, and staff
• Identify issues from patient point of view that
  need to be addressed
• Identify issues from providers that are
  challenges
• Engage in joint problem solving

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An annual report to the community

• Invite public health, other practices and
  hospitals
• Focus on new programs
• Discuss community wide strategic plans
• Review community wide problems and the role the
  practice will play
• Community level data is not a trade secret

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New tools

• Geomapping
• Practice Population data
• Public health community wide data
• Connections to other resources in the community
• Mashups like google earth, everyblock.com,

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New tools WEB 2.0 technology

• The practice as a social network
• Patient subgroups on the Practice website
• Education, social support
• Portable web based EHR
• Google
• The Shared Care Plan of Whatcom County

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The obstacles to community responsive practice

• Education
• New residency education that reflects the
  realities of community responsive practice
• Pay for care
• Pay for population, not production
• Formula based on population variables age, sex,
  race/ethnicity, SES, comorbidities, community
  vulnerability
• Pay for quality and service, not numbers
• Pay a salary with incentives, not throughput

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We must cultivate in ourselves, and in each
other, the courage to risk community, despite
all the evidence to the contrary. The alternative
is the war of all against all. Parker Palmer