Office Redesign: Give PEAs a Chance

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Office Redesign Give PEAs a Chance

• Cheryl B. Aspy, Ph.D.
• Professor, Family Preventive Medicine
• OUHSC College of Medicine
• Oklahoma City, OK

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The Problem

• Practice-Based Research Network (Oklahoma
  Physicians Resource/Research Network - OKPRN)
  projects required practice redesign to implement
  RTC protocol to increase preventive service
  delivery.
• AHRQ funded Diabetes Care project
• AHRQ funded TRIP project
• Practices have great difficulty redesigning their
  procedures without help because of continuous
  workflow.

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The Problem

• Other projects required patient recruitment and
  enrollment which meant that someone in the
  practice must be certified for protection of
  human subjects a 3-step process at our
  institution including a 1-day seminar highly
  impractical for clinic staff
• RWJ P4H project - AZMATICS
• Wellness Portal

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The Solution
Practice Enhancement Assistants - PEAs
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What is a PEA?

• A Practice Facilitator
• Develops a relationship with a group of practices
  over a period of time, in order to help them to
  evaluate and improve their quality of care
• Helps the primary care team to
• assess the current state of the practice.
• plan, implement, and evaluate the effectiveness
  of office system interventions that enhance
  prevention.

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Requirements to be a PEA

• Masters degree in a health related field (e.g.,
  MPH in Epidemiology or Health Promotion)
• Experience in healthcare
• A current drivers license and car (have help
  will travel..)
• Information Technology skills
• Interpersonal skills

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Requirements to be a PEA

• Training provided in the following
• Administrative and departmental procedures
  Human subjects protection training Health
  Insurance Portability and Accountability Act
  (HIPAA) Practice-based research skills
  Medical records review (chart auditing) Rapid
  cycle quality improvement process (PDSA cycles)
  Group facilitation and motivational methods
  (quality circles) Practice characterization
  model, change management approaches The Chronic
  Care Model and its implications Practice visits
  (shadowing PEAs in practices) Health
  information technology implementation and
  utilization Past and ongoing OKPRN studies
  Best practices study methodology Preventive
  services guidelines and implementation Billing
  and coding (EM Coding), coding resources
  Electronic Practice Record (demographics,
  progress notes, and plans for practices)
  Handouts, patient education materials, practice
  resources Project-specific training

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How Do PEAs Work with Practices?

• Usually assigned 8 practices and visit each one
  every other week 1 day per week meet with other
  PEAs to discuss projects and share ideas.
• Begin by meeting staff, developing relationships,
  and observing practice function.
• Recommend that practices implement weekly staff
  meetings attend and facilitate as needed.
• Provide any office assistance they can to build
  relationship, e.g., provide patient education
  materials, BMI charts file charts data entry.

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How Do PEAs Work with Practices?

• A PEA can help a practice implement changes
  suggested by research or clinical practice
  guidelines to improve the quality of care.
• A PEA can help a practice use health information
  technology.
• A PEA can help in the facilitation of research
  (e.g., patient enrollment, staff training)

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How Do PEAs Work with Practices?

• Conventional methods include
• medical records review, feedback, benchmarking,
  and academic detailing
• Practice facilitation techniques include
• observation and characterization of practices and
  their readiness to change, coordination of
  Plan-Do-Study-Act (PDSA) quality improvement
  cycles within the practices, identification of
  effective strategies and exemplar practices,
  cross-pollination of good ideas and solutions
  between practices, and implementation of health
  information technology

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What has Been the Outcome?
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What Has Been the Outcome?

• Practices have consistently reported their
  satisfaction and appreciation for PEA services.
• PEAs have demonstrated their contribution to
  project outcomes in both RCTs and Intervention
  Trials
• Mammography _ P4H
• TRIP _ EPSDT

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What Is Innovative About PEAs?

• There is no other position in health care that
  unites the community practitioner with the
  academic researcher like a PEA
• PEAs provide a link between the academic center
  and the community practice and this allows each
  to be influenced by the other.
• Good ideas or best practices in one practice
  are cross-pollinated into another via the PEA.
• PEAs are both us and them due to their strong
  ties to the practice and to the academic center.

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PEAs and Projects

• P4H Prescription for Health- RWJ Funded
• TRIP Translating Research into Practice
• EPSDT Quality and Rate Improvement
• Development and Testing of a Wellness Portal

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And Finally,

• PEAing What PEAs do
• PEA Pods The practices they facilitate
• Split PEAs Half-time PEAs
• PEA Soup Weekly problem solving time
• Keeping the PEAs Funding sources
• PEAs on Earth HIPAA PHS Training
• Steamed PEAs - A hot day in Oklahoma
• PEAs be with you What you learn today
• All we are saying is - Give PEAs a chance

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References

• Hulson TD, Mold JW, Scheid D, Aaron M, Aspy CB,
  Ballard NL, Boren N, Gregory ME, Truong TC.
  Diagnosing Influenza The Value of Clinical Clues
  and Laboratory Tests. The Journal of Family
  Practice 2001 December. 50(12) 1051-1056.
• Mold JW, Gregory ME. Best Practices Research.
  Family Medicine 2003 February, 35(2) 131-13
• Nagykaldi Z, Mold JW, Aspy CB. Practice
  Facilitator A Review of the Literature. Family
  Medicine 200537(8)581-8.
• Cotton A, Aspy CB, Mold JW, Stein H. Clinical
  decision-making in blood pressure management of
  patients with diabetes mellitus an Oklahoma
  Physicians Resource/Research Network (OKPRN)
  Study. Journal of the American Board of Family
  Medicine JABFM. 19(3)232-9, 2006 May-Jun

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References, contd

• Ferrell CW, Aspy CB, Mold JW. Management of
  prescription refills in primary care an Oklahoma
  Physicians Resource/Research Network (OKPRN)
  study. Journal of the American Board of Family
  Medicine JABFM. 19(1)31-8, 2006 Jan-Feb
• Aspy, C.B., Enright, M., Halstead, L. Mold, J.
  (2008). Improving mammography Screening Using
  Best Practices and Practice Enhancement
  Assistants An OKPRN Study. Journal of the
  American Board of Family Medicine, 21(4)326-333.
• Mold JW, Aspy CA, Nagykaldi Z. (2008).
  Implementation of Evidence-based Preventive
  Services Delivery Processes in Primary care An
  OKPRN Study. Journal of the American Board of
  Family Medicine, 21(4)334-344.