CPC Workshop Slides

1
The Practice Support Program An Overview of the
Modules
Davidicus Wong, M.D., April 11th, 2007
2
Objectives
In the next half-hour, I will . . .

• Introduce you to the content of the Learning
  Modules.
• 2. Convey how these programs can enhance family
  practice, engage your staff, improve patient
  outcomes satisfaction, and improve your quality
  of life.

3
My Practice
Traditional Family Practice

• Admitting obstetrical privileges at Burnaby
  Hospital
• Chair of Ethical Resources Committee, Family
  Practice Dept Head, MAC Chair, and Vice-Chair of
  HAMAC (FHA)

4
My Odyssey
A Skeptic in the Diabetes Collaborative

• Joined the collaborative in the 2nd Quarter
• Initially a non-believer in Organization Speak
  (e.g. QI, PDSA cycles, Access, Collaboratives)

5
The Learning Modules
The Topics

• Adopting Advanced Access
• Developing Patient Registries
• Implementing Planned Recall
• Adopting the CDM Toolkit
• Supporting Patient Self-Management
• Introducing Group Visits

6
The Quality Improvement (QI) Model
PDSA Cycles

• PLAN - assess needs, create an action plan
• DO - implementing incremental changes
• STUDY - measure progress
• ACT - identify practical methods for sustaining
  long-term change

7
Optimizing Your Appointment Schedule

• Improving office flow
• Reducing waiting times for the next appointment
• Adjusting for the flu season, holidays
  conferences
• Reducing the stress of running behind schedule

ADVANCED ACCESS

8
Advanced Access Concepts

• Access appointment scheduling
• The 3rd Next Available Appointment The industry
  standard for access
• Gold Standard for Family Practice zero!
• (same day that the patient calls)

9

• Capacity number of appointment slots
• Demand number of appointments requested
• Backlog number of patients waiting for an
  appointment
• Backlog Capacity - Demand

10
Tracking Patient Populations by Condition

• A registry
• An information system to track individuals as
  well as populations of patients
• Organized by medical condition
• Diabetes, CHF, HTN, Renal Failure, Depression

PATIENT REGISTRIES
11
Why Have Patient Registries?

• More focused and organized care for each
  condition
• Generate flow sheets
• Facilitates individualized goal-setting
• Helps you self-evaluate your practice
• Assists in Planned Recalls

12
Proactively Planning Visits

• Systematically calling patients in for essential
  periodic care
• Chronic disease management (e.g. diabetes review
  at 3 months)
• Lab Tests (e.g. a1c, microalbumin)
• Specific periodic examinations
• (e.g. retinoscopy, foot exam, BP)
• Superior to crisis problem list management

PLANNED RECALL
13
Web-based Registry

• Created for the CHF Diabetes Collaboratives
• Fine-tuned
• Ideal with an EMR
• Generates Useful Reports
• Patient Registries
• Recall Reports
• Patient Flow Sheets
• Graphical Practice Feedback

CDM Toolkit
14
Facilitating Positive Change

• Engaging motivating the patient
• Negotiating goals
• Incremental goal-setting
• Appropriate follow-up
• Engaging your Medical Office Assistant
• Greater patient involvement

SELF-MANAGEMENT
15
A Streamlined Team Approach

• Efficient group education
• Self-management support groups
• Patients share experiences provide
  encouragement
• Billable to MSP with respect to appropriate
  one-on-one patient care
• Details in the module
• The group visit itself is MSP billable for each
  patient seen

GROUP VISITS
16
The Prodigal PatientA Self-Management Parable

• There once was a doctor who had two diabetic
  patients.
• The first patient said, Doctor, give me my
  prescriptions and lab requisitions for a whole
  year.
• So the doctor wrote out the prescriptions with a
  standing order for lab work.
• He let the patient leave with the advice to
  exercise each day, monitor his sugars and follow
  a low-fat, low-GI diet.

17

• That first patient did not follow the doctors
  advice but carried on with riotous living.
• He never exercised. He would drive drunk through
  McDonalds drive-throughs, and he gained 50 lbs.
• For several years, he wandered from walk-in
  clinic to walk-in clinic presenting with cold,
  numb feet, leg ulcers, claudication, vision loss,
  and finally, chest pain.

18

• He decided to beg for an appointment so he bought
  two boxes of Purdys and gave one to the MOA.
• While his appointment was a long way off (The 3rd
  next available appointment was 3 months), the
  doctor noticed the patients name on the schedule
  and was moved with compassion.
• He organized a group visit with a dietician,
  nurse educator and pharmacist.

19

• During all these years, the second patient had
  stayed close to the office.
• He did his a1c and lipids every three months.
• He began each day with exercise, ate frequent
  small meals, and ended each day with a careful
  and prayerful foot examination.

20

• Seeing all the fuss over the wayward patient, the
  second patient was indignant and said to the
  doctor, This is not right!
• The doctor said, Do not resent this patient for
  he was dead and now is alive he was lost and now
  is found.

21

• Thats not what I mean, said the second
  patient.
• He should have had the self-management support
  that I did. You should have used the toolkit,
  created a registry and planned recall. He would
  have all his toes, good vision and a healthy
  heart.

22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
Changes in My Practice

• 1. Created a diabetic patient registry.
• Used the CDM Toolkit to generate flow sheets and
  recall reports.
• Implemented changes to facilitate patient
  self-management.

27
Changes in My Practice

• 4. Engaged my MOA to recall patients and
  follow-up in patients self-management goals
• 5. Implemented changes to facilitate patient
  self-management.

28
Changes in My Practice

• 6. Organized group visits at the local community
  centre with a diabetes educator.
• 7. Implemented advanced access techniques to
  reduce backlog.

29
Outcomes

• More efficient, relaxed office.
• More engaged patients.
• More engaged staff.
• Improved patient outcomes.
• Improved practice satisfaction.

30
Improving Your Practice
1. Practice Improvement Works! 2. May be tailored
to your practice. 3. Are we ready to learn more
and help our colleagues?
S U M M A R Y
Thank You!