Panel Management, Applying Population Health and Best Evidence

Panel Management, Applying Population Health and Best EvidencePaige Hatcher, MD- Diplomate, ABFM- Preventive Medicine Resident, OHSU- MPH Candidate, PSU- Health Policy Fellow, OHA

What is Panel Management?• Addresses population health through the lens of

primary care• Evidence-based protocols and to provide self-

management support• Systems to standardize care using a team-based

approach• Designing a system that “remembers” and prevents

errors of forgettingNeuwirth, E. B., Schmittdiel, J. A., Tallman, K., & Bellows, J. (2007). Understanding Panel Management: A Comparative Study of an Emerging Approach to Population Care. The Permanente Journal, 11(3), 12-20.

What is Panel Management?•Dedicated physician time for directing

clinical decision making•Dedicated staff members or staff time to

support physicians and conduct outreach•Information-technology tools to identify

care gaps•Structured work processes completed on

a routine basis

Experience at KP•Patients mostly like it•Mostly implemented without new funding

(some require resource shift)•Wide-scale dissemination through entire

facility/area•Focused on a particular disease or high-

risk group•45-180 min PCP time reserved per

provider per month

Change to Standard Practice• Requires a shift in thinking• “It doesn’t make my day easier, but it makes my

day better”.• “Giving me hope that some of my more difficult

patients might actually turn around their health status”.

• Biggest change to MA and support staff roles, but they welcomed the opportunity for job growth.

• Less face to face time can be dissatisfying.• Patients worry decisions aren’t being made by

their doctors

Managing Change•Physicians feel like they are losing control•Imperative to respond with demonstration

of performance improvement•Champions•Warm handoffs

“Topic” Selection•Often incentivized by a performance

payment opportunity•Should be evidence-based, simple, and

clear•Aim for incremental improvement

Creating a Registry•Identification of patients with particular

need•Review of list generated for

appropriateness for inclusion•Treatment decision•Follow up communication with patient

Example: I want all my patients to be up-to-date on cervical cancer screening•Generate First List•Women 21-29 with an intact cervix and no

pap result for the last 3 years•Women 30-65 years with an intact cervix

and no HPV result for the last 5 years**This should be tailored to your practice, if you haven’t been doing mandatory HPV testing, then it will be “no pap result for the last 3 years”1

Next Steps•PCP Reviews list for appropriateness of

inclusion•Outreach to schedule patients, correcting

chart where needed if Pap has been done somewhere else

•Run the list again (time interval TBD) and compare N, report results as appropriate

•PCP reviews the list again▫Then, start outreach to new group, adjust

tactic, etc.

Best Sources for Evidence

National Guideline Clearinghouse http://www.guidelines.gov/

Best Sources for EvidenceUS Preventive Services Task Force (USPSTF) http://www.ahrq.gov/clinic/uspstfix.htm

Best Sources for Evidence

National Institute for Health and Clinical Evidence (NICE) (England and Wales) http://www.nice.org.uk/

Patient InformationChoosing Wisely® campaignhttp://choosingwisely.org/

Asking your question (PICO)•Patient- children or adults, pregnant

women, patients with a specific chronic disease or problem

•Intervention- prevention, diagnosis, treatment

•Comparison- standard practice, placebo, alternative therapy

•Outcome- acute or chronichttp://libguides.ohsu.edu/content.php?pid=255709&sid=2879578

PubMed MESH search

If you search for “pap smear” and “screening” in PubMed, you get 15515 results.

Using MESH search Terms

Other Benefits•ABFM MC-FP Part IV modules are

Performance in Practice Modules (PPMs), which are designed as a Quality Improvement activity which takes place over a one week period

Additional References1. Saslow, D., Solomon, D., Lawson, H. W., Killackey, M., Kulasingam, S. L., Cain, J., ... Myers, E. R. (2012). American Cancer Society, American Society for Colposcopy and Cervical Pathology, and American Society for Clinical Pathology Screening Guidelines for the Prevention and Early Detection of Cervical Cancer. Journal of Lower Genital Tract Disease, 16(3), 00-00.