Advancing Integrated Primary Care Education in the VA Medical System Kendra Campbell, Ph.D. Assistant Professor of Psychology University of Alaska Fairbanks Daniel Baughn, Ph.D. Staff Psychologist, PCMHI James A. Haley Veterans’ Hospital Rebecca Shunk, M.D. Co-Director, Center of Excellence in Primary Care Education, Associate Director of PRIME Program, UCSF Internal Medicine Residency Eleni Romano, Ph.D. Primary Care Psychology Fellow San Francisco VA Medical Center
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Advancing Integrated Primary Care Education in the VA Medical System Kendra Campbell, Ph.D. Assistant Professor of Psychology University of Alaska Fairbanks.
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Advancing Integrated Primary Care Education in
the VA Medical SystemKendra Campbell, Ph.D.
Assistant Professor of PsychologyUniversity of Alaska Fairbanks
Daniel Baughn, Ph.D.Staff Psychologist, PCMHI
James A. Haley Veterans’ Hospital
Rebecca Shunk, M.D.Co-Director, Center of Excellence in Primary Care Education,
Associate Director of PRIME Program, UCSF Internal Medicine Residency
Eleni Romano, Ph.D.Primary Care Psychology FellowSan Francisco VA Medical Center
Patient Aligned Care Teams (PACT)• Team-based patient-centered model of care
• 1200 patients per team • Teamlet- Primary Care Provider, Registered Nurse, Licensed
Vocational Nurse and Clerical Associate
• Practice Changes • Panel Management• Pre-visit planning• Huddles• Shared Medical Appointments/Group Clinics• Walk-in appointments• Telephone appointments• Secure Messaging• Health Coaching
Diabetes Shared Medical Appointments
VA Centers of Excellence (COE)• Criteria:
• Transformative, generalizable, sustainable, and interprofessional primary care training
• Must include MD & NP trainees
• COE awards:• Up to $1 M/yr x 5 years, exclusive of any new trainee positions
• 5 COEs• Cleveland, San Francisco, West Haven, Boise, and Seattle
Mission of EdPACT:
To develop and implement an inspirational model of patient-centered, interprofessional education that will advance primary care within and beyond the VA
Joint effort with:• UCSF School of Nursing• UCSF School of Medicine • Office of Medical Education
Structure
Primary care training in a team-based, PCMH model• Practice partnership
model• Each trainee has
his/her own panel and cross-covers partners’ patients
• Interprofessional trainees support multiple trainee teamletsTeamlet
Dietetics
Social Work
Psychiatry
Pharmacy
NP student
Medicine
R2
Medicine
R2
Psychology
Health Professions Trainees
EdPACT Participants
Core EdPACT trainee teams:• Internal Medicine residents (two PGY-2 partners)• Adult NP students from UCSF (1 per pair of MD partners)• Additional interprofessional trainees:
• Clinical pharmacy, social work, psychology fellows, podiatry, nutrition, medical students, optometry, audiology, psychiatry
Teamlets:• LVN, RN, Clerk
Preceptors & Educators:• Longitudinal MD & NP preceptors• Clinical psychology faculty & fellows• Experts in communication, teamwork, performance improvement• Additional health professionals– podiatry, social work, pharmacy,
Team Development Scores by TeamFall 2012 to Spring 2013
Team 1 Team 2 Team 3 Team 4 Team 5 Team 6 Team 7 Team 8 Team 9 Team 100
10
20
30
40
50
60
70
80
90
100
55
48
82
63
6966
59 6056
6460
56
76 74
88
55
8178
73
64
Aug/Sept 2012 Mar/Apr 2013R2-NP student Teams (Fall and Spring)
TD
M S
core
s (0
- 1
00)
Outcomes: Patient Satisfaction, 2011-12
R2s NP StudentsSFVA Outpatient
Clinic FY12 YTD Qtrs1-3
N % Usually or Always N % Usually
or Always N % Usually or Always
How often did this provider explain things in a way that was easy to understand?
241 95% 73 97% 304 89.1%
How often did this provider listen carefully to you? 241 94% 73 100% 304 90.0%
How often did this provider show respect for what you had to say? 242 96% 72 100% 299 91.7%
How often did this provider seem to know the important information about your medical history?
238 94% 72 94%
• Surveys returned by 244 R2 patients and 73 NP student patients • 18% Response Rate, on average, for R2s and NP students
Outcomes: Patient Satisfaction, 2011-12
R2s NP StudentsSFVA Outpatient
Clinic FY12 YTD Qtrs1-3
N % 9 or 10 N % 9 or 10 N % 9 or 10
Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible, what number would you use to rate this provider?
242 73% 74 76% 310 68.1%
N % Definitely Yes N % Definitely
Yes
Would you recommend this provider to your family and friends? 242 79% 74 89%
Next Steps• Dissemination of our work/ Demonstrating benefit of EdPACT and PCMHI overall
• Implementation of PCMHI to VA Community- Based Clinics
• Americorps participants- health behavior coaches
• Increasing motivational interviewing/shared decision making/ other behavioral health topics into curriculum
Discussion
• Implementing change in primary care/ integrated health education within and outside of VA medical system
• Setting-based differences
• Directions for future growth/applications of current model