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Advancing Integrated Primary Care Education in the VA Medical System

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.

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Advancing Integrated Primary Care Education in the VA Medical System

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  1. 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

  2. Objectives for Today • Provide overview of EdPACT • Educational domains • Report preliminary outcomes • Challenges/Next Steps • Discussion/Q&A

  3. 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

  4. Diabetes Shared Medical Appointments

  5. 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

  6. 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

  7. Health Professions Trainees 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 teamlets Dietetics Psychology Pharmacy Social Work Teamlet Psychiatry

  8. 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, nutrition

  9. Educational Domains of EdPACT • Shared Decision-Making • Sustained Relationships • Interprofessional Collaboration • Performance Improvement

  10. Curricular Content: Interprofessional Collaboration Didactics Interactive small group seminars: Huddling Team Members Roles Handoff communication Feedback Conflict Resolution Debriefing Workplace reinforcement: Huddling Huddle Coaches Preceptors reinforce skills and provide feedback during huddles Teams engage in formative assessment processes Reflection Half-day retreat: Team building Opportunities to reflect Identifying similarities and differences

  11. Nuts & Bolts of MH Integration • Didactics • Shared Decision Making • Motivational Interviewing • Case Conferences • Diabetes Board • Collaborative Care Conference • Physical Proximity • Huddles/Huddle Checklist • Shared Medical Appointments • Team Development Retreat • Groups (Stress Management, Pain, Tobacco)

  12. Interprofessional Communication -Huddles

  13. Barriers to PC-MH Integration • Limited facility space • Increasing MH trainees/staff contact in exam room • Staff turnover and scheduling complexity • Cross discipline/specialty MH understanding of integrated care • Culture change/ paradigm shifts

  14. Measuring Outcomes

  15. Team Development Results: Years 1 & 2 Fall (Aug/Sept) Spring (Mar/Apr) Yr 1 - Trainee Teams: 59.4 Yr 2 - Trainee Teams: 62.2 Yr 1 - Trainee Teams: 64.6 Yr2 - Trainee Teams: 70.3 www.peacehealth.org/about-peacehealth/medical-professionals/eugene-springfield-cottage-grove/team-measure/Pages/Default.aspxLast Accessed 1/12/2012.

  16. Team Development Scores by TeamFall 2012to Spring 2013

  17. Outcomes: Patient Satisfaction, 2011-12 • Surveys returned by 244 R2 patients and 73 NP student patients • 18% Response Rate, on average, for R2s and NP students

  18. Outcomes: Patient Satisfaction, 2011-12

  19. 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

  20. 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

  21. Thank You

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