14 th International Health Workforce Collaborative Conference

Transcription

1 VA Health CARE Defining EXCELLENCE In the 21 st Century Innovative, Interprofessional Models of Specialty Care Delivery & Education in the Department of Veterans Affairs (VA) 14 th International Health Workforce Collaborative Conference May 8, 2013

2 Authors & Acknowledgments Office of Academic Affiliations, VA Central Office staff: Barbara K. Chang, MD, MA, Director of Medical & Dental Education Judy L. Brannen, MD, MBA, Clinical Director of Graduate & Undergraduate Education, Medical & Dental Education Christy A. Howard, MSW, Specialty Care Project Manager David M. Latini, PhD, Health Systems Specialist 2

3 Presentation Objectives Review of an innovative, interprofessional education initiative: Patient-Centered Specialty Care Education Centers of Excellence (SCE COE) Focus: Sites & innovations Early outcomes & lessons learned 3

4 Scope of Training in VA ~37,000 medical residents train in VA annually 30% total US medical residents 10,300 physician resident positions (AY 2012) 9% US positions funded by VA >2,300 ACGME-accredited programs 75 medical specialties & subspecialties; 7 combined programs Health Professions Trainees Total Physician residents 37,104 Medical students 21,502 Dental residents & students 1,231 Nursing 32,349 All other 24,608 Total 116,794 4

5 VA Primary Care System Largest integrated healthcare system in the US >850 sites of Primary Care 4.8 M primary care patients 12 M encounters annually 2-yr transition to Patient Aligned Care Teams (PACT) VA s version of patientcenter medical home 5

6 CoEs in Patient-centered Specialty Care Education (SCE COEs) 3 sites selected Criteria: Team-based, patientcentered care Physician (at least 1 medical & 1 surgical) Associated health trainees Affiliate support Potential sustainability Up to $500K/yr x 3 years for infrastructure +Trainee stipends 6

7 Goals & Objectives Overarching goal: the transformation of clinical education and patient care by preparing [trainees] to work in and lead patient-centered interdisciplinary and/or interprofessional teams providing specialty care in the setting of coordinated longitudinal primary care. Objectives: Development of exportable models of patient-centered care & education featuring Interprofessional and interdisciplinary collaboration Coordinated longitudinal care for patients requiring specialty care Performance improvement Patient-centered care 7

8 Patient-Centered Specialty Care Education COEs

9 Integrated Healthcare Team Salt Lake City VAMC Musculoskeletal Disease Center Rheumatology Orthopaedic Surgery Endocrinology Physical Therapy/Occupational Therapy Internal Medicine/Family Medicine NP, PA and Clinical Pharmacy Trainees (55) Rheumatology, Endocrinology, NP students, PA students, & Physical Medicine and Rehabilitation Residents Trainee Experience Patient- Centered Evaluation Joint Injection Clinic Didactic Training Simulation Supervised Clinical Activities Patients with MSK disorders seen by specialty care interprofessional team with Family Medicine Practitioner E*Value System, pre/post test, extraction & analysis of clinical data

10 Cleveland VAMC Transforming & Integrating Medical & Surgical Expertise Cancer Center (TIE) Integrated Healthcare Team Surgical Oncology, Hematology & Oncology, Interventional Radiology; Psychology, Nursing, Nurse Practitioner, and Social Work Trainees (25) General Surgery, Family Medicine, Oncology, Nurse Practitioner Students, Psychology Fellows, and Social Work Interns Trainee Experience Integrated Supervised Clinical Activities Case Conferences Tele-Health Patient-Centered >312 patients served in the TIE center. Family integration into patient care. Main focus Nurses (Patient Navigation, Cancer Survivorship) and Mental Health (Distress Management) Evaluation Patient Perception of Patient Centeredness; 360 o - evaluation; Didactic session evaluation tool; Templated notes for patient data collection

11 Atlanta VAMC Women s Health Center Integrated Healthcare Team Current: Family Medicine, Psychiatry, Ob-Gyn, Cardiology, Dermatology, and Ophthalmology Planned: Nursing, Clinical Pharmacy, Social Work, PA, and Nutrition Trainees (9) Family Medicine, Internal Medicine Residents, Psychiatry, and OB-GYN (Planned: PA, Pharmacy, Social Work and Nursing) Trainee Experience Patient-Centered NEW location will open summer Trainees working in temporary CBOC location with integrated team. Family Medicine integration with same day specialty appointments; OB/GYN, Cardiology, Psychiatry, Derm Evaluation Post/Pre Testing Evaluations Interviews; Working with PACT Eval Team

12 Models of Care & Highlights Site Salt Lake City - MSK Disorders Cleveland Cancer Atlanta Women s Health Models of Care Pt-ctr d, disease-specific team, incl. primary care practitioners, specialists in MSK, & trainees. Proactive risk factor screening & intervention Pt.-ctr d collaborative cancer care via huddles. Sequential same day appts. Shifting from expedited appts to pt. centered, collaborative interprofessional team approach Highlights 1-week intensive miniresidency Practitioners available immediately Risk factor follow-up Reduction in co-pays, pt. visits, & travel costs d quality of care Pt. Navigation. Distress screening w/ interventions d timeliness of appts & access to multiple specialties X-training of trainees Bi-weekly team meetings w/ Program Director & faculty to outline & strengthen model & curriculum Dual affiliation participation 12

13 Evaluation Across SCE COE Sites Team Development Measure (TDM) Annual Site Report Template Semi-structured interviews/site visits Corporate Data Warehouse Access Utilization Clinical Outcomes

14 Challenges/Lessons Learned Space/hiring issues all sites are limited by available space! Budget challenges (slow to spend) Vigilance needed RE: Physician-centric practice Parallel vs. collaborative practice Need for local marketing to ensure sustainability External accreditation standards assist

15 Summary Improvement in education & clinical systems is interdependent & iterative IPE requires changes in education, faculty relationships, infrastructure, & attention to communication & culture Evaluation is challenging Critical role of coordinating center Trainees are overwhelmingly enthusiastic!!!

16 Questions? Specialty Care Education COEs: Barbara K. Chang, MD, MA Director, Medical & Dental Education, OAA Tel. (502) Judy L. Brannen, MD, MBA Clinical Director, Undergraduate & Graduate Medical Education Tel. (804) Web: 16