Teaching the Patient Centered Medical Home PCMH Taking

Teaching the Patient Centered Medical Home (PCMH): Taking a Medical Model and Making it a Curriculum Niladri Das, MD Faculty, UPMC St. Margaret Family Medicine Residency Program Stephen A Wilson, MD, MPH Director, Faculty Development Fellowship UPMC St. Margaret Family Medicine Residency Program Linda Hogan, Ph. D Director, Faculty Development UPMC St. Margaret Family Medicine Teaching Fellowship

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Objectives On completion of this session, the participants should be able to: 1. Describe the key principles of a PCMH 2. Apply the Kemp Model of Curriculum Design and the Dreyfus Model of Skill Acquisition to the development of a PCMH Curriculum 3. Formulate teaching strategies to establish a medical home curriculum in their own practice environment

Kemp Model of Instructional Design TEACHER CHARACTERISTICS Instructional Design, 2 nd Edition, by J. E. Kemp

Teachers/Developers • Family Medicine Faculty Development Fellows (3) • Pharmacy Residents (8) • Faculty (3)

Kemp Model of Instructional Design, 2 nd Edition, by J. E. Kemp

Learner Characteristics • • • Who were our stakeholders? 3 Family Health Centers in 3 separate neighborhoods Residents Faculty Nurses/MAs Staff Nurse Managers Pharmacists Nutrition Social Workers

Dreyfus Model of Skill Acquisition Expert Proficient Competent Advanced Beginner Novice http: //moleseyhill. com/blog/2009/08/27/dreyfus-model/

Stage Learner Characteristics • Follows rules • Context free • Responsible only for following rules Advanced • Can apply rules Beginner • Still does not feel responsible Competen • Organizes rules into t principles • Responsible for own decision Proficient • Intuitive diagnosis • Conscious care planning • High commitment Expert • Pattern recognition • High commitment Novice Teaching Styles Instructor directed – break skill into discrete tasks, concepts, rules Provide practice, teach rules and reason techniques for action Facilitator- learner’s needs guide instruction Mentor - Be available, model, teach advanced or “new” skills Co-Mentor – available for synergistic interdependent

Pre. Assessment Survey Says! 1. Do you understand what a PCMH is? (27/45) 63% of Respondents Reported Understood PCMH concept 2. What would like to learn in a PCMH Curriculum? Roles Practice Improvement How the model works Billing Topics

Goals & Objectives Goals • • • Define the PCMH Concept Understand PCMH in their present practice and consider implementation in future practice environments Identify FHC PCMH needs and develop a plan to address those needs Objectives • Define the PCMH Model • Identify a current practice need • Develop an Action Plan to address that need utilizing resources available in the PCMH model

How do you define PCMH? A model for delivering primary health care http: //www. southhavenfamilyphysicians. org/sitebuildercontent/sitebuilderpictures/pcmh. jpg

Joint Principles of Medical Home • • Personal physician Physician directed medical practice Whole person orientation Care is coordinated Quality and safety Enhanced Access Payment Joint Principles of the Patient-Centered Medical Home, Published on Patient Centered Primary Care Collaborative (http: //www. pcpcc. net)

1. 2. 3. 4. 5. Personal physician (NCQA) Physician directed medical practice (NCQA) Whole person orientation/ Comprehensive Care Patient-Centered (AHRQ) Care is coordinated and/or Integrated/Coordinated Care 6. Quality and safety 7. Enhanced access to care/Accessible Services 8. Payment (NCQA) Joint Principles of the Patient-Centered Medical Home, Published on Patient Centered Primary Care Collaborative (http: //www. pcpcc. net)

Content Key Principles of a PCMH • • • Comprehensive Healthcare Coordination Improved Accessibility Safety and Quality Patient Centeredness

T&L Activities Teaching and Learning Activities Video Support Services

T&L Activities

Teachers/Developers • • Family Medicine Faculty Development Fellows (3) Pharmacy Residents (8) Faculty (3) LEARNERS

T&L Activities Diabetic Patient panel data (registry) PCMH Handout 5 WHYs Worksheet PDSA Cycle Identify a FHC Need and develop an action plan to address it

Evaluation • • Evaluation Post Curriculum Feedback Positives: Activation, Use of Technology Negatives: Continuity of Learners Variable Should have been more rigorous with Evaluation Revise

Small Groups • Develop a PMCH Curriculum utilizing the Kemp Model in Your Own Practice Setting • You have 20 minutes

Discussion & Close Please forward any comments or questions to: dasn@upmc. edu Thank You