STFM Features

Does the P4 Project Influence Match Results?—Q & A With Patricia Carney, PhD, Principal Investigator for P4

noreply@blogger.com (Traci @ STFM) — Fri, 08 Jan 2010 16:49:00 +0000

Patricia Carney, PhD will speak on Saturday, January 30, at the Predoctoral Education Conference in Jacksonville, Florida. She will highlight trends in health care reform that are likely to affect our educational programs and will address how partnerships must be formed to allow flexibility in program credentialing that will rapidly advance educational quality and improved health outcomes.

Q: Tell us about the impact of health care reform on your research. With the constant changes and unknowns, how in the world do you manage this study (any study)? It would seem challenging to measure the effects of residency redesign when nothing seems constant.

A: Yes, health care reforms are a dynamic process. We are using a case series design in P4, where each program is its own control group, and we are collecting historical cohort data, which will help us understand how features of all programs change over time. In addition, sites collect specific measures for the hypotheses they are testing that are unique to their programs. We conducted site visits to all 14 programs and reviewed/revised their hypotheses, identified data collection instruments and time periods, and we assisted them in connecting with other programs that are conducting similar studies. I like to think of our approach as health care and educational epidemiology—where we collect as much relevant data as is feasible and then conduct complex multivariate analyses designed to take into account the covariates that could be influencing outcomes.

Q: What do you believe is the most valuable lesson to date that family medicine educators can take from the P4 project?

A: Family medicine residents are very excited about the possibility of “intentional diversification;” that is, they want more flexibility in designing a residency program that will best prepare them for the type of medical practice they want to work in. Several programs are testing this innovation, and Match results (which we are analyzing now) appear to have improved for P4 sites.

Q: What, if anything, do your findings tell us about the future of family medicine education and our learners?

A: Preliminary data from the P4 project recently examined whether the innovations being tested at sites were influencing the residency Match. More specifically, we examined how programs fared in the Match, according to whether their innovations included a customized curriculum at the level of the resident. Our results show a 20% increase in LCME US graduates matching to these programs after implementation of this innovation compared to before.

Patricia Carney, PhD, is professor of family medicine and of public health and preventive medicine and associate director for Population Studies at the Oregon Health and Science University. She has contributed to the development of several clinical research grants in breast, cervical, and colorectal cancer screening, detection, and diagnosis.

Plan to attend the STFM Predoctoral Education Conference and hear more about the P4 Initiative, the initial findings, and the lessons Dr Carney believes family medicine can learn (and benefit) from.

"Guided Care" Wins Award for Innovation at the Conference on Practice Improvement

noreply@blogger.com (Traci @ STFM) — Wed, 06 Jan 2010 21:44:00 +0000

Guided Care, a new model of health care for people with multiple chronic conditions, improves patients’ quality of life and care, while improving the efficiency of treating the sickest and most complex patients. Guided Care uses patient-centered teams that include a registered nurse, two to five physicians, and other members of the office staff who work closely together for the benefit of each patient. The team monitors each patient’s health and offers comprehensive, coordinated, patient-centered health care.

Early results suggest that Guided Care improves the quality of care and reduces costs for older adults suffering from multiple chronic health conditions. A recently published study in the American Journal of Managed Care showed that in the first 8 months of a randomized controlled trial, Guided Care patients spent less time in hospitals and skilled nursing facilities and had fewer emergency room visits and home health episodes, resulting in an annual net savings of $75,000 per Guided Care nurse. Other analyses have shown that Guided Care improves the quality of patients’ care, reduces family caregiver strain, and improves physicians’ satisfaction with chronic care.

“Guided Care has increased the efficiency of our team and of patients’ office visits, as well as improved our access to evidence-based guidelines for managing chronic conditions,” said Gary Noronha, MD, FACP, Medical Director of Wyman Park Internal Medicine, part of Johns Hopkins Community Physicians. “Our physicians agree that we now have the right mix of professionals to meet the needs of these vulnerable patients.”

Guided Care recently received the Award for Innovation in Practice Improvement at the 2009 Conference on Practice Improvement in Kansas City. The annual award recognizes innovative practice improvement programs and strategies that transform medical office processes, promote patient participation, and contribute to an office practice’s overall success. “I was honored to accept the award on behalf of the many researchers, doctors, nurses, patients, and family caregivers who have made Guided Care an option for helping the 133 million Americans with chronic conditions to lead healthier lives,” said Chad Boult, MD, MPH, MBA, principal investigator of the Guided Care study and director of the Roger C. Lipitz Center for Integrated Health Care at the Johns Hopkins Bloomberg School of Public Health. STFM President-Elect Perry Dickinson, MD, (left) presented the award to Dr Boult (right). The award was sponsored by STFM, along with the American Academy of Family Physicians (AAFP), and Medical Economics magazine.

For more information about the Guided Care program, please go to: www.GuidedCare.org.

For information on the Conference on Practice Improvement, visit www.stfm.org/pic.

Medical Students Hone Altruistic Skills Through Service to the Underserved

noreply@blogger.com (Traci @ STFM) — Wed, 06 Jan 2010 19:16:00 +0000

Many family medicine departments have developed medical student-run free clinics that provide services to underserved and indigent populations. These clinics are giving students the opportunity to work within a clinical setting with physicians to experience the patient behind the science. Below, we highlight three student-run free clinic programs providing valuable services to patients across the United States.

The Free Outreach Clinics for the Underserved in San Antonio (FOCUS) project began in 2005 in the Center for Medical Humanities & Ethics at the University of Texas Health Science Center at San Antonio (UTHSCSA). The Clinics provide critical health care services, train students to care for underserved populations, and provide first-hand experience with the social justice issues and human suffering of medically under- and un-served populations. The FOCUS project provides free health care and enhanced quality of life for approximately 3,000 residents of Bexar County in south Texas, an area of the nation characterized by disproportionately high rates of chronic illness, and disproportionately low rates of access to health care.

Richard Usatine, MD, professor of Family and Community Medicine at University of Texas Health Science Center at San Antonio, was the founder of the FOCUS Free Clinics Project. The student-run free clinics accomplish two goals: providing medical care to underserved populations while enabling medical students to hone their altruistic sides. “The first 2 years of medical school are so focused on learning basic science, and students spend most of their time in class or labs. Involvement in the FOCUS clinics enables them to get out and see real people with real needs, and it reinforces why they're studying so many hours.” said Dr Usatine.

The FOCUS Free Clinics project currently operates at three residential facilities: Two for individuals and families recovering from homelessness and addiction. These FOCUS clinics have reduced the number of emergency room visits among the service populations, prevented common chronic diseases such as diabetes, and increased thousands of clients’ ability to recover from addiction and homelessness. Within one of the FOCUS Clinics housed in a residential facility for homeless pregnant/parenting adolescents, the FOCUS project will greatly reduce emergency room visits for the 2,200+ moms and their children served by this facility. In addition, providing on-site health care will help keep the young mothers enrolled in programs such as school completion and tutoring, vocational training and job readiness, counseling and therapy, and parenting skills.

You can more information about the UTHSCSA Student-run Free Clinic programs at www.studentrunclinics.org.

The University of California, San Diego, Student-Run Free Clinic Project began one night a week in the basement of a church after a meal program for the homeless. Now, 12 years later, the clinic provides services each day of the week, based in two churches and two inner city elementary schools. “We practice a humanistic, empowerment model creating environments where patients and their families achieve well being,” said Ellen Beck, MD. Dr Beck founded the clinic, along with a group of committed medical students and dedicated community partners. It provides primary care services and outpatient specialty services to more than 1,000 San Diegans who do not qualify for access to care. Another 1,000 receive ancillary services including dentistry and acupuncture. 85% of the clinic’s patients have chronic illnesses, including diabetes, hypertension, hyperlipidemia, depression and asthma. All aspects of the project are administered and managed by students with the supervision of faculty. The clinic is transdisciplinary in nature and sees the community as the teacher.

Dr Beck said the UCSD program is unique in the range and depth of services that it is able to offer and in the extent of involvement of the medical students. First- and second-year students must take an elective class with a defined curriculum to work at the free clinic project. The UCSD’s popular fourth-year clerkship, Underserved Medicine, involves the fourth-year students acting as clinical coaches, and learning to be teachers. “Students immerse themselves in primary care, and learn about working with underserved communities,” said Dr Beck. UCSD also offers a 1- to 2-year Fellowship in Underserved Healthcare that brings former student leaders back after residency to be fellows and help run the clinic.

Dr Beck has also developed a national faculty development program, “Addressing the Health Needs of the Underserved,” where faculty build community among themselves, and learn to create and sponsor these types of programs. As a result, student-run free clinic projects have been started in over 10 communities in the United States, including clinics in Hawaii, Houston, Missouri, and Mississippi.

Learn more about the student-run free clinics at the University of California, San Diego at http://meded.ucsd.edu/freeclinic/.

CARES (Community Aid Relief Education and Support) was established by Dr Wanda Gonsalves and medical students from the Medical University of South Carolina in August 2005. It is modeled after the UCSD student clinic and has evolved into an interprofessional service learning experience for medical, pharmacy, physical therapy, physician assistant, and masters of hospital administration students. Psychiatry residents are involved and see patients two times a month.

The clinic offers primary cares services, gyn (pap smears), diabetes group visits, psychiatry, and labs. Everything is free to the patients, and the clinic only sees those who are uninsured. The clinic sees patients, on a first-come basis, three nights a week in the evenings. Two volunteer MUSC faculty per night from the emergency medicine, family medicine, internal medicine, and psychiatry departments, as well community physician volunteers and practicing physician assistants.

The learning piece of the service is an elective called “Caring for the Community.” Students who take the elective are required to spend 5 nights per semester at the clinic. The CARES clinic is located in Dr Gonsalves' faculty practice, University Family Medicine, in Mt. Pleasant, SC. "Unlike many student clinics, which at times have very meager facilities, our patients are served in my office where students have access to wonderful exam rooms, equipment, and office lab procedures," said Dr Gonsalves.

“We are blessed to have a wonderful community partner, East Cooper Community Outreach (ECCO), a faith-based organization,” added Dr Gonsalves. CARES is also funded by the AAMC Caring for the community grant, the Medical Society of South Carolina, and numerous small grants given by the community. “It is a wonderful experience for our students who desperately need preclinical experience,” said Dr Gonsalves. To learn more about this program, visit www.thecaresclinic.org.

All three of the faculty members mentioned above, Drs Usatine, Beck, and Gonsalves will be participating as faculty at the Student-Run Free Clinic Conference 2010: Creating High Quality Clinics in Our Communities, being held in conjunction with the STFM Predoctoral Education Conference, in Jacksonville, Florida.