TEACHING HEALTH CENTER

CONSORTIUM COMPARATIVE

ANALYSISLinda Thomas-Hemak MD

December 2013

UNDERSTANDING OF PCMH

PRINCIPLES

Comparative Analysis

CORE PCMH PRINCIPLES Team Approach Information System Support Quality Improvement Population Management Treatment of Mental Health issues Self-Management Support Use of Guidelines Coordination of Care Patient centered care

THC-1 VS. TRADITIONAL-1 THC-1

better thanTraditional-1

THC-1 Similar to

Traditional-1

THC-1 Worse than Traditional-1

November 2011

Team ApproachInformation System SupportQuality ImprovementPopulation ManagementTreatment of Mental Health issuesOVERALL ASSESSMENT

Self-Management SupportUse of Guidelines

Coordination of CarePatient centered care

May 2012 Team ApproachInformation System SupportSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation ManagementCoordination of CareTreatment of Mental Health issuesOVERALL ASSESSMENT

Patient centered care

November 2012

Team ApproachInformation System SupportSelf-Management SupportPopulation ManagementPatient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT

Use of GuidelinesQuality ImprovementCoordination of Care

THC-1 better than

Traditional-2

THC-1 Similar to

Traditional-2

THC-1 Worse than Traditional-2

November 2011 Quality ImprovementTreatment of Mental Health issues

Team ApproachInformation System SupportSelf-Management SupportUse of GuidelinesPopulation ManagementCoordination of CarePatient centered careOVERALL ASSESSMENT

May 2012 Team ApproachSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation ManagementTreatment of Mental Health issues

Information System SupportCoordination of CarePatient centered careOVERALL ASSESSMENT

November 2012 Team ApproachInformation System SupportSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation ManagementPatient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT

Coordination of Care

THC-1 VS. TRADITIONAL-2

THC-1 VS. TRADITIONAL-3THC-1

better thanTraditional-3

THC-1 Similar to

Traditional-3

THC-1 Worse than Traditional-3

November 2011 Quality ImprovementPatient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT

Team ApproachInformation System SupportSelf-Management SupportUse of GuidelinesPopulation ManagementCoordination of Care

May 2012 Team Approach Information System SupportSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation Management Coordination of Care Patient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT

November 2012 N/A as the Traditional-3 surveyed in Nov 2011 and May 2012 had graduated from the program

2012 THC-1 VS. 2011 THC-1

2012 THC-1 better than2011 THC-1

2012 THC-1 Similar to

2011 THC-1

2012 THC-1Worse than2011 THC-1

Nov 2012 Team Approach Self-Management SupportUse of GuidelinesQuality ImprovementCoordination of Care Patient centered careTreatment of Mental Health issuesOVERALL ASSESSMENT

Information System SupportPopulation Management

2012 THC-1 VS. THC-22012 THC-1 better than

THC-2

2012 THC-1 Similar to

THC-2

2012 THC-1Worse than

THC-2Nov 2012 Coordination of Care

Patient centered careTeam Approach Information System SupportSelf-Management SupportUse of GuidelinesQuality ImprovementPopulation Management Treatment of Mental Health issuesOVERALL ASSESSMENT

Nov 2011 – May 2012 Nov 2011 – Nov 2012

Team Approach THC +19% +19%Traditional +15% +14%

Info System Support THC +10% +13%Traditional +8% +8%

Self-Management Support

THC +11% +14%Traditional +4% +9%

Use of Guidelines THC +7% +5%Traditional +4% +6%

Quality Improvement THC +6% +9%Traditional +8% +18%

Population Management

THC +21% +19%Traditional +10% +13%

Coordination of Care THC +14% +6%Traditional -1% +7%

Patient-Centered Care

THC -1% +6%Traditional 2% -1%

Mental Health Issues THC +11% +7%Traditional +11% +10%

Overall Average THC +10% +11%Traditional +6% +8%

COMPARISON ACROSS TIME: PERCENT CHANGE

Team

App

roac

h

Info

Sys

tem

Sup

port

Self

-Man

agem

ent

Supp

ort

Use

of

Gui

delin

es

Qua

lity

Impr

ovem

ent

Popu

lati

on M

anag

emen

t

Coor

dina

tion

of

Care

Pati

ent-

Cent

ered

Car

e

Men

tal H

ealt

h Is

sues

Ove

rall

Ave

rage

-5%

0%

5%

10%

15%

20%

25%

19%

10%11%

7%6%

21%

14%

-1%

11%10%

15%

8%

4% 4%

8%10%

-1%

2%

11%

6%

Percentage Change over 6 months

THCTraditional

Team

App

roac

h

Info

Sys

tem

Sup

port

Self

-Man

agem

ent

Supp

ort

Use

of

Gui

delin

es

Qua

lity

Impr

ovem

ent

Popu

lati

on M

anag

emen

t

Coor

dina

tion

of

Care

Pati

ent-

Cent

ered

Car

e

Men

tal H

ealt

h Is

sues

Ove

rall

Ave

rage

-5%

0%

5%

10%

15%

20%

25%

19%

13% 14%

5%

9%

19%

6% 6% 7%

11%

14%

8% 9%

6%

18%

13%

7%

-1%

10%8%

Percentage Change over 12 months THCTraditional

Team Approa

ch

Information

System Support

Self Manage

ment Support

Use of Guideli

nes

Quality

Initiative

Population Manageme

nt

Co-ordination

of care

Patient

Centered

Care

Treatment of

Mental Health Issues

Overall

Jermyn - Wayne residents

4.60 4.14 4.88 4.83 4.92 4.55 4.94 4.80 5.00 4.74

Jermyn - VA residents 4.10 3.25 4.38 4.50 4.00 3.50 4.50 4.30 4.50 4.11

Jermyn - Susquehanna 4.40 3.55 4.47 4.61 4.33 4.07 4.58 4.67 4.83 4.39

Jermyn - Scranton Primary

3.60 3.14 4.00 4.00 3.67 3.20 4.00 3.80 4.00 3.71

Clarks Summit- Scranton Primary

3.85 2.89 4.29 4.17 4.25 3.00 4.38 4.20 4.25 3.92

Jermyn - Wayne residents: PGY2

4.50 4.07 4.42 4.28 4.78 4.70 4.50 4.40 5.00 4.52

Scranton - Scranton Primary: PGY2

4.57 3.79 4.72 4.61 4.33 4.30 4.13 4.03 4.50 4.33

COMPARISON ACROSS TRAINING VENUES FOR THC TRACK RESIDENTS

CORRELATION ANALYSIS OF PCMH SURVEY RESULTS

Comparative Analysis

 November2012

Team Approac

h

Information

System Support

Self Manage

ment Support

Use of Guidelin

esQI Pop

MngtCoord of

carePatient Centered Care

Treatment of

Mental Health Issues

Overall Score

Days in Jermyn             

Team Approach 1

Information System Support

0.685 1 Self Management Support 0.580 0.622 1

Use of Guidelines0.675 0.582 0.736 1

QI0.528 0.693 0.695 0.451 1

Pop Mngt0.710 0.942 0.459 0.505 0.598 1

Coord of care0.640 0.497 0.587 0.754 0.658 0.438 1

Patient Centered Care0.447 0.497 0.470 0.671 0.568 0.492 0.819 1

Treatment of Mental Health Issues

0.551 0.653 0.443 0.469 0.452 0.581 0.469 0.432 1

Overall Score0.808 0.873 0.761 0.806 0.785 0.818 0.812 0.762 0.717 1

Days in Jermyn             -0.031 0.141 -0.014 0.022 0.005 0.120 0.198 0.185 0.177 0.122 1

Self

Man

agem

ent

Supp

ortTeam

Ap

proa

ch

Qua

lity

Init

iati

ves

Use

of

Gui

delin

esPo

pula

tion

M

anag

emen

t

Info

rmat

ion

Syst

em

Supp

ort

Ove

rall

Scor

e

Trea

t M

enta

l Hea

lth

Issu

es

Pati

ent

Cent

ered

Car

e

Coor

dina

tion

of C

are

-1 +10

Positive CorrelationNegative Correlation

CORRELATION BETWEEN TIME SPENT AT JERMYN AND MEDICAL HOME COMPETENCY

 November 2011

Team Approac

h

Information

System Support

Self Manage

ment Support

Use of Guidelin

esQI Pop

MngtCoord of

carePatient Centered Care

Treatment of

Mental Health Issues

Overall Score

Days in Jermyn             

Team Approach 1.000

Information System Support

0.714 1.000Self Management Support 0.438 0.621 1.000

Use of Guidelines0.593 0.635 0.852 1.000

QI0.036 0.311 -0.053 0.061 1.000

Pop Mngt0.741 0.924 0.452 0.465 0.275 1.000

Coord of care0.675 0.631 0.400 0.621 0.272 0.580 1.000

Patient Centered Care0.396 0.512 0.658 0.709 0.012 0.348 0.522 1.000

Treatment of Mental Health Issues

0.158 0.160 -0.193 -0.058 0.168 0.149 0.260 0.229 1.000

Overall Score0.761 0.879 0.683 0.802 0.333 0.779 0.813 0.734 0.336 1.000

Days in Jermyn             -0.010 -0.276 -0.140 -0.058 0.052 -0.313 0.204 -0.287 0.305 -0.060 1.000

Self

Man

agem

ent

Supp

ort

Team

Ap

proa

ch

Qua

lity

Init

iati

ves

Use

of

Gui

delin

es

Popu

lati

on

Man

agem

ent

Info

rmat

ion

Syst

em

Supp

ort

Ove

rall

Scor

e

Trea

t M

enta

l Hea

lth

Issu

es

Pati

ent

Cent

ered

Car

e

Coor

dina

tion

of C

are

-1 +10

Positive CorrelationNegative Correlation

CORRELATION BETWEEN TIME SPENT AT JERMYN AND MEDICAL HOME

COMPETENCYNOVEMBER 2011

QUALITY AND PATIENT SAFETY SURVEYS

Comparative Analysis

QUALITY AND SAFETY SURVEYS We conducted a survey to assess the

understanding of Quality and Patient safety amongst the first year residents that included both THC and Traditional track residents in September 2011

The data was aggregate and did not look at differentiating the THC vs. Traditional track residents

The same survey was re-administered in September 2012 to the same group of residents who had transitioned to Year-2 of their training

RESULTS: QUALITY AND SAFETY SURVEY The comparison showed an

improvement of 8% over time. The limitation of these results being that the results do not allow us to compare the effectiveness of THC vs. Traditional tracks

The researchers have identified this limitation and will focus on this during the next surveys

CONSORTIUM MODELS FOR THC IMPLEMENTATION

Comparative Analysis

The Wright Center for Graduate Medical

Education:A 501(c )3 not-for-profit ACGME/AOA Accredited

Sponsoring GME Institution/Consortium50 FTE IM Residency

ProgramGroup A

Group B

Mercy hospital

Community Medical Center Moses Taylor

Medicare GME Fund

39 Hospital Funded FTE

Wayne Memorial

Community Health Center

FQHC*

Wright Center Primary Care Mid-Valley**

The Wright Center Medical

Group

Veteran Administration Hospital GME Fund

2 FTE 2 FTE

4FTE

1 FTE

1 FTE

10.7FTE 11 FTE 10.3FTE

5 VA Funded FTE

Scranton Primary Health

Center*

13 FTE 13 FTE13 FTE

Hospital Participating Institutional Affiliates

HRSA Teaching Health Center

Fund

6 THC Funded FTE/year

Wright Center Primary Care Scranton**

* NEW FQHC Based Learning Environments**Established Internal Medicine Learning Environments

WCGME THC Consortium – Initial Development 2011

Medicare GME Fund

10.7FTE 8.5 FTE 10.3FTE

Regional Hospital

Community Medical Center Moses Taylor

43 Hospital Funded FTE (4

FTE > FY2011)

16 FTE 13.5 FTE13.5 FTE

Total Participating Hospital Affiliates’ Funded FTE Slots

The Wright Center for Graduate Medical Education,

a 501(c)3, not-for-profit ACGME/AOA Accredited

Sponsoring Institution and GME Consortium: 2012 Projection of

64 FTE IM Residency Program

Veteran Administration Hospital GME Fund

5 VA Funded FTE

HRSA Teaching Health

Center Fund

Established 12 THC FTE

4 FTE THC Expansion

1/3 FTE Female Health

Maternal and Family Health

Services (M&FHS)***

The Wright Center

Medical Group, P

* Established WCMG Internal

Medicine Learning Environments

** 2011 Established THC FQHC-Based Learning Environments

*** New 2012 FQHC and M&FHS Based Learning Environments in the Planned THC Expansion• Continuity Groups A-D defined as

groups of individual THC residents having Ambulatory Continuity Training Education in 2:1 ratio between a designated WCPC and FQHC site

• 2011 Established Continuity Groups• 2012 Proposed Expansion Continuity

Groups The combined venues for curriculum expansion to benefit all THC track residents = 1 Expansion FTE = 2 Individual THC track Residents with Ambulatory Continuity experience defined as Group D

2011 Established THC site FY2012 FTEs2012 Proposed Expansion THC site FTEs

Resident Group D

Resident Group B

Resident Group C

Resident Group A

Chart 1: WCGME THC Consortium Resident FTE Cost Center Funding Relationships for 2012 with Teaching Health Center Expansion Year 1

4 FTEWright Center Primary Care

Scranton*(WCPC-S)

1 FTENortheast PA Community

Health Center FQHC***

(NEPACHC)

2 FTEWayne Memorial

Community Health Center

FQHC**(WMCHC)

The Wright Center

Medical Group, PC(WCMG)

Wright Center Primary Care Mid-

Valley*(WCPC-M)

4 FTE

2 FTEScranton

Primary Health Center** (SPHCC)

1/3 FTE Oral Hygiene*** 1/3 FTE Primary

Care Psych***

2 FTE

Continuity Group B

Continuity Group D Continuity

Group A

Continuity Group C

WCGME THC Consortium 2012 Training Model

WCGME THC Consortium – Regional Family Medicine 2013

WCGME THC Consortium – National Network for Family Medicine Residency Training 2013

WCGME THC Consortium – Interdisciplinary Model for All Regional Residency Training