Coordinating Center BLAST News Links                                                 January 29, 2013

Panel Management and the Cleveland Story

Interview by Julia Kurpakus, CoEPCE Coordinating Center Photos complements of Pete Spanos, Cleveland CoEPCE

The Interprofessional champions responsible for Transforming Outpatient Care (TOPC) curriculum of the Cleveland VAMC Center of Excellence in Primary Care Education (CoEPCE) are staying true to the designation of “excellence” through transforming the quality of care that is that is provided to all of their learners’ Veteran patients.
After an interview with several of the learners in VA Cleveland’s Center of Excellence, it was clear that there is good reason to be excited about the overall progress being made. Internal medicine resident, Jeffrey Beamish, MD, PhD, is noticing a stabilization of A1c levels in his patients, meaning that the average blood glucose levels of his patients with diabetes is being better controlled. Dr. Beamish attributes this to his panel management time and enhanced continuity with patients. "What I have been noticing is a lot of my patients are making improvements, and it is really reassuring. I have flexibility to spend more time with them, and for example, help them bring their blood sugars from bad to okay and from okay to good." Panel management strategies provide tools for Dr. Beamish to take care of patients even when they are not present in the clinic.

A panel management approach employs disease management strategies for a defined population of patients, in contrast to strategies that only address the needs of patients who present for care. Successful panel management strategies require specified time for team member review of clinical data/health indicators, patient’s records, and proactive engagement with patients at times outside of the regularly scheduled clinic visit (often using telephone, telehealth or telemedicine). In the Cleveland CoE, learners are mentored by skilled interprofessional providers and other experienced professionals and are taught how to identify patient panels and provide preventive care or early treatment for those groups of patients who might be at risk of disease exacerbation.

The resulting patient/learner/provider partnerships appear to benefit everyone. Dr. Beamish, along with his team’s resident partner Heather Foreman, MD, is responsible for overseeing a panel of around 217 patients. According to Cleveland’s CoE program, former Nurse Practitioner co-director, Sharon Watts, DNP, RN-BC, CDE, the goal behind the idea of panel management is to build continuity for patients and providers while using VA’s PACT (Patient Aligned Care Team) model. She said, “It is a unique feature to have these learners be given a set block of time completely dedicated to caring for the patients, and it has had some great outcomes."

A key factor in the progress of Cleveland’s CoE is the additional patient-centered and interprofessional opportunities that aid in better care for the patients. The learners have a set time for panel management, they are able to meet with other healthcare professionals, like case manager Gloria Taylor, RN, CDE (pictured above), for instruction or advice. The learners have the opportunity to attend shared appointments and they have access to chronic disease registries of their patients. The shared medical appointments are typically run by a health psychologist, nutritionist, nurse practitioner or pharmacist, and allow a group of patients to learn more about how to improve their health using self-management strategies and through learning more about topics around diabetes or lipid management. The learners can encourage their patients to attend these meetings and be present to learn from them as well. Another important resource for the learners is the development and use of the local registry. This registry provides comprehensive, objective data about all of the patients being cared for - currently over 1,000 patients. One of Cleveland’s CoE curriculum managers, Pete Spanos, said of the registry, "It allows the learners to search their panel on a variety of targets – like patients with diabetes whose A1c levels are greater than 9% or who are overdue for an eye and foot exam." He went on to say "Having a real-time snapshot of patient data enables the learners to collaborate effectively with their team to improve outcomes." These resources and opportunities provided to the learners have changed the way they think about and provide care to their Veteran patients.

Jennie Doane, MN, RN and Alli Heilman, MN, RN, two of Cleveland’s CoE NP learners also participated in the interview. They shared their experiences with panel management and the use of resources within the CoE from the perspective of a Nurse Practitioner. When asked about highlights around dedicated time for panel management in the CoE, Jennie mentioned that "getting to see the bigger picture around patient health was invaluable." It seems that better results are being obtained in overall patient health because they are staying in better contact with all patients, and not just the patients who want to come in and be seen. Alli said of her panel management time, "It is dramatically different from previous experiences because that time and the access to the registry support patient discussion and the ability to reach out to them in other ways such as through telehealth."

Mimi Singh, MD, MS, the program’s MD co-director, elaborated that their work does not stop at face-to-face contact with the patient; it also includes being responsible for their progress and outcomes. Dr. Singh pointed out two key points that panel management helps to address: First, it attempts to completely eliminate the potential for an “out of sight, out of mind” concept, and second, it helps a provider recognize where interventions need to take place. The learners determine what they feel is important to know about their patients, and the registry can perform several tracking features.

According to Cameron Carter, Cleveland CoE/Health System Specialist, the registry is constantly evolving and new features are being added to improve the ability to provide more complete care of the patient. This work is very important to highlight because it shows significant progress in how patient care is being transformed in Center. Students are beginning to think about patient care in an entirely new way, and Dr. Singh believes the impact of this program will expand learning and ultimately improve the quality of care. Dr. Beamish said, "Being able to get to know the patients better allows me to break through barriers and better manage co-morbidities; it’s really rewarding to focus on the improvement of the patient’s overall health." In their goal of continuous improvement, improving Veteran overall health it is obvious that the panel management approach to patient-centered care is a valuable component in Cleveland CoE’s training of future health professional, as the overall health of the veterans being served is a priority.

If you would like to learn more about the registry and panel management at the Cleveland Center of Excellence Primary Care Education, please contact: Brook Watts, MD, MS at 216-791-3800 x 6027 or Cameron Carter at 216.791.2300 x 2330

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