Coordinating Center BLAST News Links                                                 May 16, 2013

Boise VA Academic PACT Engages Ambulatory ICU with Trainees

Authors: Janet Willis, RN, BSN, William Weppner, MD, MPH, FACP,C. Scott Smith, MD, FACP Melanie Nash, MSN, NP-C, RNP, Jared Bernotski, BA

Collaborative, team-based care is a central component to the success of Patient Aligned Care Teams (PACT). Considerable evidence supports the importance of this approach in patients with multiple medical and behavioral health concerns. Despite this evidence, tracking progress and evaluating outcomes across the spectrum of care has been a missing link.

In response, a group of healthcare providers at the Boise (BVAMC) Center of Excellence in Primary Care Education (CoEPCE) have developed the EFECT model to strengthen collaboration and patient tracking across disciplines.

EFECT:
E - Elicit the Narrative
F - Facilitate the Case Conference
E - Evidence Based Gap Analysis
C - Care Management
T - Track Management

Using this mnemonic as part of the Boise CoEPCE/PACT Interprofessional Care Updates (ICU) has improved interdisciplinary providers' and trainees' ability to formulate a patient care plan that hinges on tracking changes and assessing progress.

Using this mnemonic as part of the Boise CoEPCE/PACT Interprofessional Care Updates (ICU) has improved interdisciplinary providers’ and trainees’ ability to formulate a patient care plan that hinges on tracking changes and assessing progress.

Each Thursday morning, an interdisciplinary group of healthcare trainees and supervising providers join to discuss treatment care plans for complex, high acuity patients assigned to CoEPCE trainees on the outpatient Silver Team. These care conferences, otherwise known as PACT ICU, bring together a multidisciplinary cohort that consists of primary care provider (PCP) trainees (both Nurse Practitioner and Physician), nurse care managers, pharmacy trainees, behavioral health trainees, social work, and a Chaplain. Facilitators are supervising providers from some of these disciplines. In addition to improving tracking and outcomes for individual patients, PACT ICU conferences have contributed to a more comprehensive approach to primary care through helping team members develop a better understanding of roles, responsibilities and important contributions of the various disciplines.

Patients for discussion in the PACT ICU are generally selected using the Care Assessment Needs (CAN) tool which provides information on patients with high morbidity and/or most likely to be admitted into the hospital in the next 30 days. The CAN report and other pertinent information is available on a secure internal wiki. Using a brief narrative, the PCP describes issues in the patient’s overall health status. Often, this leads to a more focused discussion that draws out each discipline’s sets of expertise. The vibe is generally informal, and participants are encouraged to contribute their thoughts using evidence-based processes derived from their specific field of study. Such an approach has improved ability to communicate as a team and marshal resources that more effectively and collaboratively address complex concerns.

Generally, two patients are selected and discussed in 30 minute blocks. The patient’s electronic medical record (EMR) is revealed on a large screen and the PCP begins by eliciting the narrative of the patient’s health history. This facilitates discussion among the team members and stimulates further review of the EMR. A gap analysis is conducted to determine which areas of care are likely to have the greatest impact on the patient. Collaboratively, a care management plan is formulated and tasks are given to individuals based on their role in caring for the patient. The primary care provider summarizes the plan in the patient’s EMR and includes interdisciplinary team members as additional signers to the note. Changes are tracked over time as the interventions are started.

While research on the EFECT framework in PACT ICU still awaits IRB approval, highly positive initial feedback from providers and improvements in outcomes from high-utilizing patients look promising. Therefore, the Boise CoE plans to evaluate and share more about lessons learned from the PACT ICU in future articles. Thank you Boise CoEPCE Team!

West Haven Center of Excellence Primary Care Education

1st Annual Research and Performance Improvement Day A Presentation of CoE Faculty and Trainee Scholarly Work

Posters
Addressing outpatient continuity for residents: A novel tool for longitudinal primary care sign out. Ted Long, Andrea Uradu, Ron Castillo, John Thomas, Ryan Houk, Elisabeth Sacks

Expanding health policy education: Integrating a skills-based curriculum for the next generation of practitioners. Krisda Chaiyachati, Ted Long, Trishul Siddharthan, Ali Khan

Systematic review: Health related characteristics of elderly hospitalized patients and nursing home residents associated with short-term mortality. John Thomas, Leo Cooney, Terri Fried

When physicians and patients disagree: clinical experience as a determinant of physicians' willingness to comply with the requests of patients at the end of life. John Thomas

MedLEAD: Building a health professional curriculum in medicine and public service. Ali Khan, Ted Long,

Medicine, policy, and public leadership: The next paradigm for primary care education Ali Khan, Ted Long

Developing an interdisciplinary primary care training program: Pre-program assessment of perceptions of internal medicine residents and nurse practitioner students. Ted Long, Ali Khan SCAN ECHO (Specialty Care Access Network Extension for Community Healthcare Outcomes) Implementation: A pilot study Courtney Price, Sarah Dann, Ellie Doig, Ron Castillo

Establishing principles for collaboration between nurse practitioners and physicians: A consensus process. COE trainee working group

Presentations
Expanding health policy education: Integrating a skills-based curriculum for the next generation of practitioners. Krisda Chaiyachati and Ted Long

Addressing the gender gap in LDL control in men and women with diabetes in a large Veterans Affairs medical center. Ellie Doig and Andrea Uradu

When physicians and patients disagree: Clinical experience as a determinant of physicians' willingness to comply with the requests of patients at the end of life. John Thomas

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