Interprofessional Care

Team

Panel

• Stuart Gilman, MD, MPH; Director, VA Centers of Excellence

• Kathryn Rugen, PhD, FNP-BC; Nurse Consultant, VA Centers of Excellence

• Kristin Weaver, MS, ANP-BC, San Francisco VA Center of Excellence

• Lupe Shelton, MSN, RN, San Francisco VA Center of Excellence

• Morgan Fitzpatrick, MPH, MS, RN; NP trainee, San Francisco VA Center of Excellence

• Sunita Puri, MD trainee, San Francisco VA Center of Excellence

3

Learning

Patient

Caring

POINT OF CARE

HEALTHCARE

SYSTEM

STRUCTURE FINANCING

Time for Change

• IOM report 2003 “Health Professions Education: A Bridge to Quality

– delivering patient-centered care

– working as part of interdisciplinary teams

• Interprofessional Education Collaborative Core Competencies, 2009

– Value/ethics for interprofessional practice

– Roles/responsibilities

– Interprofessional communication

– Teams and teamwork

• VHA transforming Primary Care Delivery: Patient Aligned Care Teams (PACT), 2009

• Future of Nursing, 2010– Nurses should practice to the full extent

of their education and training

– Nurses should be full partners, with physicians and other health care professionals, in redesigning health care

Many Groups Agree with ChangeMany Groups Agree with Change

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Primary Care in the Veterans Health Administration

• Largest integrated health care system in the US

• Comprehensive electronic medical record

• >850 sites of Primary Care

– 152 Medical Centers

– >700 Community Based Outpatient Clinics (CBOC)

• 4.8 million primary care patients-each assigned to

an individual primary care provider

– 53% in CBOCs

• 12 million encounters/year

4

Pillars of Patient Aligned Care Team (PACT)

17

VA’s Support of Education

• Mission: "To educate for VA and for the Nation"

• VA oversees the largest health professions

training program in the nation. Each year, over

100,000 medical and associated health students,

residents and fellows receive some or all of their

clinical training in VA facilities through

affiliations with over 1,200 educational

institutions including 112 medical schools.

Centers of Excellence in Primary Care

Education

• Educational Goals– Shared-Decision Making

– Sustained Relationships

– Interprofessional Collaboration

– Performance Improvement

• Core Requirements– Joint sponsorship & engagement

– Integrated interprofessional teams

– 30% time commitment

• Resources– S1M/year/center for 5 years for operations

– Trainee stipend support

– National evaluation

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Funded Programs Patient Aligned Care Team - Design

• Team-based, patient-

centered model

• 1200 patients per

team

– 9 teams in Medical

Practice

– 1 team in each CBOC

Practice Changes

– Panel Management

– Pre- visit planning

– Huddles

– Shared Medical Appointments

– Group Clinics

– Walk-in appointments

– Telephone appointments

– Secure Messaging

– Health Coaching

– Each discipline practices to the full scope of licensure

EdPACT Team Design

N=50

N=75N=75

← continuity

← rotate

← cross-cover

Core EdPACT trainee teams:

•UCSF Internal Medicine residents

(two R2 partners that rotate from

in-patient to out-patient in 2

month blocks)

•UCSF Adult NP students provide

continuity of care

•All three provide cross-coverage

N=300

EdPACT Team DesignAdditional inter-professional trainees:

• pharmacy, social work, psychology fellows, podiatry, nutrition

Teamlets:

• LVN, RN, Clerk

Preceptors & Educators:

• Longitudinal MD & NP preceptors (both VA & UCSF)

• Clinical psychology faculty & fellows

• Experts in communication, teamwork, performance improvement, behavior change

Patients are oriented to EdPACT with:

• Business cards

• One-hour orientation (new patients only)

EdPACT Nested in PACT Panels

Interprofessional Communication - Huddles Accomplishments• PCP/trainee huddles with teamlet staff

• Shared medical appointments (pain, diabetes,

smoking cessation, advanced directives)

• Collaborative medical appointments

• Collaborative case conferences

• Diabetes Board

• Root Cause Analysis to evaluate patient safety

• QI projects

Accomplishments

•Culture change

• R2s & NP2s are collaborating

•EdPACT trainees work on teams thus re-

enforcing PACT with all staff

•NP faculty now involved directly in interprofessional and medical education

through practice-based curriculum and

clinical precepting.

Questions???