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PCMH

IM Residents and the PCMH

Montefiore Medical Center

 

 

Goals: To provide medical housestaff with a community ambulatory experience within an established practice, with incorporation of the tenets of the PCMH. To expose residents to an alternate system of practice (busy primary care settings not primarily focused on teaching) which include different patient populations, different payers, and different staffing models.

 

 

Learning Objectives:

At the end of this rotation the resident will be able to:

1.       Compare and contrast the structure of a teaching vs. a non-teaching ambulatory site

2.       Identify unique features of the PCMH and care management

3.       Recognize external factors (such as geographic access, copayments, etc) that influence medical care

4.       Provide direct patient care to a cohort of patients distinct from their continuity patient panel

 

Methods:

Residents (PGY- 3s) will be assigned one of the MMG designated sites for a 4 week/month rotation. Initial rotations will be at Bronx East and Grand Concourse sites; initial rotations will send 3 residents/month. Preceptors will be available at each of the selected sites for 4-6 patient sessions per week. Residents are expected to see patients with their preceptors. Residents will continue to attend their continuity clinic at their assigned teaching site (CFCC, CHCC, FCC) 1 day/week.

 

Residents will follow the clinic schedule, although they may attend Grand Rounds if their site is close to Montefiore and if it is not disruptive to the clinic schedule.

 

 

Educational Activities:

 

1. Academic Time sessions will include the following opportunities:

A) Interactions with the various members of the PCMH teams

B) Didactic information in 4 areas of practice:

1 Access and communication

2 Teamwork, PCMH and care management

3 Quality, safety, peer review, documentation

4 Brief overview of integrated delivery system (Montefiore), and the ACO; brief review of how medical care is paid and the movement toward producing value

 

 

A) Interactions with members of the PCMH teams will include two-half days each week for

·         Office interactions with Administration, Diabetic Educator, Pharmacist (when available), Social Worker, Health Educator, PCMH Nurses and Teams, care managers and care transition team

·         Attendance at  PCMH Pod meetings

B) Didactic lectures (6 sessions per month) with focus on entry level nitty-gritty of practice in 4 areas. These may be face-to-face or web-based pod-casts

 

1. Access techniques: doing today's work today, working toward same day access; scheduling issues of running clinic on time; timely return of calls and coverage; Communication skills: Patient Experience: concentrate on communication skills, review surveys and top box scoring, patient self-management techniques; patient portal use

 

2. Teamwork relationships:  establishing trust, being part of a team of which you are not necessarily the leader; PCMH structure including working with PCMH Teams and CMO Care Management and their Teams

 

3. Quality metrics and data collection; patient safety and peer review especially with regard to identifying systems issues;  National quality initiatives: NCQA, PQRI, HEDIS, QARR, MU, 4-Star, etc; transparency of data reporting to physicians, training on documentation,

 

4. The structure of Monte as an example of an integrated medical care delivery system; major changes of the new health care system emphasis on shifting care from acute intervention to chronic care management and prevention, and innovation;  the ACO as a model of change;

How income is generated and paid; the future under capitation and shared risk arrangements; the concept of value in the delivery of care

 Additional experiences may possibly include attendance at a Peer Review or CMO Care Managers meeting. Resident schedules are subject to call responsibilities and duty-hours restrictions.

 

 2. Self-Study/Hopkins Modules will include the following 8 modules:

Immunizations 1 and 2; Palliative Care 1 and 2; Professional 3 (Challenging Conversations and Encounter);Home Visits – Medicare, Community Resources; Preoperative Evaluation

 

 

 

Evaluation:

Residents will evaluate the rotation and their preceptors via on-line NI evaluation forms. Preceptors will also evaluate the resident in at month’s end in regards to the 6 ACGME competencies, via paper evaluations for preceptors without access to NI.

 

 

Logistics: Initial Three sites of Participation

1. Bronx East

2300 Westchester Ave

Bronx, NY 10462

Parking Available

Train - # 6

Bus- #4 stops in front; # 22 stops Castle Ave; # 8, # 31, # 40, # 41 stop at Westchester Ave and connect to # 4 or train

2. Cross County

1010 Central Park Avenue

Yonkers, NY  10704

Parking Available

Bus-20, 21, 25

 3. Grand Concourse

2532 Grand Concourse

Bronx NY 10458

Trains - D and #4 to Fordham RD

Bus routes include the 1, 2, 9, 12, 22, 28 and 34

 

                                          Resident PCMH Rotation (Sample Template)

2013-2014

 

 

 

MONTH: _____________                                           RESIDENT: _____________________

 

 

 

 

 

Monday

Tuesday

Wednesday

Thursday

Friday

 

 

 

WEEK

 ONE

AM

Orientation

 

PCMH Clinic

Academic Time

 

PCMH Clinic

 

PCMH Clinic

Continuity Clinic (CFCC, CHCC, AMP)

 

 

PM

 

PCMH Clinic

 

PCMH Clinic

Hopkins Modules/ Self Study

 

PCMH Clinic

 

Continuity Clinic

 

 

 

 

WEEK

TWO

 

 

AM

 

PCMH Clinic

Academic Time

 

PCMH Clinic

 

PCMH Clinic

Continuity Clinic

 

 

 

PM

 

PCMH Clinic

 

PCMH Clinic

Hopkins Modules/ Self Study

 

PCMH Clinic

Continuity Clinic

 

 

 

 

 

WEEK

THREE

AM

 

PCMH Clinic

Academic Time

 

PCMH Clinic

 

PCMH Clinic

 

Continuity Clinic

 

 

PM

 

PCMH Clinic

 

PCMH Clinic

Hopkins Modules/ Self Study

 

PCMH Clinic

Continuity Clinic

 

 

 

 

 

WEEK

FOUR

AM

 

PCMH Clinic

Academic Time

 

PCMH Clinic

 

PCMH Clinic

 

Continuity Clinic

 

 

PM

 

PCMH Clinic

 

PCMH Clinic

Hopkins Modules/ Self Study

 

PCMH Clinic

Continuity Clinic

 

 

 

 

 

Assignments




Self-Study/Hopkins Modules will include the following 8 modules:

Immunizations 1 and 2; Palliative Care 1 and 2; Professional 3 (Challenging Conversations and Encounter);Home Visits – Medicare, Community Resources; Preoperative Evaluation

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