STFM 27th Annual Conference on Patient Education Plenary Sessions

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Friday, November 10
8:15-10 am

"From Barriers to Bridges: Improving Chronic Disease and Preventive Care"
Richard Wender, MD, Thomas Jefferson University
Our flawed health care system is perfectly designed to achieve exactly the results we observe everyday—lots of gaps in preventive care and chronic disease management achieved at a very high expense. Primary care clinicians are almost all committed to doing the right thing for their patients, and are successful for some. While virtually all clinicians care for these complex patients, the degree to which offices have implemented systems to improve preventive and chronic care varies enormously. Implementing the bridges to overcome the barriers requires a commitment to improving care, innovative thought and creativity, and some investment of time and resources. Good chronic disease management offers unique opportunities for improving patient care and reducing costs. In this plenary, Richard Wender, MD, will discuss essential components to dramatically improve chronic disease and preventive care. He will also suggest key approaches that we can all take to help us get there.
Learning Objectives

1. Discuss the implications of a flawed health care system on chronic disease management.
2. List essential components to improving chronic disease management and preventive care.
3. Discuss key approaches that clinicians can use to meet the challenge of chronic disease management.
4. Issue a call to advocate for more fundamental change.

Dr Wender is alumni professor and chair of the Department of Family and Community Medicine at Thomas Jefferson University (TJU). He directed the TJU family medicine residency program for 10 years, became vice chair of the Department in 1995 and chair in 2002. His major area of academic focus has been cancer prevention and screening. He served as president of the Philadelphia Division of the American Cancer Society and first president of the newly-formed Commonwealth Division, now known as the Pennsylvania Division of the American Cancer Society. He is currently serving as president-elect on the ACS National Board of Directors. He has lectured and written extensively about the role of primary care clinicians in preventive care. Understanding and overcoming barriers to primary-care based preventive health services delivery and chronic disease management remains his principal focus of teaching and investigation.

Saturday, November 11
8:30-10:15 am

"Creating an Ideal Practice"
L. Gordon Moore, MD, University of Rochester
The problems of primary care make it a relatively unattractive specialty choice and may be a driving force behind the failures of the U.S. health care system. Many current and planned approaches appear likely to exacerbate rather than improve our problems. One approach appears capable of achieving breakthrough results. A growing network of primary care practices demonstrates an unmatched ability to deliver patientcentered collaborative care through the use of simple technology, the Internet, and process improvement. This plenary will describe the design elements of an ideal practice and the attendant results in patients with chronic conditions when implemented.
Learning Objectives

1. Explain the components of an ideal practice.
2. Understand how innovation approaches in the Internet helps practices and patients with chronic conditions.
3. Describe outcomes achieved by some ideal practices.

L. Gordon Moore, MD, has a solo practice in family medicine. He works with the Institute for Healthcare Improvement as core faculty working on ambulatory practice from independent to academic across the US, and leads the clinical office transformation of inner city practices in the Reweaving the Safety Net project in Rochester, NY (www.rsafetynetproject.com). He is a clinical assistant professor with the University of Rochester Department of Family Medicine and Community and Preventive Medicine. He is the principal investigator of a study funded by the Physicians Foundation for Health System Excellence of this growing movement of Ideal Micro Practices (www. idealmicropractice.org).

Sunday, November 20
9:45-11:00 am

"How Can We Help Practices Redesign to Improve Care?”
Perry Dickinson, MD; Marjie Harbrecht, MD ; Carolyn Shepherd, MD, University of Colorado
Most physicians agree their most critically ill patient is the health care system itself, but what can the individual physician do to fix it? Expectations are not being met and frustration continues to mount among doctors, employers, consumers, hospital administrators, health plan executives, and patients. The scope of the problem is ominous, presenting challenges that point to the need for major system redesign, both in the overall health care system and in individual practices. There are a number of initiatives around the country focused on helping practices accomplish redesign to improve various aspects of care. This plenary will present practical experiences from the perspectives of three family physicians working actively in this arena, but with different roles: a medical director of a community health center, the director of a statewide organization, and a researcher. This session will provide an overview of a broad variety of approaches to practice redesign.
A primary model for practice improvement has been the Institute for Healthcare Improvement’s Breakthrough Series, in which practices from around the country gather in a series of “collaborative” sessions to discuss the Chronic Care Model and quality improvement. Clinica Campesina, a community health center in the Denver/Boulder area, has been one of the most successful practices in implementing the changes modeled in the Breakthrough Series. Carolyn Shepherd, MD, the medical director of Clinical Campesina and an accomplished Breakthrough Series veteran, will review their experiences, highlighting their successes, challenges, and innovations.
Colorado is one of two states to pilot Improving Performance in Practice (IPIP), created through the American Board of Medical Specialties and the boards and societies of family medicine, internal medicine, and pediatrics, to restructure and improve health care delivery. The initiative ties quality improvement measures, collaborative networks, and implementation of technology to board certification for the three specialties. IPIP is led locally by the Colorado Clinical Guidelines Collaborative. Marjie Harbrecht, MD, medical/executive director of CCGC, will present information about both CCGC’s overall statewide effort to improve practice and the IPIP project.
Researchers at the University of Colorado Health Sciences Center, Department of Family Medicine have worked on multiple projects directed toward assisting practice redesign, especially focusing on improving chronic care. These projects have utilized a number of different approaches to practice change and redesign, and Perry Dickinson, MD, will share experiences and key lessons from several of these projects.
Participants in this session will be able to:

1. Delineate several different approaches to helping practices with redesign and quality improvement.
2. Discuss barriers to change in primary care practices.
3. Describe processes that can assist practices in overcoming barriers to change and in becoming more reflective and responsive to their environments.

Dr Dickinson is professor in the Department of Family Medicine of the University of Colorado. He is currently the president of the North American Primary Care Research Group (NAPCRG) and of the Board of Directors of the Annals of Family Medicine, Inc. He has previously served as chair of the Research Committee for the Society of Teachers of Family Medicine (STFM) and as a member of the Board of STFM. He has worked on multiple studies investigating the process of practice redesign, particularly focusing on the impact of practice organizational features on practice change efforts and on the use of elements of the chronic care model in primary care practices. He also is involved in a number of projects developing health information technology tools to support aspects of practice redesign and chronic care.
Dr Harbrecht serves as the medical/executive diirector of the Colorado Clinical Guidelines Collaborative (CCGC). She worked as a physician risk manager with COPIC Insurance Company where she developed a comprehensive Breast Management Guideline Program to prevent delays in diagnosis of breast cancer. She has used that experience for several other guideline projects and has lectured nationally about quality improvement, risk management, and patient safety issues. She also serves as an assistant clinical professor in Family Medicine at the University of Colorado.
Dr Shepherd received her medical degree from the University of California in 1979. She completed her family medicine residency at Merced Community Medical Center in Merced, California. She spent most of her life in the Central Valley in California and came to Clinica Campesina as medical director in 1988. She is also on the clinical faculty for the Department of Preventive Medicine at the University of Colorado. She is the quality chair for the iPN, a community wide consortium of private physicians, Avista Hospitaland the Boulder County Health Department who are now implementing a shared community electronic health record and quality improvement programs.

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