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March 22, 2013 - USA Family Medicine Focusing on Quality Improvement
In an effort to improve the quality, safety, efficiency and effectiveness of health care throughout the country, primary care centers are turning to a model of care that facilitates partnerships between individual patients, their personal physicians, and their family.

The goal of this model, referred to as a patient-centered medical home (PCMH), is to improve the patient experience and medical outcomes through a more holistic approach that emphasizes patient education, access, and patient-physician communication.

The University of South Alabama Department of Family Medicine is working to achieve a PCMH model of care by modifying their approach from physician-only care to one where physicians, nurses and clinic staff work as a team to take care of the whole patient.

“The goal of a PCMH model of care is to provide health care that is centered on the patient,” said Dr. Tangela Atkinson, assistant professor of family medicine at USA. “This is important because it improves the effectiveness and efficiency of health care.”

USA Family Medicine currently has three quality improvement groups – comprised of physicians, nurses and clerical staff – that meet three days a month to discuss ways of providing team-based care to their patients.

According to Renetta McMillan, clinical operations manager at USA Family Medicine, the department is also enhancing patient care by providing patients with information to become more engaged in their medical care.

“We have a patient portal that gives the patient a way to directly communicate with their provider between visits, and patients can request a referral or schedule an appointment online,” McMillan said.

Information on treatment plans, preventative and follow-up care reminders, and access to medical records are also posted on the secure portal.

“This benefits patients by giving them more control of their care and more accessibility to their individual physician,” said Dr. Atkinson. “Having a patient portal in place allows the patient to securely request medication refills and receive results of labs and radiologic studies from the comforts of home at a time convenient to them.”

In addition to the patient portal, Dr. Atkinson said the department also provides electronic prescriptions and has implemented an electronic health record system that organizes the patients’ charts.

Dr. Atkinson said the PCMH model of care improves the quality of care delivered in the office and allows care to take place outside of the office when the patient doesn’t need a face-to-face clinic visit.

Another standard of a PCMH is to demonstrate a commitment to quality improvement by engaging in performance measurement, as well as measuring and responding to patient experiences.

Specifically, Dr. Atkinson said the department is focusing its efforts on improving diabetes care and asthma care, as well as reducing the use of tobacco products.

The department set a goal that 90 percent of all diabetic patients receive a hemoglobin A1c test – a blood test that gauges how well you are managing your diabetes – every three months. Initially, only 55 percent of patients met that goal.

“Interventions were put in place, which included patient reminder cards and a standing order that patients may obtain a hemoglobin A1c test without a concurrent office visit,” Dr. Atkinson said.

“After two months, there was a 50 percent improvement in the number of diabetic patients who received the test.”

Quality improvement can also be seen in asthma patients. “By putting standing order in place, which allows nurses to give all asthma patients an influenza vaccine without additional physician order, influenza vaccine rates in this population improved from 20 percent to 35 percent,” she said.

Quality improvement efforts in the cessation of tobacco included first identifying patients in the clinic ages 13 and older who use tobacco products.

“By taking a team-based approach, the documentation of tobacco use and identification of those patients occurred 98 percent of the time, which exceeded our goal of 85 percent,” Dr. Atkinson said. “Patients were then provided tobacco cessation counseling and resources.”

Dr. Atkinson said this is the second year USA Family Medicine has been focusing on quality improvement efforts, and the department hopes to attain certification by the end of 2013.

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