5.1 Understand the institutions and individuals that participate in healthcare delivery and role of the physicians in the health care system.
Over the last few years, there have been several national trends in health care including reorganizing primary care into a patient centered medical home (PCMH). At these PCMH many different health care workers come together to provide comprehensive care. During my third year Family Medicine rotation at Lewis Center, I had the opportunity to work in a PCMH and interact with many different health care professionals who helped with patient care. In particular, they had care coordinators, medical assistants, nurses, social workers, counselors, behavioral health specialists, physical therapists, xray technicians, lab staff, and pharmacists. By interacting with these various individuals involved in patient care I learned more about each of their roles, and how multidisciplinary collaboration can improve patient outcomes.
There was one particular patient encounter at the Lewis Center Family Medicine Clinic that illustrated how a multidisciplinary team can improve patient care. This patient was a 65 y/o male who was found to be in a-fib on EKG. Our plan was to prescribe the patient a DOAC (eliquis) for anticoagulation because his schedule didn’t allow him to go in for frequent INR monitoring. Unfortunately, we didn’t pay attention to the patient’s insurance or what anticoagulation medications that his pharmacy carries. The pharmacist caught this mistake and informed us that by sending the patient home on xarelto ($25 per month) vs eliquis ($149 per month), we could save the patient a lot of money. This medication change most likely increased the probability that the patient was able to purchase his medications and consistently take it. In the future, one of my goals is to pay more attention to insurance status and ensure that my treatments are the most cost efficient therapy for that patient. This could even mean calling pharmacies to inquire on drug prices to satisfy this goal.
I also learned a lot from my interactions with the care coordinators. While working with them, they taught me about the importance of identifying how the patient transports his/herself. This information is essential to helping link patients with necessary resources, and coordinating care so that a patient can see multiple providers with one visit. They also taught me that I need to pay attention to the patient’s work schedule before ordering fasting lab work so that they can fit it into their schedule. We also talked about how MDs should anticipate patient’s needs and allocate sufficient time for each visit to improve work flow. Allocating a complex patient to a regular time slot, will back up the entire clinic and prevent ancillary staff from doing their jobs on time. These teaching points are lessons that I want to incorporate into my future practice.
After learning these lessons in my clinical years, I was able to utilize my understanding of the various individuals involved in patient care to improve the no-show rate in an outpatient orthopaedic hand center as a part of our HSIQ project. Our initial baseline data showed that 26% of patients missed their routine post-op appointment, and 65% of patients incorrectly believed that they had completed follow up. In order to address this we completed a prioritization matrix (shown below) which identified that automated calls, AVS dot phrases that pulled up next appointment dates for patients discharged from the ED, and office staff identifying patients who no showed and sending this list to central scheduling as well as the surgeon were the most beneficial interventions. As a result, we worked very closely with the medical assistants, physician assistants, and office managers to keep a detailed excel document of every patient who didn’t show up to clinic. Our group was then able to call the patients who didn’t show up and help them make an appointment. This project highlighted how working together with the many individuals who help take care of patients in the office can improve health care outcomes. As an intern I hope to continue to learn from the various health care members to improve my practice. I especially want to work closely with social work and PT to coordinate care for my post-op patients.