Category Archives: Primary care
The Robert Wood Johnson Foundation’s (RWJF) LEAP National Program is working to create a culture of health by discovering, documenting and sharing innovations in the primary care workforce. To advance this goal, the program is holding a series of six webinars that highlight best practices. Summaries of the first two webinars in the series are available here and here. The third webinar in the series focused on building an effective primary care team. Speakers included leaders from three primary care sites around the country that the LEAP program has deemed exemplars.
LEAP Director Ed Wagner, MD, MPH, began the webinar by framing the question for participants: Patients need multiple forms of contact across a primary care team, he observed. Given that, how does an organization build an effective team? How does an organization go from a collection of employees to a coherent, high-functioning team?
Charles Burger, MD, Medical Director Emeritus at Martin’s Point Health Care in Bangor, Maine, discussed the importance of recruitment and training.
He began by describing the members of Martin’s Point’s teams: a medical provider, practice administrator, collaborative care nurses, medical assistants, and care team patient service representatives.
The recruiting process is quite rigorous, he explained. “We invite the whole team in reviewing and selecting new team members,” he said. “Really what we are looking for are certain behavioral characteristics.” He said training is similarly rigorous: a six- to eight-week competency-based training period for each new team member, working one-on-one with a trainer and moving steadily through a number of modules. Each new team member moves through each module at his or her own pace, and move on when they demonstrate competence with the material in each module.
The Robert Wood Johnson Foundation’s (RWJF) LEAP National Program is working to create a culture of health by discovering, documenting and sharing innovations in the primary care workforce. To advance this goal, the program is holding a series of six webinars that highlight best practices. (Read a post summarizing the first of the six webinars.) The second of the webinars in the series focused on team-based care for complex cases. Presenters included leaders from four primary care sites around the country that the LEAP program has deemed exemplars.
Managing Care for the Most Complex Patients
Kathy Bragdon, RN, director of care management at Penobscot Community Health Center in Bangor, Maine, discussed the rapid growth of the health center, and went on to describe its system of care management for the most complex patients.
The center relies on a transitions care manager, who shares information back and forth with the hospital and with patients’ medical homes. In addition, the manager meets with patients when they are in the hospital, looking to identify potential barriers to recovery and to provide any needed referrals.
“One of the big roles—we didn’t realize how big—was that a tremendous number of patients had no primary care at the time of admission,” she said. “We worked really closely with the hospitals trying to provide those services and make that linkage to those patients who needed primary care providers.”
Around the country, print, broadcast, and online media outlets are covering the groundbreaking work of Robert Wood Johnson Foundation (RWJF) leaders, scholars, fellows, alumni, and grantees. Some recent examples:
RWJF Clinical Scholar Chileshe Nkonde-Price, MD, shared her experiences with the medical system during the last week of her recent pregnancy in a video featured on Nasdaq.com. Despite have given birth via Cesarean section earlier, Nkonde-Price wished to deliver vaginally with this pregnancy if she could do so safely. C-section has become the nation’s most common major surgery, the piece says. It examines some of the factors behind the sharp increase in the number of women delivering via C-section in the United States.
In a Health Affairs Blog, José Pagán, PhD, analyzes Medicare’s Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals with excessive 30-day readmissions for conditions such as pneumonia and heart failure. While Pagán says that not all readmissions can be avoided, hospitals can improve their performance through effective discharge planning and care coordination. With more incentive programs on the horizon, Pagán suggests that health care organizations “seek and monitor collaborative partnerships and, more importantly, strategically invest in sustaining these partnerships” so they can survive and thrive. He is an RWJF Health & Society Scholars program alumnus and recipient of an RWJF Investigator Award in Health Policy Research.
A study led by RWJF Nurse Faculty Scholar Lusine Poghosyan, PhD, RN, looks at how Nurse Practitioners (NPs) rate their work environments. It finds that those working in Massachusetts fared better that those working in New York on every topic in the survey: support and resources, relations with physicians, relations with administration, visibility and comprehension of their role, and independence of practice. The survey also found that NPs working in community health clinics and physicians’ offices rated their work experiences better than NPs working in hospital-affiliated clinics. Poghosyan told Science Codex the findings suggest “the practice environment for NPs in New York can improve once the state’s NP Modernization Act,” which will expand NPs’ scope of practice, takes effect.
The federal government announced on July 7 it had awarded more than $83 million to expand access to care by training hundreds of new primary care providers.
The money will be used to support primary care residency programs in family medicine, internal medicine, pediatrics, obstetrics and gynecology, psychiatry, geriatrics, and general dentistry at 60 health centers across the country. The expanded residency programs will help train more than 550 residents in coming academic year—about 200 more than were trained in the previous academic year, according to the U.S. Department of Health and Human Services (HHS). The funds will also be used to boost the number of states with teaching health centers from 21 to 24.
“This program not only provides training to primary care medical and dental residents, but also galvanizes communities,” said Mary K. Wakefield, PhD, RN, head of the Health Resources and Services Administration, a division of HHS. “It brings hospitals, academic centers, health centers, and community organizations together to provide top-notch medical education and services in areas of the country that need them most.”
The Robert Wood Johnson Foundation’s (RWJF) LEAP National Program is working to create a culture of health by discovering, documenting, and sharing innovations in the primary care workforce. To advance this goal, the program is holding a series of six webinars that highlight best practices. The first webinar addressed the responsibility of health delivery organizations to strengthen community health and the ways primary care providers can address social determinants of health. It featured leaders from four primary care sites around the country that the LEAP program has deemed exemplars.
Bringing Change to a Low-Income Community in Philadelphia
Patricia Gerrity, PhD, RN, associate dean for community programs at Drexel University and director of 11th Street Family Health Services at Drexel University, discussed the origins and work of her clinic, which is a partnership with the Philadelphia Housing Authority (PHA) that began in 1996. In response to a letter between the University and the PHA, Gerrity worked to gain mutual trust with the aim of improving the residents’ health status.
Getting started wasn’t easy, Gerrity noted. To achieve some wins, she assigned a public health nursing faculty member from Drexel to each public housing development. The nurse faculty members asked residents about pressing problems—and then became partners in solving them. For instance, residents said car accidents were an issue, so stop signs were put up. Residents wanted to learn CPR, so training was offered. Residents expressed concerns about dog bites, so they worked with Animal Control to remove stray dogs. “We had to have some short term wins to gain trust,” Gerrity said.
The Robert Wood Johnson Foundation’s LEAP National Program is working to create a culture of health by discovering, documenting, and sharing innovations in the primary care workforce. Across the country, innovative practices have found ways to make care more efficient and effective for both patients and providers, which can lead to improved health outcomes and health savings. The LEAP project has identified and visited practices based in large health systems and rural community clinics ranging from Maine to California, and has brought the sites together in person and via webinars to discuss their innovations.
LEAP stands for The Primary Care Team: Learning from Effective Ambulatory Practices. Over the past six months, the 31 “exemplar sites” have been actively engaged in discussing their workforce best practices. The goal is to allow others across the country to learn from and replicate these innovations, ultimately via a dissemination website.
Linnea Windel, MSN, RN, president and CEO of VNA Health Care in Aurora, Ill., received the Illinois Primary Health Care Association’s Danny K. Davis Award last fall for her leadership of and service to the community health center movement. She is an alumna of the Robert Wood Johnson Foundation (RWJF) Executive Nurse Fellows program (2008-2011).
Human Capital Blog: Congratulations on your award! What does this mean for you and for your organization’s work?
Linnea Windel: The community health center movement (and the work that we do) reaches thousands of uninsured and underinsured people who, in most cases, wouldn’t have access to primary health care services otherwise. The award highlights the purpose of our work and the work of many.
HCB: The award is named for Danny K. Davis, a member of the U.S. House of Representatives and a champion of the community health center movement. How is VNA Health Care carrying out his mission?
Windel: When we became a federally qualified health center (FQHC) 12 years ago, we were serving 6,000 patients; this year we are on track to serve 60,000 patients. In the space of 12 years, we’ve expanded our service area and now have nine health centers in suburban Chicago. We live out the purpose of the community health center movement and the purpose of the award through the provision of care in communities with significant need.
Nurses are “the backbone of efforts” to expand New Mexico’s primary care workforce, according to Gov. Susana Martinez, and they help ensure that people living in the state’s rural and underserved communities can get the high quality care they need and deserve. A video from the governor helped open the Robert Wood Johnson Foundation Academic Progression in Nursing meeting in Washington, D.C., this week, which brought together nurse leaders from around the country. In her remarks, Governor Martinez explains why New Mexico has implemented a common statewide nursing curriculum, made it easier for nurses in the state to further their education, and placed “a strong emphasis on nurses.”
Have you signed up to receive Sharing Nursing’s Knowledge? The monthly Robert Wood Johnson Foundation (RWJF) e-newsletter will keep you up to date on the work of the foundation’s nursing programs, and the latest news, research, and trends relating to academic progression, leadership, and other essential nursing issues. These are some of the stories in the January issue:
Patients Slowly Gaining Access to Care Provided by Advanced Practice Registered Nurses
In recent years, several states have taken steps to ease restrictions on advanced practice registered nurses (APRNs), indicating that efforts to empower them and improve patient access to care are picking up steam. However, many consumers still lack unfettered access to care provided by APRNs because two-thirds of states do not allow them to practice without physician supervision—and even in states that do, APRNs aren’t always able to practice independently.
Stronger Primary Care System Is Goal of RWJF Scholar
RWJF Executive Nurse Fellow Margaret Flinter, PhD, APRN, has been at the center of three movements: community-oriented primary care, the growth of the community health center movement, and the growth of nurse practitioners as primary care providers. She founded the country’s first formal post-graduate residency training program for new nurse practitioners, and co-directs The Primary Care Team: Learning from Effective Ambulatory Practices, a national project supported by RWJF that is working to help health care organizations develop and accelerate innovations.
Arthur Kellermann, MD, MPH, FACEP, an alumnus of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars and Health Policy Fellows programs, is dean of the F. Edward Hébert School of Medicine at the Uniformed Services University of the Health Sciences. He wrote an article in the November issue of Health Affairs calling for a new class of health care provider—the primary care technician—to improve accessibility to and affordability of primary care.
Human Capital Blog: What is the thrust of your idea?
Arthur Kellermann: We’ve had a decades-long shortage of primary care physicians in this country and, up until now, it has defied solution. One definition of insanity is to continue to do the same thing over and over again and expect a different result. My article suggests a rethinking, and literally a reengineering, of how we deliver primary care in this country. It makes the case for a new class of providers—primary care technicians (PCTs)—who would work remotely, under the online supervision of primary care physicians or nurse practitioners (NPs), to manage stable chronic disease patients, treat minor illnesses and injuries, and provide basic preventive services. These PCTs would make primary care more accessible, more convenient, and more affordable to Americans, wherever they live.