Partnerships Project: Jamaica Hospital Medical Center, Jamaica, N.Y., 1999-2001

Partnerships for Quality Education

Field of Work: Aligning the training of physicians and nurse practitioners with the demands of 21st-century clinical practice.

Problem Synopsis: In the 1990s, managed care became one of the dominant forces in health care. Physicians and nurse practitioners (NP's) were expected to know how to manage patients' health, often within a fixed budget. Although care was increasingly taking place in outpatient settings, physicians continued to receive most of their training in hospitals rather than in ambulatory care centers. They also received little training in preventive care, or in interprofessional collaboration.

New York State's transition to mandatory enrollment in managed care for its Medicaid Recipients was slow and beset by delays.

Synopsis of the Work: Partnerships for Quality Education (PQE) (April 1999 through January 2009), was initially funded by the Pew Charitable Trusts (during which time it focused on physicians only) and then by RWJF (which expanded it to include NP's). The program sought to improve a core set of skills in physicians and nurse practitioners, including interprofessional collaboration, chronic illness management, systems-based care and practice-based quality.

The family practice clinic at Jamaica Hospital participated in the Partnerships Program component of PQE.

Key Results: During the time of the grant, staff of the family practice clinic at Jamaica Hospital increased their percentage of Medicaid billings to managed care plans from zero to 50 percent.

At Jamaica Hospital Medical Center the Partnerships Program altered customary practice in three areas:

  • Classroom teaching. The hospital created approximately 24 lectures for faculty and residents on all aspects of managed care. The lectures, which were delivered by experts from their managed care partner (a Manhattan managed care organization) and other institutions, addressed topics such as cost-effective test ordering or prescribing; the quickest way to get patients access to care; expediting care through the managed care system; and documentation, coding and billing issues.
  • Clinical interventions. Residents worked at a community practice to gain experience with a managed care patient population. They also worked with faculty preceptors trained in practicing under managed care guidelines.
  • Administration rotation. Residents undertook a one-week administrative rotation at their managed care partner organization, Neighborhood Health Providers, in Manhattan. They participated in committee meetings, performed chart reviews, reviewed and discussed practice patterns, and sat in on case manager/provider/patient discussions.

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