November 9, 2010 — One hundred years ago, people mainly went to their primary care doctor for acute care — setting broken bones, for example — and paid a fee for that service.
But today’s primary care physicians spend most of their time treating patients with chronic illnesses, such as diabetes and hypertension, and a primary care delivery model meant for acute, episodic care doesn’t meet those needs, according to Michael K. Magill, M.D., professor and chair of the Department of Family and Preventive Medicine (DFPM) in the University of Utah School of Medicine and executive medical director of University of Utah Health Care’s community clinics.
As the nation aims for health care reform to rein in spiraling costs and produce better patient outcomes, the DFPM and University of Utah Health Care’s community clinics, including collaboration with colleagues from the David Eccles School of Business, the Department of Economics and the College of Pharmacy, is on the forefront of redesigning primary health care for today’s doctors and patients. With the aid of three new federal grants totaling $4.5 million they’re going to implement changes in two key areas: the use of information technology to help U community clinic physicians better manage chronic diseases and patient education so people can do better controlling their chronic conditions and watching their overall health.
“Insurance reform, by itself, won’t hold down costs or improve quality,” says Magill, principal investigator on the grants. “We have to change the way we deliver health care, and these three grants are all about redesigning the delivery of primary care.”
Rob Lloyd, executive director of the University’s community clinics, said, “Our community clinics are uniquely suited to participate in this innovative project. As an academic health care system, part of our mission is to help lead the way in improving the way health care is delivered. This project will put us at the forefront of primary care practice and redesign.”
Two of the three grants (Beacon Community Cooperative Agreement and Primary Care Practice Redesign – Successful Strategies) were funded by the economic stimulus package that Congress passed in early 2009, the grants were awarded through the Department of Health and Human Services (HHS) and the Agency for Healthcare Research and Quality (AHRQ).
The HHS/Beacon Community Cooperative Agreement Program will focus on using information technology for improved care protocols for a group of diabetes patients. The funds, totaling approximately $960,000, will enable the U of U community clinics to join a statewide computer information exchange for establishing the protocols with other doctors and hospitals. The grant also provides funds to hire care managers to ensure those diabetes patients receive the care developed under the protocols.
The Beacon grant program was set up to help select communities build and strengthen their health information technology. The University’s grant was awarded as a subcontract of the $16 million Utah Beacon cooperative agreement being led by HealthInsight, a Salt Lake City-based non-profit dedicated to improving the health care systems of Utah and Nevada.
The U of U community health centers already use an electronic medical record (EMR) system that gives patients access to lab test results, the ability to request appointments, and even communicate with their providers through a secure Web portal. More than 5,000 patients have signed up to take advantage of it.
With the two other grants, Transformed Primary Care – Care by Design and Primary Care Practice Redesign – Successful Strategies, both awarded through AHRQ for approximately $3.5 million, the University community clinics will expand the diabetes care-management plan implemented through the Beacon grant, as well as evaluate and expand Care by Design, a new approach to primary care that the clinics put in place in 2004. Those changes introduced an integrated system in which acute, chronic, and preventive care are overseen by a team of providers, including a primary care physician, nurses, physician assistants, pharmacists, medical assistants (M.A.s), and others as needed. This approach, in which each team member fills a specific role, gives patients more personalized care while allowing physicians more time to discuss preventive care and other issues that can make long-term impacts on patient health. The project will also help educate and engage patients to be more active and informed in caring for themselves.
Patient education is integral to both Care by Design and the new grants, and the U of U community clinics will use the funds to expand the patient education program started several years ago. For example, the health centers hold meetings where patients with similar chronic illnesses are invited to meet with nurses, pharmacists, physicians, and others to learn how to better manage their conditions through diet, exercise or other ways.
“I can treat my patients’ chronic conditions, but ultimately it’s up to them to manage their health,” Magill says. “If we manage chronic illness more effectively, we can reduce visits to the emergency room and hospitalizations.”
With the AHRQ money, the community clinics can evaluate how effective their changes in primary care have been so far, as well undertake comparative effectiveness research, which looks at different health care treatments and therapies to find those that have the best patient outcomes.