Moving Primary Care Training to the Community - Pennsylvania ...

A unique, 501 © (3), not for profit
GME sponsoring institution:
The Mission of the Wright Center
is to provide excellent GME in an
innovative and collaborative spirit
in order to deliver high quality,
evidence-based and patient
centered care to the people of
Northeastern Pennsylvania.

The Balancing Act of The Wright Center’s Dual Mission
Guiding principles are GME Mission Management, Transparency, Trust,
Collaboration, and Continuous Quality Improvement in Care Delivery and
Workforce Development driven by Outcomes and Regional Needs.

The Wright Center Brings Relevant Resources to the
National THCGME development:
• A flourishing, well accredited 35 year old Community Based Internal
Medicine Residency.
• Currently pursuing ACGME IRC approval to be a Multi-Program
Institutional Sponsor to assume transfer of a well accredited
Northeast PA Family Medicine Residency.
• A pioneering HRSA funded Teaching Health Center Consortium that
has already begun ambulatory curriculum overhaul with a Matrix of
ACGME, Medical Home and EMR Meaningful Use Competencies.
• A GME infrastructure that has already developed and implemented
direct observation tools and related Milestones based evaluations
that can be shared with other disciplines.

The Wright Center has Practice Transformation Experience
Wright Centers for Primary Care are established
NCQA Level 3 Certified Medical Homes actively
engaged in the Pennsylvania DOH Practice
Transformation Collaborative. All providers are
certified for 2011 EMR Meaningful Use.

Objectives:
1) Create an understanding of the organization and structure
of a Teaching Health Center or GME Consortium to meet
ACA defined funding eligibility requirements
2) Share the experiences of the Wright Center for Graduate
Medical Education as an established THCGME Consortium
3) Highlight experiences of implementation of new
learning/teaching GME environments at FQHCs and their
integration with our established primary care residency
program; including input from the residents present today
based on their experiences
4) Share unique curriculum used for resident training that
includes innovative training in Medical Home, EMR
Meaningful Use, Public Health and Population
Management, Care Coordination and Continuous Quality
Improvement
5) Briefly overview WCGME’s first level of evaluation based
on focus groups and clinician surveys/assessments.

Teaching Health Center
Highway to Keep Primary Care GME Services
Relevant to Community Health
2011 HRSA designation of The Wright Center for
Graduate Medical Education meeting ACA defined
Funding Eligibility for Expansion of our Primary Care,
Community based Internal Medicine Residency

ACA Defined HRSA THCGME Funding Eligibility
A community-based ambulatory patient care center that
operates a primary care medical or dental residency program.
Specific eligible outpatient settings include, but are not limited to
FQHC, Community Mental Health Centers, Rural Health Clinics,
Indian Health Service Clinics or Title X funded entities.
OR
A collaborative, accredited GME consortium that
gives the above ambulatory entity a “crucial” role in the
administrative, financial and academic oversight of the primary care
residency program. This Consortium may include academic medical
centers, medical school, and hospitals, but the designated
sponsoring institution for the residency program must be the
Consortium entity.

WCGME THCGME Consortium
• Convening platform of inclusive GME community
stakeholders who have mutual vested interests in
regional healthcare delivery, education and workforce
quality
• Evolving role from advisory board to engaged
shareholders
• Academic, Financial and Administrative oversight of
collective resources including GME federal funding from
HRSA THC, VA and CMS payments to affiliated hospitals
• Stewardship of Inter-professional workforce development
and distribution, patient care quality and safety
initiatives, relevant scholarly work, community
engagement, physician renewal, new provider skill sets,
educational outcomes, meeting the public trust

WCGME’s Pioneering FQHC THC and Title X
Funded Community Partners
• Scranton Primary Health Care Center and Public Dental
Clinic
• Wayne Memorial Community Health Care Centers-Pike
County
• Northeast PA Community Health Care Centers-
Hallstead and Susquehanna
• Maternal and Family Health Services Center, Scranton
• Eager collaborations just starting in Family Medicine
with Rural Health Network with pending HRSA funding
announcements this week.

WCGME Consortium 2012-13

Implementation and Daily Challenges
Stakeholder and Governance Education about a New
Training Model
Scheduling Complexities
ACGME/AOA Requirements
FTE Federal Cost Center Allocations and
Reconciliations
Clinic Logistics
New Curriculum Integration
Medical Home and ACGME Competency Matrix
Didactic Conference Overhaul
Staff and Faculty Development

Implementation and Daily Challenges
Culture Change
Resident and Faculty Resistance to Change
Patients and Clinic Staff
Competing Priorities
WCGME
Leadership Transition and new Hospital
and TCMC partners
FQHCs
Medical Home and EMR Meaningful
Use Transformation

Enablers and Catalysts
Residents, Staff, Faculty and Patients
FQHCs experience in educating IPE students and in
public health collaboratives
New Skills Sets of the curriculum expansion are the
physician leadership skill sets to drive EMR Meaningful
Use and Medical Home Transformation
PA IPIP Residency Program/Community Health Center
Medical Home Collaborative
Groundwork of the PA DOH CCI and the practice and
residency transformation work at The University of
Colorado
Other pioneering THCs and GWU
HRSA

Curriculum Expansion
• New FQHC Learning Environments
• ACGME and PCMH Curriculum Matrix
• New 21 st Century Physician Skill Sets in Medical
Home, EMR Meaningful Use, Public Health and
Population Management, Care Coordination and
Continuous Quality Improvement
• Female Gynecological Health and Family Planning
education with M&FHS
• Oral Hygiene Education in Scranton Primary Health
Care Center’s Public Dental Clinic
• Behavioral Health Education in Collaboration with
Wilkes University’s New Psych NP Program

The Six ACGME Competencies
• Patient Care
• Medical Knowledge
• Practice-based Learning and Improvement
• Interpersonal and Communication Skills
• Professionalism
• System-based Practice

The Chronic Care Model
Community
Health System
Resources and
Policies
Self-
Management
Support
Health Care Organization
Delivery
System
Design
Decision
Support
Clinical
Info
Systems
Informed,
Activated
Patient
Productive
Interactions
Prepared,
Proactive
Practice Team
Improved Outcomes

THC Consortium Year 1 and 2 Outcomes
PCMH Clinician Assessment Survey Measures Medical
Home Sub-Competencies in the following arenas:
• Team Based Care
• Information Systems
• Self Management Support
• EB Guidelines Use
• Population Management
• CQI
• Care Coordination
• PCMH
• Mental Health

THC Consortium Year 1 and 2 Outcomes
• HC residents year 1 showed 0.39 overall average competency score
improvements by May 2012
• Global Score Improvement in May 2012 was 10% for THC interns,
6% for Traditional Interns and 3% for Traditional Seniors.
• THC scores improved more significantly than traditional groups in
each sub-competency, except patient centeredness where no
cohort showed change
• May composite THC intern scores for each sub-competency
exceeded comparative scores for all traditional track groups
• November 2012 Year 2 outcomes preliminary look shows
consistent if not better improvement, and the beginning of a
probable spillover improvement effect on all residents

THC Consortium 2012 Evaluation Outcomes
• There has been tremendous faculty, staff and THC resident
engagement in driving constructive CQI programmatically
• THC interns expressed significant interest in primary care and
service oriented careers in non-discriminatory safety net systems
• FQHC Learning Environment Faculty, Resident and Staff Evaluations
have all been very positive
• Patients have been incredibly receptive and patient evaluations of
residents have been very good and appear less biased because
they are distributed by staff
• FQHC Faculty report higher job satisfaction
• Active engagement in the PA IPIP RPC Collaborative has been
notable.
• FQHC Medical Home and EMR Meaningful Use
endeavors have been enabled and a focus of resident
scholarly work

Teaching Health Center GME Consortiums Can Unify
Community Stakeholders in Health Care Workforce Development
Dr Linda Thomas-Hemak, President and CEO
thomasl@thewrightcenter.org
Cell 570-954-5758