Transcript Slide 1

Practice Enhancement Assistants (PEAs) within UNYNET
Elizabeth McLean-Plunkett, Renee Kee, Kathryn Glaser, and Saburo Okazaki
Family Medicine Research Institute, Department of Family Medicine, State University of New York at Buffalo
Abstract
Practice enhancement assistants (PEAs) have played a key role in primary care
practice initiatives since the 1980’s. The concept and utilization of PEAs initially
began in Europe and Australia where they participated in practice-based research
and quality improvement projects. It is only within the last decade that PEAs have
been introduced and incorporated into the healthcare system within the United States
(Nagykaldi et. al 2005, 2006). Since their introduction in the United States the PEA
position has been found to be a valuable resource for Practice Based Research
Networks (PBRNs). The Oklahoma Physicians Resource/Research Network
(OKPRN) was the first PBRN to utilize PEA’s and more PBRN’s (e.g. UNYNET,
ORPRN, and NJFMRN) have acknowledged their usefulness and consider the PEA
model an ideal approach to help improve quality of care in primary care practices.
This poster focuses on the evolving PEA model. Specifically within UNYNET how
PEAs have helped establish relationships with network practices for sustained
periods of time; how they have helped improve practice systems and patient care
utilizing a substantial array of resources from the academic medical environment as
well as act as assistants in research studies.
Purpose and Utilization of PEA within UNYNET
What is a PEA?
“Healthcare
professionals who assist primary care clinicians in research and
quality improvement Projects.” (Nagykaldi 2005)
When did they begin?
• Initially developed as Practice Facilitators in Europe and Australia
• Introduced to North America by James Mold Director of the OKPRN.
Research
Assistant
Population Demographics
•Urban and Rural Regions (e.g. Buffalo and Akron)
•Large and Small Practices (e.g. greater than 10,000 or less than 4,000)
•Underserved Communities (e.g. Low-income )
•Minority and Refugee Populations
An Example of PEAs Working on a UNYNET Study
The PEA can overcome the barriers and create change by assisting in the facilitation of:
• The research process.
• Practice enhancements (implementation)
• Communication within and between clinical practices.
What is a Practice Based Research Network (PBRN)?
4 Control Sites
8 CRM
Intervention
Sites
If your patient is taking
the following
medications...
ACE Inhibitors
Accupril/quinapril, Vasotec/Enalapril,
Lotensin/Lotrel, Captopril, Fosinopril,
Lisinopril/Zestril, Ramipril (altace)
Diuretics
Furosemide,
Lasix/Hydrochlorthiazide/HCTZ,
Diuril, Hydrodiuril, Enduron
Cardiac Medications
Digoxin, Lanoxin
What do PBRNs do?
• Involve community-based clinicians and their staff in activities designed to improve primary care.
• They link relevant clinical questions with rigorous research methods in community settings to
produce scientific information that is externally valid, and can be assimilated more
easily into everyday practice.
You should consider
ordering
the following lab(s)…
SMA-7 (Na+, K+, Cl-, TCO2, BUN, creatinine,
blood sugar) when med is prescribed
Then after 1-2 weeks
Then SMA-7 every 12 months †
SMA-7 (Na+, K+, Cl-, TCO2, BUN, creatinine,
blood sugar) at the time med is prescribed
Then after 1-2 weeks
Then every 12 months †
Digoxin level one week after starting
Then every 12 months †
Cholesterol Medications
Lipitor, Crestor, Mevacor,
Pravachol, Zocor, Crestor
LFTs and CPK 3-4 weeks after starting
Then LFT every 12 months †
Seizure Medications
Dilantin, Tegretol, Depakote
B.
4 Sites using
CRM only
4 Sites Using
CRM with PEA
Intervention =
Crew Resource Management (CRM)
Step 1:
Measure
perception of
potential
Medication error causes
using Questionnaires
Step 2:
Team-based
Prioritization
(i.e. what safety
issues concern
them the most?)
AHRQ defines a primary care practice-based research network, or PBRN, as a group of
ambulatory practices devoted principally to the primary care of patients, and affiliated in their
mission to investigate questions related to community-based practice and to improve the quality of
primary care.
P.E.A.
• Lab monitoring reminder posters
developed by PEA to ensure that proper lab
work is ordered for corresponding
medications prescribed.
Attention Doctors
Drug level 1 week after starting
Then every 12 months †
• Easy-to-understand Medication Safety brochures developed by a PEA to increase patient education and
compliance with medications.
• Medication patient assistance program lists developed for patients to increase patient compliance with
medications.
• Cross-fertilization: Some projects implemented at PEA sites have been passed on to other cites
(e.g. medication brochures and patient assistant program lists).
• The PEAs partner with providers to create and edit guidelines.
• PEAs Disseminate the Quick Reference Chronic Kidney Disease Guide to the Primary Care Physician’s.
12 Randomized
Practices
Primary Care Physicians face the daunting task of caring for patients with chronic
diseases. With a population of patients with chronic disease comes the immediate task
of managing their care leaving little time to implement practice changes:
Barriers to change within a PCP Practice:
• Busy Offices
• Limited Staff
• Limited Patient-Provider Interaction time.
• Immediate task of managing patient care.
• Little time to re-organize or implement new projects.
PBRN
Practice
Sites
QI Projects Implemented with the Help of PEAs:
† indicates HEDIS guideline
PEA’s are incorporated within the Primary Care Setting for the purpose of facilitating
progressive changes in:
• Chronic Disease Management and
• Patient Safety
UNYNET
Office
A.
Study Objective :
Comparison of Overall Quality of Care and Medication Errors between Control
Site and Crew Resource Management (CRM) sites. Does the inclusion of a
PEA with CRM further improve the overall quality of care and assist in
reducing medication errors?
• Develop a Relationship with the
Practice.
• Help Provider and Staff Identify and
implement Practice Changes.
• Identify Best Practices
• “Cross-fertilization.”
PEAs are the bridges between the Research and Clinical
Communities.
PEA Success Stories
AHRQ Medication Safety Study:
How to reduce medication errors in clinical outpatient practices?
Quality
Improvement
Agent
PEA
• Data Management
• Chart Audits
• Patient Recruitment
and Interviews
• Attend Conferences
and Workshops
Populations Served: Primary Care Community
Step 4:
Team-Based
Implementation
Step 3:
Team-based
Solutions
How do they
Plan to address
these concerns?
PEA Keys to Success
• Let the Practice Staff Know who you are:
“As soon as the staff members understood who we were and what our intentions were, they
started to make changes on their practices.” S. Okazaki
• It is vital to involve the Practice Leader of the site. Without the leader it seemed very hard to
start making changes.
C.
Lessons Learned
• Clinicians and staff already have too much work to do.
• Practice changes (e.g. new electronic medical record system or new staff members) make quality
improvement difficult.
• Practice administrative changes creates difficulties when attempting to develop relationships with the
practice staff.
• PEAs = outsiders.
A critical part of the PEA tasks is cooperation from medical staff members. Cooperation and acceptance
may be a challenge. The staff are not familiar with "PEAs." Some of them are weary about allowing
strangers to have access to their clinic, go into their chart system, and "pick on" the service they provide
to their patients.
Solution –
First, try to observe as many things as possible (from office environment,
communication style, flow of orders, etc.). After that, try your best to let everybody
know who you are, what you want from them and what you could provide for them.
Then things should start running smoothly.
UNYNET Studies Utilizing PEAs:
Making CKD Guidelines Work in Underserved Practices
Site Survey on Asthma Guidelines
Provider Survey on Asthma Guidelines.
Making Asthma Guidelines Work in Primary Care Practices
Cross-Sectional Study if Asthma Medication Adherence.
For Comments or Questions Please contact: Elizabeth McLean-Plunkett at [email protected]