Transcript MA Responsibilities Working to top of licensure - PCMH e

AF Williams MA scope
in the APEX Model
Corey Lyon DO
Medical Director, AF Williams FMS
Associate Program Director
Brief Overview
• Implemented the APEX model of primary care
– Modeled after University of Utah “Care By Design”
• Goals of new model
– Ensure all team members are functioning at the top of
their scope and ability: right job; right person
– Improve patient, provider, and staff satisfaction
– Improve access
– Build on the culture of quality and team based care
– Improve the health and health care of our patients and
their families
www.medschool.ucdenver.edu
Brief Overview (cont)
• 5 MAs to 2 provider ratio
• MA stays with pt during entire clinic visit
• MA stays in room to assist with documentation, and
implementing plan
• MA completes post-exam tasks, provides after visit
summary
www.medschool.ucdenver.edu
Goals of new model
•
•
•
•
•
•
MAs collect/update patient information
Identify gaps in care, tee up orders
Documentation assistance
Greater In-Basket support
Reduce patient waiting time
Everyone practices at top of scope
www.medschool.ucdenver.edu
www.medschool.ucdenver.edu
www.medschool.ucdenver.edu
www.medschool.ucdenver.edu
www.medschool.ucdenver.edu
www.medschool.ucdenver.edu
Changes in MA practice
• Instituted PARTy (Patient Arrival Time – yay)
– 20 minutes before provider scheduled time
• Detailed PMH/PSH/Social/FH in EPIC
• Update pt demographics (used to be done at front
desk)
• Agenda setting (with chief complaint)
www.medschool.ucdenver.edu
www.medschool.ucdenver.edu
www.medschool.ucdenver.edu
Changes in MA practice (cont)
• Detailed med recon
– Removes
•
•
•
•
•
patient reported meds no longer taking
meds placed in error
Duplicate (ie same med, but 2 doses)
Therapy completed
Old prescriptions (original Rx >12 months)
– Pends medications needed refilled
www.medschool.ucdenver.edu
www.medschool.ucdenver.edu
Changes in MA practice (cont)
• Completes orders based on protocol
–
–
–
–
–
–
–
UA
HCG
Strep
A1c
pulse ox
Flu
peak flows
www.medschool.ucdenver.edu
Changes in MA practice (cont)
• Gaps in care
– Orders and pends any test/services overdue based on
the Health Maintenance Module in EPIC
•
•
•
•
Lipids
Colonoscopy
DM test – A1c, monofilament, creatinine
Imms (eventually)
www.medschool.ucdenver.edu
Changes in MA practice (cont)
• HPI and ROS documentation support
– Use “xfiles”
• Preloaded questions and ROS for symptoms or diseases
www.medschool.ucdenver.edu
www.medschool.ucdenver.edu
www.medschool.ucdenver.edu
Changes in MA practice (cont)
• Post exam
– Completes any tasks in the room (blood draws,
immunizations, etc)
– Makes follow up appts in the room
– Prints AVS and reviews with patient
– Escorts pt out of the clinic
www.medschool.ucdenver.edu
Changes in MA practice (cont)
• In-Basket Management
– All messages (except symptomatic triage calls) go to
MAs
– MA address as much as possible
• Call pt for more information
• Pend any orders
• Draft pt requested letters
– Then forward to provider as needed for sign offs,
additional information, etc.
www.medschool.ucdenver.edu
Road Bumps
• Not fully staffed
– Short 6 MAs
– Good staff hard to find and retain
– Lots of training
• No in-room support due to shortage
– Leads to post exam communication issues
• Lose continuity
• Culture shift
– UCH culture, change in provider practice, MA practice
www.medschool.ucdenver.edu
Next steps
• Measure provider and staff satisfaction
– Survey planned in June
– Sense of increase in MA satisfaction
• Most frustration with post exam communication
• Following other metrics
– Time to note completion, colonoscopy orders, pt
touches, time to In-Basket tasks, etc
• Move to full model
www.medschool.ucdenver.edu
Questions
www.medschool.ucdenver.edu