# Presentation: 512058

## How Can New Practice Models for Primary Care Help Community Preparedness?

- Tricia Trinité, MSPH, APRN; Sally Phillips, PhD, RN; Helen Burstin, MD, MPH; Therese Miller, DrPH

- Agency for Healthcare Research & Quality
- National Prevention Summit
- Washington DC
- October 27, 2006

## IOM “Crossing the Quality Chasm” Report

- Six goals proposed to improve preventive services and health care delivery:
- Safe
- Effective
- Patient-centered
- Timely
- Efficient
- Equitable
- How do we get there?

*Quality Chasm Series: Transforming Health Care Quality, January 2003*

## Improvement based on new models of health care 

- Evolving new practice models include the following and result in prepared/proactive clinical teams and informed/activated patients:
- Patient self-management support
- Health Information Technology/Registries
- Clinical decision support
- Full use of multi-disciplinary teams
- Linking clinical practice with community based programs: Partnerships, Communication and Coordination

## Model Elements How can these elements assist with Preparedness?

- Health information technology/registries:
- Able to search practice populations and proactively reach patients that need preventive care, such as immunizations and screenings
- Electronic personal health records
- Clinical decision support
- Electronic prompts and references available when needed, such as at the point of care
- Tools and processes to assist clinicians do the right thing at the right time for patients– such as evidence-based clinical preventive services

## Model Elements How can these elements assist with Preparedness?

- Patient self management support
- Prepare and support patients to manage their own health and health care
- Diabetes education and self-care
- Community Health Workers (CHW) reach out to the community supporting health and wellness. Promote health, enhance communication and connection to clinical providers.
*Additional CHW support to promote self-triaging and self-care during emergencies related to health needs*

## Model Elements How can these elements assist with Preparedness?

- Community Resources and Clinical linkage
- Form partnerships with community organizations to support and develop interventions that fill gaps in needed services
- Community health workers facilitate linkages with community programs

## Emergency Preparedness Examples

- Surge Capacity
- The ability of a health care system to rapidly expand beyond normal services to meet the increased demand for medical care and public health services in the event of a public health emergency or disaster.
- Symptom/Syndromic Surveillance

## Voluntary Shelter-in-Place through Community Health Call Centers

**Goal:** To develop, implement and test a model to reverse engineer patient call centers, such as poison control centers, nurse call lines, etc, to support home care/shelter-in-place approaches in certain mass casualty incidents.

## Voluntary Shelter-in-Place through Community Health Call Centers

- Using protocols and algorithms developed for certain scenarios, the model will be used  to advise community members how to identify symptoms, call in, be managed in homes or on site ( ie: schools, businesses) potentially with home/ on-site visits, blood assessments, tele-health systems, and seek care within the primary care networks
- This community strategy will enhance surge capacity by managing a segment of the population at home or on site at a school, place of business or other sites

## Practice-Based Research NetworkSymptom Surveillance Project

- Launched by the Cincinnati Pediatric Research Group, which includes 45 providers in 22 practices
- Web-based surveillance system
- Facilitates communication between community providers and government agencies which monitor health data
- Regular two-way communication allows tracking of both naturally occurring and intentional outbreaks

## Symptom Surveillance Project

- Providers enter data about prevalent symptoms and any unusual cases presenting to them
- Interactive computer graphs enable physicians to view customized snapshot of symptoms prevalent in their region which they can compare with what they are seeing in their practice
- Weekly online data collection on password protected site takes about 10 minutes to complete
- Involving community providers in responding to a potential public health emergency
- Allows for timely detection of disease outbreaks

## Syndromic Surveillance

- Institute for Urban Family Health
- Health Center - medically underserved in New York City
- 180,000 primary care visits / 60,000 patients
- Fully paperless since September 2002
- Epic Electronic Health Record (EHR)

- Source: Neil Calman, MD

**Notes:**
Through a small grant, the IUFH implemented, PHINMS – a secure data transfer mechanism (encrypted). PHINMS enables the IUFH to transmit a nightly data abstract to the health department. Because the IUFH is paperless, there is very little lag time from encounter to entry.

## Single patient visit yields complex EHR data

- Patient Address
- Race / Age / Gender
- Medical history
- Provider Location
- Reason for visit
- Problem list

- Temperature
- Height/weight
- Respirations
- Procedures
- Medications
- Lab results
- Diagnoses

- Source: Neil Calman, MD

## Fever AND respiratory syndrome

**Fever AND respiratory syndrome**

**Blue    = ER “flu/fever”**
**Brown = EHR T****≥ 100****o ****and                                                         ****	****Respiratory Syndrome**

- Source: Neil Calman, MD

**Notes:**
The spike over base line is more pronounced for the EHR fever/Resp syndrome. with an increase from about 0.06 to 0.24 (or fourfold) for just fever. And a 0.06 to 0.42 increase (or sevenfold) for the combination syndrome. The is shows a clearer signal. It also appears to be an earlier signal.

## Practice Alert in EHR for age < 18 yo, relevant Sx/Dx, requests provider to do viral stool culture and call DOH for immediate pick-up and viral ID by DOH lab

**Practice Alert in EHR for age < 18 yo, relevant Sx/Dx, requests provider to do viral stool culture and call DOH for immediate pick-up and viral ID by DOH lab**

**DOH receives signal of outbreak of diarrheal illness in children**

- Source: Neil Calman, MD

**Notes:**
And that is to integrate epidemiologic data into clinical care. For example knowledge of respiratory disease in the community can help provide epidemiologic awareness to clinicians. This could be through the incorporation of timely surveillance information into diagnostic and treatment decisions (for example, influenza surveillance and upper respiratory infections.

Note to self:
Pharyngitis is caused by a variety of microorganisms. Most cases are caused by a virus, including the virus causing the common cold, flu (influenza virus), adenovirus, mononucleosis, HIV, and various others. 

## Partnering for Preparedness

- Emergency preparedness professionals need to dialog with primary care professionals
- Create common language and coordination
- Including HIT as possible and when needed
- Consistent message to communities may help to instill confidence during emergencies
- Avoid waste and duplication
- Leverage resources and new developments in the field of primary care and preparedness
- It is about relationships