Paige Hatcher, MD
- Diplomate, ABFM
- Preventive Medicine Resident, OHSU
- MPH Candidate, PSU
- Health Policy Fellow, OHA

• Addresses population health through the lens of primary care
• Evidence-based protocols and to provide selfmanagement support
• Systems to standardize care using a team-based approach
• Designing a system that “remembers” and prevents errors of forgetting
Neuwirth, E. B., Schmittdiel, J. A., Tallman, K., & Bellows,
J. (2007). Understanding Panel Management: A
Comparative Study of an Emerging Approach to Population
Care. The Permanente Journal, 11(3), 12-20.

• Dedicated physician time for directing clinical decision making
• Dedicated staff members or staff time to support physicians and conduct outreach
• Information-technology tools to identify care gaps
• Structured work processes completed on a routine basis

• Patients mostly like it
• Mostly implemented without new funding (some require resource shift)
• Wide-scale dissemination through entire facility/area
• Focused on a particular disease or high-risk group
• 45-180 min PCP time reserved per provider per month

• Requires a shift in thinking
• “It doesn’t make my day easier, but it makes my day better”.
• “Giving me hope that some of my more difficult patients might actually turn around their health status”.
• Biggest change to MA and support staff roles, but they welcomed the opportunity for job growth.
• Less face to face time can be dissatisfying.
• Patients worry decisions aren’t being made by their doctors

• Physicians feel like they are losing control
• Imperative to respond with demonstration of performance improvement
• Champions
• Warm handoffs

• Often incentivized by a performance payment opportunity
• Should be evidence-based, simple, and clear
• Aim for incremental improvement

• Identification of patients with particular need
• Review of list generated for appropriateness for inclusion
• Treatment decision
• Follow up communication with patient

Example: I want all my patients to be upto-date on cervical cancer screening
• Generate First List
• Women 21-29 with an intact cervix and no pap result for the last 3 years
• Women 30-65 years with an intact cervix and no
HPV result for the last 5 years*
*This should be tailored to your practice, if you haven’t been doing mandatory HPV testing, then it will be “no pap result for the last 3 years” 1

• PCP Reviews list for appropriateness of inclusion
• Outreach to schedule patients, correcting chart where needed if Pap has been done somewhere else
• Run the list again (time interval TBD) and compare N, report results as appropriate
• PCP reviews the list again
▫ Then, start outreach to new group, adjust tactic, etc.

Best Sources for Evidence
National Guideline
Clearinghouse http://www.guidelines.
gov/

Best Sources for Evidence
US Preventive Services Task Force (USPSTF) http://www.ahrq.gov/clinic/uspstfix.htm

Best Sources for Evidence
National Institute for
Health and Clinical
Evidence (NICE)
(England and Wales) http://www.nice.org.u
k/

Patient Information
Choosing Wisely ® campaign http://choosingwisel y.org/

• Patient- children or adults, pregnant women, patients with a specific chronic disease or problem
• Intervention- prevention, diagnosis, treatment
• Comparison- standard practice, placebo, alternative therapy
• Outcome- acute or chronic http://libguides.ohsu.edu/content.php?pid=25570
9&sid=2879578

PubMed MESH search
If you search for “pap smear” and “screening” in PubMed, you get 15515 results.

• ABFM MC-FP Part IV modules are Performance in Practice Modules (PPMs), which are designed as a Quality Improvement activity which takes place over a one week period

1. Saslow, D., Solomon, D., Lawson, H. W.,
Killackey, M., Kulasingam, S. L., Cain, J., ... Myers,
E. R. (2012). American Cancer Society, American
Society for Colposcopy and Cervical Pathology, and
American Society for Clinical Pathology Screening
Guidelines for the Prevention and Early Detection of Cervical Cancer. Journal of Lower Genital Tract
Disease, 16(3), 00-00.