Advisory Committee Ad Hoc Group
Strategic Planning Call
March 21, 2014
On the call:
Greg Prazar, Dale Lea, Natalie Mikat-Stevens, Kate Reed, Michele Roberts, John
Moeschler, Monica McClain, Peter Antal, Karen Smith
Overview - how did we get here
 NEGC suspended medical home activities after Carl Cooley resigned. Now thinking of how to
augment activities focusing on care coordination
 Became involved with GPCI when a NE practice (Dr. Peter Kenny) participated in their QI
learning collaborative (Michele Roberts was mentor)
 Last December our advisory committee discussed medical home and the potential to
o utilize existing network in northern NE
o offer MOC modules (at AAP state chapter meeting or other venues)
 Purpose of this call is to advise us on how to move forward
Introductions
 Monica – background in epidemiology, interest in collaborations to move projects forward
 Greg – pediatrician, president of NH AAP, on NEGC committees, worked on medical home work
with Carl, really love GPCI projects
 Kate – recently joined Jackson Lab for clinical continuing education program, before that was at
NCHPEG which closed. Interested in collaborations, working on family history, risk assessment
for cancer for primary care. Met Monica recently.
 Dale – ME, advance practice nurse in genetics, working on ME genetics plan; visiting ME schools
of nursing, integrating genetics into curriculum.
 John – medical geneticist at Dartmouth and co-PI of NEGC, was seminar leader with GPCI
 Peter – NEGC evaluator
 Natalie – working with GPCI which is coming to an end at the end of May
GPCI QI project – Natalie
Overview
 Two goals: 1) collecting family history; 2) managing their patients with diagnosed genetic
conditions and improving care
 10 month project, of that there was 6 month action period and lots to do
 Diverse group of practices; need to obtain buy-in
 Identified mentor (Michele Roberts for NE) paired with a practice (Dr. Peter Kenny for NE)
 Didn’t collect patient outcomes but GPCI knows they were successful
 Have recommendations and best practices – small tests of change
Genetic Family Health History
o Collect info
o Document in chart
o Discuss with family and have follow up plan for families with positive history
Discussion
 Didn’t collect on things like obesity, asthma; collected on things like family history with genetic
defect, any family member have 2 or more miscarriages (components developed by expert
consensus)
o Greg – wouldn’t have thought to ask about miscarriages – big learning curve
o Kate –to know how to implement they have to narrow it down; what were they told
about what they should ask; what they should say after
o Natalie - they wanted to keep it small so it wasn’t so cumbersome
 Natalie noted Dr. Peter Kenney has continued to work with them
 John agreed GPCI did high quality work
Managing patient care
 Practices were given list of codes for genetic conditions, asked to create patient registry
o provide services applicable for the condition (following guidelines, including transition)
 emergency plans, special ed, etc.
o payment discussions
 practices ranged in size from 50-500 patients
 Some practices never heard of gen counselor before, so this helped them get connected, more
appropriate utilization of genetic services
 Most interesting finding was that they were following genetic health guidelines
 Dissemination –
o There will be publications - change package – lessons learned, what worked.
o Incorporating into a free toolkit which will be available this spring. User friendly, can be
replicated.
Discussion
 Greg – how long it took to take to do family history?
o Natalie –1) less than 10 minutes
 Greg – was it done on paper or electronically?
o Some used paper and had families pre-fill it out with help of a nurse, some used
electronic portal
 Greg – was it done on all families?
o Yes, but not all at once. Practices used different strategies. For ex., they started by
doing all newborns (around 2 months worked best).
o 1 size does not fit all, and they are not recommending just one family history form
o GPCI gave list of sample questions and sample format, and doctors could choose.
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Greg noted that the topics covered by GPCI are important for practicing pediatricians as well as
residents in training.
What makes sense for NEGC going forward?
Group discussed potential activities.
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Collaborating through QI / MOC activities
o On call in Dec. we discussed pediatric improvement projects. Judith Shaw has
experience in VT. NH has activities. Dale mentioned visiting nurses programs in ME.
o NEGC doing QI with genetics community / metabolic centers
Could we recruit ped practices to extend GPCI model?
o Greg – what works for ped practices is to hear how other practices used and
benefited
o Kate – not focusing just on adults, some projects applicable to ped primary care.
Jackson Lab would like to help develop and implement plan. They have expertise in
clinical decision support tools, but don’t have as many local contacts.
What is best way to provide education that we can couple with QI?
o John – lots of confusion about microarray so education /support tools are helpful
(who should do what, when)
o Greg – peds don’t always think about cost but it’s another important piece
o Dale – pharmacy genetics and genomics – testing to see if people will respond to
drug / what dosage
o Kate – Gene Facts (www.genefacts.org ), or something online that would help
clinician on relatively common genetic conditions. Written by geneticist. This could
be expanded. Not a lot of resources. Could be a part. Somewhat like GEMSS but
focuses on heath rather than education.
Discussed further funding for GPCI – if NEGC collaborates, will you be there after May?
o Natalie – haven’t heard about continued funding. Meeting with Joan Scott at HRSA
soon. AAP as an org will still have section on genetics, & has QI section.
Greg – Is there a PROS study we could do? We’d have to make proposal.
Discussion of next steps
Interests
 John - extending GPCI model in a few practices in NE
 Greg - MOC part IV is important and creates a potential market. Noted this was attached to GPCI
pilot.
 Natalie – nice to do EQUIP module though expensive. Dr. Nichols is president of AAP.
o Greg will see Dr. Nichols next week and will bring it up.
 Greg – working 3 states today would be a great idea (ME, NH, VT)
o
Monica – we’ll follow up on this idea
John proposed the group forming as ad hoc.
 Greg – yes
 Kate – yes, this will help her work as well
 Dale – phys assistants important group as well as nurses
Are MOC Part IV hard to get, could NEGC do it?
 Natalie - yes, NEGC could apply via AAP.
 Greg – usually involves project that takes 3-4 months to do. Document what you started with,
what you did, what changed
 John – would also be good to get our QI activities MOC. John said we’ll follow up with GPCI re:
QI.
 Natalie – their project was ambitious; recommends we cut it in half, do a better job of recruiting
Discussed gathering at the annual meeting. Perhaps after Advisory.
Other:
 Natalie will contact Dale to be a reviewer on NAFNAT curriculum which is under development.