Linda Thomas-Hemak MD
December 2013
Comparative Analysis
 Team
Approach
 Information System Support
 Quality Improvement
 Population Management
 Treatment of Mental Health issues
 Self-Management Support
 Use of Guidelines
 Coordination of Care
 Patient centered care
THC-1
better than
Traditional-1
November
2011
May 2012
November
2012
Team Approach
Information System Support
Quality Improvement
Population Management
Treatment of Mental Health issues
OVERALL ASSESSMENT
Team Approach
Information System Support
Self-Management Support
Use of Guidelines
Quality Improvement
Population Management
Coordination of Care
Treatment of Mental Health issues
OVERALL ASSESSMENT
Team Approach
Information System Support
Self-Management Support
Population Management
Patient centered care
Treatment of Mental Health issues
OVERALL ASSESSMENT
THC-1
Similar to
Traditional-1
Self-Management
Support
Use of Guidelines
THC-1
Worse than
Traditional-1
Coordination of Care
Patient centered care
Patient centered care
Use of Guidelines
Quality Improvement
Coordination of Care
THC-1
better than
Traditional-2
THC-1
Similar to
Traditional-2
THC-1
Worse than
Traditional-2
November 2011
Quality Improvement
Treatment of Mental Health issues
Team Approach
Information System Support
Self-Management Support
Use of Guidelines
Population Management
Coordination of Care
Patient centered care
OVERALL ASSESSMENT
May 2012
Team Approach
Self-Management Support
Use of Guidelines
Quality Improvement
Population Management
Treatment of Mental Health issues
Information System Support
Coordination of Care
Patient centered care
OVERALL ASSESSMENT
November 2012
Team Approach
Information System Support
Self-Management Support
Use of Guidelines
Quality Improvement
Population Management
Patient centered care
Treatment of Mental Health issues
OVERALL ASSESSMENT
Coordination of Care
November 2011
THC-1
better than
Traditional-3
Quality Improvement
Patient centered care
Treatment of Mental Health
issues
OVERALL ASSESSMENT
THC-1
Similar to
Traditional-3
THC-1
Worse than
Traditional-3
Team Approach
Information System
Support
Self-Management
Support
Use of Guidelines
Population Management
Coordination of Care
May 2012
Team Approach
Information System Support
Self-Management Support
Use of Guidelines
Quality Improvement
Population Management
Coordination of Care
Patient centered care
Treatment of Mental Health
issues
OVERALL ASSESSMENT
November 2012
N/A as the Traditional-3 surveyed in Nov 2011 and May 2012 had graduated from
the program
Nov 2012
2012 THC-1
better than
2011 THC-1
Team Approach
Self-Management
Support
Use of Guidelines
Quality Improvement
Coordination of Care
Patient centered care
Treatment of Mental
Health issues
OVERALL
ASSESSMENT
2012 THC-1
Similar to
2011 THC-1
2012 THC-1
Worse than
2011 THC-1
Information
System Support
Population
Management
Nov 2012
2012 THC-1
better than
THC-2
Coordination of Care
Patient centered care
2012 THC-1
Similar to
THC-2
2012 THC-1
Worse than
THC-2
Team Approach
Information
System Support
SelfManagement
Support
Use of Guidelines
Quality
Improvement
Population
Management
Treatment of
Mental Health
issues
OVERALL
ASSESSMENT
Team Approach
THC
Traditional
Info System Support THC
Traditional
Self-Management
THC
Support
Traditional
Use of Guidelines
THC
Traditional
Quality Improvement THC
Traditional
Population
THC
Management
Traditional
Coordination of Care THC
Traditional
Patient-Centered
THC
Care
Traditional
Mental Health Issues THC
Traditional
Overall Average
THC
Traditional
Nov 2011 – May 2012
+19%
+15%
+10%
+8%
+11%
+4%
+7%
+4%
+6%
+8%
+21%
+10%
+14%
-1%
-1%
2%
+11%
+11%
+10%
+6%
Nov 2011 – Nov 2012
+19%
+14%
+13%
+8%
+14%
+9%
+5%
+6%
+9%
+18%
+19%
+13%
+6%
+7%
+6%
-1%
+7%
+10%
+11%
+8%
10%
6%
Overall Average
11%
Mental Health Issues
-1%
Patient-Centered Care
8%
Coordination of Care
10%
Population Management
4%
Quality Improvement
5%
Use of Guidelines
10%
Self-Management Support
15%
Info System Support
20%
Team Approach
Percentage Change over 6 months
25%
21%
THC
19%
Traditional
15%
14%
11% 11%
10%
7%
8%
6%
4%
2%
0%
-1%
-5%
8%
5%
6%
Overall Average
7%
Mental Health Issues
6%
Patient-Centered Care
13%
Coordination of Care
19%
Population Management
9%
Quality Improvement
10%
Use of Guidelines
14%
Self-Management Support
15%
Info System Support
20%
Team Approach
Percentage Change over 12 months
19%
18%
THC
Traditional
14%
13%
10%
11%
9%
7%
8%
5%
6%
0%
-1%
-5%
Team Approach
Information System
Support
Self Management
Support
Use of Guidelines
Quality Initiative
Population
Management
Co-ordination of
care
Patient Centered
Care
Treatment of Mental
Health Issues
Overall
Jermyn - Wayne
residents
4.60
4.14
4.88
4.83
4.92
4.55
4.94
4.80
5.00
4.74
Jermyn - VA residents
4.10
3.25
4.38
4.50
4.00
3.50
4.50
4.30
4.50
4.11
Jermyn - Susquehanna
4.40
3.55
4.47
4.61
4.33
4.07
4.58
4.67
4.83
4.39
Jermyn - Scranton
Primary
3.60
3.14
4.00
4.00
3.67
3.20
4.00
3.80
4.00
3.71
Clarks SummitScranton Primary
3.85
2.89
4.29
4.17
4.25
3.00
4.38
4.20
4.25
3.92
Jermyn - Wayne
residents: PGY2
4.50
4.07
4.42
4.28
4.78
4.70
4.50
4.40
5.00
4.52
Scranton - Scranton
Primary: PGY2
4.57
3.79
4.72
4.61
4.33
4.30
4.13
4.03
4.50
4.33
Comparative Analysis
Team Approach
Days in Jermyn
Overall Score
Treatment of
Mental Health
Issues
Patient Centered
Care
Coord of care
Pop Mngt
QI
Use of Guidelines
Self Management
Support
Information System
Support
Team Approach
November
2012
1
Information System
Support
0.685
1
Self Management
Support
0.580
0.622
1
0.675
0.582
0.736
1
0.528
0.693
0.695
0.451
1
0.710
0.942
0.459
0.505
0.598
1
0.640
0.497
0.587
0.754
0.658
0.438
1
0.447
0.497
0.470
0.671
0.568
0.492
0.819
1
0.551
0.653
0.443
0.469
0.452
0.581
0.469
0.432
1
0.808
0.873
0.761
0.806
0.785
0.818
0.812
0.762
0.717
1
0.141 -0.014
0.022
0.005
0.120
0.198
0.185
0.177
0.122
Use of Guidelines
QI
Pop Mngt
Coord of care
Patient Centered Care
Treatment of Mental
Health Issues
Overall Score
Days in Jermyn
-0.031
1
0
Coordination of Care
Patient Centered Care
Treat Mental Health Issues
Information System Support
Overall Score
Population Management
Use of Guidelines
-1
Quality Initiatives
Self Management Support
Team Approach
Negative Correlation
Positive Correlation
+1
Team Approach
1.000
Information System
Support
0.714
1.000
Self Management
Support
0.438
0.621
1.000
0.593
0.635
0.852
1.000
0.036
0.311 -0.053
0.061
1.000
0.741
0.924
0.452
0.465
0.275
1.000
0.675
0.631
0.400
0.621
0.272
0.580
1.000
0.396
0.512
0.658
0.709
0.012
0.348
0.522
1.000
0.158
0.160 -0.193 -0.058
0.168
0.149
0.260
0.229
1.000
0.761
0.879
0.333
0.779
0.813
0.734
0.336
Use of Guidelines
QI
Pop Mngt
Coord of care
Patient Centered Care
Treatment of Mental
Health Issues
Overall Score
Days in Jermyn
0.683
0.802
-0.010 -0.276 -0.140 -0.058
0.052 -0.313
0.204 -0.287
Days in Jermyn
Overall Score
Treatment of
Mental Health
Issues
Patient Centered
Care
Coord of care
Pop Mngt
QI
Use of Guidelines
Self Management
Support
Information System
Support
Team Approach
November
2011
1.000
0.305 -0.060
1.000
Treat Mental Health Issues
Coordination of Care
-1
Quality Initiatives
Team Approach
Use of Guidelines
Overall Score
Self Management Support
Information System Support
Patient Centered Care
Population Management
Negative Correlation
Positive Correlation
0
+1
Comparative Analysis
 We
conducted a survey to assess the
understanding of Quality and Patient safety
amongst the first year residents that
included both THC and Traditional track
residents in September 2011
 The data was aggregate and did not look at
differentiating the THC vs. Traditional track
residents
 The same survey was re-administered in
September 2012 to the same group of
residents who had transitioned to Year-2 of
their training
 The
comparison showed an improvement of
8% over time. The limitation of these results
being that the results do not allow us to
compare the effectiveness of THC vs.
Traditional tracks
 The researchers have identified this
limitation and will focus on this during the
next surveys
Comparative Analysis
WCGME THC Consortium – Initial Development 2011
Medicare GME
Fund
10.7FTE
Veteran Administration
Hospital GME Fund
11 FTE
HRSA Teaching
Health Center
Fund
10.3FTE
5 VA Funded FTE
Mercy
hospital
Community
Medical Center
Moses Taylor
Hospital Participating Institutional Affiliates
13 FTE
13 FTE
13 FTE
39 Hospital
Funded FTE
The Wright Center for
Graduate Medical
Education:
A 501(c )3 not-for-profit
ACGME/AOA Accredited
Sponsoring GME
Institution/Consortium
50 FTE IM Residency
Program
6 THC Funded
FTE/year
1 FTE
4FTE
The Wright
Center Medical
Group
Wayne
Memorial
Community
Health Center
FQHC*
Group A
Group B
1 FTE
* NEW FQHC Based Learning Environments
**Established Internal Medicine Learning
Environments
Scranton
Primary Health
Center*
2 FTE
Wright Center
Primary Care
Scranton**
2 FTE
Wright Center
Primary Care
Mid-Valley**
Chart 1: WCGME THC Consortium Resident FTE Cost Center Funding Relationships for 2012 with Teaching Health Center Expansion Year 1
Medicare GME
Fund
10.7FTE
Veteran Administration
Hospital GME Fund
8.5 FTE
Regional
Hospital
10.3FTE
Community
Medical Center
5 VA Funded FTE
HRSA
Teaching Health
Center Fund
Established
12 THC FTE
*
**
***
16 FTE
1 FTE
Northeast PA
Community
Health Center
FQHC***
(NEPACHC)
Moses Taylor
Total Participating Hospital Affiliates’
Funded FTE Slots
13.5 FTE
4 FTE THC
Expansion
13.5 FTE
43 Hospital
Funded FTE
(4
FTE > FY2011)
Established WCMG Internal
Medicine Learning Environments
2011 Established THC FQHC-Based
Learning Environments
New 2012 FQHC and M&FHS Based
Learning Environments in the
Planned THC Expansion
2011 Established THC site FY2012 FTEs
2012 Proposed Expansion THC site FTEs
• Continuity Groups A-D defined as
groups of individual THC residents
having Ambulatory Continuity Training
Education in 2:1 ratio between a
designated WCPC and FQHC site
• 2011 Established Continuity Groups
• 2012 Proposed Expansion Continuity
Groups
The Wright Center for
Graduate Medical Education,
a 501(c)3, not-for-profit
ACGME/AOA Accredited
Sponsoring Institution and
GME Consortium:
2012 Projection of
64 FTE IM Residency Program
1/3 FTE Female
Health
Maternal and
Family Health
Services
(M&FHS)***
4 FTE
Wright Center
Primary Care
Scranton*
(WCPC-S)
Continuity
Resident
Group
GroupBB
The Wright
Center
The
Wright
Medical
Center
Group,
PC
Medical
(WCMG)
Group,
P
Continuity
Resident
GroupCC
Group
2 FTE
Wright Center
Primary Care MidValley*
(WCPC-M)
4 FTE
Continuity
Resident
Group
Group
D D
2 FTE
Scranton
Primary Health
Center**
(SPHCC)
1/3 FTE Oral
Hygiene***
The combined venues for curriculum expansion to benefit all THC track residents = 1 Expansion FTE = 2
Individual THC track Residents with Ambulatory Continuity experience defined as Group D
Resident
Continuity
Group A
Group A
2 FTE
Wayne Memorial
Community
Health Center
FQHC**
(WMCHC)
1/3 FTE Primary
Care Psych***
WCGME THC Consortium 2012 Training Model
WCGME THC Consortium – Regional Family Medicine 2013
WCGME THC Consortium – National Network for Family Medicine Residency Training 2013
WCGME THC Consortium – Interdisciplinary Model for All Regional Residency Training