Practice Transformation

Practice Coaching has become an important tool in improving primary care. Practice Coaches (interchangeably called Practice Facilitators) assist primary care practices and clinics to improve using the Building Blocks model. CEPC provides direct coaching to practices undergoing transformation.

Spreading Adoption of eConsult in the Safety Net (2015-2016). eConsultation and referral systems (eCR) are delivery system innovations that enable primary care providers and specialists to consult electronically about a patient’s conditions, determine the optimal manner of care, and engage in effective co-management of patient conditions. Pilot testing of eCRs has taken place at San Francisco General Hospital, the University of California, San Francisco, the Los Angeles Department of Health Services, and the L.A. Care Health Plan. The strong successes of eCR models in Los Angeles and San Francisco has generated interest in adoption of the model from safety net healthcare providers around the state. This interest is heightened by the expansion of Medi-Cal enrollment to over 11 million people, which promises to increase demand for access to specialty care by vulnerable Californians. The Center for Innovation in Access and Quality (CIAQ) at UCSF-SFGH is partnering with the CEPC and Community Partners to provide technical assistance to 6 California county systems on various stages of eCR design, implementation, adoption, spread and sustainability, with the goal of creating efficient and robust eCR systems throughout the safety net in California (A Blue Shield of California Foundation Grantmaking Initiative).

Developing a Model for High-Performing Primary Care Teaching Clinics: A Roadmap to Excellence in Teaching Environments (2014-2015). Central to fulfilling the CEPC mission is a focus on the primary care pipeline and optimizing undergraduate and graduate medical education as they relate to primary care specialties, thereby bolstering and sustaining interest and satisfaction in primary care. As we have applied the Building Blocks, we have identified the need to differentiate how they relate to or are modified for primary care teaching practices, which train the future generation of primary care clinicians. Our goal is to identify best practices among high-performing primary care teaching practices in order to develop a model for transformation that can serve as a practical blueprint for other teaching practices to provide the optimal experience for students, residents, staff, and patients alike. Funded by the Josiah Macy Foundation.

10 Building Blocks Coaching program. In collaboration with the San Francisco Health Plan (SFHP), UCSF’s Center for Excellence in Primary Care (CEPC) is offering practice coaching to 28 clinics in San Francisco to transform Primary Care. The goals of the 10 Building Blocks Coaching program are to improve patient experience and patient health by implementing measurable and sustainable changes that support primary care clinics in delivering high-quality care to patients. Participating clinics are assigned a practice coach who meets regularly with the clinic’s improvement team and the project lead to implement components of the 10 Building Blocks of High-Performing Primary Care. Practice Coaches will focus on building clinic capacity to ensure that changes are sustainable. This means their role will be as trainers and facilitators, not doers. Coach support ensures that everyone keeps their eyes on the prize - positive outcomes in patient health and patient satisfaction. Supported by San Francisco Health Plan and the Metta Foundation.

PHASE (Preventing Heart Attacks and Strokes Everyday) is a program first implemented by Kaiser Permanente to follow evidence-based cardiovascular and diabetes guidelines in day-to-day practice. This program combines the use of four affordable and effective heart protective medications with promotion of healthy lifestyle changes and attaining control of three cardiovascular targets. In addition, this program has helped to expand use of panel management, as clinical assistants take responsibility for identifying and closing care gaps for patients at risk of cardiovascular complications. Since 2008, the San Francisco Department of Public Health (SFDPH) and the UCSF Center for Excellence in Primary Care has received support from Kaiser Community Benefits to provide support to seven Department of Public Health clinics to help them implement panel management. They are beginning work in an eighth site. This funding has improved IT infrastructure through widespread use of the i2iTracks registry and automated transfer of vital signs. PHASE has also been a vehicle for implementing panel management and using clinical data to guide interventions. Supported by Kaiser Community Benefits.

The Data Wall is intended to make data about patient care visible, help health center teams take pride in their successes, and identify areas needing improvement. CEPC and the San Francisco Department of Public Health's Community Oriented Primary Care Team developed a system-wide "Primary Care Data Wall" of quality measures and implemented a system for ongoing distribution and display of the data using both a bulletin board display in each health center and, at some health centers, a web-based electronic display. The Data Wall highlights 15 common quality measures and features a quality metric of the clinic’s choosing. These 15 measures cover many aspects of quality including clinical quality, access and operations, as well as patient and staff satisfaction. Additional explanatory panels on how to read the data, how to use the data, and where the data comes from have been developed to familiarize all clinic staff with data. The Data Wall has been rolled out at many of the San Francisco Department of Public Health primary clinics and is scheduled to roll out at additional sites in the coming year. This project was funded by a grant from Kaiser Community Benefit.

San Francisco Health Network Nurse Role Transformation Initiative. The San Francisco Health Network has been leading the way in the nation to optimize the role of the RN in the ambulatory care setting. The goals are for RNs to become fully integrated members of the care team working at the top of their scope and licensure to improve patient outcomes; to develop clear protocols and standards, and to enhance RN recruitment, retention, and joy of work. Initial efforts have focused on developing nurse leadership and visibility throughout the network with the creation of a year-long nursing leadership academy and extensive chronic disease management training for all nurses in the network. UCSF’s Center for Excellence in Primary Care (CEPC) is assisting with the development of an implementation plan that clearly outlines the tasks, responsibilities, resources and timing of the proposed expanded role plan.

Patient Advocacy is work of the Team Up For Health project, by which CEPC has supported the creation of a Patient Advisory Board for the Family Health Center at San Francisco General Hospital.