Improving Your Health Care: A New Approach

May you live in interesting times…ancient curse

These are interesting times indeed for primary care medicine.
A recent study by The Commonwealth Fund Commission estimated that up to 150,000 lives and $100 billion dollars could be saved annually if primary health care reached higher performance levels (1).

More than two decades of accumulated evidence has revealed that having a primary care physician:

  • Reduces illness days and deaths caused by cardiovascular and pulmonary diseases
  • Decreases use of emergency departments and hospitals
  • Improves preventive care
  • Improves detection of breast cancer
  • Reduces the incidence and mortality caused by colon and cervical cancer
  • Fewer tests, higher patient satisfaction, less medication use, and lower care-related costs
  • Reduces health care inequalities, particularly for populations with wide income variation, including improved vision, more complete immunization, better blood pressure control, and better oral health (2)

Yet, in the United States of America, while leading the world in total per capita health care spending, we lag behind nearly all other industrialized nations in quality of primary care services and suffer accordingly with high rates of preventable diseases.

Not surprisingly, as support for primary care services in this country has fallen, fewer doctors in training are choosing to become Family Physicians, General Internists and Pediatricians, the primary care specialists. The American Academy of Family Practice and the Institute of Medicine have predicted a collapse of primary care if changes do not occur (3). We appear to lack the political will to reorient our health system to primary care and to provide coverage and access to health care for all America.

The “New Model of Care”

However, the news in primary care is not all bad. Despite the stresses, and perhaps in part because of them, primary care physicians have been forced to reevaluate their work and to determine its true value to those that they serve, their patients. A new focus on quality with measurable improvements in health outcomes is driving physicians and health systems to define a “New Model of Care” that is patient-centered, safe, timely, effective, equitable, and efficient.

A pioneer in this effort, Dr. Ed Wagner, M.D., has described “The Planned Care Model”. This model of care, developed with the support of The Robert Wood Johnson Foundation and the MacColl Institute for Healthcare Innovation identifies the essential elements of a health care system that encourage high-quality care. These elements are the community, the health system, self-management support, delivery system design, decision support and clinical information systems.

Planned Care Model

Family Medicine of Port Angeles has embraced the planned care model while pioneering the use of the electronic health record on the North Olympic Peninsula. We have been measuring and improving the health statistics of the thousands of patients we care for and are redesigning our clinic to continue to provide measurable improvements in care. These changes are designed to streamline the process of care while fulfilling our mission: To provide our patients with the highest quality primary care in the world.

We are especially dedicated to developing a clinical model that brings informed, activated patients in contact with a prepared, proactive practice team to have productive interactions and improved health outcomes, as envisioned in the planned care model.

What characterizes an “informed, activated” patient?

  • He or she understands the disease process, and realizes his/her role as the daily self manager.
  • Family and caregivers are engaged in the patient’s self-management.
  • The physician is viewed as a guide on the side, not the sage on the stage

What characterizes a “prepared” practice team?

  • At the time of the visit the people, patient information, equipment, decision support, and time are available to deliver evidence-based care and self-management support.

What are productive interactions and improved health outcomes?

  • Productive interactions in the primary care setting translate into fewer cancers, fewer chronic diseases such as diabetes, and decreased catastrophic events such as heart attacks and strokes. Feeling better and living longer in a state of good health are goals we can work towards together.

How are we doing?

  • At Family Medicine of Port Angeles we are “thinking prevention” for every patient at every opportunity, even when you are not present in our office. These are our latest health outcomes data. They are derived anonymously from all of our patients with the stated health conditions.

Your Personal Medical Home

At Family Medicine of Port Angeles we seek to provide our patients with a medical home where they are known and their health care needs are taken care of efficiently and with high quality. We provide our patients the following services:

Urgent care
If you are sick or injured call us for an appointment. Same day service is available. For life threatening illness please call 911 for emergency care.

  • Diagnosis and management of new injuries and illnesses, with referral to the Emergency Room or specialty care as appropriate.
  • Management of chronic illness (such as diabetes or heart failure) flare ups.

Planned care
At Family Medicine of Port Angeles we are proud to provide these services to people of all ages.

  • General health assessment.
  • Preventive Care.
  • Patient education and support for self-care and health promotion.
  • Diagnosis and management of chronic diseases (high blood pressure, diabetes, high cholesterol, arthritis) including referral to specialists.
  • Integration of personal health care and patient advocacy (care management in a complex health system).
  • Supportive care, including nursing home and end-of-life care.
  • Primary mental health care.
  • Obstetrical care.
  • Quality improvement and practice-based research.

Your Clinic Visit

High Quality Care without waiting is the goal we strive for. It takes commitment and planning from activated patients and prepared, proactive practice teams to make it work.

Urgent Care: If you are ill, an appointment will be offered on the day you call. Please call (360) 452-7891 for an appointment. Plan on spending 5 to 10 minutes with your provider during a typical Urgent Care visit, but you may spend additional time with other staff during diagnosis or treatment. For life threatening illness please call 911 for emergency care.

Planned care: Appointments are typically scheduled in advance, focused on a single problem such as diabetes or high blood pressure, and are improved by preparation. Whether you are completely healthy or are living with a health condition such as high blood pressure, diabetes, or a heart condition, preparation is important to get the most out of your visit. Plan on spending 5 to 10 minutes with your provider during a typical Planned Care visit, however you may spend additional time with other staff during diagnosis or treatment.

  • Know the purpose of your visit, (which medical problem will you be focusing on?). Are you following your Activation Rx! Care Plan?
  • Get your labs done 3-5 days before your visit. We will have results available to discuss at the time of your visit.
  • If you are monitoring blood pressures, blood sugars, or other clinical information at home, please be sure to bring your journal.
  • Do you know your medications? Please bring up to date information on medications and health supplements you are taking.
  • Has your insurance plan changed?

A special type of planned care visit is the annual preventive care exam.

All visits: High Quality Care without waiting is a goal we can strive for together. Please see your provider as soon as possible for each new health issue. Lists of problems saved up over months make time management in the office difficult or impossible, thereby making your visit rushed, disorganized and decreasing quality of care for you or those following you. Every problem you bring to our attention will be worked up thoroughly. You may find answers to many of your health concerns in our patient resources section.

Your prepared, proactive practice team will be preparing for your visit.

During your appointment we will:

  • review your preventive care needs.
  • print, review, and organize lab tests and other reports.
  • provide printed copies of your reports and discuss the results.
  • update all of your prescriptions to last until your next planned care visit.
  • schedule follow up or needed planned care appointments.

Preventive care is most effective when scheduled at regular intervals. An important part of your health care visit is scheduling your next appointment!

Medication refills: are done as a part of your planned care visits. If you are running out of medication it is time for a planned care appointment directed at the problem for which you take the medication. At each planned care appointment we will refill all of your medications to last until your next planned appointment. If your medication supply is low with no more refills it is time to visit your provider for preventive care or chronic disease management (Planned Care). Please call for an appointment 2-3 weeks before you run out of medication.

1 The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from a National Scorecard on U.S. Health System Performance, The Commonwealth Fund, September 2006

2 American Family Physician, August 1, 2004 by Robert L. Phillips, Jr., Barbara Starfield.

3 NEJM Volume 355:861-864 August 31, 2006 Number 9 , Primary Care — Will It Survive? Thomas Bodenheimer, M.D.