University of Utah Health Care

Redesigning Primary Care Delivery

To address changing needs of both providers and patients, University of Utah (U of U) Health Care’s community health clinics have redesigned their primary care systems with emphasis on health information technology and patient education. This modified strategy of care delivery emphasizes care management - as opposed to disease management - and aims to control costs and produce better patient outcomes. U of U’s primary care delivery system is now organized around three key principles: access to care, care in teams and planned care.
 
Care by Design involves an integrated system in which acute, chronic and preventive care are overseen by a team of providers, including a primary care physician, nurses, physician assistants, pharmacists, medical assistants, and others as needed. This approach, in which each team member fills a specific role and determines care based on individual needs rather than disease-specific needs, gives patients more personalized care while allowing physicians more time to discuss preventive care and other issues that can make long-term impacts on patient health. The project also helps educate and engage patients to be more active and informed in caring for themselves.

Thanks to three federal grants totaling $4.5 million, U of U is expanding and enhancing this primary care delivery transformation, which began in 2003. Two of the three grants were funded by the economic stimulus package that Congress passed in early 2009 under the U.S. Department of Health and Human Services (HHS) and the federal Agency for Healthcare Research and Quality (AHRQ).

The HHS/Beacon Community Cooperative Agreement Program focuses on using information technology for improved care protocols for a group of diabetes patients. The funds, totaling approximately $960,000, are enabling the community clinics to join a statewide computer information exchange for establishing the protocols with other doctors and hospitals. The grant also provides funds to hire care managers to ensure those diabetes patients receive the care developed under the protocols.
 
The U of U community health centers already use an electronic medical record (EMR) system that gives patients access to lab test results, the ability to request appointments, and even communicate with their providers through a secure Web portal. At the end of 2010, more than 5,000 patients had signed up to take advantage of it.
 
With the two other grants, both awarded through AHRQ for approximately $3.5 million, the U of U community clinics are expanding the diabetes care-management plan implemented through the Beacon grant, as well as evaluating and expanding Care by Design.
 
Patient education is integral to both Care by Design and the new grants, and the U of U community clinics will use the funds to expand a patient education component of the program, which started several years ago. The health centers conduct group meetings for patients with similar chronic conditions. Care providers speak with patients extensively about how they can better manage their health conditions. Healthy practices, such as diet and exercise, are discussed, and speakers enable patients to become an active participant in their own care. These patients are invited to meet with providers, including nurses, physicians, physician assistants, pharmacists, and medical assistants, enabling these caregivers to play a specialized role in the patient’s care. This collaboration makes care more integrated and personalized.

With the AHRQ funding, the U of U community clinics can evaluate how effective their changes in primary care have been so far, as well undertake comparative effectiveness research, which looks at different health care treatments and therapies to find those that have the best patient outcomes.
Preliminary data demonstrates steady improvement in patient satisfaction and clinical quality measures. Five measures of patient satisfaction, including recommendation of the physician, explanation of procedures, overall satisfaction, time with physician, and length of time waiting at the office all improved between 26% and 41% from 2003 to 2009. For clinical quality measures, statistically significant improvements were seen in the number of patients with completed colon cancer screening, which increased 29 percent, and A1c testing, which improved by 25 percent.
 
Another unique aspect of the program is it’s integration with the Utah All Payer Database. According to staff, this will enable them to measure the total cost of patients in primary care programs - not just the cost to the system. With Medicaid and Medicare data, as well, they estimate they will be able to measure more than 95 percent of the cost of care.
 
All the programs at the University of Utah empower patients to manage their own health conditions by providing them with the tools they need to care for themselves. It is the University’s hope that these efforts will better equip primary care to treat pervasive chronic conditions, which may ultimately reduce costly visits to the emergency room and hospitalizations.

For more information:
Tina E. Waters, MPA Director , Development & Communication Director, Office of the Chairman, Michael K. Magill, MD
375 Chipeta Way, Ste: A
Salt Lake City, Utah 84108
tina.waters@hsc.utah.edu