Transforming Care Delivery

Advanced Medical Homes

familyURMC’s Center for Primary Care (CPC) continued to lead the region in implementing the Advanced Medical Home (AMH) concept. In an AMH model, physician practices restructure themselves to provide chronic disease management in a more patient-centered way, a critical short-term strategy for controlling ED visits and readmissions, and setting the stage to accept risk in a managed care environment.  In 2010, more than 40 (?) primary care physicians joined together with over 100 practice staff to conduct a gap analysis and plan to transform from traditional practice models to medical homes. The effort represents a significant cultural change with ongoing staff retraining. Plus, the key to success is having the data to manage risk for a specific population. CPC practices are making full use of the existing ambulatory and soon-to-be-live inpatient electronic medical records, even developing a home-grown dashboard in 2010 that enables broad surveillance of patients and the ability to intervene with preventive measures. For the first time, URMC doctors will have the tools to target specific subsets of patients for defined clinical activities or needs.

The Center’s pilot practice achieved the highest – Level 3 – status by the National Committee for Quality Assurance this fall, and all 20 physician practices will complete the certification process by the end of 2011. Advanced medical homes have been credited nationally with improving access, patient and provider satisfaction, and cost efficiency.

Clinical Reengineering Continues in Dentistry

Eastman Dental has made significant strides to reengineer its entire clinical operation and improve patient care, thanks in part, to a $3.9 million grant awarded in 2008. Major projects finished in 2010 include new treatment rooms, expanded waiting rooms and renovations to the General Dentistry, Pediatric, Orthodontic, and Periodontics/Prosthodontics/Faculty Practice clinics. In addition, construction for the new Eastman Dental Urgent Care was completed and the Center has been operating at full capacity since it opened in April. It is the only dedicated urgent dental clinic in the region. The final phase—renovating the atrium area—will be complete in early 2011.

Growing the Physician Workforce

Family Medicine Expands Trainees

In 2010, the Highland Family Medicine residency program received a $1.9 million federal grant that will add two positions per year for the next five years. The School of Medicine and Dentistry is the major source of primary care physicians in the Rochester region. Investing in the primary care workforce is one of the key elements of health care reform. By expanding training programs and making them more attractive to medical students, government and health officials hope to dramatically increase the numbers of new physicians entering the primary care field, which includes family medicine and general internal medicine. The grant will fund 12 medical residents per year instead of 10. In the past decade approximately 300 family physicians have graduated from the UR, with about half remaining in the Rochester area.

Physicians for Older Patients

The nation is facing a growing shortage of geriatricians to care for older adults at a time when its population is aging rapidly. A $1 million grant from the Donald W. Reynolds Foundation, received in 2010 by URMC’s Division of Geriatrics and Aging, is enabling geriatricians at Highland to teach non-geriatrician physicians about the special needs of elderly patients. URMC was one of 10 medical schools in the nation to receive Reynolds grants for geriatric care that total almost $10 million. The grant will allow geriatricians at Highland to share their knowledge with hospitalists and specialists in orthopedics; physical medicine and rehabilitation; emergency medicine; and neurology. The project will annually impact 260 students, 188 residents, 14 hospitalists, and 85 subspecialty faculty. Benefits will continue long after the grant funding period, because physicians who have completed the training will become trainers themselves – they’ll be able to pass on what they’ve learned about geriatric care to their colleagues.