Re: FW: The National Medical Home Summit- ex diabetes nurse educator

[Guest guest]

RE diabetes nurse educator, why this DOESN'T work

Did this when I worked at HMO staff model.

One NP in the office -- she did this.

Sent all of our diabetics to her -- no show rate was VERY VERY high.

Had a big book with algorithm of "how to use diabetic" meds. Didn't work.

Only have gotten glucoses down now with newer meds.

Gordon -- let us know how the conference goes, hope some of info will be practical, for now, I'll just wait it out as a solo FP x 4 years now

Matt in Western PA

RE: FW: The National Medical Home Summit

This looks like a great list of speakers, any number of whom are likely to point out the flaws in the current methodology being promoted to measure “medical home-ness.”

The current tool (NCQA’s PPC PCMH) has some good elements but relies too heavily on infrastructure and process and not enough on important outcomes. As I’ve pointed out before, it emphasizes a large team approach to care – thus confusing form (“diabetes nurse educator”) for function (“diabetes education”). The latter is what makes the difference for patients. One path to the good education is indeed a good diabetes nurse educator, but to posit that this work cannot be done by a good provider means that this approach is likely to write off the 45% of practices in the US that are solo and small.

The second big flaw is that this tool obscures the importance of the fundamental attributes of effective primary care (first point of contact, relationship over time, etc). In doing so it over-emphasizes vendor driven solutions (like ePrescribing) and weak interventions (“we have a policy that says we’re really good with access”). Organizations and normal docs are likely to be caught up in the overwhelming detail of the 109 different measures and fail to address the fundamental work. This has been pointed out by Bob Berenson (one of the key speakers) as well as Dana Safran (big Tufts researcher), and Barbara Starfield (decades of research on primary care).

If the conference fails to address the fundamental flaws in the PPC-PCMH tool it will be an expensive waste of time. If key speakers raise this issue (as they have done repeatedly in private but to no seeming effect with NCQA) then maybe there will be a good conversation on how we might use the NCQA tool for its strengths but mitigate its weaknesses with other tools and approaches, thus opening the door to the 45% of practices that are solo & small.

Gordon

From: [mailto: ] On Behalf Of Pedro BallesterSent: Saturday, December 20, 2008 11:18 AMTo: Subject: Re: FW: The National Medical Home Summit

I wonder how many of the presenters are IMP or even a small (3 practitioners or less) medical practice?-- Pedro Ballester, M.D.Warren, OH