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The Hospitalist. 2006 March;2006(03):

March 1, 2006 | The Hospitalist

Other hospitalists find their special niches. Shaun Frost, MD, is breaking ground in peri-surgical care in orthopedics, urology and neurology, and is active in process improvement teams. Howard Epstein, MD, leads the palliative care team, while John Degelau, MD, chief of hospital medical at North Memorial, pursues his interest in geriatrics. Rich Mahr, MD, is the physician champion for electronic health records.

So being an HPMG hospitalist allows physicians to pursue many avenues of clinical and process improvement, including national initiatives and teaching. Dr. Anderson sums up what HPMG is about: “I joined this group because of its passion for medicine. When we get older we’ll look back and say that we had our moment, our time to give it 100%.”

Dr. Kealey calls them “an energized creative group. Everyone wants to go to national meetings and to keep ahead of the pack, to ask what’s next to learn?” TH

Writer Marlene Piturro regularly writes practice profiles for The Hospitalist.

Pursuing Perfection—Prepared Practice Teams

Administrators and clinicians at HealthPartners knew they excelled at patient care when compared with national benchmarks, but believed they could do better.

“We were on a plateau and weren’t going higher,” says Beth Waterman, vice president of primary care and clinic operations. In 2001 she raised the bar by applying for a $50,000 Robert Wood Johnson Foundation “Pursuing Perfection” Phase I grant. According to Sue Knudson, senior director of Health Partners, the foundation awarded dozens of pilot project grants to providers in the United States, Canada, and Europe, attracting many organizations with different approaches to improving care quality. After a pilot project, HPMG was one of only seven grantees in 2002-2004’s Phase II $1.9 million grants, with which HealthPartners developed a planned care model.

HealthPartners’ new model started with the recognition that even though its physicians provided highly integrated care across settings, they weren’t sure if the patients saw care as smooth or fragmented. To start improving things Waterman and Knudson brought together 200 HealthPartners staff for a two-day Rapid Design Workshop. They mapped workflow processes that moved patients through the system, identified stumbling blocks to smooth handoffs from pre-visit through after-care, and called the reengineered path “the planned care model.”

Under this model prepared practice teams streamlined care by closing gaps in pre-visit, visit, post-visit, and between-visit care. For example, all patients now receive calls to have lab work done pre-visit, providers are more consistent writing after-visit summaries for patients, and clinic nurses round with hospitalists to coordinate after-care. To further make care patient-centered, HealthPartners is pilot-testing a subset of its larger electronic medical records (EMR) system for their patients called “My Chart.”

Unlike many other Pursuing Perfection grantees that focused on individual disease states, HealthPartners stayed disease-neutral. “At first there was some confusion about not working on clinical pathways,” says Waterman, “but we didn’t want to make transformational change one disease at a time. We haven’t regretted that decision at all.”

Although planned care isn’t generally disease-specific, HPMG focused on heart failure for Phase III, running from 2004-2006. Its task is to redefine how the team manages heart failure along the care continuum. Using a rapid design team of 20 people, the group tackled issues such as operationalizing the roles of cardiologists and primary care physicians in one day. The team reviews the literature on the stages of CHF and how it will be co-managed by specialist and primary physician, embedding CHF guidelines in the EMR, writing a co-management protocol for admitting CHF patients, and revising inpatient order sets and work flows. —MP