Featured Network Clinic Panel Saturday, November 10, 2018

Transcription

1 Featured Network Clinic Panel Saturday, November 10, 2018

2 Froedtert and Medical College of Wisconsin Neurology Memory Disorders Clinic WAI Affiliation: 1998 Team Members: Piero Antuono, MD Diane Book, MD Elizabeth Daly, APNP Malgozata Franczak, MD Ruth Fuentes, RN Elias Granadillo, MD Sue Moser, LCSW Julie Bobholz PhD

3 Froedtert and Medical College of Wisconsin Neurology Memory Disorders Clinic Froedtert Hospital and Medical College of Wisconsin UCC Latino Clinic VAMC Clinic Neurology Clinic Start: 1985 WAI Affiliation: 1998 City: Wauwatosa County: Milwaukee County Population: 955,306 County Population 65 + years: 116,184 (12.2 % )

4 Froedtert and Medical College of Wisconsin Neurology Memory Disorders Clinic Clinic Logistics : Three different clinics: Three ½ days/wk with one visit for initial eval: 12 Pts Six ½ days/wk with two visits for initial eval.: 24 Pts Five ½ days/wk follow up clinic: 25 Pts 1 or 2 hours for new eval. and 30/45 min for f/u Wait time: 2 3 weeks Comprehensive model Does post clinic coordination EHR: EPIC Billing codes: 1631 visits: AD 32% FTD 20% MCI 15% Memory loss 11%

5 Froedtert and Medical College of Wisconsin Neurology Memory Disorders Clinic Clinic Flow IMAP Clinic RN Intake Two hr visit MD (20 min) NP (1hr) SW (30 min) MD, NP (10 min) Referral CT,MRI Wait : 2 3 wks Consult Model Telephone Triage by Scheduling Staff No previous Assestment? Over 55yrs? No NPH dx? No prior NP evaluation? Follow up clinic APNP Memory Clinic One Hr visit MD RN/NP tester Wait: 2 3 wks Referrals NP,CT etc Follow up

6 Froedtert and Medical College of Wisconsin Neurology Memory Disorders Clinic Patient population and unique clinic characteristics Younger adults, Neurology Clinic, Normals, Suburban setting Diagnostic quality measurement set Post diagnosis approaches : NP focused Strengths: Research referrals IMAP: one stop eval. Diagnostic Consensus Conferences, support group Direct connect referrals to Alzheimer Assoc. Weakness: RN Intakes (time, reliability) Consultation model vs follow up Lack of quality measures Use of time of SW or NP in the IMAP clinic Low minority participation (1%)

7 Prevea Eau Claire Family Medicine Clinic WAI Affiliation: 1999 Team Members: Kathy Ertz, MSW Joan Hamblin, MD Amy Nelson, RN Val Running, RN

8 Prevea Eau Claire Family Medicine Clinic Prevea Health System (UW Family Medicine Residency) Family Medicine Clinic Start: 1997 WAI Affiliation: 1998 City: County Eau Claire County Population: 101,907 County Population 65 + years: 14,136 (13.9 % ) Caring for Patients and families and training family docs for the future****

9 Prevea Eau Claire Family Medicine Clinic Clinic Logistics 2 1/2 days a month or squeeze into schedule 2 visits for initial evaluation & result/discussion/tx 2 3 hours total to complete an evaluation and f/u Wait time: < month Primarily a consult model Post clinic coordination EMR: EPIC Frequent billing codes: 99205, or (rare)

10 Prevea Eau Claire Family Medicine Clinic Clinic Flow 6 Time Cognition & Medical (RN, MD, Resident) Psychosocial (Master Level SW,Resident) Time Results Appointment 2nd Appointment (MD, Master Level SW, Resident) 8:30am Team Meeting Team Meeting 12:30pm Team Meeting 8:35am Patient 1 Support System 1 1:00pm Patient/Support System 1 (Teleconference additional support system members: i.e. Face Time, Skype) 10:00-10:30am Debrief/Teaching Debrief/Teaching 2:00-2:15pm Debrief/Teaching

11 Prevea Eau Claire Family Medicine Clinic Patient population Adults both within clinic and outside referrals Individuals with intellectual developmental disabilities Triage and intake process records from clinic/hospital/er last 3 yrs Caregiver evaluation of pt and caregiver assess & resources Specialty and unique clinic characteristics : family medicine & residency (+ Med students) : learn about dx and importance of team evaluation vs traditional office setting training docs for the future

12 Prevea Eau Claire Family Medicine Clinic Diagnostic quality measurement set Depression screens GDS/Cornell; Functional assess: Lawton/Katz Pharmacologic meds Caregiver Assessment previously our own; now NPI Q Diagnostic Tests Addenbrooke s (MME, CLOXI add CLOX II, animal Fluency)/ RBANS Post diagnosis approaches: ADRC/ Alzheimers Assoc / Advanced Directives /Community Resources/ and as needed f/u Strengths and struggles: Flexible Scheduling, appropriate billing for labor, teaching residents and students

13 Comments, questions, discussion