The healthcare environment is continually changing. In order to effectively meet the task of preparing the next generation of family medicine physicians we must adapt to changing regulations, community needs and market forces while at the same time holding firm to our core values. Through its 2012-17 strategic plan, the Department of Family and Community Medicine will improve the quality of healthcare through primary care and interprofessional education, patient-centered and family-centered care, explore new initiatives and will conduct research that informs public policy for the improvement of the health and welfare of the communities we serve. We invite you to explore these pages to learn more about the goals and accomplishments of the Department of Family and Community Medicine.
I. Patient Centered Medical Home (PCMH)
Develop leadership in the Patient Centered Medical Home (PCMH)and champion the approach within the UC Davis Health System. The PCMH is an approach to providing comprehensive primary care across the lifespan. The PCMH is a health care setting that facilitates a partnership between individual patients, their families and their “health care team”.
There’s something nostalgic about the family doctor. In small towns and in urban neighborhoods, there was a time when a family might see the same physician throughout their lives. Whether in the office or in your home, this caring provider knew your medical history, family relationships, social situation and health habits, and would use this knowledge to provide you with the right care at the right time. Like bell bottom jeans, heirloom tomatoes and 1960s modern furniture, everything old is new again. Family docs still treat multiple generations; consider the community and social context of their patients’ health; design care plans that not only reduce illness but promote wellness; and encourage their patients practice healthy behaviors. While the patient-centered medical home has gained prominence in recent years as a recommended model of care, practitioners of family medicine have long incorporated the tenets of patient-centered care into their practices. The PCMH is the foundation for teaching primary care by providing an exemplary medical home that emphasizes the key components of family medicine: continuity, collaboration, comprehensive services, coordination, communication, and community engagement. For this reason, expanding the patient-centered model of care into training and practice in the Department of Family and Community Medicine is a pillar of the Department’s 2012-2017 Strategic Plan. During the first year of the strategic plan implementation, the PCMH Committee, led by co-chairs Tom Balsbaugh, M.D., Residency Director, and Joann Seibles, M.D., Medical Director of the Family Practice Center, made significant strides in putting multiple facets of the PCMH model into practice. The goal of the implementation of the patient-centered model of care is to pass a rigorous evaluation by the National Committee on Quality Assurance (NCQA) in order to receive their accreditation as a PCMH. But the ultimate objective is measured in the increased knowledge of our medical residents and the improved health of our patients.
Key Accomplishments of the PCMH Committee, 2012-13:
• Implemented best practice protocols for panel management (hypertension, retinal camera, adolescent immunizations and post-immunization follow-up calls).
• Continued implementation of the medicine reconciliation process and monitored metrics.
• Implemented a best practice pilot for referral management.
• Implemented policy to submit resident templates six months ahead to improve scheduling for continuity.
• Completed HRSA Collaborative primary care faculty development initiative with Departments of Pediatrics and Internal Medicine
• Provided residents with training on transitioning patients.
• Initialized a new quality improvement project for hypertension in the Family Practice Center.
• Piloted ongoing LVN protocols to coordinate labs needed for diabetes care.
• Launched Family Practice Clinic website to promote patient engagement
• Met with the leadership of CommuniCare Health Center to explore opportunities for increased collaboration.
II. Community Engagement
Engage the community in family and community medicine. The Department of Family and Community Medicine will work to redefine how we engage with and serve our community. This process begins by fostering a greater sense of community and involvement among faculty, staff and learners. We will harness our shared passion for community health improvement to engage our extended communities, including the Health System as well as Sacramento neighborhoods and the Northern California region.
While the traditional model of health care is to deliver responsive treatment to an individual’s unique symptoms, far too often the context of a person’s health is ignored or neglected. According to a report from the Robert Wood Johnson Commission to Build a Healthier America, the most accurate predictor of health status is a person’s zip code. The social determinants of health—such as where we live, how we live and who we live with—are contributing factors to our overall health. While many medical residents devote years training to understand pulmonary, orthopedic or other biological systems, family medicine encourages physicians to see the social context in which their patients live their lives. Since the UC Davis Department of Family and Community Medicine was established in 1971, community engagement has been an essential component of resident training curriculum. To help develop new ways for our residents and faculty to interact with the neighborhoods and populations we serve, Community Engagement was selected as a goal of the Department’s five-year strategic plan. During the first year of the strategic plan implementation, the Community Engagement Committee, led by co-chairs Kay Nelsen, M.D., Associate Residency Director, and Suzanne Eidson-Ton, M.D., Predoctoral Education Director, has opened doors to the community. Among the accomplishments was the hiring of a Community Liaison who will serve as a point of contact between the Department and community groups and neighborhood residents. The structure is now in place to support the creation of a Family Medicine Community Engagement Council made up of a group of diverse local residents who will inform the Department of emergent health concerns and needs.
Key Accomplishments of the Community Engagement Committee, 2012-13:
• Hired a Community Liaison.
• Disseminated and analyzed a survey of faculty, staff and residents regarding their sense of community.
• Initiated conversations with local organizations to explore community needs and opportunities for collaboration.
• Drafted Community Engagement Council guidelines, member job descriptions and recruitment tools.
• Established department task force to explore FCM-FQHC partnerships.
• Developed and adopted plan to transition Snively Visiting Professorship into a half-day interactive Symposium in 2014.
• Community Leadership Track residents build community coalition to develop a satellite clinic in Delta region.
• Put family in Family and Community Medicine by holding two social events for residents, faculty, staff and their families.
III. Interprofessional Education
Create a valued and expected culture of interprofessional collaboration to promote excellence in primary care education. Collaboration among primary care providers (physicians, nurse practitioners, physician assistants, nurses and other professionals) is crucial for the future delivery of high‐quality, patient‐centered primary care. We plan to excel in training our future family physicians by creating and supporting models of interprofessional collaboration in education, clinical care and research.
Among the many medical disciplines, family physicians are perhaps the most versatile. They bring new life into the world and provide palliative care. They treat coughs and cuts as well as debilitating chronic illness. They are their patients’ health encyclopedias, teachers, therapists and coaches. They can do it all, but…for the sake of their wellbeing…they don’t have to. The current model of medical care practice follows a team-based approach. While primary care physicians remain at the center of their patients’ health care orbits, they are supported by a range of professionals who collaborate on the care of their patients. Nurse practitioners and physician assistants are trained to provide a range of primary care services under a physician’s guidance. Therapists and social workers can be called on to attend to mental health and social service needs. Specialists can advise patients on the treatment of a specific illness or infirmity. Pharmacists, dentists and health educators play important roles on the health delivery team. Under the team-based model, each professional is providing service to the highest level of his or her respective licensing and training. In training the next generation of medical professionals, it is essential that they gain the skills necessary to be effective in contemporary team-based practice settings. The Department of Family and Community Medicine has made a commitment to enhancing opportunities for interprofessional education through its inclusion in its strategic plan. During the first year of the strategic plan implementation, the Interprofessional Education Committee, led by co-chairs Huey Lin, M.D., Associate Professor, and Debra Bakerjian, Ph.D., FNP, Senior Director for Nurse Practitioner and Physician Assistant Clinical Education and Practice, has made important strides toward bridging the strengths of Health System’s graduate medical education programs.
Key Accomplishments of the Interprofessional Education Committee, 2012-13:
• Established interprofessional education in the Doctoring 1 course.
• Conducted inventory existing relationships with community health centers and existing areas in the residency program where we currently have IPE experiences.
• Hosted an interprofessioned faculty workshop to build expertise in teaching underrepresented students.
• Evaluated curriculum of a physical exam skills course to incorporate interprofessional education.
• Began planning an interprofessional workshop/lecture series for residents and NP/PA for the 2013-14 academic year.
IV. Research and Scholarly Activity
Maintain preeminence in primary care scholarship. Excellence in primary care scholarship is a widely acknowledged indicator of the quality of family medicine departments within academic health centers. As such, it’s essential that the Department of Family and Community Medicine invest resources to continue to build the quality and reputation of this critical function.
In science fiction, a doctor of the future might wave an electronic sensor over a patient’s body to record vital signs and to diagnose an illness. While some form of that future is coming (and sooner than many people may think!), today’s physicians collect patient data using a range of tools and techniques and apply it to a body of evidence in order to determine the best treatment approach. It’s not an exact science, but it is a rigorous one, and the UC Davis Health System is an international leader in health science research. But research isn’t just delving into futuristic solutions to intractable problems. An important part of research is evaluating medical treatments and systems of care for effectiveness in the day-to-day practice of medicine. That’s where the faculty of the Department of Family and Community Medicine has made its mark. The Departmental strategic plan recognizes the importance of primary care outcomes research and set a goal of increasing the faculty’s capacity to conduct relevant research and to disseminate their findings. Among the important accomplishments during the first year of the five-year plan was the recruitment of a research development officer. While not directly involved with research, this individual will make the research possible by supporting faculty efforts to secure grant funding, and to proactively disseminate their knowledge to the public. During the first year of the strategic plan implementation, the Research and Scholarly Activity Committee, led by co-chairs Anthony Jerant, M.D., Associate Professor, and Joy Melnikow, M.D., Professor and Director of the Center for Healthcare Policy Research, has strengthened its reputation for scholarly achievement.
Key Accomplishments of the Research and Scholarly Work Committee, 2012-13:
• Hired research development officer.
• Developed opportunities to introduce research opportunities and act as mentors to residents interested in research.
• Established process for researching and disseminating new grant funding opportunities.
• Created process for recruiting a new junior research faculty position.
• Two faculty members have served on review committees for national grant funding competitions.
• Received federal funding for the Center for Healthcare Policy and Research to recruit three research fellows, one of whom will focus on issues related to family and community medicine.
• Presented research findings to peers at international conferences.
V. Faculty and Staff Development
Recruit, support, and retain a diverse and proficient faculty and staff. The Department of Family and Community Medicine seeks to build a more diverse and vibrant faculty and staff. This growth will enable the department to meet the ongoing needs of its patients and learners, as well as enhance its contributions to research and improve its ability to adapt to the changing health care climate.
A basic lesson of business and management is that it is easier to maintain an existing customer than it is to hook a new one. A variation of this lesson can be applied to faculty and staff recruitment: it is easier to develop a current customer (that is, medical student, resident or fellow) than it is to recruit a new faculty member. A significant accomplishment of the Faculty and Staff Development Committee in 2013-14 is the recruitment of a new clinical faculty member who is scheduled to begin in September 2013. Dr. Kris Srinivasan, our new junior clinical faculty recruit, is no stranger to UC Davis. He received his undergraduate degree, attended medical school and performed his residency training all at UC Davis. For the past year, Dr. Srinivasan has served as a fellow in the Department of Family and Community Medicine, during which time he has research the potential for collaboration between academic medical institutions and community health centers. Dr. Srinivasan has repeatedly demonstrated his academic inquisitiveness, teaching skills and leadership qualities that made him an ideally qualified for a position on faculty. That lesson will inform our recruitment efforts as we seek to fill additional faculty and fellow opportunities. While we hope to attract highly qualified candidates, we recognize that they may already be part of our “family.” The Faculty and Staff Development Committee is committed to building a process for informing, identifying and cultivating highly motivated students and residents that can nurture to build tomorrow’s faculty. At the same time, it is important to maintain continuity among staff members while at the same time encouraging professional growth. We are committed to providing program and support staff with opportunities to learn and grow that will in the short term benefit the Department and over the long term enhance employee’s professional opportunities. During the first year of the strategic plan implementation, the Faculty and Staff Development Committee, led by co-chairs Shelley Henderson, Ph.D., Assistant Professor and Director of Behavioral Medicine, and Sarah Marshall, M.D., Assistant Professor, have made built a structure for ensuring the highest level of professionalism among Departmental employees.
Accomplishments of the Faculty/Staff Development Committee, 2012-13:
• Established two new searches - Research track and Clinical educator track.
• Department website links were created for faculty and staff to system wide training and development resources.
• Successfully recruited clinical educator to begin fall 2013.
• Formed a Staff Professional Development Committee.
• Surveyed staff to identify professional development interests and needs.
• Dr. Bertakis met with health sciences advancement to develop strategies for identifying and soliciting major donors to support Departmental initiatives.
• Drafted a new Faculty Orientation and Mentor/Mentee manual.
• Dr. Bertakis met with potential donor to discuss Departmental priorities.
• Held two staff training seminars, one on financial education and a second on effective communication in the workplace.