AAFP’s two-year practice redesign demonstration project concludes

Texas practice among “elite” of TransforMED

After two years of tests and evaluation, the TransforMED National Demonstration Project has come to a close. During the NDP, 36 family medicine practices—including the sole Texas practice, Trinity Clinic in Whitehouse—applied practice redesign initiatives to move toward the New Model of Family Medicine, as delineated in the 2004 Future of Family Medicine report.

The New Model recommends implementing advanced information systems like electronic medical records, providing open access to patients, using a team approach to care, focusing on quality and safety, and redesigning offices to be more functional. Practices were split into two categories, facilitated and self-directed. Trinity Clinic and other facilitated practices regularly participated in daily or monthly meetings, site visits, e-mails, and phone calls with TransforMED staff and other facilitated practices. The self-directed practices used the plan as a compass, but applied their own ideas to the system to find what would work best for their practice.

From the beginning, Trinity Clinic and its physicians, TAFP members Melissa Gerdes, M.D., Janet Hurley, M.D., and Amy Mullins, M.D., emerged as leaders in the project. “Trinity Whitehouse Clinic was one of the elite practices compared to the other facilitated NDP practices,” said David Garrett, M.H.A., TransforMED practice enhancement facilitator. “Like all of the other practices, Whitehouse had periods of change fatigue, frustration and circumstances outside of its control. This group was nimble and aggressive enough to be proactive and roll with challenges as they presented.”

In this project, willingness to change was key, which was one reason for the Trinity Clinic’s success. The physicians were already putting roughly half of the New Model recommendations into place when they applied, Gerdes said in a profile article published in the winter 2007 edition of TEXAS FAMILY PHYSICIAN. Trinity Clinic also had solid leadership in place and a strong communication base among the clinic staff in addition to an electronic medical record and same-day access slots for patients.

Gerdes says that the practice gained more confidence that they were headed in the right direction. “We also learned, as did many other practices, that people, staffing and communication are essential foundation components to enable change. If a practice does not have these elements in place, they will be the Achilles’ heel in halting change.”

The electronic medical record and same-day scheduling have become permanent components of the practice, Gerdes says, as well as open access and population-based chronic disease management. “However, the key is to have a solid values system, support people, and flexibility to change and implement new concepts as needed.”

Garrett said the TransforMED staff gained knowledge on “practice readiness to change, change process, barriers to change, quality measures and operational efficiencies.” You can find an outline of the practices’ process on the TransforMED Web site, www.transformed.com. Using the NDP practices’ experiences as a starting point should be helpful to other family physicians because, as Gerdes says, she learned that family physicians “are all in this together.”

“Even with such diversity, we are more alike than we think,” she says. “We have the same struggles with things like payers and staffing. [Family medicine’s] strength is the diversity of solutions to these struggles and we need to share these solutions more as a group.”

As an LLC owned by AAFP, the next step for TransforMED will be to engage primary care practices on a contractual basis. Garrett recommends practices make use of the TransforMED Web site to gain insight on how family physicians can change their practices to meet patients’ needs. A formal report on the NDP will be available in fall 2009.