Scott AFB medical clinic 'leading the pack' with family healthcare initiative

Published Feb. 3, 2011
By Senior Airman Amber R. Kelly-Herard
375th Air Mobility Wing Public Affairs

SCOTT AIR FORCE BASE, Ill. -- Professionals announced recently during the Military Health System conference that the Scott medical clinic here is leading the pack in outcome measures among Air Force military treatment facilities who have implemented the "family healthcare initiative," or FHI.

In early 2009, the 375th Medical Group implemented the FHI at the Scott clinic. With this change, clinic staffing levels were revised slightly, the numbers of patients enrolled per provider decreased, and a philosophy of a patient-centered medical home took hold.

This model of care delivery assigns patients to a team of healthcare providers, and that team is responsible for delivery of all primary care services to their enrolled beneficiaries. The goals of the FHI are to: increase the continuity of care of a patient with his or her provider; enhance the quality of care delivered with measurable improvement in health; increase patient satisfaction by focusing on patients' goals and values for their care; and improve efficiency while decreasing costs.

"Continuity of care is enhanced when a patient sees the same provider, or team of providers, each time they come in for a clinic visit. This approach helps providers become more familiar with their patients," said Lt. Col. Joann Frye, 375th MDG Healthcare Integrator.

Col. Pennie Pavlisin, 375th Medical Operations Squadron commander, added, that "FHI allows for patients and their provider to form a partnership for the best possible way to meet their healthcare needs. As they work together, the provider gets to know the patient's needs better and is able to use their past medical history to help make treatment plans and reach better outcomes."

Continuity of care can be challenging as the medical group keeps readiness its top priority and supports deployment requirements.

"This past AEF cycle we had about 20 personnel deployed," said Colonel Pavlisin. "When team members deploy, other members of the team are there to fill in. In some cases, we also hire contractors as back fills."

The Scott medical clinic has three FHI teams. One team typically consists of two providers, five technicians and one nurse. Each team is responsible for about 2,500 patients to include active duty members, Guard, Reserve, family members and retirees.

When calling to schedule an appointment, if a patient is unable to see their primary provider, they will see a partner provider who is assigned to the same team. This allows for shared information and continuity of care.

Medical technicians are also on the frontlines in the FHI teams. They are the first team members the patients interacts with in the clinic.

Airman 1st Class Aramin Tosses, 375th MDOS medical technician, said, "We update any changes to the patient's history, check their symptoms and help by doing what the providers ask us to do. Our role is to guide their appointment."

In addition to the providers, the nursing support staff plays an integral role in the FHI team. Registered nurses enhance team production by managing workload that comes in over the phone.

Capt. Brian Kennedy, 375th MDOS nurse, explained, "Nurses help care for patients in the clinic, help refill prescriptions and help with referral issues, this helps the providers move on to other patients."

Maj. Angela Schloer, a nurse practioner for the 375th MDOS, added, that "It truly is a team concept. We take care of each other and each other's patients, just like a Wingman would do."

Thanks to extensive initial training and recurring local training, the FHI change has been a fairly seamless transition for the medical staff and patients. Major Schloer worked at Scott prior to the FHI and has seen the changes the 375th Medical Group has made.

"Before I would see a patient once and then they would go to another provider for a follow up. Now we have continuity of care, and I get to know the patients not only medically, but personally," she said.

Before FHI, patients were seen by the same provider approximately 35 percent of the time. Almost two years after implementation, patients are seen by their assigned provider close to 75 percent of the time and by a provider on the same team about 85 percent of time. Scott's FHI clinics are outperforming other FHI clinics in this Air Force level measure by 10 percent.

There are several other groups of medical personnel that have assisted in the FHI teams' successes, such as the healthcare integrators who oversee collaboration of the disease management nurses and FHI teams on patients who have medical conditions who require closer management. These nurses help educate the patients, coordinate follow up care and provide guided prescription management.

Colonel Frye said, "The Women's Health Clinic and the radiology department also assist in the delivery of prevention screening services. The bulk of our cervical cancer screening tests are accomplished in women's health, and our radiology clinic contacts patients by mail to offer breast cancer screening services.

"The Belleville Clinic staff contributes to the FHI teams' improved performance measures as well. The residents and staff providers deliver colon cancer screening services inside the MTF. These are services that otherwise would be referred off-base."

These cancer screening and other prevention and wellness measures are part of the Healthcare Effectiveness Data and Information Sets -- tools used to measure quality of care delivered by an organization. HEDIS measures are used by more than 90 percent of insurance companies across the nation. Scott's FHI clinic was also recognized for outstanding performance in eight different HEDIS measures.

A patient's healthcare experience is essential to the clinic's success and so feedback from patients is very important and highly valued by the FHI teams.

Mr. Shawn Saunders, MDG Patient Advocate, said, "Through a program in Washington, D.C., patients are called within a week of being seen and asked about the service received. Results are delivered weekly which allows us to make timely changes. Changes targeted to continuously improve your medical home."