{"id":4941,"date":"2016-01-20T00:00:00","date_gmt":"2016-01-20T07:00:00","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/2016\/01\/20\/lone-tree-primary-care-wins-pcmh-practice-of-the-year-award\/"},"modified":"2022-08-18T07:20:58","modified_gmt":"2022-08-18T13:20:58","slug":"lone-tree-primary-care-wins-pcmh-practice-of-the-year-award","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/lone-tree-primary-care-wins-pcmh-practice-of-the-year-award\/","title":{"rendered":"Lone Tree Primary Care wins PCMH \u2018Practice of the Year\u2019 award"},"content":{"rendered":"<div style=\"margin-top: 0px; margin-bottom: 0px;\" class=\"sharethis-inline-share-buttons\" ><\/div><p>The team at UCHealth\u2019s Lone Tree Primary Care knew that years of hard work to turn their family- and internal-medicine practice into a patient-centered medical home (PCMH) was paying off for patients. But validation from one\u2019s peers is always nice, too.<\/p>\n<p>Lone Tree Primary Care (formerly University Family Medicine\u2013Park Meadows) got exactly that last month, when the Colorado Academy of Family Physicians (<a href=\"https:\/\/www.coloradoafp.org\/\">CAFP<\/a>) awarded the clinic with its Patient-Centered Medical Home Practice of the Year award.<\/p>\n<p>\u201cI am just so honored that we got this because it helps to show \u2013 especially the staff, they\u2019ve worked so hard, and it was not easy \u2013 that it\u2019s made a difference,\u201d said Debra Bislip, MD, the clinic\u2019s medical director.<\/p>\n<figure id=\"attachment_2117\" aria-describedby=\"caption-attachment-2117\" style=\"width: 300px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-2117 size-medium\" src=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145146\/EXT_012016-BislipKarpLinger-LoneTree_20160112_041-ed-scaled.webp\" width=\"300\" height=\"214\" srcset=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145146\/EXT_012016-BislipKarpLinger-LoneTree_20160112_041-ed-scaled.webp 1600w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145146\/EXT_012016-BislipKarpLinger-LoneTree_20160112_041-ed-300x214.webp 300w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145146\/EXT_012016-BislipKarpLinger-LoneTree_20160112_041-ed-1024x731.webp 1024w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145146\/EXT_012016-BislipKarpLinger-LoneTree_20160112_041-ed-768x549.webp 768w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145146\/EXT_012016-BislipKarpLinger-LoneTree_20160112_041-ed-1536x1097.webp 1536w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145146\/EXT_012016-BislipKarpLinger-LoneTree_20160112_041-ed-2048x1463.webp 2048w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145146\/EXT_012016-BislipKarpLinger-LoneTree_20160112_041-ed-150x107.webp 150w, https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145146\/EXT_012016-BislipKarpLinger-LoneTree_20160112_041-ed-200x143.webp 200w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><figcaption id=\"caption-attachment-2117\" class=\"wp-caption-text\">From left, Debra Bislip, Sarah Karp and David Linger of UCHealth&#8217;s Lone Tree Primary Care.<\/figcaption><\/figure>\n<p>The PCMH concept stresses continuity in patient care with special emphasis on those with chronic conditions. It has been a major focus of UCHealth\u2019s primary care practices for years. The AF Williams Family Medicine\u00a0Clinic was the <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28145146\/af20williams20pcmh20designation-1.pdf\">first to land National Committee for Quality Assurance (NCQA) Level 3 certification<\/a> for PCMH in 2011; University of Colorado Hospital\u2019s other seven primary care practices have all followed suit, with Lone Tree earning its PCMH wings in 2013.<\/p>\n<p>What&#8217;s more, by the end of 2017, all of UCHealth&#8217;s primary care practices aim to join UCH&#8217;s as NCQA-certified patient-centered medical homes, says Travis Sherman, UCHealth&#8217;s senior director of population health.<\/p>\n<p><strong>Write it up<\/strong><\/p>\n<p>NCQA Level 3 certification isn\u2019t an end in itself, but rather another step in a process of continuously refining the PCMH practice model. That model involves making many changes in how primary care practices approach the work of caring for patients \u2013 or perhaps better, the work surrounding the work of caring for patients. As Anita Wolfe, NP, a nurse practitioner in Lone Tree put it, before PCMH, \u201cI wasn\u2019t doing anything different \u2013 I just wasn\u2019t documenting it.\u201d<\/p>\n<p>Susan Karp, RN, the clinic\u2019s charge nurse, agreed, saying the practice did a \u201cgreat job\u201d treating patients before PCMH. The difference, she says, is that \u201cnow we\u2019ve got the numbers telling us exactly what we\u2019re doing.\u201d<\/p>\n<p>The success of PCMH hinges on documentation, but it\u2019s not paperwork for paperwork\u2019s sake. Monitoring details of patient status in the UCHealth Epic electronic health record and tracking pools of patients with chronic conditions using patient registries \u2013 population management \u2013 lets Lone Tree amplify the voices of patients in their own care and ensure that they stay connected with the clinic and on top of their health.<\/p>\n<p><strong>A different path<\/strong><\/p>\n<p>Lone Tree was neither UCHealth\u2019s first PCMH practice, nor the first to win the CAFP\u2019s PCMH Practice of the Year award. AF Williams <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28145145\/af20williams20pcmh20of20the20year.pdf\">earned the honor<\/a> in 2014 and UCHealth\u2019s Boulder and Westminster were similarly cited last year in a joint award. These awards, says Robin Pettigrew, UCHealth\u2019s director of operations for Ambulatory Services, \u201care an acknowledgement of the team\u2019s hard work and commitment to making a difference for our patients, not to mention the transformation that is occurring in all of our primary care practices.<\/p>\n<p>&nbsp;<\/p>\n<p>\u201cIt\u2019s about changing how we provide care as a team, rather than as one individual, and keeping the patient at the center of the transformation work that\u2019s going on,&#8221; Pettigrew added. The medical home model has fostered a culture of ongoing process improvement in our practices and has paved the way for this success.\u201d<\/p>\n<p>Yet while the Lone Tree team benefited from the examples of AF Williams and others \u2013 as well as from consultations with UCHealth PCMH coach Angel Perez \u2013 the practice had to find its own way to PCMH, Bislip says.\u00a0 For one thing, AF Williams is a\u00a0much larger practice, and includes medical residents and diverse onsite resources in areas such as behavioral health, social work and case management.<\/p>\n<p>\u201cSo it was difficult to say we\u2019re cloning whatever happened at AF Williams because we really didn\u2019t,\u201d Bislip said. \u201cWe really couldn\u2019t, because we\u2019re different.\u201d<\/p>\n<p>Staffing was the big challenge, Bislip says. Producing more thorough patient records takes more time to collect information from\u00a0them and to update their status during and after visits. Creating and updating patient registries also meant additional work for a lean team of 11 providers and nine support staff.<\/p>\n<p>Lone Tree\u2019s big-picture approach will ring familiar to those familiar with PCMH. They\u2019ve created and maintain patient registries for those with diabetes, high blood pressure, and depression, enabling close tracking for follow-up appointments and medication management.\u00a0 The same tracking happens with complex patients with other combinations of conditions that put them at risk of sudden decline.<\/p>\n<p><strong>Patient role<\/strong><\/p>\n<p>The clinic reels these chronic and complex patients into their own care through worksheets that describe patients\u2019 goals and why they are important, their confidence that they can attain them, their progress toward meeting them, and the barriers they perceive to doing so. Providers and patients then talk through the worksheets during routine appointments. Medical assistants and physicians\/nurse practitioners \u201chuddle\u201d regarding each appointment, talking through the patient\u2019s specifics and establishing what tests should happen before the provider knocks on the exam room door.<\/p>\n<p>With time, Lone Tree Primary Care has also applied its patient-tracking skills to making sure patients are up-to-date on their mammograms, tobacco screenings and certain vaccinations. They\u2019re also tracking those taking narcotic medications to handle chronic pain in a similar fashion. They\u2019re planning on adding asthma patients to a new registry, too.<\/p>\n<p>It is working, the numbers show. From October 2014 to October 2015, the clinic\u2019s pneumococcal vaccination rate rose from 63 to 76 percent and the breast cancer screening rate rose from 52 percent to 80 percent. Ninety-nine percent of patients diagnosed with depression did the long-form <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28145145\/tool_phq9.pdf\">PHQ9 screen<\/a>, up from 91 percent the year before, and tobacco screening was at 100 percent.<\/p>\n<p><strong>Not easy<\/strong><\/p>\n<p>The clinic\u2019s lean staffing has meant more work for everyone to make all this happen. Front desk staff not only greet patients, but also maintain registries and reach out to patients by phone (chronic and complex patients get calls for appointments every three months or six months, depending on the case). Medical assistants do deep dives into the records of incoming patients to prepare for huddles and to handle up-front clinic-room tasks such as urinalysis or HbA1c blood-sugar testing. For doctors and nurse practitioners, the approach has meant more time on non-diagnostic tasks, such as going over medications or talking patients through their health goals. Physician appointments relating to chronic or complex conditions are booked at twice the typical 20 minutes, though they\u2019re dialing that back to 30 minutes, Karp says.<\/p>\n<p>Just because something\u2019s straightforward doesn\u2019t mean it\u2019s easy to manage, either. PCMH practices strive to have patients always see the same provider; the clinic manages this about 70 percent of the time, says David Linger, manager of clinic operations for Lone Tree Primary Care. That number understates the reality, too. One morning in early January, for example, a patient on the diabetes registry came to the clinic with a sinus infection. Wolfe saw him for the urgent need, but told him he\u2019d need to come back to meet with Doris Sturtevant, MD, MPH, his primary care physician, to discuss his diabetes.<\/p>\n<p>\u201cBecause you do get better care when you see the same provider,\u201d Wolfe said.<\/p>\n<p><strong>Creative additions<\/strong><\/p>\n<p>Lone Tree Primary Care also leverages UCHealth\u2019s scope to help patients boost their involvement in their health. One example is remote pharmacy consultations with Joseph Vande Griend, PharmD, who helps patients better understand their mix of medications and the importance of each. Another is once-a-week office hours with a diabetes educator from CU\u2019s Department of Endocrinology, Metabolism &amp; Diabetes, for both one-on-one and group visits regarding nutrition and other diabetes topics. The clinic has also partnered with the <a href=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2017\/02\/28145145\/coaw20filming.pdf\">Consortium of Older Adult Wellness<\/a> (COAW) on a six-week workshop to help patients manage their own health.<\/p>\n<p>While the team isn\u2019t resting on its PCMH Practice of the Year laurels, it\u2019s nice to have been endowed with them.<\/p>\n<p>\u201cWe\u2019re really excited that we won the award, because we feel like the outside recognition is going to push everyone to continue to work really hard \u2013 because it is hard work,\u201d Karp said.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The team at UCHealth\u2019s Lone Tree Primary Care knew that years of hard work to turn their family- and internal-medicine practice into a patient-centered medical home (PCMH) was paying off for patients. But validation from one\u2019s peers is always nice, too. Lone Tree Primary Care (formerly University Family Medicine\u2013Park Meadows) got exactly that last month, [&hellip;]<\/p>\n","protected":false},"author":23,"featured_media":2117,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[8],"tags":[417,351],"class_list":["post-4941","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-news","tag-lone-tree-health-center","tag-primary-care"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.7 (Yoast SEO v27.7) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Lone Tree Primary Care wins PCMH \u2018Practice of the Year\u2019 award - UCHealth Today<\/title>\n<meta name=\"description\" content=\"The team at UCHealth\u2019s Lone Tree Primary Care knew that years of hard work to turn their family- and internal-medicine practice into a patient-centered medical home (PCMH) was paying off for patients. But validation from one\u2019s peers is always nice, too. Lone Tree Primary Care...\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.uchealth.org\/today\/lone-tree-primary-care-wins-pcmh-practice-of-the-year-award\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Lone Tree Primary Care wins PCMH \u2018Practice of the Year\u2019 award\" \/>\n<meta property=\"og:description\" content=\"The team at UCHealth\u2019s Lone Tree Primary Care knew that years of hard work to turn their family- and internal-medicine practice into a patient-centered medical home (PCMH) was paying off for patients. But validation from one\u2019s peers is always nice, too. Lone Tree Primary Care (formerly University Family Medicine\u2013Park Meadows) got exactly that last month, [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.uchealth.org\/today\/lone-tree-primary-care-wins-pcmh-practice-of-the-year-award\/\" \/>\n<meta property=\"og:site_name\" content=\"UCHealth Today\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/uchealthorg\/\" \/>\n<meta property=\"article:published_time\" content=\"2016-01-20T07:00:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2022-08-18T13:20:58+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/1970\/01\/28145146\/EXT_012016-BislipKarpLinger-LoneTree_20160112_041-ed-scaled.jpg\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Todd Neff, for UCHealth\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@uchealth\" \/>\n<meta name=\"twitter:site\" content=\"@uchealth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Todd Neff, for UCHealth\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/lone-tree-primary-care-wins-pcmh-practice-of-the-year-award\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/lone-tree-primary-care-wins-pcmh-practice-of-the-year-award\\\/\"},\"author\":{\"name\":\"Todd Neff, for UCHealth\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#\\\/schema\\\/person\\\/da7733ff5562e48e55c027d111ee5911\"},\"headline\":\"Lone Tree Primary Care wins PCMH \u2018Practice of the Year\u2019 award\",\"datePublished\":\"2016-01-20T07:00:00+00:00\",\"dateModified\":\"2022-08-18T13:20:58+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/lone-tree-primary-care-wins-pcmh-practice-of-the-year-award\\\/\"},\"wordCount\":1408,\"publisher\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/lone-tree-primary-care-wins-pcmh-practice-of-the-year-award\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/uchealth-wp-uploads.s3.amazonaws.com\\\/wp-content\\\/uploads\\\/sites\\\/6\\\/1970\\\/01\\\/28145146\\\/EXT_012016-BislipKarpLinger-LoneTree_20160112_041-ed-scaled.webp\",\"keywords\":[\"Lone Tree Health Center\",\"Primary care\"],\"articleSection\":[\"News\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/lone-tree-primary-care-wins-pcmh-practice-of-the-year-award\\\/\",\"url\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/lone-tree-primary-care-wins-pcmh-practice-of-the-year-award\\\/\",\"name\":\"Lone Tree Primary Care wins PCMH \u2018Practice of the Year\u2019 award - 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