Resources Relevant to the Implementation
of Core ACGME-Required Competencies

Module III
    Systems-based practice
          Resources
Knowledge of
practice & delivery
systems
      		 What is the health care system in the United States? What are the characteristics and attributes of various practice and delivery models, and what impact do these have on the care that is delivered?

The resources included in this section of the module were selected to provide training programs with materials and tools designed to point learners to information that will stimulate learning around these important questions.
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Institute of Medicine The Institute of Medicine has produced a number of reports that address issues related to the health care system and to improvement. Training programs will want to ensure that fellows are familiar with two documents, in particular:

     • To Err is Human: Building a Safer Health System , published in 2000, describes the magnitude of the problem of medical errors and suggests a systems approach to improvement.

     • Crossing the Quality Chasm: A New Health System for the 21st Century recommends a radical redesign of the health care system and offers specific principles to be included.
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Medicare Learning Network The Medicare Learning Network is designed to provide Medicare-related information to health professionals.

Resources available on the site include:

     • Information about the Health Insurance Portability and Accountability Act (HIPAA)
     • Information for physicians about Medicare, titled, “Medicare & You, 2002, Physician Edition”

     • Quick learning guides for many topics, such as outpatient prospective payment and and physician referral
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Medicaid Professional/Technical Information The Medicaid Professional/Technical Information site, sponsored by the Health Care Financing Administration (HCFA) provides an overview of the Medicaid program and detailed information on a number of topics, including managed care, the drug rebate program, and fraud and abuse.
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Group visits
for chronic care		 Knowledge of practice and delivery systems may include not only knowledge of traditional systems but also of emerging systems that may improve both the quality and the cost-effectiveness of care. Group visits for chronic care are one such emerging system.

Information on group visits for chronic care are available from a number of sources, including:

     • Improving Chronic Illness Care is an organization sponsored by the Robert Wood Johnson Foundation. The goal of ICIC is to foster improvement in chronic illness care by supporting health care providers with guidelines, expertise, and systems. A set of critical tools, including a worksheet comparing different models of group care and a Group Visit Starter Kit are provided.

     • A recent article from the journal Effective Clinical Practice can be found on the American College of Physicians - American Society of Internal Medicine (ACP-ASIM) site. This article, “Reducing Emergency Visits in Older Adults with Chronic Illness: A Randomized, Controlled Trial of Group Visits,” provides information that can be useful in understanding group visits as a delivery system.

     • A recent article from the journal Family Practice Management titled, “Planning Group Visits for High Risk Patients,” provides information about group visits for chronic care, including sample documentation forms and information about developing a diagnosis-specific patient registry.
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Managed Care Education Connection The Managed Care Education Connection is a product of the Partnerships for Quality Education (PQE) sponsored by the Pew Charitable Trusts and the Robert Wood Johnson Foundation.

The Connection provides extensive information, curricula, web-based tools, and teaching cases that can be used to teach and learn about cost-effective care and improvement.

          *The site requires free registration to access materials from its database.*

          *The site requires free registration to access materials from its database.*

A sample of materials available from the site include:

     • a Coding and Billing module designed to provide residents with information about coding for patient care and reimbursement.

     • a Case-based Reflective Learning Curriculum on Managed Care. Although designed primarily for family medicine and pediatric residents, much of the information and assessment tools contained in this curriculum are generalizable across specialties.

     • a case study titled, “Costs, Care, and Chronic Illness: Impacts on the Health Care System,” is a case that considers a patient with asthma.

      • a case study titled, “Management of a Pediatric Asthma Patient in a Managed Care Setting,” is a case that provides information about the concepts of clinical economics and utilization management.

  • a managed care curriculum developed at the Oregon Health Sciences University. Designed for residents in primary care specialties, the information in this module is generalizable across specialties. This extensive curriculum (80 hours covering six core areas) could be sampled from and/or adapted for A/I programs. Given the size of many A/I training programs and the intensity required to utilize a curriculum on managed care, this resource may be best used in collaboration with other residency or fellowship programs.
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Practice Makes Perfect The Practice Makes Perfect program, funded by Aetna U.S. Healthcare Academic Medicine and Managed Care Forum and the Josiah Macy, Jr. Foundation, is a demonstration program designed to provide residents with the tools they will need to operate successfully in the managed care environment.

Profiling asthma, managed care competencies, and pharmacy profiling are exercises that can be adapted for use at individual institutions.
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American Journal of Managed Care For those interested in designing their own managed care curriculum, an article in the American Journal of Managed Care describes the process undertaken at the Michigan State University to create such a curriculum and the outcomes obtained with it.

The article is located at:
Colenda, C. C., Wadland, W., Hayes, O., Anderson, W., Priester, F., Pearson, R., Keefe, C., & Fleck, L. (2000. Training tomorrow’s clinicians today - Managed care essentials: A process for curriculum development. American Journal of Managed Care, 6(5): 561-72.
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Weill Medical College of Cornell University An article titled, “A Practice-profiling System for Residents,”describes a program designed to introduce residents to the concepts of population medicine and to improve feedback to residents by providing them with a three-part practice profile.

The article abstract can be freely viewed.

The article is located at:

Callahan, M., Fein, O., & Battleman, D. (2002). A practice-profiling system for residents. Academic Medicine, 77(1): 34-9.
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