Each student will synthesize the CARE assignment in a 3-5 page "consultation note" that students will submit to their AHEC campus clerkship director during session #4. If the campus does not have a fourth session, the campus clerkship director will announce the due date. The note will provide 3 prioritized and specific suggestions on how to improve the care of the selected patient using interventions that can be implemented during the office visit. The note will also provide one detailed intervention that requires systems changes in the practice or the community.
HERE ARE THE DETAILS
Part I: Individual Patient Management
Prior to Session #1:
- With the help of your preceptor, select a complex patient with at least one chronic disease. Ideally please choose a chronic disease from the list of 13 common chronic diseases under the Clinical Log tab.
- Ask your preceptor what are the specific challenges/questions in caring for this patient. For example:
- This patient comes to all her visits but is clearly not taking her insulin and I can’t figure out why.
- He says he wants to quit smoking but every visit he’s still at 2 packs per day, is there anything we can do to help motivate him?
- This patient has chronic pain which limits her mobility but she really wants to lose weight. What options can we give her?
- Arrange a time (either during the office visit, at a later time in the office, or a home visit) to do a more in-depth VIDEO RECORDED interview with the patient about how they manage their health and struggles they may be having. Try to address your preceptor’s questions. Practice using motivational interviewing techniques with attention to minimally disruptive medicine principles. Note that you get written consent from patient using consent form provided and make sure low battery level on Flip is OK when you start interview.
- Select portions of your video that illustrate how you assessed patient’s social context and/or your motivational interviewing techniques. Clips should be relatively short (8-10 minutes total) and do not have to be perfect or edited.
- Familiarize yourself with the guidelines for the chronic diseases of your patient.
After Session #1:
- Write a summary of the guidelines that are relevant to your patient. This is the beginning of your CARE consultation note.
- Write a summary of your insight into the patient’s context, goals and motivation.
- Develop a management plan that answers preceptor’s questions, integrates the most beneficial interventions and responds to patient’s context and goals. Write 3 specific suggestions for the care of this patient. Good examples of CARE notes are included below.
Part II: Population Health Improvement (Systems of Care and Practice Improvement)
After Session #2: Population management and registries
- Define a patient population that has characteristics similar to the patient you selected above for your video.
- For example, your patient may have diabetes, depression, COPD and HTN. However, the patient’s diabetes is most important to that patient and depression is the co-morbid condition that is making control of diabetes most difficult to achieve. Therefore, you might define the "population" as all patients in the practice with diabetes and depression.
- With your preceptor’s help, identify 8-10 patients who have the conditions you have chosen (DM and depression). Review the charts and define characteristics and outcomes of interest for your population. Is it A1C levels? PHQ-9 scores? Co-management by psychiatry?
- Write a description of your chart audit
- Write your reflections on the implications and the limitations of your audit
- Using your knowledge of population management as well as the results of your chart audit, write one detailed intervention your practice could undertake to improve the care for this particular population. The suggestion should be specific, detailed and require systems based changes in the practice or in the community.