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Primary Care Change Agents: HMS Fellows Push for Innovation

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Harvard Medical School, photo via flickr.

Each year, the Innovation Fellows program at Harvard Medical School’s Center for Primary Care selects doctors to focus on one of America’s biggest healthcare puzzles: primary care. The fellows create communities of clinician innovators and mentors, promote cross-disciplinary collaborations, and lead innovations in diabetes, depression management, group visits, health information technology, and much more.

This year’s 2014-2015 fellows come from many backgrounds and have many interests. We asked three of them about their intended projects.

Fellow: Bevin Kenney, Brigham and Women’s Hospital

Innovation Project: “Medical Students as Health Coaches and Change Agents”

Dr. Kenney works in a community clinic where patients deal with many social, educational and economic issues that impact their health. This is common for community health centers, she says, and is something that can be solved with skilled help. “Many of these issues don’t require a medical provider or even a social worker or a therapist,” she says. “A skilled person could help them with information, goal-setting or encouragement.”

Once she realized this, Kenney developed a plan. Her clinic didn’t have extra money to hire health coaches or extra time to train the current staff, so she decided to bring medical students on board to fill the gap.

“In my project, the students will work as coaches but also as change agents,” she says. “By that I mean that I expect them to teach us how and where to transform our practice.”

She hopes that the medical students will be able to identify key patient needs, as well as high-yield coaching techniques that can be taught to existing staff members. This approach is revolutionary, as several studies have been conducted using students as health coaches, but none with students as change agents. “I think having the students involved with primary care transformation at the ground level in a community setting is a new idea – and a way to convince the most talented students to stay with primary care,” Kenney says.

Fellow: Kitty O’Hare, Boston Children’s Hospital

Innovation Project: “Transition to Adult Care”

Dr. O’Hare trained in both Internal Medicine and Pediatrics, so she looks at the healthcare system from both sides of the age spectrum. In her project, she plans to work with clinicians at Boston Children’s Hospital and at adult institutions to improve systems for a smooth transfer from pediatric to adult care.

To illustrate this gap between pediatric and adult care, she sites a patient named Sara. “Sara has a complex form of congenital heart disease,” she says. “She stopped seeing a primary care doctor when she was 18, when her pediatrician told her she was too old to come to his office anymore.”

O’Hare says that Sara continued to see pediatric specialists, but struggled to take care of herself. None of the specialists talked to each other, and eventually a cardiologist realized that she had no primary care provider. At this point, Sara had been jumping from specialist to specialist for four years.

“The cardiologist made an appointment for Sara with me,” O’Hare says. “I was able to help her understand how her heart disease would affect her life, including her desire to have children. We gave her some vaccines that her pediatrician has not thought to give her. Also, I was able to coordinate care among all of her providers and even come up with a plan for transferring care to adult specialists.”

This gap in transitional care is especially pressing for children with chronic conditions, according to O’Hare. Over 90% of these children will reach adulthood, but fewer than half of them will receive all the help they need – and the young adult period is high risk. “I hope to make all young adult primary care transitions less stressful and more seamless for patients like Sara,” she says.

Fellow: Stephanie Power, Family Practice Group, Mount Auburn Hospital

Innovation Project: “Implementing a Collaborative Care Model to Treat Co-morbid Medical and Psychological Conditions in Primary Care”

Dr. Power’s project focuses on mental illness in the United States, citing a staggering statistic: about a third of U.S. adults suffer from some sort of mental illness within any given year, but fewer than half of them will seek out treatment. 8% of those patients will see their primary medical provider at least once each year, making primary care a good jumping off point for dealing with mental health issues.

But the challenge here is that most primary care physicians can’t manage the medical, psychological and social issues that are present in co-morbid patients. “My innovative solution to this problem is to train our medical assistants to be health coaches so that they can serve as a bridge between the medical provider and psychologist,” she says. “My hope is that this added layer of services will begin to address the patients complex care needs beyond visits with the PCP.”

Right now, Power is creating a training curriculum to teach medical assistants skills in health coaching (ie. establishing rapport, motivational interviewing, behavioral activation, problem soling, agenda setting, creating SMART goals, and monitoring patient progress). Training starts this month, so the medical assistants will be able to start working with patients in September.

Why spend all this time (and money) focusing on primary care? Power believes that it’s vital for our healthcare system. “Our country spends an extraordinary amount of money on health care, which does not always lead to improved outcomes,” she says. “It is really important for us to identify more effective and cost efficient way to address our patients’ needs.”

In addition to Kenney, O’Hare and Power, the complete list of 214-2015 HMS Primary Care Innovation Fellows includes: Justin Chen, Massachusetts General Hospital; Mary-Louise Jean-Baptiste, Cambridge Health Alliance; Rose Kakoza, Brigham and Women’s Hospital; Arshiya Seth, Cambridge Health Alliance; Natalie Bloch, Mount Auburn Hospital; and Sarah Teasdale, Boston Children’s Hospital.

Are you innovating primary care? HMS and Medstro are co-sponsoring a Primary Care Challenge to highlight the best and brightest innovators – submit your ideas now!

Jenni Whalen

Jenni Whalen

    Jenni Whalen is the Executive Assistant of Editorial at Upworthy. She was previously MedTech Boston's Managing Editor and has an MS in Journalism from Boston University, as well as a BA in Psychology from Bucknell University. Whalen has written for Greatist, Boston magazine, AZ Central Healthy Living and the New England Journal of Medicine, among other places. She has also worked as a conference planner, ghost writer, researcher and content developer.

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