Palo Alto
Palo Alto Medical Foundation
Inside Palo Alto Medical Foundation
The Palo Alto demonstration site is a joint collaboration between the Palo Alto Medical Foundation (PAMF), the Palo Alto Medical Foundation Research Institute (PAMFRI), and the University of California-San Francisco (UCSF). PAMF, which will serve as the clinical site for the project, is a multi specialty medical group in the San Francisco Bay Area that includes both primary care and subspecialty clinics and serves more than 750,000 patients. Initially, the project will focus on primary care clinics within the Palo Alto region. Investigators from PAMFRI and UCSF will coordinate the research portion of the project.
Varied Methods for Clinic Sites
When designing this demonstration project, team leaders were challenged by the significant differences in set-up and operations of the clinic sites within the local Palo Alto region. These differences prevented the team from crafting a single method for distributing and using decision aids. Instead, the team will allow variation in methods among sites, but require that sites use a common set of standards that relate to the mission of the organization, which is to ensure quality care is being given and to improve affordability and value of health care. The team will also create a process by which clinic and research staff can share best practices. Based on these goals, the steering committee focused on the need for tools to help achieve better quality, more patient-centered care, and a practical, efficient, sustainable way of making shared decision-making a reality in clinical practice.
Four PAMF primary care practices will serve as initial pilot sites for the project. The project steering committee, which consists of the project manager, physicians from each pilot site plus other staff, designed the shared decision-making process to take advantage of existing resources, including PAMF’s electronic medical record, an online patient portal, nurse-staffed community health resource centers, and shared medical appointments (group appointments with a physician that include evaluation and management for each patient).
A New Position Created
The Shared Decision-Making Navigator—a new position created for this demonstration project—will receive referrals for shared decision-making programs, make outreach calls to patients to connect them with their preferred method of receiving information, and will be the point person to assist providers in referring patients to shared decision-making programs. Patients will be identified as potential candidates for a shared decision-making program through a variety of means, including direct referral by physicians during clinic visits, electronic medical record health maintenance reminders, referral by nurses, and referral from the appointment scheduling staff to the Shared Decision-Making Navigator.
Patient Logistics
All decision aid DVDs will be available at the three PAMF community health resource center locations. Patients will be able to schedule an appointment to view decision aids at the center and speak with a nurse in person about their medical decision or borrow a DVD, view it at home, and speak with a nurse by phone. Scheduling of the appointment will link through the electronic health record to the electronic referral system for this project. Patients will also be able to view DVDs received by postal mail, and can follow up with a physician or nurse after viewing. Alternatively, patients will be able to join scheduled shared medical appointments during which they can view the decision aids and speak with physicians or nurses. Each of the four clinical sites will offer one or two decision aids, with a total of nine aids offered across all sites, including hip osteoarthritis, coronary artery disease, acute back pain, disc disease, spinal stenosis, dysfunctional uterine bleeding, fibroids, and colon cancer screening. For more information about this implementation project, please contact Project Manager Suepattra May at mays@pamfri.org.