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Thursday, September 9, 2010

Peer-to-peer learning

Peer-to-peer learning was a major benefit of participating in the National Demonstration Project (NDP). On the facilitated side, the study was set up with three groups of six practices. Each group had a facilitator who conducted monthly conference calls, with topics ranging from a review of technology vendors to emotional support in going through changes. A Balint/book review group was spun off from our group, where we reviewed and discussed books like Better by Atul Gawande and How Doctors Think by Jerome Groopman. This format allowed members from each of the six practices to have tight personal relationships with others who were going through the same transformative processes.

We also attended several learning collaboratives, where we heard from national experts on topics such as open access, implementing an EHR system and group visits. Hearing from the experts was valuable, but so was hearing from one other. At one collaborative, for example, we heard an impromptu presentation by one practice that had achieved the best cycle times (i.e., the time it takes a patient to complete his or her visit at the office), and we naturally wanted to hear details on how they did it. Flexibility in the schedule allowed for this extremely helpful learning to occur.

Peer-to-peer learning continued after the NDP closed, with the Touchstone group continuing monthly calls for about one year and having two annual “reunion” collaboratives thus far. These continue to be wonderful opportunities for networking and ongoing assistance in navigating the medical home. Many of the practices are now embarking on NCQA recognition and learning from NDP peers on how to most efficiently do this.

One of the best peer learning tools is Delta Exchange. This networking web site launched by TransforMed now has hundreds of members, from physicians to nurses, consultants and practice managers. Members can share documents, read blogs and articles, and post questions to the group. Just last week, in going through the NCQA application process, our practice needed a one-page handout to inform patients about the medical home. Instead of reinventing the wheel, I went to Delta Exchange and “asked” the group if anyone already had such a document. That same day, I had three examples.  This type of sharing is invaluable. It helps the spread of ideas and saves time in busy offices.

Clearly new pilots and experiments in the medical home arena must have peer-to-peer learning as a component of the project. Unfortunately, many states prohibit this type of shared learning due to legislative prohibition of collective bargaining. Family physicians need to be aware of these restrictions especially when discussing financial arrangements to fund medical home initiatives. Several pilots have been successful in getting legislative “safe harbors” to allow such exchange of information. (See http://www.coloradoguidelines.org/pcmh/conveningorg.asp.)

Think back to medical school where a peer group was so helpful to maintaining your sanity. Study groups, late night “talks” and social events kept us going through those four years. Hopefully most of our lives have settled down now. However, the type of change required to transform the typical family medicine practice into a medical home reminds me of those fours years. It was invaluable to have my “buddies” in the form of other practice members helping me through the process.

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About the Author

Melissa Gerdes, MD, is a family physician practicing at Methodist Family Health Center – South Arlington in Arlington, Texas, and former president of the Texas Academy of Family Physicians.

Note: This blog is no longer updated; this is archived content.

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Real-Life Practice Transformation is a Family Practice Management (FPM) blog. However, the views expressed here are those of the individual authors. They do not necessarily reflect the opinion of FPM or the AAFP. The FPM blogs are not intended to provide medical, financial or legal advice. For more information see Terms of Use.