Prenatal Group Visit Curriculum DocumentLast updated at 08/27/2007 10:37:21 AM EST by Traci Nolte
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Centering Pregnancy©/ Prenatal Group Visits Curriculum
Angela Yerdon McLeod, DO and Cynthia LaClair, RN
Goal:
Centering Pregnancy© prenatal group visit experience is designed to provide Family Practice Residents with a set of basic skills needed to facilitate group visits in their primary care practice. These skills include: social and medical risk assessment, facilitative leadership, clinical time management, development of multidisciplinary care plans, as well as appropriate medical knowledge.
It is intended that the skills acquired during this experience will allow the Family Physician the ability to incorporate any number of group visit types into their practice such as prenatal care, chronic disease management, well child care or health maintenance/preventative care. The significant learning experience will be gained during the resident’s third year as part of the larger scale 6-month longitudinal curriculum. The resident will acquire some needed skills through the first and second years of residency as well. They will recognize patients’ needs, call for and develop care plans for a group of pregnant patients at the CRFHC. The resident will work with Family physicians who practice OB/GYN, Cynthia LaClair, RN (prenatal nurse coordinator), care managers, and OB/GYN faculty to gain knowledge and experience. Angela Yerdon, DO will coordinate these efforts.
Objectives:
1. Patient Care
The graduate will be able to:
· Demonstrate group facilitative skill through addressing confidentiality: establishing rules that reflect the group’s needs, allowing one person to speak at a time; initiating meaningful dialogue; incorporating opening & closing rituals; using group process to help group members adhere to lifestyle changes; and recognizing, without stigmatizing, outliers
· Conduct brief, focused medical exams
· Appropriately triage less critical issues to later exams/interviews
· Work with patient’s family members
· Assess psychosocial risks
2. Medical Knowledge
The graduate will be able to
· Explain in lay language the etiology, assessment, treatment, and life-style modifications for targeted issues
· Recognize own limitations in scope and working with groups and seek assistance
· Identify other professionals to teach about nutrition, exercise, mind-body techniques
· Demonstrate prenatal care appropriate for gestational age
· Cite adequate prenatal screening at appropriate gestational ages
3. Practice Based learning and improvement
The graduate will be able to:
· Identify meaningful outcomes (e.g. medical, functioning, satisfaction, cost)
· Develop a plan to monitor outcomes over the course of the group
· Appropriately bill for group medical visits with supporting documentation
· Create a multidisciplinary care plan to monitor outcomes
4. Interpersonal/Communications skills
The graduate will be able to:
· Demonstrate interactive teaching and discussion skills
· Use motivational interviewing skills that include
1. eliciting patient’s vision of health
2. facilitating self-management plans and self-care decisions
3. conducting group problem-solving conversations
4. using health information to guide participant’s self-care decisions
· Appropriately identify patients for group visits using diagnosis-specific registries, (pharmacy usage profiles, ICD insurance-based diagnoses)
· Use mailings, posters, handouts, receptionists calls and one-on-one recruitment to successfully recruit patients for group visits
· Identify patients from own patient panel who would likely benefit from group model of care
5. Professionalism
The graduate will be able to:
· Review OB intake prior to initial visit
· Identify the utility of focused and timely chart reviews prior to each group visit
· Document the group medical visit in a timely manner
· Record the agreed upon biological markers and self-management goals
· Maintain cultural awareness
6. System based practice
The graduate will be able to:
· Partner with a multidisciplinary team in planning, debriefing, sharing process, and defining roles
· Document an obstetrical progress note that includes a pertinent review of systems, a brief exam that includes blood pressure, fundal height, fetal heart tones, and an assessment and plan
· Make appropriate use of written material for invitational letters, HIPAA forms, confidentiality forms, agreement to participate forms and pay forms
· Appropriately use community resources
Teaching/ Learning Experiences to meet the Objectives:
First Year Residents
MCH rotation, OB core presentations, OB readings
OB clinic, review of OB intake for medical, social, educational, financial, nutritional, dental risk factors
Home visit with Early Head Start home visitor
OB continuity experience and continuity deliveries
Medical home/ Fundamentals of Generalism curriculum topics
Second Year Residents
MCH rotation, supervisory role
OB continuity experience and continuity deliveries
High Risk Review (medical and social) with Obstetrician
Attend Social Risk Review with Prenatal Nurse, Care Management, Resource social worker, hospital social worker, Nurse Clinician from the Family Place
OB ‘high risk’ consult clinic with Obstetrician
Third Year Residents
MCH rotation, supervisory role
OB continuity experience and continuity deliveries
High Risk Review (medical and social) with Obstetrician
OB ‘high risk’ consult clinic with Obstetrician
*6 month Longitudinal rotation with Centering Pregnancy groups
Evaluation Strategies:
Evaluation of Learner Performance
Evaluation of Program
Implimentation Plan:
Identification of High Risk Patients
Prenatal patients are assessed by a multidisiplinary team that identifies both medical risks and psycho-social risks. This team is made up of nursing, social work, nutrition, obstetrical and family practice providers. A nurse or the intern gathers an initial history. This is reviewed by a social worker/resource person. Second and third year residents work with the obstetrician doing a thorough review of the patient’s history to identify medical risks and social risks for the pregnancy. These assessments are all part of the care plan for obstetrical care and are individualized for each client.
As high-risk issues arise during the prenatal course, patients are re-referred to the obstetrician for chart review or more formal obstetrical consultation.
Higher-risk patients may continue to attend Centering Pregnancy visits, but may require additional visits in a usual care model to address particular issues that are not covered in the group format.
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