The EVMS Department of Family and Community Medicine offers three distinctive residency programs, including the family medicine programs at Portsmouth and Ghent; and the Combined Family Medicine/Internal medicine program, for which the continuity patient site is Ghent. The programs share faculty resources, including overlap in their core curriculum didactic series; guidance in development of clinically-based research or QI projects during residency; and faculty expertise in areas such as the EHR, quality improvement, geriatrics, women's health, procedural skills, behavioral medicine, clinical pharmacy, community service-learning and global medicine opportunities. The family medicine maternity care program includes patient care at the Portsmouth Health Department, Maryview Medical Center, Sentara Norfolk General Hospital, and continuity with OB patients that occurs at both residency sites; as well as the opportunity to co-facilitate Centering Pregnancy and Parenting groups (prenatal or well child care offered in the group setting, an innovative way to improve patient outcomes and provide an amazing experience in the impact of pregnancy and parenting on the family for residents). The department places special emphasis on primary care geriatrics, provides medical care for a PACE (program for all-inclusive care for the elderly) and is an integral partner in the newly funded Statewide Geriatric Education Center. Interested residents have the opportunity to conduct practicum projects in public or global health, that with course work through EVMS' graduate program in public health, will satisfy requirements for a Certificate in Public Health Leadership.

The Department has embraced the national focus in primary care to transform our practice of medicine through the Patient-Centered Medical Home model. The opportunities for improving outcomes for our patients, realizing enhanced reimbursement through pay-for-performance programs (Medicare's PQRL and Meaningful Use) and NCQA accreditation as a Patient-Centered Medical Home; as well as preparing our graduates to be leaders in the altered landscape of health care reform all motivate our commitment We are focusing on:

• Providing leadership within the school in the use of (now 6 years old) electronic record-keeping
• Serving as the pilot site for implementation and incorporating residents and students;
• Pioneering the linkage of the electronic record with continuous quality measurement and improvement

• Providing residents with regular reports on quality indicators for patients with key diseases in our practice,
• Dr Rick Bikowski chairs the Academic Users' Group for the Allscripts/Enterprise users nationally and leads the IT team as a national demonstration project site for Allscripts.
• Participating in departmental and school-wide quality improvement projects addressing multiple aspects of medical and business practice.
• Residents are key contributors to EVMS' participation in the I3 collaborative, a network of 30 FM, IM and Pediatric residencies in Virginia, North and South Carolina who are assisting each other in achieving PCMH certification through the National Committee on Quality Assurance, and are members of our department teams addressing each of the nine PCMH standards.
  

Key current elements of PCMH implementation include

• using evidence-based practice guidelines to improve care for patients with diabetes, hypertension and congestive heart failure;

• providing and enhancing self-management support;
• enhancing patient access to their healthcare team (with appointment- and non-appointment-based methods);
• proactively tracking consult reports and imaging studies and achieving bidirectional interfaces for lab orders;
• offering group visits; and
• coding for enhanced reimbursement.

These are challenging times for health care, with dramatic disparities in access to and outcomes of care, many individuals without health insurance, anticipated changes and new challenges related to health care reform legislation, and a national reimbursement system with significant inequity in rewarding contributions to population health. Residents who are trained in the residency programs at EVMS have the opportunity to make a difference, whether by service-learning activities for the underserved in our community; participation in quality improvement and advocacy efforts through the department, or linkages with regional or global health-related organizations. These shared strengths together with the programs' unique approaches combine to produce exceptional educational options for candidates who want to prepare for leadership as competent and compassionate family physicians in the future of medicine.

Christine C. Matson, M.D.
Glenn R. Mitchell Chair,
EVMS Department of Family and Community Medicine
September 2010