Clinton Family Health Center Rochester General Hospital

Rochester, NY

The problems come from poor systems … not bad people
—In its current form, habits, and environment, American health care is incapable of providing the public with the quality health care it expects and deserves.

(image: bar graph titled "Diabetes Hospitalizations")

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• Community Health Center
• 9,000 patients
• Inner city, mostly Hispanic
• High rate of uninsured, Medicaid

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• Team Formation
• Open Access Scheduling
• Preventive Care
  — Group Medical Visits

• Daily Huddle
• Weekly Meeting
• Small PDSA Cycles

• Do today's work today
• Provides Timely Care
• Decreases ED Visits

• Prevention at every visit
• Team Approach to Prevention
• Group Medical Visits

One-on-One Office Visit	Group Office Visit
Check-in 5 minutes (waits in waiting room 15 minutes) Vital signs with nurse 5 minutes (waits in exam room 15 minutes) See provider for 7-15 minutes, labs ordered (waits in exam room another 15 minutes) Labs, check-out, next appointment 15 minutes	Provider, secretary and nurse meet the group patients at an assigned time in the group room. Check-in, vital signs, labs, provider time are all done in the same room at the same time on eight to ten patients.
Patient spends 1.5 hours in office 7-15 minutes with provider	Patient spends 1.5 hours in office 1.5 hours with provider

(image: chart titled "CFHC: Number of days until third available long office visit")

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(image: bar graph titled "Clinton Family Health Center Percentage of Diabetics to Goal (As of July 2006)")

(image: line graph titled "Average A1C of All Diabetics at CFHC 2003-2006")

	2003	2004	Change	% Change
Clinton Family Health Center	622.66	475.89	-146.77	24%

(image: line graph titled "CFHC New Patients Entering the Practice Per Quarter")

(image: line graph titled "How smoothly do things generally run in your team?")