Transforming Outpatient Care (TOPC)
The Louis Stokes Cleveland VA Medical Center
Center of Excellence in Primary Care Education
Thank you for your interest in the TOPC curriculum. A brief overview of the program background, setting, curricular components, schedule, and logistics is provided below.
Background: In January 2011, the Louis Stokes Cleveland Veterans Affairs Medical Center (VAMC) received a five million dollar federal grant to offer physician and nurse practitioner learners a novel and visionary approach to healthcare in the 21st century. In collaboration with the Cleveland Clinic Internal Medicine Residency Program, the Frances Payne Bolton School of Nursing, and supported by the VA Office of Academic Affiliations, this Center of Excellence will prepare residents and nurse practitioner students to work in new models of care that demand teamwork and patient centered care. Students will be offered novel educational opportunities to build on current strengths in the curriculum as well as acquire new skill sets.
The VA Primary Care Clinics: The outpatient clinical experience at the Cleveland VAMC serves a diverse patient population of varying age and medical complexity with oversight by dedicated faculty who are selected on academic merit and proven commitment to clinical education. In this environment, trainees manage patients in collaboration with pharmacists, psychologists, and registered nurses. Emphasis on chronic disease management is provided via traditional office visits, shared medical appointments, tele-health communication, and through utilization of locally-developed diabetes, chronic kidney disease and heart failure disease registries. The Cleveland VAMC will have fully implemented the “PACT” (Patient-Aligned Care Team) model (synonymous with patient centered medical home) which provides dedicated interdisciplinary team members to enhance patient care and provider and patient satisfaction.
Training in Six Sigma and other Performance Improvement Tools: The Center of Excellence is excited to partner with faculty from the Case Weatherhead School of Management to provide trainees with the skills and tools necessary to implement performance improvement into the everyday care of patients. Learners will have the opportunity to receive training in management skills such as six sigma taught by Weatherhead faculty.
Leadership in Quality Care Improvement: Learners will become competent in leading and incorporating quality measures and performance improvement into the delivery of healthcare. Specific to the Center of Excellence, residents and NP students will have access to chronic disease registries and will be provided various opportunities to learn how to use these tools effectively for panel and population management, and improve safety and quality at the system level.
Interdisciplinary team based care: Learners in the program will engage in a team based model for healthcare delivery. To facilitate this model, the VA has partnered with CCF and the Frances Payne Bolton School of Nursing to support the integration of the education of medical residents and nurse practitioner students. As members of a PACT team, residents and nurse practitioners will work collaboratively with RNs, LPNs, social workers, pharm-Ds, health psychologists, as well as dedicated administrative support for a specified panel of patients. The goal of this model is to provide comprehensive patient care while enhancing provider and nursing staff satisfaction.
Proactive Care: Medical residents and nurse practitioner students will learn motivational interviewing (via collaboration with our behavioral health specialists) and teaching patient self-management skills (via collaboration with the Frances Payne Bolton School of Nursing’s NIH funded Self Management Advancement through Research and Translation Center).
Real time real patient feedback: Medical residents and nurse practitioner students will be provided unique opportunities to obtain real-time feedback from selected patients to understand the patient experience along the entire continuum of healthcare as patients experience it.
Humanities in Healthcare: Medical residents and nurse practitioners students will engage in a Narrative Healthcare Course, which will include pre-designated reading assignments of relevant popular press and/or movies and discussion of these readings at regular meetings led by members of the Department of Bioethics and Case Western Reserve University. Additionally, the VA has partnered with the Cleveland Museum of Art to develop an Art in Healthcare curriculum as well as with the Allen Memorial Art Library to provide a historical perspective to the practice of Medicine and Nursing.