The Primary Care Clinical Program (PCCP) began in 1998, focusing initially on patients with diabetes, asthma, and community-acquired pneumonia. Today, the program encompasses a range of health issues, including mental health integration and depression, attention deficit disorder, obstructive sleep apnea, and pediatric upper respiratory infections. The newest development team addresses chronic pain.

The Primary Care Clinical Program staff works with leaders in the Medical Group and SelectHealth, as well as with regional nurse consultants and frontline clinicians, to evaluate, develop, and implement these important initiatives. Close coordination with other clinical programs has led to improvements in caring for patients with congestive heart failure, chronic obstructive pulmonary disease (COPD), obesity, and hypertension.

Recent initiatives in the Primary Care Clinical Program include:

Diabetes

Our board goal in 2010 is to reach patients who have had HbA1c test results greater than 8 for more than one year. HbA1c is a blood test that measures how well a patient's blood sugar has been controlled over the past three months. High levels lead to more frequent serious complications such as kidney failure, blindness, amputations, and heart attacks. This has been our most challenging board goal in recent years. To meet the goal, SelectHealth and the endocrinologists in our diabetes work group are working closely with our primary care clinicians.

Mental Health Integration

Intermountain's Mental Health Integration (MHI) Program takes a multi-disciplinary approach to caring for patients with mental health conditions in primary care practices. Team members include primary care physicians, mental health professionals, care managers, community resources, and all the clinical and operational staff at the health center. This approach is now standard at many primary care sites in the Intermountain Medical Group, and we are supporting this process in specialty practices both within Intermountain and at five major non-Intermountain sites nationally (including a community health center in Salt Lake City). Earlier this year, a major healthcare publication highlighted our Mental Health Integration team's work.

Chronic Anticoagulation

There are many health conditions that result in inappropriate blood clotting. This can result in stroke or pulmonary embolism (a potentially life-threatening condition in which a blood clot from the legs lodges in the lungs). Medications are required to prevent these complications, and these patients require close monitoring to find the fine balance between blood's clotting too easily or not well enough. There are currently 14 sites in Intermountain that use our protocols to efficiently and effectively care for patients on chronic anticoagulation.

These are just a few examples of the work Intermountain's Primary Care Clinical Program provides to support the communities we serve and continue our legacy of innovation. Ask your regional leadership about your region's work with the program.


B. Reiss-Brennan, P. C. Briot, L. A. Savitz, W. Cannon, and R. Staheli, "Cost and Quality Impact of Intermountain's Mental Health Integration Program," Journal of Healthcare Management 55 (2) (Mar/Apr 2010): 97-113.

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