Guest guest Posted June 13, 2009 Report Share Posted June 13, 2009 , As with the last story he wrote, this is brilliant. I admire his insight and honesty. He is not being politically correct, he is being straightforward (perhaps his surgical training has helped him cut through the fat and get straight to the real issue J). Yes, we should make him aware that we are another one of the “positive outliers.” Gordon, you want to take this one on or do you think several of us should write in to make our collective voices heard? From: [mailto: ] On Behalf Of Seto Sent: Saturday, June 13, 2009 2:47 AM To: Subject: Positive deviants My wife told me about this article by Dr. Atul Gawande, a surgeon who writes wonderful articles for New Yorker magazine. It was his commencement address to the Pritzker School of Medicine this year. He told a story about how a friend ran a program to reduce malnutrition in Vietnamese villages, but they had little funding. So instead of the usual methods, they went low-tech and travelled to different villages, identified which families had the best nourished children and then analyzed what they were doing differently from the other families. They were the " positive deviants " , the outliers. They took their ideas and spread them to other villages, measured their results and used those results to convince other villages to adopt their methods. As a result, malnutrition dropped 65-85%, which was even more effective than the usual methods suggested by outside experts. Gawande then goes on to explain how the United States is now that village: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html He points out that, like the researchers in Vietnam, we need to look for successful outliers if we are to solve our healthcare crisis. But while he zooms in to some degree of some unique models, he doesn't zoom in small enough. I think the " positive deviants " he and the rest of the country are looking for are IMPs. Small, low-overhead, cost-effective practices that have highly satisfied patients and healthcare providers, with reproducible measures of success. Definitely outside the norm. Maybe somebody should write a letter to the editor. Maybe I will. Maybe if a bunch of us write then, like the Whos in Whoville, we might get heard. Comments can be sent to " themail@... " . Yopp! Seto South Pasadena, CA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2009 Report Share Posted June 13, 2009 You get up too early Brady. thanks for this Unfortunately for health care the sun just appeared after years of rain so I am outside... butlater iwill write to them GAry thanksThe other Atul Gwande article was apparenlty requested By the hospital in TExas Mc that was NOT the rich doctor owned one .They were looking to calla atteniton to the mess down there and had tried t get 60min to come.My CEO here just came form there That hospital had been noting the strip malls of cash only MRIs and the " you cannot even imagine what the board room descrbedin the article in the dr's hospital lookslike Jean' and of course now I imagine CMS ay be all over that town so they should be careful w hat they asked for... Intersting stuff. Yestresday I had a guy I charge 80 for a visit to got my 70 in cash 10.00 disount I felt rich wow 70.00 in touchable dollars. He needed a CT I do not order alot of tests but he neededit I said cut a deal offer topay now -he did- and they cahrged him 1800 , he told me at 6 30lastngiht when I told him about the diverticulitis i wasn;t sure about he is so young and goes back t o nantucket today where he works during the week so i referred him for followup to Greg Hinson are IMP maps cool or what 1800.00 ! for a ct. I explained cost shifting tohim He sid what can I do about this and i gave him BArack Obama's name.....Jean , As with the last story he wrote, this is brilliant. I admire his insight and honesty. He is not being politically correct, he is being straightforward (perhaps his surgical training has helped him cut through the fat and get straight to the real issue J). Yes, we should make him aware that we are another one of the “positive outliers.” Gordon, you want to take this one on or do you think several of us should write in to make our collective voices heard? From: [mailto: ] On Behalf Of Seto Sent: Saturday, June 13, 2009 2:47 AM To: Subject: Positive deviants My wife told me about this article by Dr. Atul Gawande, a surgeon who writes wonderful articles for New Yorker magazine. It was his commencement address to the Pritzker School of Medicine this year. He told a story about how a friend ran a program to reduce malnutrition in Vietnamese villages, but they had little funding. So instead of the usual methods, they went low-tech and travelled to different villages, identified which families had the best nourished children and then analyzed what they were doing differently from the other families. They were the " positive deviants " , the outliers. They took their ideas and spread them to other villages, measured their results and used those results to convince other villages to adopt their methods. As a result, malnutrition dropped 65-85%, which was even more effective than the usual methods suggested by outside experts. Gawande then goes on to explain how the United States is now that village: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html He points out that, like the researchers in Vietnam, we need to look for successful outliers if we are to solve our healthcare crisis. But while he zooms in to some degree of some unique models, he doesn't zoom in small enough. I think the " positive deviants " he and the rest of the country are looking for are IMPs. Small, low-overhead, cost-effective practices that have highly satisfied patients and healthcare providers, with reproducible measures of success. Definitely outside the norm. Maybe somebody should write a letter to the editor. Maybe I will. Maybe if a bunch of us write then, like the Whos in Whoville, we might get heard. Comments can be sent to " themail@... " . Yopp! Seto South Pasadena, CA -- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2009 Report Share Posted June 13, 2009 You know , I kind of like the thought of being a positive deviant. Sounds so cool and sinister and goes really well with our name. I think a bumper sticker is in order— IMPs. Positively Deviant (and not afraid to show it)—just put the www.impcenter.org below it. J From: [mailto: ] On Behalf Of Seto Sent: Saturday, June 13, 2009 2:47 AM To: Subject: Positive deviants My wife told me about this article by Dr. Atul Gawande, a surgeon who writes wonderful articles for New Yorker magazine. It was his commencement address to the Pritzker School of Medicine this year. He told a story about how a friend ran a program to reduce malnutrition in Vietnamese villages, but they had little funding. So instead of the usual methods, they went low-tech and travelled to different villages, identified which families had the best nourished children and then analyzed what they were doing differently from the other families. They were the " positive deviants " , the outliers. They took their ideas and spread them to other villages, measured their results and used those results to convince other villages to adopt their methods. As a result, malnutrition dropped 65-85%, which was even more effective than the usual methods suggested by outside experts. Gawande then goes on to explain how the United States is now that village: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html He points out that, like the researchers in Vietnam, we need to look for successful outliers if we are to solve our healthcare crisis. But while he zooms in to some degree of some unique models, he doesn't zoom in small enough. I think the " positive deviants " he and the rest of the country are looking for are IMPs. Small, low-overhead, cost-effective practices that have highly satisfied patients and healthcare providers, with reproducible measures of success. Definitely outside the norm. Maybe somebody should write a letter to the editor. Maybe I will. Maybe if a bunch of us write then, like the Whos in Whoville, we might get heard. Comments can be sent to " themail@... " . Yopp! Seto South Pasadena, CA Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 13, 2009 Report Share Posted June 13, 2009 did you send a secure email to Gregg of this note? ;-) Matt Re: Positive deviants You get up too early Brady. thanks for this Unfortunately for health care the sun just appeared after years of rain so I am outside... butlater iwill write to them GAry thanksThe other Atul Gwande article was apparenlty requested By the hospital in TExas Mc that was NOT the rich doctor owned one .They were looking to calla atteniton to the mess down there and had tried t get 60min to come.My CEO here just came form there That hospital had been noting the strip malls of cash only MRIs and the "you cannot even imagine what the board room descrbedin the article in the dr's hospital lookslike Jean' and of course now I imagine CMS ay be all over that town so they should be careful w hat they asked for... Intersting stuff.Yestresday I had a guy I charge 80 for a visit to got my 70 in cash 10.00 disount I felt rich wow 70.00 in touchable dollars. He needed a CT I do not order alot of tests but he neededit I said cut a deal offer topay now -he did- and they cahrged him 1800 , he told me at 6 30lastngiht when I told him about the diverticulitis i wasn;t sure about he is so young and goes back t o nantucket today where he works during the week so i referred him for followup to Greg Hinson are IMP maps cool or what 1800.00 ! for a ct. I explained cost shifting tohim He sid what can I do about this and i gave him BArack Obama's name.....Jean On Sat, Jun 13, 2009 at 7:33 AM, Dr. Brady <drbradythevillagedoctor (DOT) hrcoxmail.com> wrote: , As with the last story he wrote, this is brilliant. I admire his insight and honesty. He is not being politically correct, he is being straightforward (perhaps his surgical training has helped him cut through the fat and get straight to the real issue J). Yes, we should make him aware that we are another one of the “positive outliers.” Gordon, you want to take this one on or do you think several of us should write in to make our collective voices heard? From: [mailto: ] On Behalf Of SetoSent: Saturday, June 13, 2009 2:47 AMTo: Subject: Positive deviants My wife told me about this article by Dr. Atul Gawande, a surgeon who writes wonderful articles for New Yorker magazine. It was his commencement address to the Pritzker School of Medicine this year. He told a story about how a friend ran a program to reduce malnutrition in Vietnamese villages, but they had little funding. So instead of the usual methods, they went low-tech and travelled to different villages, identified which families had the best nourished children and then analyzed what they were doing differently from the other families. They were the "positive deviants", the outliers. They took their ideas and spread them to other villages, measured their results and used those results to convince other villages to adopt their methods. As a result, malnutrition dropped 65-85%, which was even more effective than the usual methods suggested by outside experts. Gawande then goes on to explain how the United States is now that village: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html He points out that, like the researchers in Vietnam, we need to look for successful outliers if we are to solve our healthcare crisis. But while he zooms in to some degree of some unique models, he doesn't zoom in small enough. I think the "positive deviants" he and the rest of the country are looking for are IMPs. Small, low-overhead, cost-effective practices that have highly satisfied patients and healthcare providers, with reproducible measures of success. Definitely outside the norm. Maybe somebody should write a letter to the editor. Maybe I will. Maybe if a bunch of us write then, like the Whos in Whoville, we might get heard. Comments can be sent to "themailnewyorker". Yopp! Seto South Pasadena, CA -- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2009 Report Share Posted June 14, 2009 IMP needs a study or demonstration project that can measure the economic and quality impact of small, networked ideal practices and gain credibility and visibility among the reform planners. Otherwise, ideal practices, like other small practices, may be marginalized and pushed aside by the reforms designed to create either less than ideal medical homes (PCMH) or large integrated systems via accountable care organizations. Gordon and the other well connected folks here may have ideas on how to do this. The irony is that the Dartmouth Atlas group seems highly regarded by the reformers and yet IMP also has significant ties to Dartmouth via Dr Wasson and the Clinical Microsystems group (if I understand IMP history correctly). R. Pierce MD Rockport, Maine www.midcoastmedicine.com Dr. Brady wrote: > > > Dude is amazingly accomplished and has a cool website at > www.gawande.com <http://www.gawande.com>. We can e-mail him through > his website, but I don’t know if it would be nice for us all to > barrage him. What do others think? > > > > *From:* > [mailto: ] *On Behalf Of * Eads > *Sent:* Saturday, June 13, 2009 12:45 PM > *To:* > *Subject:* RE: Positive deviants > > > > > We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him? > Via the New Yorker?? > > Eads, MD > > Pinnacle Family Medicine > > Colorado Springs, Colorado > > www.PinnacleFamilyMedicine.com > > *From:* > [mailto: ] *On Behalf Of * Seto > *Sent:* Saturday, June 13, 2009 12:47 AM > *To:* > *Subject:* Positive deviants > > > > > > My wife told me about this article by Dr. Atul Gawande, a surgeon who > writes wonderful articles for New Yorker magazine. It was his > commencement address to the Pritzker School of Medicine this year. He > told a story about how a friend ran a program to reduce malnutrition > in Vietnamese villages, but they had little funding. So instead of the > usual methods, they went low-tech and travelled to different villages, > identified which families had the best nourished children and then > analyzed what they were doing differently from the other families. > They were the " positive deviants " , the outliers. They took their ideas > and spread them to other villages, measured their results and used > those results to convince other villages to adopt their methods. As a > result, malnutrition dropped 65-85%, which was even more effective > than the usual methods suggested by outside experts. > > Gawande then goes on to explain how the United States is now that village: > > http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-o\ f-chicago-medical-school-commencement-address.html > <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-\ of-chicago-medical-school-commencement-address.html> > > He points out that, like the researchers in Vietnam, we need to look > for successful outliers if we are to solve our healthcare crisis. But > while he zooms in to some degree of some unique models, he doesn't > zoom in small enough. I think the " positive deviants " he and the rest > of the country are looking for are IMPs. > > Small, low-overhead, cost-effective practices that have highly > satisfied patients and healthcare providers, with reproducible > measures of success. Definitely outside the norm. Maybe somebody > should write a letter to the editor. Maybe I will. Maybe if a bunch of > us write then, like the Whos in Whoville, we might get heard. Comments > can be sent to " themail@... " . Yopp! > > Seto > > South Pasadena, CA > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2009 Report Share Posted June 14, 2009 Sent an e-mail to the New Yorker... > > My wife told me about this article by Dr. Atul Gawande, a surgeon who > writes wonderful articles for New Yorker magazine. It was his > commencement address to the Pritzker School of Medicine this year. He > told a story about how a friend ran a program to reduce malnutrition > in Vietnamese villages, but they had little funding. So instead of the > usual methods, they went low-tech and travelled to different villages, > identified which families had the best nourished children and then > analyzed what they were doing differently from the other families. > They were the " positive deviants " , the outliers. They took their ideas > and spread them to other villages, measured their results and used > those results to convince other villages to adopt their methods. As a > result, malnutrition dropped 65-85%, which was even more effective > than the usual methods suggested by outside experts. > > Gawande then goes on to explain how the United States is now that > village: > http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-o\ f-chicago-medical-school-commencement-address.html > > He points out that, like the researchers in Vietnam, we need to look > for successful outliers if we are to solve our healthcare crisis. But > while he zooms in to some degree of some unique models, he doesn't > zoom in small enough. I think the " positive deviants " he and the rest > of the country are looking for are IMPs. > > Small, low-overhead, cost-effective practices that have highly > satisfied patients and healthcare providers, with reproducible > measures of success. Definitely outside the norm. Maybe somebody > should write a letter to the editor. Maybe I will. Maybe if a bunch of > us write then, like the Whos in Whoville, we might get heard. Comments > can be sent to " themail@... " . Yopp! > > Seto > South Pasadena, CA > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2009 Report Share Posted June 14, 2009 One way we can do this is by entering the X prize for medicine--I strongly believe that IMP practices fit the requirements for the X prize and the group should join: the sponsors are looking for a paradigmatic shift in healthcare delivery, specifically a 50% improvement in measurable outcomes at a decreased cost--the key feature that IMP has is the PCP and the relationship we have with patients over time. Gordon and the group should join. IMP needs a study or demonstration project that can measure the economicand quality impact of small, networked ideal practices and gain credibility and visibility among the reform planners. Otherwise, idealpractices, like other small practices, may be marginalized and pushedaside by the reforms designed to create either less than ideal medical homes (PCMH) or large integrated systems via accountable care organizations.Gordon and the other well connected folks here may have ideas on how todo this.The irony is that the Dartmouth Atlas group seems highly regarded by the reformers and yet IMP also has significant ties to Dartmouth via DrWasson and the Clinical Microsystems group (if I understand IMP historycorrectly). R. Pierce MDRockport, Maine www.midcoastmedicine.com Dr. Brady wrote:>>> Dude is amazingly accomplished and has a cool website at> www.gawande.com <http://www.gawande.com>. We can e-mail him through > his website, but I don’t know if it would be nice for us all to> barrage him. What do others think?>> >> *From:* > [mailto: ] *On Behalf Of * Eads> *Sent:* Saturday, June 13, 2009 12:45 PM> *To:* > *Subject:* RE: Positive deviants>>>>> We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him?> Via the New Yorker??>> Eads, MD >> Pinnacle Family Medicine>> Colorado Springs, Colorado>> www.PinnacleFamilyMedicine.com>> *From:* > [mailto: ] *On Behalf Of * Seto> *Sent:* Saturday, June 13, 2009 12:47 AM> *To:* > *Subject:* Positive deviants>>>>>> My wife told me about this article by Dr. Atul Gawande, a surgeon who> writes wonderful articles for New Yorker magazine. It was his > commencement address to the Pritzker School of Medicine this year. He> told a story about how a friend ran a program to reduce malnutrition> in Vietnamese villages, but they had little funding. So instead of the > usual methods, they went low-tech and travelled to different villages,> identified which families had the best nourished children and then> analyzed what they were doing differently from the other families. > They were the " positive deviants " , the outliers. They took their ideas> and spread them to other villages, measured their results and used> those results to convince other villages to adopt their methods. As a > result, malnutrition dropped 65-85%, which was even more effective> than the usual methods suggested by outside experts.>> Gawande then goes on to explain how the United States is now that village: >> http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html > <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html> >> He points out that, like the researchers in Vietnam, we need to look> for successful outliers if we are to solve our healthcare crisis. But> while he zooms in to some degree of some unique models, he doesn't > zoom in small enough. I think the " positive deviants " he and the rest> of the country are looking for are IMPs.>> Small, low-overhead, cost-effective practices that have highly> satisfied patients and healthcare providers, with reproducible > measures of success. Definitely outside the norm. Maybe somebody> should write a letter to the editor. Maybe I will. Maybe if a bunch of> us write then, like the Whos in Whoville, we might get heard. Comments > can be sent to " themail@... " . Yopp!>> Seto>> South Pasadena, CA>>------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2009 Report Share Posted June 14, 2009 We have., L. G., & Wasson, J. H. An introduction to technology for patient-centered, collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 195–198. Wasson, J. H., , D. J., , R., , J., & MacKenzie, T. A. Patients report positive impacts of collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 199–206.this article describes the link between patient experience of care and typical quality metrics like A1c, missed days from work, hospitalization rates. LG, Wasson JH. The Ideal Medical Practice Model: Maximizing Efficiency, Quality, and the Doctor-Patient Relationship. Family Practice Management September 2007 pp. 20-24This article compares IMP to non-IMP in terms of ability to deliver patient-centered collaborative care.G IMP needs a study or demonstration project that can measure the economic and quality impact of small, networked ideal practices and gain credibility and visibility among the reform planners. Otherwise, ideal practices, like other small practices, may be marginalized and pushed aside by the reforms designed to create either less than ideal medical homes (PCMH) or large integrated systems via accountable care organizations.Gordon and the other well connected folks here may have ideas on how to do this.The irony is that the Dartmouth Atlas group seems highly regarded by the reformers and yet IMP also has significant ties to Dartmouth via Dr Wasson and the Clinical Microsystems group (if I understand IMP history correctly). R. Pierce MDRockport, Mainewww.midcoastmedicine.comDr. Brady wrote:Dude is amazingly accomplished and has a cool website at www.gawande.com <http://www.gawande.com>. We can e-mail him through his website, but I don’t know if it would be nice for us all to barrage him. What do others think?*From:* [mailto: ] *On Behalf Of * Eads*Sent:* Saturday, June 13, 2009 12:45 PM*To:* *Subject:* RE: Positive deviantsWe gotta tell Dr. Gawande about IMPs! Anyone know how to contact him? Via the New Yorker?? Eads, MDPinnacle Family MedicineColorado Springs, Coloradowww.PinnacleFamilyMedicine.com*From:* [mailto: ] *On Behalf Of * Seto*Sent:* Saturday, June 13, 2009 12:47 AM*To:* *Subject:* Positive deviantsMy wife told me about this article by Dr. Atul Gawande, a surgeon who writes wonderful articles for New Yorker magazine. It was his commencement address to the Pritzker School of Medicine this year. He told a story about how a friend ran a program to reduce malnutrition in Vietnamese villages, but they had little funding. So instead of the usual methods, they went low-tech and travelled to different villages, identified which families had the best nourished children and then analyzed what they were doing differently from the other families. They were the "positive deviants", the outliers. They took their ideas and spread them to other villages, measured their results and used those results to convince other villages to adopt their methods. As a result, malnutrition dropped 65-85%, which was even more effective than the usual methods suggested by outside experts.Gawande then goes on to explain how the United States is now that village:http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html>He points out that, like the researchers in Vietnam, we need to look for successful outliers if we are to solve our healthcare crisis. But while he zooms in to some degree of some unique models, he doesn't zoom in small enough. I think the "positive deviants" he and the rest of the country are looking for are IMPs.Small, low-overhead, cost-effective practices that have highly satisfied patients and healthcare providers, with reproducible measures of success. Definitely outside the norm. Maybe somebody should write a letter to the editor. Maybe I will. Maybe if a bunch of us write then, like the Whos in Whoville, we might get heard. Comments can be sent to "themail@...". Yopp! SetoSouth Pasadena, CA------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2009 Report Share Posted June 14, 2009 Liza, I think Gordon looked into this and the way it is set up, they (the organizers) point you to an area and then let you do your thing. In order for IMPs to be involved in this, we would have to have 10 or so docs ready to relocate to the specified area, then somehow make ends meet for the specified time (I think it is 2 years) and then we could enter our data in to win the prize. In other words, it is lots of difficult coordination and sacrifice to prove what we do. I agree this would be a wonderful forum to “show off” our talents, but it would really only work if we were somehow allowed to each use our own data where we exist now and add it together. Unfortunately, that is not how the X-prize is set up (at least as far as I understand it). From: [mailto: ] On Behalf Of Liza Samson Sent: Sunday, June 14, 2009 1:02 PM To: Subject: Re: Positive deviants One way we can do this is by entering the X prize for medicine--I strongly believe that IMP practices fit the requirements for the X prize and the group should join: the sponsors are looking for a paradigmatic shift in healthcare delivery, specifically a 50% improvement in measurable outcomes at a decreased cost--the key feature that IMP has is the PCP and the relationship we have with patients over time. Gordon and the group should join. On Sat, Jun 13, 2009 at 6:26 PM, Pierce wrote: IMP needs a study or demonstration project that can measure the economic and quality impact of small, networked ideal practices and gain credibility and visibility among the reform planners. Otherwise, ideal practices, like other small practices, may be marginalized and pushed aside by the reforms designed to create either less than ideal medical homes (PCMH) or large integrated systems via accountable care organizations. Gordon and the other well connected folks here may have ideas on how to do this. The irony is that the Dartmouth Atlas group seems highly regarded by the reformers and yet IMP also has significant ties to Dartmouth via Dr Wasson and the Clinical Microsystems group (if I understand IMP history correctly). R. Pierce MD Rockport, Maine www.midcoastmedicine.com Dr. Brady wrote: > > > Dude is amazingly accomplished and has a cool website at > www.gawande.com <http://www.gawande.com>. We can e-mail him through > his website, but I don’t know if it would be nice for us all to > barrage him. What do others think? > > > > *From:* > [mailto: ] *On Behalf Of * Eads > *Sent:* Saturday, June 13, 2009 12:45 PM > *To:* > *Subject:* RE: Positive deviants > > > > > We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him? > Via the New Yorker?? > > Eads, MD > > Pinnacle Family Medicine > > Colorado Springs, Colorado > > www.PinnacleFamilyMedicine.com > > *From:* > [mailto: ] *On Behalf Of * Seto > *Sent:* Saturday, June 13, 2009 12:47 AM > *To:* > *Subject:* Positive deviants > > > > > > My wife told me about this article by Dr. Atul Gawande, a surgeon who > writes wonderful articles for New Yorker magazine. It was his > commencement address to the Pritzker School of Medicine this year. He > told a story about how a friend ran a program to reduce malnutrition > in Vietnamese villages, but they had little funding. So instead of the > usual methods, they went low-tech and travelled to different villages, > identified which families had the best nourished children and then > analyzed what they were doing differently from the other families. > They were the " positive deviants " , the outliers. They took their ideas > and spread them to other villages, measured their results and used > those results to convince other villages to adopt their methods. As a > result, malnutrition dropped 65-85%, which was even more effective > than the usual methods suggested by outside experts. > > Gawande then goes on to explain how the United States is now that village: > > http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html > <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html> > > He points out that, like the researchers in Vietnam, we need to look > for successful outliers if we are to solve our healthcare crisis. But > while he zooms in to some degree of some unique models, he doesn't > zoom in small enough. I think the " positive deviants " he and the rest > of the country are looking for are IMPs. > > Small, low-overhead, cost-effective practices that have highly > satisfied patients and healthcare providers, with reproducible > measures of success. Definitely outside the norm. Maybe somebody > should write a letter to the editor. Maybe I will. Maybe if a bunch of > us write then, like the Whos in Whoville, we might get heard. Comments > can be sent to " themail@... " . Yopp! > > Seto > > South Pasadena, CA > > ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2009 Report Share Posted June 14, 2009 in an effort to be clear - there is a significant policy difference between the dartmouth atlas and the IMP " movement " . the dartmouth atlas represents a fact while the IMP " movement " reprsents a health care solution. the dartmouth atlas, excellent as it is, represents a well known observation of a fact: significant variations in medical care. this fact has been well known for almost 50 years. and very little has been done about this fact. the dartmouth atlas people propose no solution other than a theoretical model which has not been implemented anywhere (the accountable health care organization) and which has not insignificant challenges. the IMP " movement " represents an attempt at one aspect of a solution to the variation in practice patterns importantly documented by the dartmouth atlas people. as such the movement steps on others toes. i am optimistic that this " movement " will overtime catch significant fire. norbert " L. Gordon " Sent by: 06/14/2009 01:23 PM Please respond to To cc Subject Re: Positive deviants We have. , L. G., & Wasson, J. H. An introduction to technology for patient-centered, collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 195–198. Wasson, J. H., , D. J., , R., , J., & MacKenzie, T. A. Patients report positive impacts of collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 199–206. this article describes the link between patient experience of care and typical quality metrics like A1c, missed days from work, hospitalization rates. LG, Wasson JH. The Ideal Medical Practice Model: Maximizing Efficiency, Quality, and the Doctor-Patient Relationship. Family Practice Management September 2007 pp. 20-24 This article compares IMP to non-IMP in terms of ability to deliver patient-centered collaborative care. G IMP needs a study or demonstration project that can measure the economic and quality impact of small, networked ideal practices and gain credibility and visibility among the reform planners. Otherwise, ideal practices, like other small practices, may be marginalized and pushed aside by the reforms designed to create either less than ideal medical homes (PCMH) or large integrated systems via accountable care organizations. Gordon and the other well connected folks here may have ideas on how to do this. The irony is that the Dartmouth Atlas group seems highly regarded by the reformers and yet IMP also has significant ties to Dartmouth via Dr Wasson and the Clinical Microsystems group (if I understand IMP history correctly). R. Pierce MD Rockport, Maine www.midcoastmedicine.com Dr. Brady wrote: Dude is amazingly accomplished and has a cool website at www.gawande.com <http://www.gawande.com>. We can e-mail him through his website, but I don’t know if it would be nice for us all to barrage him. What do others think? *From:* [mailto: ] *On Behalf Of * Eads *Sent:* Saturday, June 13, 2009 12:45 PM *To:* *Subject:* RE: Positive deviants We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him? Via the New Yorker?? Eads, MD Pinnacle Family Medicine Colorado Springs, Colorado www.PinnacleFamilyMedicine.com *From:* [mailto: ] *On Behalf Of * Seto *Sent:* Saturday, June 13, 2009 12:47 AM *To:* *Subject:* Positive deviants My wife told me about this article by Dr. Atul Gawande, a surgeon who writes wonderful articles for New Yorker magazine. It was his commencement address to the Pritzker School of Medicine this year. He told a story about how a friend ran a program to reduce malnutrition in Vietnamese villages, but they had little funding. So instead of the usual methods, they went low-tech and travelled to different villages, identified which families had the best nourished children and then analyzed what they were doing differently from the other families. They were the " positive deviants " , the outliers. They took their ideas and spread them to other villages, measured their results and used those results to convince other villages to adopt their methods. As a result, malnutrition dropped 65-85%, which was even more effective than the usual methods suggested by outside experts. Gawande then goes on to explain how the United States is now that village: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html> He points out that, like the researchers in Vietnam, we need to look for successful outliers if we are to solve our healthcare crisis. But while he zooms in to some degree of some unique models, he doesn't zoom in small enough. I think the " positive deviants " he and the rest of the country are looking for are IMPs. Small, low-overhead, cost-effective practices that have highly satisfied patients and healthcare providers, with reproducible measures of success. Definitely outside the norm. Maybe somebody should write a letter to the editor. Maybe I will. Maybe if a bunch of us write then, like the Whos in Whoville, we might get heard. Comments can be sent to " themail@... " . Yopp! Seto South Pasadena, CA ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2009 Report Share Posted June 14, 2009 There is a possibility here.I agree that the way we practice would be a perfect platform, assuming we could convince 10 local PCPs (and maybe seed the community with some ringers) to engage in the full scope of effective primary care.The prize organizers expect to be able to join together applicants who have part of the solution. We could link up with a funding source that is interested in a delivery system solution.Anyone with passion and time out there want to help work on this?GLiza,I think Gordon looked into this and the way it is set up, they (the organizers) point you to an area and then let you do your thing. In order for IMPs to be involved in this, we would have to have 10 or so docs ready to relocate to the specified area, then somehow make ends meet for the specified time (I think it is 2 years) and then we could enter our data in to win the prize. In other words, it is lots of difficult coordination and sacrifice to prove what we do.I agree this would be a wonderful forum to “show off” our talents, but it would really only work if we were somehow allowed to each use our own data where we exist now and add it together. Unfortunately, that is not how the X-prize is set up (at least as far as I understand it). From: [mailto: ] On Behalf Of Liza SamsonSent: Sunday, June 14, 2009 1:02 PMTo: Subject: Re: Positive deviants One way we can do this is by entering the X prize for medicine--I strongly believe that IMP practices fit the requirements for the X prize and the group should join: the sponsors are looking for a paradigmatic shift in healthcare delivery, specifically a 50% improvement in measurable outcomes at a decreased cost--the key feature that IMP has is the PCP and the relationship we have with patients over time. Gordon and the group should join. On Sat, Jun 13, 2009 at 6:26 PM, Pierce <bpiercemidcoastmedicine> wrote:IMP needs a study or demonstration project that can measure the economicand quality impact of small, networked ideal practices and gaincredibility and visibility among the reform planners. Otherwise, idealpractices, like other small practices, may be marginalized and pushedaside by the reforms designed to create either less than ideal medicalhomes (PCMH) or large integrated systems via accountable care organizations.Gordon and the other well connected folks here may have ideas on how todo this.The irony is that the Dartmouth Atlas group seems highly regarded by thereformers and yet IMP also has significant ties to Dartmouth via DrWasson and the Clinical Microsystems group (if I understand IMP historycorrectly). R. Pierce MDRockport, Mainewww.midcoastmedicine.comDr. Brady wrote:>>> Dude is amazingly accomplished and has a cool website at> www.gawande.com <http://www.gawande.com>. We can e-mail him through> his website, but I don’t know if it would be nice for us all to> barrage him. What do others think?>> >> *From:* > [mailto: ] *On Behalf Of * Eads> *Sent:* Saturday, June 13, 2009 12:45 PM> *To:* > *Subject:* RE: Positive deviants>>>>> We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him?> Via the New Yorker??>> Eads, MD>> Pinnacle Family Medicine>> Colorado Springs, Colorado>> www.PinnacleFamilyMedicine.com>> *From:* > [mailto: ] *On Behalf Of * Seto> *Sent:* Saturday, June 13, 2009 12:47 AM> *To:* > *Subject:* Positive deviants>>>>>> My wife told me about this article by Dr. Atul Gawande, a surgeon who> writes wonderful articles for New Yorker magazine. It was his> commencement address to the Pritzker School of Medicine this year. He> told a story about how a friend ran a program to reduce malnutrition> in Vietnamese villages, but they had little funding. So instead of the> usual methods, they went low-tech and travelled to different villages,> identified which families had the best nourished children and then> analyzed what they were doing differently from the other families.> They were the "positive deviants", the outliers. They took their ideas> and spread them to other villages, measured their results and used> those results to convince other villages to adopt their methods. As a> result, malnutrition dropped 65-85%, which was even more effective> than the usual methods suggested by outside experts.>> Gawande then goes on to explain how the United States is now that village:>> http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html> <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html>>> He points out that, like the researchers in Vietnam, we need to look> for successful outliers if we are to solve our healthcare crisis. But> while he zooms in to some degree of some unique models, he doesn't> zoom in small enough. I think the "positive deviants" he and the rest> of the country are looking for are IMPs.>> Small, low-overhead, cost-effective practices that have highly> satisfied patients and healthcare providers, with reproducible> measures of success. Definitely outside the norm. Maybe somebody> should write a letter to the editor. Maybe I will. Maybe if a bunch of> us write then, like the Whos in Whoville, we might get heard. Comments> can be sent to "themailnewyorker". Yopp!>> Seto>> South Pasadena, CA>>------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2009 Report Share Posted June 14, 2009 Excellent analysis and right on target.One of the solutions I find most intriguing and described in Gawande's New Yorker piece is the 'virtual accountable organization' in Colorado.What if a group of PCPs in a region banded together around quality and worked to better the health outcomes of the people they served? What if that group were able to catch the attention of local entities that then were more willing to join in solutions (e.g. hospitals really working to inform community docs about inpatients and to work on transitions, etc)?It would be terrific if there were a concentration of IMPs in a region that could work together like this.Gordonin an effort to be clear - there is a significant policy difference between the dartmouth atlas and the IMP "movement". the dartmouth atlas represents a fact while the IMP "movement" reprsents a health care solution. the dartmouth atlas, excellent as it is, represents a well known observation of a fact: significant variations in medical care. this fact has been well known for almost 50 years. and very little has been done about this fact. the dartmouth atlas people propose no solution other than a theoretical model which has not been implemented anywhere (the accountable health care organization) and which has not insignificant challenges. the IMP "movement" represents an attempt at one aspect of a solution to the variation in practice patterns importantly documented by the dartmouth atlas people. as such the movement steps on others toes. i am optimistic that this "movement" will overtime catch significant fire. norbert "L. Gordon " <gmooreidealhealthnetwork> Sent by: 06/14/2009 01:23 PMPlease respond to To ccSubjectRe: Positive deviantsWe have., L. G., & Wasson, J. H. An introduction to technology for patient-centered, collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 195–198.Wasson, J. H., , D. J., , R., , J., & MacKenzie, T. A.Patients report positive impacts of collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 199–206.this article describes the link between patient experience of care and typical quality metrics like A1c, missed days from work, hospitalization rates. LG, Wasson JH. The Ideal Medical Practice Model: Maximizing Efficiency, Quality, and the Doctor-Patient Relationship. Family Practice Management September 2007 pp. 20-24This article compares IMP to non-IMP in terms of ability to deliver patient-centered collaborative care.G IMP needs a study or demonstration project that can measure the economic and quality impact of small, networked ideal practices and gain credibility and visibility among the reform planners. Otherwise, ideal practices, like other small practices, may be marginalized and pushed aside by the reforms designed to create either less than ideal medical homes (PCMH) or large integrated systems via accountable care organizations.Gordon and the other well connected folks here may have ideas on how to do this.The irony is that the Dartmouth Atlas group seems highly regarded by the reformers and yet IMP also has significant ties to Dartmouth via Dr Wasson and the Clinical Microsystems group (if I understand IMP history correctly). R. Pierce MDRockport, Mainewww.midcoastmedicine.comDr. Brady wrote: Dude is amazingly accomplished and has a cool website at www.gawande.com <http://www.gawande.com>. We can e-mail him through his website, but I don’t know if it would be nice for us all to barrage him. What do others think? *From:* [mailto: ] *On Behalf Of * Eads *Sent:* Saturday, June 13, 2009 12:45 PM *To:* *Subject:* RE: Positive deviants We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him? Via the New Yorker?? Eads, MD Pinnacle Family Medicine Colorado Springs, Colorado www.PinnacleFamilyMedicine.com *From:* [mailto: ] *On Behalf Of * Seto *Sent:* Saturday, June 13, 2009 12:47 AM *To:* *Subject:* Positive deviants My wife told me about this article by Dr. Atul Gawande, a surgeon who writes wonderful articles for New Yorker magazine. It was his commencement address to the Pritzker School of Medicine this year. He told a story about how a friend ran a program to reduce malnutrition in Vietnamese villages, but they had little funding. So instead of the usual methods, they went low-tech and travelled to different villages, identified which families had the best nourished children and then analyzed what they were doing differently from the other families. They were the "positive deviants", the outliers. They took their ideas and spread them to other villages, measured their results and used those results to convince other villages to adopt their methods. As a result, malnutrition dropped 65-85%, which was even more effective than the usual methods suggested by outside experts. Gawande then goes on to explain how the United States is now that village: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html> He points out that, like the researchers in Vietnam, we need to look for successful outliers if we are to solve our healthcare crisis. Butwhile he zooms in to some degree of some unique models, he doesn't zoom in small enough. I think the "positive deviants" he and the rest of the country are looking for are IMPs. Small, low-overhead, cost-effective practices that have highly satisfied patients and healthcare providers, with reproducible measures of success. Definitely outside the norm. Maybe somebody should write a letter to the editor. Maybe I will. Maybe if a bunch of us write then, like the Whos in Whoville, we might get heard. Comments can be sent to "themailnewyorker". Yopp! Seto South Pasadena, CA ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2009 Report Share Posted June 14, 2009 Believe or not I am working on the same idea, even have an app that permits all doctors within the system to access each other calendar for referrals. My plan is to bind this into my virtual hospital service and provide home care and semi acute care at the home, instead of hospital, think cellulites that needs 2 days IV Abx. My rough estimate is that I can slash Hospital cost at least in half. José form Hoboken. From: [mailto: ] On Behalf Of L. Gordon Sent: Sunday, June 14, 2009 2:17 PM To: Subject: Re: Positive deviants Excellent analysis and right on target. One of the solutions I find most intriguing and described in Gawande's New Yorker piece is the 'virtual accountable organization' in Colorado. What if a group of PCPs in a region banded together around quality and worked to better the health outcomes of the people they served? What if that group were able to catch the attention of local entities that then were more willing to join in solutions (e.g. hospitals really working to inform community docs about inpatients and to work on transitions, etc)? It would be terrific if there were a concentration of IMPs in a region that could work together like this. Gordon in an effort to be clear - there is a significant policy difference between the dartmouth atlas and the IMP " movement " . the dartmouth atlas represents a fact while the IMP " movement " reprsents a health care solution. the dartmouth atlas, excellent as it is, represents a well known observation of a fact: significant variations in medical care. this fact has been well known for almost 50 years. and very little has been done about this fact. the dartmouth atlas people propose no solution other than a theoretical model which has not been implemented anywhere (the accountable health care organization) and which has not insignificant challenges. the IMP " movement " represents an attempt at one aspect of a solution to the variation in practice patterns importantly documented by the dartmouth atlas people. as such the movement steps on others toes. i am optimistic that this " movement " will overtime catch significant fire. norbert " L. Gordon " Sent by: 06/14/2009 01:23 PM Please respond to To cc Subject Re: Positive deviants We have. , L. G., & Wasson, J. H. An introduction to technology for patient-centered, collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 195–198. Wasson, J. H., , D. J., , R., , J., & MacKenzie, T. A.Patients report positive impacts of collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 199–206. this article describes the link between patient experience of care and typical quality metrics like A1c, missed days from work, hospitalization rates. LG, Wasson JH. The Ideal Medical Practice Model: Maximizing Efficiency, Quality, and the Doctor-Patient Relationship. Family Practice Management September 2007 pp. 20-24 This article compares IMP to non-IMP in terms of ability to deliver patient-centered collaborative care. G IMP needs a study or demonstration project that can measure the economic and quality impact of small, networked ideal practices and gain credibility and visibility among the reform planners. Otherwise, ideal practices, like other small practices, may be marginalized and pushed aside by the reforms designed to create either less than ideal medical homes (PCMH) or large integrated systems via accountable care organizations. Gordon and the other well connected folks here may have ideas on how to do this. The irony is that the Dartmouth Atlas group seems highly regarded by the reformers and yet IMP also has significant ties to Dartmouth via Dr Wasson and the Clinical Microsystems group (if I understand IMP history correctly). R. Pierce MD Rockport, Maine www.midcoastmedicine.com Dr. Brady wrote: Dude is amazingly accomplished and has a cool website at www.gawande.com <http://www.gawande.com>. We can e-mail him through his website, but I don’t know if it would be nice for us all to barrage him. What do others think? *From:* [mailto: ] *On Behalf Of * Eads *Sent:* Saturday, June 13, 2009 12:45 PM *To:* *Subject:* RE: Positive deviants We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him? Via the New Yorker?? Eads, MD Pinnacle Family Medicine Colorado Springs, Colorado www.PinnacleFamilyMedicine.com *From:* [mailto: ] *On Behalf Of * Seto *Sent:* Saturday, June 13, 2009 12:47 AM *To:* *Subject:* Positive deviants My wife told me about this article by Dr. Atul Gawande, a surgeon who writes wonderful articles for New Yorker magazine. It was his commencement address to the Pritzker School of Medicine this year. He told a story about how a friend ran a program to reduce malnutrition in Vietnamese villages, but they had little funding. So instead of the usual methods, they went low-tech and travelled to different villages, identified which families had the best nourished children and then analyzed what they were doing differently from the other families. They were the " positive deviants " , the outliers. They took their ideas and spread them to other villages, measured their results and used those results to convince other villages to adopt their methods. As a result, malnutrition dropped 65-85%, which was even more effective than the usual methods suggested by outside experts. Gawande then goes on to explain how the United States is now that village: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html> He points out that, like the researchers in Vietnam, we need to look for successful outliers if we are to solve our healthcare crisis. But while he zooms in to some degree of some unique models, he doesn't zoom in small enough. I think the " positive deviants " he and the rest of the country are looking for are IMPs. Small, low-overhead, cost-effective practices that have highly satisfied patients and healthcare providers, with reproducible measures of success. Definitely outside the norm. Maybe somebody should write a letter to the editor. Maybe I will. Maybe if a bunch of us write then, like the Whos in Whoville, we might get heard. Comments can be sent to " themail@... " . Yopp! Seto South Pasadena, CA ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2009 Report Share Posted June 14, 2009 One of the solutions I find most intriguing and described in Gawande's New Yorker piece is the 'virtual accountable organization' in Colorado. YES ME TOO! I wanted to know more and how to DO That?? What if a group of PCPs in a region banded together around quality and worked to better the health outcomes of the people they served? What if that group were able to catch the attention of local entities that then were more willing to join in solutions (e.g. hospitals really working to inform community docs about inpatients and to work on transitions, etc)? It would be terrific if there were a concentration of IMPs in a region that could work together like this. I wonder what could be done in a smallish state like MAine where ther e are now a bunch of us- but unfortuanltey spread out- but wth the small ness o f maine might maybe lend some ability to approach say MAinecare (medicaid) - they already have called me to say hey what is going on over there yourpractie keeps people out of teh ER . " cept those guys always need special waivers to get special projects... I wouldl ove to do something here - in MAIne everyone knows everyone else but toprove outcomes would be tough I guess.. Pierce and i have talked about talking at the MAine MEdical Assocaitionmtg in Sept - the only time all year teh medical assocaition has everytone meet.Jean Gordon in an effort to be clear - there is a significant policy difference between the dartmouth atlas and the IMP " movement " . the dartmouth atlas represents a fact while the IMP " movement " reprsents a health care solution. the dartmouth atlas, excellent as it is, represents a well known observation of a fact: significant variations in medical care. this fact has been well known for almost 50 years. and very little has been done about this fact. the dartmouth atlas people propose no solution other than a theoretical model which has not been implemented anywhere (the accountable health care organization) and which has not insignificant challenges. the IMP " movement " represents an attempt at one aspect of a solution to the variation in practice patterns importantly documented by the dartmouth atlas people. as such the movement steps on others toes. i am optimistic that this " movement " will overtime catch significant fire. norbert " L. Gordon " Sent by: 06/14/2009 01:23 PM Please respond to To ccSubjectRe: Positive deviants We have., L. G., & Wasson, J. H. An introduction to technology for patient-centered, collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 195–198. Wasson, J. H., , D. J., , R., , J., & MacKenzie, T. A.Patients report positive impacts of collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 199–206. this article describes the link between patient experience of care and typical quality metrics like A1c, missed days from work, hospitalization rates. LG, Wasson JH. The Ideal Medical Practice Model: Maximizing Efficiency, Quality, and the Doctor-Patient Relationship. Family Practice Management September 2007 pp. 20-24 This article compares IMP to non-IMP in terms of ability to deliver patient-centered collaborative care.G IMP needs a study or demonstration project that can measure the economic and quality impact of small, networked ideal practices and gain credibility and visibility among the reform planners. Otherwise, ideal practices, like other small practices, may be marginalized and pushed aside by the reforms designed to create either less than ideal medical homes (PCMH) or large integrated systems via accountable care organizations. Gordon and the other well connected folks here may have ideas on how to do this.The irony is that the Dartmouth Atlas group seems highly regarded by the reformers and yet IMP also has significant ties to Dartmouth via Dr Wasson and the Clinical Microsystems group (if I understand IMP history correctly). R. Pierce MDRockport, Mainewww.midcoastmedicine.com Dr. Brady wrote: Dude is amazingly accomplished and has a cool website at www.gawande.com <http://www.gawande.com>. We can e-mail him through his website, but I don’t know if it would be nice for us all to barrage him. What do others think? *From:* [mailto: ] *On Behalf Of * Eads *Sent:* Saturday, June 13, 2009 12:45 PM *To:* *Subject:* RE: Positive deviants We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him? Via the New Yorker?? Eads, MD Pinnacle Family Medicine Colorado Springs, Colorado www.PinnacleFamilyMedicine.com *From:* [mailto: ] *On Behalf Of * Seto *Sent:* Saturday, June 13, 2009 12:47 AM *To:* *Subject:* Positive deviants My wife told me about this article by Dr. Atul Gawande, a surgeon who writes wonderful articles for New Yorker magazine. It was his commencement address to the Pritzker School of Medicine this year. He told a story about how a friend ran a program to reduce malnutrition in Vietnamese villages, but they had little funding. So instead of the usual methods, they went low-tech and travelled to different villages, identified which families had the best nourished children and then analyzed what they were doing differently from the other families. They were the " positive deviants " , the outliers. They took their ideas and spread them to other villages, measured their results and used those results to convince other villages to adopt their methods. As a result, malnutrition dropped 65-85%, which was even more effective than the usual methods suggested by outside experts. Gawande then goes on to explain how the United States is now that village: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html> He points out that, like the researchers in Vietnam, we need to look for successful outliers if we are to solve our healthcare crisis. Butwhile he zooms in to some degree of some unique models, he doesn't zoom in small enough. I think the " positive deviants " he and the rest of the country are looking for are IMPs. Small, low-overhead, cost-effective practices that have highly satisfied patients and healthcare providers, with reproducible measures of success. Definitely outside the norm. Maybe somebody should write a letter to the editor. Maybe I will. Maybe if a bunch of us write then, like the Whos in Whoville, we might get heard. Comments can be sent to " themail@... " . Yopp! Seto South Pasadena, CA ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 14, 2009 Report Share Posted June 14, 2009 I think the PCPs relationship to the patients over time is key to what makes IMPs successful so we should get a waiver from the X prize organizers as it would not make sense to uproot the doc from his practice, as this is what defines IMP--so in this case the test area/test subjects are already in place--we can still distinguish ourselves with the outcomes data and the cost savings but probably need to fight for the " no uprooting " piece as that is part of what makes IMP an IMP. Maybe new docs can try the model but they still need to be connected to their patients. Liza, I think Gordon looked into this and the way it is set up, they (the organizers) point you to an area and then let you do your thing. In order for IMPs to be involved in this, we would have to have 10 or so docs ready to relocate to the specified area, then somehow make ends meet for the specified time (I think it is 2 years) and then we could enter our data in to win the prize. In other words, it is lots of difficult coordination and sacrifice to prove what we do. I agree this would be a wonderful forum to “show off” our talents, but it would really only work if we were somehow allowed to each use our own data where we exist now and add it together. Unfortunately, that is not how the X-prize is set up (at least as far as I understand it). From: [mailto: ] On Behalf Of Liza Samson Sent: Sunday, June 14, 2009 1:02 PMTo: Subject: Re: Positive deviants One way we can do this is by entering the X prize for medicine--I strongly believe that IMP practices fit the requirements for the X prize and the group should join: the sponsors are looking for a paradigmatic shift in healthcare delivery, specifically a 50% improvement in measurable outcomes at a decreased cost--the key feature that IMP has is the PCP and the relationship we have with patients over time. Gordon and the group should join. IMP needs a study or demonstration project that can measure the economicand quality impact of small, networked ideal practices and gaincredibility and visibility among the reform planners. Otherwise, ideal practices, like other small practices, may be marginalized and pushedaside by the reforms designed to create either less than ideal medicalhomes (PCMH) or large integrated systems via accountable care organizations. Gordon and the other well connected folks here may have ideas on how todo this.The irony is that the Dartmouth Atlas group seems highly regarded by thereformers and yet IMP also has significant ties to Dartmouth via Dr Wasson and the Clinical Microsystems group (if I understand IMP historycorrectly). R. Pierce MDRockport, Mainewww.midcoastmedicine.com Dr. Brady wrote:>>> Dude is amazingly accomplished and has a cool website at > www.gawande.com <http://www.gawande.com>. We can e-mail him through > his website, but I don’t know if it would be nice for us all to> barrage him. What do others think?>> >> *From:* > [mailto: ] *On Behalf Of * Eads> *Sent:* Saturday, June 13, 2009 12:45 PM> *To:* > *Subject:* RE: Positive deviants>>>>> We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him?> Via the New Yorker??>> Eads, MD >> Pinnacle Family Medicine>> Colorado Springs, Colorado>> www.PinnacleFamilyMedicine.com>> *From:* > [mailto: ] *On Behalf Of * Seto> *Sent:* Saturday, June 13, 2009 12:47 AM> *To:* > *Subject:* Positive deviants>>>>>> My wife told me about this article by Dr. Atul Gawande, a surgeon who> writes wonderful articles for New Yorker magazine. It was his > commencement address to the Pritzker School of Medicine this year. He> told a story about how a friend ran a program to reduce malnutrition> in Vietnamese villages, but they had little funding. So instead of the > usual methods, they went low-tech and travelled to different villages,> identified which families had the best nourished children and then> analyzed what they were doing differently from the other families. > They were the " positive deviants " , the outliers. They took their ideas> and spread them to other villages, measured their results and used> those results to convince other villages to adopt their methods. As a > result, malnutrition dropped 65-85%, which was even more effective> than the usual methods suggested by outside experts.>> Gawande then goes on to explain how the United States is now that village: >> http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html > <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html> >> He points out that, like the researchers in Vietnam, we need to look> for successful outliers if we are to solve our healthcare crisis. But> while he zooms in to some degree of some unique models, he doesn't > zoom in small enough. I think the " positive deviants " he and the rest> of the country are looking for are IMPs.>> Small, low-overhead, cost-effective practices that have highly> satisfied patients and healthcare providers, with reproducible > measures of success. Definitely outside the norm. Maybe somebody> should write a letter to the editor. Maybe I will. Maybe if a bunch of> us write then, like the Whos in Whoville, we might get heard. Comments > can be sent to " themail@... " . Yopp!>> Seto>> South Pasadena, CA>> ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2009 Report Share Posted June 15, 2009 I am working on the same sort of banding here in Grand County, Colo. We only have 12 providers spread over 1200 sq miles and 13,000 people. Several docs work for a large Denver hospital, so we trying to use them for some capital. You should contact Dave West in Grand Junction, if you want to know more. I have known him for 30 years and he can give you the scoop. ________________________________________ From: [ ] On Behalf Of [jnantonucci@...] Sent: Sunday, June 14, 2009 12:53 PM To: Subject: Re: Positive deviants On Sun, Jun 14, 2009 at 2:16 PM, L. Gordon > wrote: One of the solutions I find most intriguing and described in Gawande's New Yorker piece is the 'virtual accountable organization' in Colorado. YES ME TOO! I wanted to know more and how to DO That?? What if a group of PCPs in a region banded together around quality and worked to better the health outcomes of the people they served? What if that group were able to catch the attention of local entities that then were more willing to join in solutions (e.g. hospitals really working to inform community docs about inpatients and to work on transitions, etc)? It would be terrific if there were a concentration of IMPs in a region that could work together like this. I wonder what could be done in a smallish state like MAine where ther e are now a bunch of us- but unfortuanltey spread out- but wth the small ness o f maine might maybe lend some ability to approach say MAinecare (medicaid) - they already have called me to say hey what is going on over there yourpractie keeps people out of teh ER . " cept those guys always need special waivers to get special projects... I wouldl ove to do something here - in MAIne everyone knows everyone else but toprove outcomes would be tough I guess.. Pierce and i have talked about talking at the MAine MEdical Assocaitionmtg in Sept - the only time all year teh medical assocaition has everytone meet.Jean Gordon On Jun 14, 2009, at 11:04 AM, nigoldfield@... wrote: in an effort to be clear - there is a significant policy difference between the dartmouth atlas and the IMP " movement " . the dartmouth atlas represents a fact while the IMP " movement " reprsents a health care solution. the dartmouth atlas, excellent as it is, represents a well known observation of a fact: significant variations in medical care. this fact has been well known for almost 50 years. and very little has been done about this fact. the dartmouth atlas people propose no solution other than a theoretical model which has not been implemented anywhere (the accountable health care organization) and which has not insignificant challenges. the IMP " movement " represents an attempt at one aspect of a solution to the variation in practice patterns importantly documented by the dartmouth atlas people. as such the movement steps on others toes. i am optimistic that this " movement " will overtime catch significant fire. norbert " L. Gordon " > Sent by: <mailto: \ > 06/14/2009 01:23 PM Please respond to <mailto: \ > To <mailto: \ > cc Subject Re: Positive deviants We have. , L. G., & Wasson, J. H. An introduction to technology for patient-centered, collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 195–198. Wasson, J. H., , D. J., , R., , J., & MacKenzie, T. A.Patients report positive impacts of collaborative care. Journal of Ambulatory Care Management, July-September 2006 29(3), 199–206. this article describes the link between patient experience of care and typical quality metrics like A1c, missed days from work, hospitalization rates. LG, Wasson JH. The Ideal Medical Practice Model: Maximizing Efficiency, Quality, and the Doctor-Patient Relationship. Family Practice Management September 2007 pp. 20-24 This article compares IMP to non-IMP in terms of ability to deliver patient-centered collaborative care. G IMP needs a study or demonstration project that can measure the economic and quality impact of small, networked ideal practices and gain credibility and visibility among the reform planners. Otherwise, ideal practices, like other small practices, may be marginalized and pushed aside by the reforms designed to create either less than ideal medical homes (PCMH) or large integrated systems via accountable care organizations. Gordon and the other well connected folks here may have ideas on how to do this. The irony is that the Dartmouth Atlas group seems highly regarded by the reformers and yet IMP also has significant ties to Dartmouth via Dr Wasson and the Clinical Microsystems group (if I understand IMP history correctly). R. Pierce MD Rockport, Maine www.midcoastmedicine.com<http://www.midcoastmedicine.com/> Dr. Brady wrote: Dude is amazingly accomplished and has a cool website at www.gawande.com<http://www.gawande.com> <http://www.gawande.com>. We can e-mail him through <http://www.gawande.com/> his website, but I don’t know if it would be nice for us all to barrage him. What do others think? *From:* <mailto: \ > [mailto: <mailto:rovement1 >] *On Behalf Of * Eads *Sent:* Saturday, June 13, 2009 12:45 PM *To:* <mailto: \ > *Subject:* RE: Positive deviants We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him? Via the New Yorker?? Eads, MD Pinnacle Family Medicine Colorado Springs, Colorado www.PinnacleFamilyMedicine.com<http://www.PinnacleFamilyMedicine.com> *From:* <mailto: \ > [mailto: <mailto:rovement1 >] *On Behalf Of * Seto *Sent:* Saturday, June 13, 2009 12:47 AM *To:* <mailto: \ > *Subject:* Positive deviants My wife told me about this article by Dr. Atul Gawande, a surgeon who writes wonderful articles for New Yorker magazine. It was his commencement address to the Pritzker School of Medicine this year. He told a story about how a friend ran a program to reduce malnutrition in Vietnamese villages, but they had little funding. So instead of the usual methods, they went low-tech and travelled to different villages, identified which families had the best nourished children and then analyzed what they were doing differently from the other families. They were the " positive deviants " , the outliers. They took their ideas and spread them to other villages, measured their results and used those results to convince other villages to adopt their methods. As a result, malnutrition dropped 65-85%, which was even more effective than the usual methods suggested by outside experts. Gawande then goes on to explain how the United States is now that village: http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-o\ f-chicago-medical-school-commencement-address.html <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-\ of-chicago-medical-school-commencement-address.html> <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-\ of-chicago-medical-school-commencement-address.html><http://www.newyorker.com/on\ line/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-co\ mmencement-address.html> He points out that, like the researchers in Vietnam, we need to look for successful outliers if we are to solve our healthcare crisis. But while he zooms in to some degree of some unique models, he doesn't zoom in small enough. I think the " positive deviants " he and the rest of the country are looking for are IMPs. Small, low-overhead, cost-effective practices that have highly satisfied patients and healthcare providers, with reproducible measures of success. Definitely outside the norm. Maybe somebody should write a letter to the editor. Maybe I will. Maybe if a bunch of us write then, like the Whos in Whoville, we might get heard. Comments can be sent to " themail@... " . Yopp! Seto South Pasadena, CA ------------------------------------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2009 Report Share Posted June 15, 2009 I think we could do this in the NW---Portland and Seattle, for instance. We could get some new coverage too... and ads. I would think advertising that to let people know that we are trying to change medical care by doing this would be huge. I tell pts all the time but I don't think they fully understand the implications. We are having an open house this summer and one of the goals is to let people know how different we are in the way we deliver health care. Ellen L. Gordon wrote: > > > Excellent analysis and right on target. > > > One of the solutions I find most intriguing and described in Gawande's > New Yorker piece is the 'virtual accountable organization' in Colorado. > What if a group of PCPs in a region banded together around quality and > worked to better the health outcomes of the people they served? What > if that group were able to catch the attention of local entities that > then were more willing to join in solutions (e.g. hospitals really > working to inform community docs about inpatients and to work on > transitions, etc)? > > It would be terrific if there were a concentration of IMPs in a region > that could work together like this. > Gordon > On Jun 14, 2009, at 11:04 AM, nigoldfield@... > wrote: > >> >> >> >> in an effort to be clear - there is a significant policy difference >> between the dartmouth atlas and the IMP " movement " . the dartmouth >> atlas represents a fact while the IMP " movement " reprsents a health >> care solution. >> >> the dartmouth atlas, excellent as it is, represents a well known >> observation of a fact: significant variations in medical care. this >> fact has been well known for almost 50 years. and very little has >> been done about this fact. the dartmouth atlas people propose no >> solution other than a theoretical model which has not been >> implemented anywhere (the accountable health care organization) and >> which has not insignificant challenges. >> >> the IMP " movement " represents an attempt at one aspect of a solution >> to the variation in practice patterns importantly documented by the >> dartmouth atlas people. as such the movement steps on others toes. i >> am optimistic that this " movement " will overtime catch significant fire. >> >> norbert >> >> >> * " L. Gordon " * >> Sent by: >> >> 06/14/2009 01:23 PM >> >> Please respond to >> >> >> >> >> To >> >> cc >> >> Subject >> Re: Positive deviants >> >> >> >> >> >> >> >> >> >> >> >> >> We have. >> >> , L. G., & Wasson, J. H. An *introduction to technology for >> patient-centered, collaborative care.* /Journal of Ambulatory Care >> Management/, July-September 2006 /29/(3)/, /195–198. >> >> >> Wasson, J. H., , D. J., , R., , J., & >> MacKenzie, T. A.*Patients report positive impacts of collaborative >> care*. /Journal of Ambulatory Care Management/, July-September 2006 >> /29/(3), 199–206. >> >> this article describes the link between patient experience of care >> and typical quality metrics like A1c, missed days from work, >> hospitalization rates. >> >> >> LG, Wasson JH. *The Ideal Medical Practice Model: Maximizing >> Efficiency, Quality, and the Doctor-Patient Relationship*. /Family >> Practice Management/ September 2007 pp. 20-24 >> >> This article compares IMP to non-IMP in terms of ability to deliver >> patient-centered collaborative care. >> >> G >> >> >> >> >> >> IMP needs a study or demonstration project that can measure the economic >> and quality impact of small, networked ideal practices and gain >> credibility and visibility among the reform planners. Otherwise, ideal >> practices, like other small practices, may be marginalized and pushed >> aside by the reforms designed to create either less than ideal medical >> homes (PCMH) or large integrated systems via accountable care >> organizations. >> >> Gordon and the other well connected folks here may have ideas on how to >> do this. >> >> The irony is that the Dartmouth Atlas group seems highly regarded by the >> reformers and yet IMP also has significant ties to Dartmouth via Dr >> Wasson and the Clinical Microsystems group (if I understand IMP history >> correctly). >> >> >> >> R. Pierce MD >> Rockport, Maine >> _ >> __www.midcoastmedicine.com_ <http://www.midcoastmedicine.com/> >> >> >> >> >> Dr. Brady wrote: >> >> >> Dude is amazingly accomplished and has a cool website at >> www.gawande.com <http://www.gawande.com>. We can e-mail him through >> <http://www.gawande.com/> >> his website, but I don’t know if it would be nice for us all to >> barrage him. What do others think? >> >> >> >> *From:* >> [mailto: ] *On Behalf Of * >> Eads >> *Sent:* Saturday, June 13, 2009 12:45 PM >> *To:* >> *Subject:* RE: Positive deviants >> >> >> >> >> We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him? >> Via the New Yorker?? >> >> Eads, MD >> >> Pinnacle Family Medicine >> >> Colorado Springs, Colorado >> >> www.PinnacleFamilyMedicine.com >> >> *From:* >> [mailto: ] *On Behalf Of * Seto >> *Sent:* Saturday, June 13, 2009 12:47 AM >> *To:* >> *Subject:* Positive deviants >> >> >> >> >> >> My wife told me about this article by Dr. Atul Gawande, a surgeon who >> writes wonderful articles for New Yorker magazine. It was his >> commencement address to the Pritzker School of Medicine this year. He >> told a story about how a friend ran a program to reduce malnutrition >> in Vietnamese villages, but they had little funding. So instead of the >> usual methods, they went low-tech and travelled to different villages, >> identified which families had the best nourished children and then >> analyzed what they were doing differently from the other families. >> They were the " positive deviants " , the outliers. They took their ideas >> and spread them to other villages, measured their results and used >> those results to convince other villages to adopt their methods. As a >> result, malnutrition dropped 65-85%, which was even more effective >> than the usual methods suggested by outside experts. >> >> Gawande then goes on to explain how the United States is now that >> village: >> >> http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-o\ f-chicago-medical-school-commencement-address.html >> <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-\ of-chicago-medical-school-commencement-address.html> >> <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-\ of-chicago-medical-school-commencement-address.html> >> <http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-\ of-chicago-medical-school-commencement-address.html> >> >> >> He points out that, like the researchers in Vietnam, we need to look >> for successful outliers if we are to solve our healthcare crisis. But >> while he zooms in to some degree of some unique models, he doesn't >> zoom in small enough. I think the " positive deviants " he and the rest >> of the country are looking for are IMPs. >> >> Small, low-overhead, cost-effective practices that have highly >> satisfied patients and healthcare providers, with reproducible >> measures of success. Definitely outside the norm. Maybe somebody >> should write a letter to the editor. Maybe I will. Maybe if a bunch of >> us write then, like the Whos in Whoville, we might get heard. Comments >> can be sent to " themail@... " . Yopp! >> >> Seto >> >> South Pasadena, CA >> >> >> >> >> ------------------------------------ >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2009 Report Share Posted June 15, 2009 G et. al. What we really need is a IMP owned hospital? Just heard presentation that on average hospital collects 12 times what they pay primary care, think 2 million dollars annual. Compared to 6 times what they pay specialist. I am sure if I had access to that type of capiatal I could improve healthcare and decrease cost. >>> Dude is amazingly accomplished and has a cool website at > www.gawande. com <http://www.gawande. com>. We can e-mail him through > his website, but I don’t know if it would be nice for us all to> barrage him. What do others think?>> >> *From:* Practiceimprovement 1yahoogroups (DOT) com> [mailto:Practiceimprovement 1yahoogroups (DOT) com] *On Behalf Of * Eads> *Sent:* Saturday, June 13, 2009 12:45 PM> *To:* Practiceimprovement 1yahoogroups (DOT) com> *Subject:* RE: [Practiceimprovemen t1] Positive deviants>>>>> We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him?> Via the New Yorker??>> Eads, MD>> Pinnacle Family Medicine>> Colorado Springs, Colorado>> www.PinnacleFamilyM edicine.com>> *From:* Practiceimprovement 1yahoogroups (DOT) com> [mailto:Practiceimprovement 1yahoogroups (DOT) com] *On Behalf Of * Seto> *Sent:* Saturday, June 13, 2009 12:47 AM> *To:* Practiceimprovement 1yahoogroups (DOT) com> *Subject:* [Practiceimprovemen t1] Positive deviants>>>>>> My wife told me about this article by Dr. Atul Gawande, a surgeon who> writes wonderful articles for New Yorker magazine. It was his> commencement address to the Pritzker School of Medicine this year. He> told a story about how a friend ran a program to reduce malnutrition> in Vietnamese villages, but they had little funding. So instead of the> usual methods, they went low-tech and travelled to different villages,> identified which families had the best nourished children and then> analyzed what they were doing differently from the other families.> They were the "positive deviants", the outliers. They took their ideas> and spread them to other villages, measured their results and used> those results to convince other villages to adopt their methods. As a> result, malnutrition dropped 65-85%, which was even more effective> than the usual methods suggested by outside experts.>> Gawande then goes on to explain how the United States is now that village:>> http://www.newyorke r.com/online/ blogs/newsdesk/ 2009/06/atul- gawande-universi ty-of-chicago- medical-school- commencement- address.html> <http://www.newyorke r.com/online/ blogs/newsdesk/ 2009/06/atul- gawande-universi ty-of-chicago- medical-school- commencement- address.html>>> He points out that, like the researchers in Vietnam, we need to look> for successful outliers if we are to solve our healthcare crisis. But> while he zooms in to some degree of some unique models, he doesn't> zoom in small enough. I think the "positive deviants" he and the rest> of the country are looking for are IMPs.>> Small, low-overhead, cost-effective practices that have highly> satisfied patients and healthcare providers, with reproducible> measures of success. Definitely outside the norm. Maybe somebody> should write a letter to the editor. Maybe I will. Maybe if a bunch of> us write then, like the Whos in Whoville, we might get heard. Comments> can be sent to "themailnewyorker (DOT) com". Yopp!>> Seto>> South Pasadena, CA>> ------------ --------- --------- ------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 15, 2009 Report Share Posted June 15, 2009 , If you look at there media presentation, they have a technological backbone to reach peole over a wide area. SO, if they want to see quality we would put every IMP on their platform then aggregate the results. This would show the ability to deploy a network o like minded physicians anywhere in the US and save money. Just ask them for the platform. I am sure we could develop the process and IMPlement it. >>> Dude is amazingly accomplished and has a cool website at > www.gawande. com <http://www.gawande. com>. We can e-mail him through > his website, but I don’t know if it would be nice for us all to> barrage him. What do others think?>> >> *From:* Practiceimprovement 1yahoogroups (DOT) com> [mailto:Practiceimprovement 1yahoogroups (DOT) com] *On Behalf Of * Eads> *Sent:* Saturday, June 13, 2009 12:45 PM> *To:* Practiceimprovement 1yahoogroups (DOT) com> *Subject:* RE: [Practiceimprovemen t1] Positive deviants>>>>> We gotta tell Dr. Gawande about IMPs! Anyone know how to contact him?> Via the New Yorker??>> Eads, MD>> Pinnacle Family Medicine>> Colorado Springs, Colorado>> www.PinnacleFamilyM edicine.com>> *From:* Practiceimprovement 1yahoogroups (DOT) com> [mailto:Practiceimprovement 1yahoogroups (DOT) com] *On Behalf Of * Seto> *Sent:* Saturday, June 13, 2009 12:47 AM> *To:* Practiceimprovement 1yahoogroups (DOT) com> *Subject:* [Practiceimprovemen t1] Positive deviants>>>>>> My wife told me about this article by Dr. Atul Gawande, a surgeon who> writes wonderful articles for New Yorker magazine. It was his> commencement address to the Pritzker School of Medicine this year. He> told a story about how a friend ran a program to reduce malnutrition> in Vietnamese villages, but they had little funding. So instead of the> usual methods, they went low-tech and travelled to different villages,> identified which families had the best nourished children and then> analyzed what they were doing differently from the other families.> They were the "positive deviants", the outliers. They took their ideas> and spread them to other villages, measured their results and used> those results to convince other villages to adopt their methods. As a> result, malnutrition dropped 65-85%, which was even more effective> than the usual methods suggested by outside experts.>> Gawande then goes on to explain how the United States is now that village:>> http://www.newyorke r.com/online/ blogs/newsdesk/ 2009/06/atul- gawande-universi ty-of-chicago- medical-school- commencement- address.html> <http://www.newyorke r.com/online/ blogs/newsdesk/ 2009/06/atul- gawande-universi ty-of-chicago- medical-school- commencement- address.html>>> He points out that, like the researchers in Vietnam, we need to look> for successful outliers if we are to solve our healthcare crisis. But> while he zooms in to some degree of some unique models, he doesn't> zoom in small enough. I think the "positive deviants" he and the rest> of the country are looking for are IMPs.>> Small, low-overhead, cost-effective practices that have highly> satisfied patients and healthcare providers, with reproducible> measures of success. Definitely outside the norm. Maybe somebody> should write a letter to the editor. Maybe I will. Maybe if a bunch of> us write then, like the Whos in Whoville, we might get heard. Comments> can be sent to "themailnewyorker (DOT) com". Yopp!>> Seto>> South Pasadena, CA>> ------------ --------- --------- ------ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2009 Report Share Posted June 16, 2009 My brother Mike is the Colorado physician Atul Gawande interviewed about the Grand Junction health care system. He is going to send me Dr. Gawande’s direct email address. He sounds like someone who would be very interested in the innovative ideas we have been working on. If he responds I’ll refer him to Gordon who could probably do a much better job communicating our ideas than I ever could. M. Pramenko, MD 2310 Nott Street East Niskayuna, NY 12309 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2009 Report Share Posted June 16, 2009 He's your brohter? oooh.So . Some of us would like to talk to your brother. Can either of you come to Seattle OR Boston- Oct 13 or there abouts?(AAFP confernce is the 14-17) I would like t o learn lessons form Grand Junction Co. My brother Mike is the Colorado physician Atul Gawande interviewed about the Grand Junction health care system. He is going to send me Dr. Gawande’s direct email address. He sounds like someone who would be very interested in the innovative ideas we have been working on. If he responds I’ll refer him to Gordon who could probably do a much better job communicating our ideas than I ever could. M. Pramenko, MD 2310 Nott Street East Niskayuna, NY 12309 -- If you are a patient please allow up to 24 hours for a reply by email/please note the new email address.Remember that e-mail may not be entirely secure/ MD ph fax impcenter.org Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 16, 2009 Report Share Posted June 16, 2009 Cool.GMy brother Mike is the Colorado physician Atul Gawande interviewed about the Grand Junction health care system. He is going to send me Dr. Gawande’s direct email address. He sounds like someone who would be very interested in the innovative ideas we have been working on. If he responds I’ll refer him to Gordon who could probably do a much better job communicating our ideas than I ever could. M. Pramenko, MD2310 Nott Street EastNiskayuna, NY 12309 Quote Link to comment Share on other sites More sharing options...
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