P2 Collaborative
just for the provider

What is a " Practice Enhancement Associate" (PEA)?

Practice Enhancement Associates (PEAs) have played a key role within the primary care setting for improvement initiatives since the 1980's. Originally used in the United Kingdom and modified by the Oklahoma Physicians Resource/Research Network (OKPRN). PEAs are now being used across the United States conducting research within Practice Based Research Networks (PBRNs). A PEA's purpose is to improve preventive services, chronic disease management, communication, catalyze change and practice re-design, and help in the translation of research into practice.

PEA's activities include:

  • Developing a relationship with the practice (see below)
  • Starting a QI cycle using (PDSA cycles)
  • Screening patients for a given criteria
  • Creating patient registry for a particular chronic disease (e.g. DM, CKD, asthma)
  • Providing patient education (potentially)
  • Prompting the physicians as to the status of the patient
  • Prompting physicians on guidelines through flagging charts and providing notes
  • Obtaining feedback from physicians, staff, and patients: how are we doing?
  • Working on additional QI projects seen by the staff, providers, patients, or PEA
  • Linking PCP with community resources

 

Full Time PEAs

One PEA as an FTE could work in up to 6 practices, depending on the scope of the study. Looking at the number practices or the number of providers in a practice is not the same as looking at the total number of patients that a PEA will follow during the duration of a study, especially at what intervals a PEA will be reviewing charts (e.g. 3 month, 6 month, etc.) as well as the type of medical record system (EMR vs. paper charts).

The QI Cycle

  • Data is aggregated based on problem list, progress notes, medication lists, lab reports, and significant referrals and correspondence.
  • Recommendations are then generated to give evidence based support to PCP and can either be accepted, rejected or modified.
  • Quality improvement cycle to improve patient outcomes and quality of care through evidence based research
  • PEA presents data and change over time to MD and office staff
  • PEA shares insights from other practices working on the same project
  • Discussion of what worked and what didn't is done and appropriate modifications are made
  • Performance graphs will be shared with each practice based on the intervals determined by the study design and timeline
PEA Plan

Process and Outcome Measures

Process and outcome measures will depend based on the project goals. For example, if the PEAs are following National Kidney Foundation (NKF) guidelines, or the AAFP metric modules, process measures will vary. Outcome measures will generally depend on the patients, and PEAs can also work linking patients to community resources, or if they are a RN, provide case-management services for the patient. If PEAs are not an RN, they could work more in community outreach and make calls to patients to follow up on if they did get their labs drawn, prescriptions filled, followed through with referrals, etc.

Outcome measures on a past PEA projects on Chronic Kidney Disease (CKD) included:

  • Dx of CKD (GFR < 60)
  • Dx of anemia
  • Metabolic control (BP, lipids and glucose)
  • Recognition and treatment of anemia
  • Dx disorders of bone metabolism
  • Starting helpful meds (ACE/ARB and ASA)
  • Stopping harmful meds
  • Metformin, NSAIDS

 

PEA Training

PEA training is broken into modules, and provides ongoing training for PEAs while they are in the field.

Module one is an orientation designed to help PEAs understand PEA concept and function, develop a core skill set, and prepare for entering the clinical setting. The basic concepts that will be covered are the Chronic Care Model, Medical Home Model, translating research into practice, quality improvement using PDSA Cycles (Plan Do Study Act), PEA concept and function, the history of PEA model, quantitative and qualitative research methods, and basics in human subjects training and HIPAA.

Module two is designed to help PEAs understand creating a patient registry, ICD-9 codes, principles of data collection using a database, using EMR and paper charts, and conducting chart extraction.

Module three is designed to work on audit and feedback including providing recommendations that are generated according chart reviews driven by evidence based guidelines, using DM/HM reports and alerts (if EMR site), creating graphs and charts for physicians, presenting results, sharing best practices, E/M coding and billing.

Module four is designed to work on other aspects of QI projects, including use of AAFP Metric Modules or other metrics, as well as additional QI projects or transitioning to a new QI project.