Transcript PCMH - Indiana Association for Healthcare Quality

PCMH
Putting the Patient First:
Using Quality to Transform
Primary Care
Julia Barton, RN, MSN
Purdue Healthcare Advisors
Purdue Research Foundation 2012
Why PCMH?
Institute of Medicine: Crossing the
Quality Chasm (2001)
10 Simple Rules
1.
2.
3.
4.
Care based on continuous healing relationships
Care based on patient needs and values
Patient as the source of control
Patient access to medical information and clinical
knowledge
5. Evidence-based decision making
6. Patient safety
7. Transparency of information
8. Anticipation of needs
9. Continuous decrease in waste
10. Cooperation among clinicians
Crossing the Quality Chasm: 6 Aims
2001 IOM Report:
Crossing the Quality
Chasm: A New Health System for the 21st Century
• Health care should be:
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


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Safe
Effective
Patient-Centered
Timely
Efficient
Equitable
The Joint Principles of the PCMH (2007)
Endorsed by the ACP, AAFP, AAP, AOA
Key Characteristics of the Medical Home:
•
•
•
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Personal physician
Physician directed medical practice
Whole person orientation
Care is coordinated and/or integrated
across all elements of the complex health
care system and the patient’s community
The Joint Principles of the
PCMH
Also included that:
• Quality and safety are hallmarks of the
medical home
 Care planning, evidence-based medicine,
clinical decision support, continuous quality
improvement, patient participation and
feedback, and appropriate Health
Information Technology
• Enhanced Access
• Payment Based on Value not Volume
The Triple Aim
(2008)
• A framework developed by the Institute
for Healthcare Improvement (IHI) that
describes an approach to health system
performance
• The three dimensions are:
1. Improving the patient experience of care
(including quality and satisfaction)
2. Improving the health of populations
3. Reducing the per capita cost of health care
( Donald Berwick-The Institute for Healthcare Improvement—2008)
The National Committee for
Quality Assurance (NCQA)
• Founded in 1990
• Private, independent non-profit healthcare
quality oversight organization
• >32 States have Public and Private PCMH
initiatives that use NCQA recognition
• >5,000 NCQA-Recognized medical homes
nationwide
• PCMH Standards are aligned with
Meaningful Use objectives
• 3 Levels of recognition
Patient Centered Medical Home: A
Strategy for Quality Improvement
1. Long-term partnerships, not hurried visits
2. Care that is coordinated among providers
3. Better access through expanded hours
and on-line tools
4. Shared decisions so patients make
informed choices
5. Lower costs from reduced ER/hospital use
6. More satisfied patients and providers
6 PCMH Standards
PCMH 1: Enhance Access and Continuity
PCMH 2: Identify and Manage Patient
Populations
PCMH 3: Plan and Manage Care
PCMH 4: Provide Self-Care Support and
Community Resources
PCMH 5: Track and Coordinate Care
PCMH 6: Measure and Improve
Performance
6 Must Pass Elements (27 total)
PCMH 1, Element A: Access During Office
Hours
PCMH 2, Element D: Use Data for
Population Management
PCMH 3, Element C: Care Management
PCMH 4, Element A: Support Self-Care
Process
PCMH 5, Element B: Referral Tracking and
Follow-Up
PCMH 6, Element C: Implement
Continuous Quality Improvement
Factors
• 149 Total Factors
 A scored item in an element. For
example, an element may require the
practice to demonstrate how the practice
team provides a range of patient care
services. Each type of item, in this case,
is a factor
• 8 Critical Factors
 A factor that is required for practices to
receive more than minimal points, or in
some cases any point for the element
The Factor Path
TM
STANDARD 1: Enhance Access and Continuity
The practice provides access to culturally and linguistically appropriate
routine care and urgent team-based care that meets the needs of
patients/families
Element D: Continuity
Factors:
1.
2.
3.
Selecting a personal
clinician
Documenting patient
choice
Monitoring team visit
percentage
Key Points:
 Notify patients about the
process for choosing a
personal clinician
 Patient’s choice of personal
clinician and care team
documented in patient’s
chart
 Monitor the percentage of
patient visits that occur with
the selected personal
clinician and care team
STANDARD 1: Enhance Access and Continuity
The practice provides access to culturally and linguistically appropriate
routine care and urgent team-based care that meets the needs of
patients/families
Element G: The Practice Team
Factors:
1.
2.
4.
5.
6.
Defined Team Roles
Team meetings and
communication
Care teams trained to
coordinate care for
individual patients
Care teams trained to
support selfmanagement, selfefficacy and behavior
change
Care teams trained to
manage patient
populations
Key Points:
 Team meetings may include
daily huddles or review of
daily schedules, with followup tasks
 Care team members are
trained in evidence-based
approaches to selfmanagement support, such
as patient coaching and
motivational interviewing
STANDARD 3: Plan and Manage Care
The practice systematically identifies individual patients and plans,
manages and coordinates their care, based on their condition and
needs and on evidence-based guidelines
Element A: Implement Evidence-Based Guidelines
Factors:
1.
2.
3.
The first important
condition
The second important
condition
The third condition,
related to unhealthy
behaviors or mental
health or substance
abuse
Key Points:
 Analyze the entire practice
population to determine the
important conditions
 Conditions can include
chronic or recurring
conditions such as COPD,
hypertension, HIV/AIDS, and
asthma
 Factor 3 is a critical factor
STANDARD 3: Plan and Manage Care
The practice systematically identifies individual patients and plans,
manages and coordinates their care, based on their condition and
needs and on evidence-based guidelines
Element B: Identify High-Risk Patients
Factors:
1.
2.
Identify high-risk or
complex patients
Determines the
percentage in its
population
Key Points:
 The practice establishes
criteria and a systematic
process for identifying
complex or high risk may
include
 The criteria may include:
• Frequent visits for
urgent or emergent care
• Frequent
hospitalizations
• Noncompliance with
prescribed
treatment/medication
• Terminal illness
• Multiple risk factors
STANDARD 3: Plan and Manage Care
The practice systematically identifies individual patients and plans,
manages and coordinates their care, based on their condition and
needs and on evidence-based guidelines
Element D: Medication Management
Factors:
1.
3.
4.
5.
6.
Medication reconciliation
for >50% of care
transitions
New prescription
information to >80% of
patients/families
Assesses medication
understanding for >50%
of patients
Assesses medication
response/barriers to
adherence for >50% of
patients
Documents OTC, herbals,
& supplements for >50%
of patients/families
Key Points:
 Information given on new
prescriptions includes side
effects, drug interactions,
medication instructions and
the consequences of not
taking it
 Factor 6 - at least annually,
the practice reviews and
documents in the medical
record
STANDARD 5: Track and Coordinate Care
The practice systematically tracks tests and coordinates care across
specialty care, facility-based care and community organization
Element A: Test Tracking and Follow-Up
Factors:
1.
2.
3.
4.
5.
9.
Tracks lab tests until available,
following up on overdue
results
Tracks imaging tests until
available, following up on
overdue results
Flags abnormal lab results to
the attention of the clinician
Flags abnormal imaging
results to the attention of the
clinician
Notifies patients/families of
normal and abnormal lab and
imaging test results
Electronically incorporates
>40% of all clinical lab test
results into medical record
Key Points:
 Factor 1 & 2 are critical
factors
 Flagging draws attention to
results as an icon that
automatically appears in the
EHR or a manual tracking
system with a timely
surveillance process
 Factor 5 - filing normal and
abnormal results in the
patient’s medical record for
patient’s next office visit
does not meet the intent of
the factor
STANDARD 6: Measure and Improve Performance
The practice uses performance data to identify opportunities for
improvement and acts to improve clinical quality, efficiency and patient
experience
Element B: Measure Patient/Family Experience
Factors:
1.
Conduct a survey to
evaluate patient/family
experiences
Key Points:
 The practice conducts a
survey to evaluate
patient/family experiences
on at least 3 of the following
categories:
• Access
• Communication
• Coordination of Care
• Whole-person care/selfmanagement support
Applying Lean to Quality
Improvement Efforts
• Lean is a methodology based on
providing better quality, identifying
value and eliminating waste.
• Lean methodology employs a bottom
up approach where improvement
ideas and changes come from patients
and staff.
• This requires commitment to quality
and improvement throughout the
organization.
Lean Key Points
• Identify, name and reduce waste
• Engage everyone involved to help fix a
broken process
• Use visual displays to engage and inform
staff of progress
• Agree on standard work and build in
training
• Managers and senior leaders set priorities
and keep the organization focused
Quality Improvement Strategy
• QI strategy is the driver of PCMH
transformation
• Case study: Group Health Cooperative in
Seattle, WA used Lean to Implement and
Spread the Patient-Centered Medical
Home Model of Care
– Before: 7% of patients got their questions
answered via phone on their first attempt
– After: 65% of patients got their questions
answered on their first attempt
Additional Services Available from PHA
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Meaningful Use for Stage 1 & Stage 2
Security Risk Assessment
Consulting
Patient Centered Medical Home Transformation
Lean Six Sigma Healthcare
Allison Bryan, MS, CHES
Field Operations Manager
(765) 496-9791
[email protected]
www.pha.purdue.edu
Purdue Research Foundation 2012