Transcript Slide 1

North Hudson Community Action Corporation
Health Center
Maritza De La Rosa, MD
Nishie Perez, MA, RN
Family Medicine
Organizational Improvement Director
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Community Action Corporation
◦ Active since 1963
◦ Services include:
 Immigration and Naturalization Programs
 Job Placement
 Affordable Housing
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Senior Services
Emergency Food and Shelter
Head Start
WIC.
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Health Center
◦ Active since 1994.
◦ Services include:
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Pediatrics
Adult Medicine
Women’s Health
Behavioral Health
Addictive Services
Dental
NHCACHC 2009 STATISTICS
Patients Served:
Patients Visits:
Patients with Medicare:
Patients with Medicaid:
Patients with private insurance:
Uninsured patients:
68,955
236,362
3%
41%
6%
50%
NHCACHC is the largest FQHC in New Jersey
NHCACHC participates in this federal initiative to
eliminate health disparities among underserved
populations.
Any identification with racial, ethnicity, language,
generation, citizenship status or economic group should not
lead to better or worse outcomes for a given disease.
The Care Model is the brainchild of the Institute for
Healthcare Improvement (http;//www.ihi.org/ihi/about) and
puts the management of chronic disease in the hands of
health professionals, patients and families.
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Improve outcomes. Encourage high quality
clinical and chronic disease care. The model
can apply to different chronic illness, health
care settings and target populations.
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Community Resources
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Community Partnerships
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Create culture promoting safety and high quality
of care
Health Care Organization
Self Management Support
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Patients are in Charge of their own care
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Evidence based guidelines and protocols
Access to specialty care
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Workflow
Roles
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ie - Reminders
Decision Support
Delivery System Design
Clinical Information Systems
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Productive Interactions
◦ Patient Centered : Informed, empowered patient &
family
◦ Coordinated - Evidence based and safe change
concepts
- Prepared proactive team
The Care Model summarizes the basic elements
for improving care in the health systems at the community,
organization, practice and patient levels.
Development and Implementation
of Patient Care Teams
at NHCAC.
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Organizational Improvement Strategy.
Identify areas that need improvement (clinical, financial,
operational, etc) at each site.
Inform clinical and non-clinical staff at each specific site
of audit results.
Implement changes and promote a collaborative
environment.
Empower staff and clinicians to manage and improve
services at their specific site.
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To develop a well prepared, stable and proactive care
team to promote the delivery of safe evidence-based
clinical management.
Empower and inform patients and families.
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Inform providers and staff of indicators being monitored,
audit results and plan for improvement
Develop and implement recommendations and plan for
improvement.
The care team meets monthly to discuss the progress in
reaching goals.
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Perform audits.
Provide summary of results and discuss quarterly with
care teams .
Provide support when necessary as requested by the
teams.
Provide tools (health plan, health disparities
collaborative and indicator list).
Provide analysis of medication errors, adverse drug
reactions and medical emergency reports .
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Select your “new team”. Select specific members
from all staff.
Team members should be regular staff members
who spend the majority of their time at that specific
health center.
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Understand and accept changes will take place in
order to meet patient needs and improve center
services:
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Change staff hours
Redefine roles and redistribute tasks
Change or reassign staff responsibilities
Change center hours
Change services provided
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Develop clinical sessions with defined starting and ending
time.
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This will allow to have a well prepared and proactive team.
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Managers are essential for the success of the patient care
team.
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Managers need to engage every one at the center from
housekeeping to providers.
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Managers are required to monitor the patient flow “clear
obstacles” and act as troubleshooters. This will enable the
patient care team to provide quality services to patients
instead of trying to solve operational problems.
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Maximize the full resources from each staff member.
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Discover and use talents and prior experiences from team members.
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Provide a place where patients feel “at home” and where they know
their health issues and concerns will be addressed in a professional
manner.
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Patients and families will be informed and empowered. They will be
able to understand their disease and their role as daily self managers.
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Change the services provided from: patient visits to a proactive
comprehensive care of a panel of patients of a specific community.
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Comprehensive system change.
◦ Improve quality of care to patients – improvement in
quality indicators
◦ Improve outcomes with same resources
◦ Improve patient satisfaction
◦ Improve employee morale and satisfaction
◦ Accountability
◦ Opportunity for staff development and creativity
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Provides a process to improve the quality of care at an
accelerated pace.
Small cycle test of change to evaluate if changes will
have benefits at a larger scale.
PLAN = Objective
Who, What, Where, When, Why
DO
= Carry out plan
Study = Analyze data and compare to predictions.
Summarized what was learned.
Act
= What changes to be made.
2009
1st Quarter 2010
HgA1c < 9
71%
80%
BP < 140/90
62%
55% *
Pediatrics Immunization
2 Year Old
87%
92%
Prenatal Early
Enrollment (1stTrimester)
63%
58%
*1st Qtr 90% of patients with HTN who were not compliant with BP ≤ 140/90
had an intervention at time of visit.
Core measures of our Health Plan
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Internal Medicine residents and attending practice: WH,
PEDS, IM
Training provided to all IM residents on NHCAC
required documentation in medical records.
Assigned HIM staff member to prepare incomplete
charts and work with residents during clinic hours.
Residents instructed to complete medical records at the
beginning of their clinical sessions.
CMA’s are assigned to prepare charts for NHCAC
providers for completion.
# Incomplete Medical
Records
500
450
400
350
300
250
200
150
100
50
0
434
287
276
246
231
258
126
Oct-09
Nov-09
Data: HIM Monthly Report
Dec-09
Jan-10
Feb-10
Mar-10
Apr-10
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CMA’s were responsible for confirming
appointments at the end of the day.
CMA’s were unable to make calls – involved in
active patient care.
Responsibility for confirmation appointments
was reassigned to registration staff.
Site Coordinators to measure and monitor
percentage of missed appointments.
50.00%
41.20%
40.00%
% Missed
Appointments
33.50%
29%
30.00%
31%
32.10%
Feb-10
Mar-10
33.20%
GOAL - decrease missed appt
rate from 41% to 26%
in 6 months.
20.00%
10.00%
0.00%
Nov-09
Dec-09
Data Source: Practice Management system
Jan-10
Apr-10
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Excessive amount of unfiled lab reports.
Determine how lab reports come into the Health
Center and streamline the process.
Assign a nurse to separate and sort lab reports.
Provider review and signs lab reports on a daily basis
and send to HIM department.
HIM staff file lab reports daily.
Decrease patient visit waiting time.
Decrease in duplicate lab reports.
Decrease in lab reports awaiting provider review and
signature.
600
500
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# Unfiled lab reports
400
250
300
183
200
86
100
40
0
Dec-09
Data : HIM Monthly Report
Jan-10
Feb-10
Mar-10
Apr-10
% Filed Lab Reports at visit time
100%
75%
50%
63%
37%
25%
0%
Medical Records with Labs
Medical Records without Labs
GOAL : All patients following up on
lab results must have labs in
medical record at time of visit
100%.
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Create a “Help Desk” located in the front registration area
during peak morning hours.
The help desk staff will act as a patient advocate and address
the patient’s needs in a timely fashion.
Duties:
◦ Assist patients arriving without appointments:
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Determine reason for their visit: Triage & medications refill forms developed
Obtain medical record
Communicate to patient how the request will be resolved.
Bridges communication gap between NHCAC staff, patients & families.
Periodically updates patients in waiting room.
Develop patient satisfaction survey to measure the success
and on going need of the help desk.
# of Internal Medicine patients
250
223
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158
150
100
■ Mon - Fri 2 hrs daily
9 - 11 am
65
50
0
RX refill
Data Source: Tabulation of Completed patient forms.
Walk in/triage (nurse)
Total Help desk users
Dates March 15, 2010 – April 30, 2010
# Total IM visits
1159
#IM help desk users 9-11 am
223
% Satisfied Patients
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IM residents receives training on completion of medical
records.
“Help Desk” – Help desk forms developed and assigned
staff as patient advocate.
HIM employee works with residents to complete records.
Laboratory reports reviewed daily by clinicians & filed by
HIM personnel.
Appointments are confirmed on a daily basis.
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Staff realigned to match clinic sessions.
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Courtesy Service training provided to all staff.
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Patient education classes (DM, HTN,
Hyperlipidemia and nutritional) given weekly.
Medical Management Intervention for patients
not achieving goals are done at time of visit.
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Monthly – Set up dates/calendars
Start & finish on time – 1 hr
Agenda/minutes
Discuss audits results
Discuss team accomplishments
Divide group/sections discussions – New issues
Team discussions summary
Plan for improvement
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Quarterly Audits Results
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Pediatrics
Adult Medicine
Women’s Health
Dental
Care Team Drivers:
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J. Verea, MD, Chief Medical Officer
M. De la Rosa, MD, Family Practice
N. Perez, RN, Director of OI
O. Love, RHIT, Director of HIM
C. Brillantes, Quality Analyst
Maritza De La Rosa, MD
[email protected]
Nishie Perez, MA, RN
nishiep@ nhcac.org