Transcript Document
Maine Chronic Disease
Improvement Collaborative (CDIC)
IMPROVING DIABETES AND HYPERTENSION
NOVEMBER 2014 – JUNE 2015 PILOT
Launch Webinar: November 7, 2015: 8 – 10 AM
(866) 740-1260 ; 1120970#
www.readytalk.com #1120970
Rhonda Selvin, NP
Associate Medical Director, Maine Quality Counts
Joanne O’Neil Lafferty, M.Ed.
Quality Improvement Specialist, Maine Quality Counts
Agenda
Welcome and Introductions (45 minutes)
Quality Counts Staff
Practice Teams
Project Overview (45 mins)
Setting the Stage
Collaborative Model
Benefits of Participation
Collaborative Overview
Next Steps
Q&A
Maine Quality Counts Staff & Faculty
CDIC Participating Teams
Naples Family Practice
York Family Practice
Midcoast Brunswick Family Practice
Capeheart Community Health Center (PCHC)
Pines Presque Isle
Welcome
Your name and role (all team members)
A little bit about your team (improvement
initiatives involved in, etc.)
One thing your practice is most proud of
One thing you want to learn from the
collaborative
Six word sentence that describes your teams’
feelings going into this
Why Now?
National Front
Local Front
32% of mortalities in
Chronic disease is the
number one cause of
death.
Maine in 2010
Diabetes rates have
risen from 6% to 8.7%
in 10 years
92,000 adult residents
living with diabetes
Why Maine?
Strong primary care leadership
Active participation by Maine practices in
Medical Home & Health Home, others…
Rural communities increase isolation and
the need for support for chronic disease
patients
Your readiness & willingness!
About the Project
Funder: Maine Centered for Disease Control (CDC)
1305: State Public Health Actions to Prevent & Control Diabetes, Heart Disease &
Obesity
Project Partners:
Maine Quality Counts: project leadership, practice coaching, PCMH expertise
Maine CDC: grantee and partner
Partnership for Health: evaluation partner
Stakeholder group … strong and growing!
Including:
MMC Diabetes Collaborative
Maine Cardiovascular
Health Council
Medical Care Development/Public Health
HealthCentric Advisors Quality Improvement Organization (QIO)
Area Agencies on Aging
Maine Nurse Practitioner Association
Primary care practice and Specialty provider groups
Our Goals
Expand
knowledge on
evidence based, safe,
cost effective care
Implement/spread
best practices and
algorithms across the
state
Improve quality, cost
and safety
Teach and spread
science of quality
improvement
Leading Improvement
Patients/families
Health
Provider
support
Leadership
Teams
Relationships
Data
CDIC
Collaborative Model
JOANNE O’NEIL LAFFERTY, M.ED.
MAINE QUALITY COUNTS,
QUALITY IMPROVEMENT SPECIALIST
Benefits of Participation
Dedicated,
on-site improvement coaching support
Learning sessions—all teach all learn
Case conference calls with clinical experts
Virtual learning communities—”share seamlessly and
steal shamelessly”
Maintenance of Certification & CME available
(contact Joanne for information)
Benefits of Participation
Dedicated, on-site improvement coaching support
A dedicated improvement coach on-site to support you with the program
requirements 2 times a month at a time convenient for you
Assess
current state and support ongoing improvement
work
Optimize registry to inform improvement
Support data collection and reporting
Develop team meeting and improvement skills
Benefits of Participation
Building In-person & virtual Learning Communities
Most of the learning will be virtual, allowing you to stay in your office
Share & network across the state
Access to clinical and quality improvement experts
Access to best practices, tools & templates
November December January
Launch
Webinar
Learning
Session 1
February
March
April
May
June
CaseConference
Call
Practicebased SelfStudy
CaseConference
Call
Learning
Session 3
2/26/15
3/19/15
Anytime
5/21/15
(Optional)
6/18/15
9AM – 3PM
12:15 – 1:15
this month
12:15 – 1:15
9AM – 3PM
CaseConference
Call
Practicebased SelfStudy
Learning
Session 2
1/15/15
Anytime
this month
A chance to learn, share and spread best practices
11/7/14
12/4/14
8AM10AM
9 AM – 3 PM 12:15 – 1:15
Benefits of Participation
Additional Benefits of Participation
An
easy way to achieve Maintenance of Certification
(optional)
CME
available (optional) for your staff
CDIC Aims 2014-2015
By July, 2015, the CDIC participants will aim to redesign their practices
to:
Improve blood pressure control of hypertensive patients
so that 65% of hypertensive patients have BP<140/90 mm
Hg.
Improve HbA1c control of diabetic patients so that 80% of
diabetic patients whose most recent HbA1c level is <9.0%
during the measurement year.
How might we meet that Aim?
Drivers for Improving Chronic Care
Family of Measures
Outcome measure
Overall measure of success
Voice of customer or clinical outcome
Process measures
How work gets done
More sensitive to change
Come and go as work changes
Our Measures
Note:
Will vary based on MOC participation
Outcome Measures:
HTN BP Control (<140/90) (NQF 18) and/or LDL <100 (NQF 0074)
DM A1c Control (>9%) (NQF 59) and/or a1c <8% (NQF 0575)
Process Measures:
Registry Use
Population Management
Pre-Visit Planning
Self-Management Plan
Referral
Others…
Balancing and Structural:
Systems Assessment
Staffing
Patient Satisfaction
Time
Others??
CDIC Evaluation
Federally required evaluation.
Partnerships For Health is based in Augusta and has been
awarded the evaluation contract.
Two components of the evaluation – performance measures
and qualitative evaluation.
Qualitative evaluation
Performance measures:
1 - 45 minute interview with an
Approximately 6 measures
administrative leader / manager
Need to be reported beginning/end
1 - 1 hour focus group with staff
Partnerships For Health will be
3 - 45 minute individual interviews
available to assist with data
with patients
collection
Balancing…
Is there any other part of the system that might
be influenced by your changes?
Patient
Satisfaction
Length of Visit
Finances
Staff Satisfaction
Structural
Staffing
(turn over)
Educated Care Team
How have we learned that we can accelerate
change and increase improvements in healthcare?
Aim
Measure
Change Idea
Changes Tied to Aim/Measures
Measures
Aims
Change Ideas
Next Steps
Meet your QI Support! (Onsite)
1.
2.
3.
BUILD your team
ASSESS your systems and registry
CLARIFY your needs for support
1.
2.
3.
4.
4.
5.
Measure collection
Registry optimization
Workflow optimization
Others…
BRAINSTORM Aims and improvement opportunities
ORIENT team to resources
How Ready are You?
On a scale of 1 (low) – 10 (high)
1.
We have are excited to meet with QI Specialist and get
started!
2.
We can easily pull measures that tell each team how they are
doing with Diabetes and Hypertension patients!
3.
We have tested things in the past that seem to have gone
well!
4.
Our team can work with our QI Specialist 2x/month
5.
Here’s where we think we might start:
__________________________________
Contacts
Joanne O’Neil Lafferty, M.Ed.
[email protected]
Rhonda Selvin, NP
[email protected]
•
General CDIC Mailbox
[email protected]
Questions?