Transcript External Mapping - Clinical microsystem

Exploring the external context of the clinical microsystem for improving the
health of a given subpopulation of patients…
Building a Team to Manage A Panel of Primary Care Patients
MIssion: The Dartmouth-Hitchcock Clinic exists to serve the health care needs of our patients.
People with
healthcare
needs
4
Healthy
P
A
Prevention
Acute
C
Chronic
People with
healthcare
needs met
E
Educate
Chronic
PACE
Very High Risk
Very High Risk +++
1
Healthy
Very High Risk
Assign to
PCP
2
3
Orient to
Team
Assess &
Plan Care
Functional
& Risks
Biological
Functional
& Risks
ACPPE
Palliative
Expectations
Costs
Biological
Satisfaction
Costs
PACPPE
Chronic ++
Healthy
Chronic
PACE
Healthy
5
6
7
8
9
10
11
12
13
14
Info Systems
& Data
Phone,
Nurse First
Scheduling
Medical
Records
Laboratory
Radiology
Pharmacy
Referrals
Billing
Physical
Space
Department
Division and Community
Southern Region
Hitchcock Clinic System
TEAM MEMBERS:
Nashua Internal Medicine
Measuring Team Performance & Patient Outcomes and Costs
Sherman Baker, MD
Missy, RN
Amy, Secretary
Measure
Leslie Cook, MD
Diane, RN
Buffy, Secretary
Panel Size Adj.
Joe Karpicz, MD
Katie, RN
Mary Ellen, Secretary
Deb Urquart, NP
Bonnie, LPN
Kristy, Secretary
Carole, LPN
Charlene, Secretary
Ron Carson, PA
Erica, RN
Nancy, LPN
Laura, RN
Mary Beth, MA
Maggi, RN
Lynn, MA
Skill Mix: MDs _2.8_ RNs _6.8_ NP/PAs __2__ MA _4.8 LPN _____ SECs __4_
Current
Direct Pt. Care Hours:
MD/Assoc.
% Panel Seeing Own
PCP:
Total PMPM Adj.
PMPM-Team
Micro-System Approach 6/17/98
Revised: 1/27/00
Target
Measure
Current
Target
External Referral Adj.
PMPM-Team
Patient Satisfaction
Access Satisfaction
Staff Satisfaction
c
Eugene C. Nelson, DSc, MPH
Paul B. Batalden, MD
Dartmouth-Hitchcock Clinic, June 1998
Place a bold line around the rectangle of the “most important contributors” to the improved health of
the subpopulation. Illustrate the relationships with a blue line. Add an arrow head if the direction of the
relationship is clear. If the relationship can be significantly improved, use red for the line.
© 2/10/03 Ruth Kennedy , NHS, UK/MM Godfrey, Trustees of Dartmouth College
Exploring the external context of the clinical microsystem for improving the
health of a given subpopulation of patients…
VNA
School
Healthy Start
Building a Team to Manage A Panel of Primary Care Patients
MIssion: The Dartmouth-Hitchcock Clinic exists to serve the health care needs of our patients.
People with
healthcare
needs
4
P
Prevention
Healthy
A
C
Acute
Chronic
People with
healthcare
needs met
E
Educate
Chronic
PACE
Very High Risk
Very High Risk +++
1
Healthy
Very High Risk
Assign to
PCP
2
3
Orient to
Team
Assess &
Plan Care
Functional
& Risks
Biological
Palliative
Expectations
Costs
Social
Services
Functional
& Risks
ACPPE
Biological
Satisfaction
Costs
PACPPE
Chronic ++
Healthy
Chronic
PACE
Healthy
5
6
7
8
9
10
11
12
13
14
Info Systems
& Data
Phone,
Nurse First
Scheduling
Medical
Records
Laboratory
Radiology
Pharmacy
Referrals
Billing
Physical
Space
Department
Division and Community
Southern Region
Hitchcock Clinic System
TEAM MEMBERS:
Nashua Internal Medicine
Measuring Team Performance & Patient Outcomes and Costs
Sherman Baker, MD
Missy, RN
Amy, Secretary
Measure
Leslie Cook, MD
Diane, RN
Buffy, Secretary
Panel Size Adj.
Joe Karpicz, MD
Katie, RN
Mary Ellen, Secretary
Deb Urquart, NP
Bonnie, LPN
Kristy, Secretary
Carole, LPN
Charlene, Secretary
Ron Carson, PA
Erica, RN
Nancy, LPN
Laura, RN
Mary Beth, MA
Maggi, RN
Lynn, MA
Current
Direct Pt. Care Hours:
MD/Assoc.
% Panel Seeing Own
PCP:
Total PMPM Adj.
PMPM-Team
Micro-System Approach 6/17/98
Revised: 1/27/00
Skill Mix: MDs _2.8_ RNs _6.8_ NP/PAs __2__ MA _4.8 LPN _____ SECs __4_
Target
Measure
Current
Target
External Referral Adj.
PMPM-Team
Patient Satisfaction
Access Satisfaction
Staff Satisfaction
c
Eugene C. Nelson, DSc, MPH
Paul B. Batalden, MD
Dartmouth-Hitchcock Clinic, June 1998
Volunteer
Services
Hospice
Clergy
Physical
Therapy
Place a bold line around the rectangle of the “most important contributors” to the improved health of
the subpopulation. Illustrate the relationships with a blue line. Add an arrow head if the direction of the
relationship is clear. If the relationship can be significantly improved, use red for the line.
© 2/10/03 Ruth Kennedy , NHS, UK/MM Godfrey, Trustees of Dartmouth College