Transcript July 2012 Webinar • PDSA Sharing • Month 1 Reporting • CCI Practice: Byrnes Family Medicine.

July 2012 Webinar
• PDSA Sharing
• Month 1 Reporting
• CCI Practice: Byrnes Family Medicine
Testing on a Small Scale
• Conduct the test with one provider in the
office, or with one patient
• Conduct the test over a short time period
• Test the change with the members of the
team that helped develop the plan
• Test the change on a small group of
volunteers
• Minimize confusion, frustration until bugs
are worked out, then spread
PDSA Sharing
• Pre-visit planning: Eastbrook, Oyster Point, Green Hill
• Use of diabetes template: Seneca
• Population alerts: Warren, Corry, General Internal
Medicine
• Outreach for overdue patients: Manor, Mountville
• Data capture/reporting: Hamilton Health
• Patient education/Self management support: Oil Valley,
Hamilton Health
• Complication screening (feet, eyes, kidneys): Carlisle,
Sandrowicz, Oyster Point
Super Strategies
• Staff education/training
• Staff meetings
• Standing orders
• Process auditing
• Small, rapid PDSA cycles
PDSA Assistance, Reporting
• Talk with your practice facilitator about your
PDSAs – they are there to help you!
• South Central – Sharon Adams
814-344-2222, [email protected]
• North West – Patty Stubber
814-217-6029, [email protected]
• Please fill out your entire PDSA worksheet,
including what you’re learning (not just what you
plan to do).
• Submit your PDSA worksheets ongoing or with
your monthly reports.
Monthly Reporting
• We’ve simplified the reporting form, so there is just 1 column
for you to add the monthly data.
Measures
Count of DM patients ages 18-75
A1C >9
A1C <8
BP <140/90
LDL <100
Tobacco query
Nephropathy screening/treatment
Dilated eye exam results documented
Foot exam
Patients with self-management goal(s)
Count of DM patients who use tobacco
Tobacco cessation intervention
HEDIS 90th This Month This Month
Percentile (numeric
% (AutoGoal % digits only)* Calculates)
<13.63%
>74.7%
>76.33%
>58.15%
>90%
>92.46%
>90%
>90
>90%
>90%
• We are sending everyone a new report form with your old
information copied into it. Please use the new form.
• Double-click on the form to enter data.
• Percentage column (blue) will auto-calculate.
Rest of the Report
• Please update the “critical changes” section as
you test and implement these changes.
Critical Changes Integrated in Diabetes Population Management
Population alert (to visually ID records of all diabetes patients)
Use of template/flowsheet with embedded clinical guidelines
Use of standing orders for team members
Providing planned care at every visit
Use of patient report card/progress report
Patients setting self-management goals
Risk assessment at every visit
Follow-up care for high-risk patients
Date Accomplished
In process
In process
Not for diabetes, yet
No
Partially
implemented
No
Not automatically
Not automatically
Improvement Plan for Measures Not at Goal (keep typing in the boxes below to add lines as needed)
Month
Your PDSAs (what you planned, what you did, what you learned, how you refined or implemented)
June 2012
We are working on the identification of all DM patients within the electronic record. Once this has been
completed we will be meeting with providers and staff to educate them as to this ID. Since we have a
flow chart already in place and a process in place to be prepared for the DM visit we will be measuring
the compliance with a PDSA on the identification of the DM patient with a single provider and assistant.
Improvement Plan for Measures Not at Goal (keep typing in the boxes below to add lines as needed)
Month
Your PDSAs (what you planned, what you did, what you learned, how you refined or implemented)
June 2012
Created laminated list of measures, working off overdue and increased A1C list and calling and
scheduling labs and appointments. Seeing patients 1 on 1 with A1C>15, now down to 10.1 with diabetic
educator. Staff/nursing meeting scheduled to discuss diabetic measures. In 2 weeks we will have staff
meeting with doctors and team members to formulate additional plans.
Staff seminar for nurses to discuss diabetic measures. Meeting with physician champion to discuss PDSA.
Nurse will focus on calling patients 2 weeks out and gather data-observe for completed measures. PDSA
worked with are physician schedules. Tracked two working days of their schedule. Put in orders, gave
alerts. Measures met at 80% as this physician is very proactive in his approach to diabetes.
Improvement Plan for Measures Not at Goal (keep typing in the boxes below to add lines as needed)
Month
Your PDSAs (what you planned, what you did, what you learned, how you refined or implemented)
1.
June 2012
2.
PDSA Cycle One – Creating Panel for Dr. A. William, and discovered that we can run reports on
additional providers using two visit criteria. Registration is entering PCP and Doctor of Record
as patients come in for visits.
PDSA Cycle – Data Integrity and improving ability to create reports
Lab data such as HgbA1c and LDL are readily available for review.
Podiatry referrals are readily pulled for reports using Dr. Black as primary podiatrist.
Ophthalmology referral data needs to be refined. Initially the report was created using Premier
Eye Group as our primary indicator for eye consults. However, discovered after chart review,
providers are using Ophthalmology consults as well Premier Eye Group. The report was refreshed
and captured eye referrals using Dr. A. William’s panel.
Another problem related to referrals – HHC has started a new referral process using the EMR. The
referral consults will be marked completed once the actual reports are scanned into the EMR by
HIS. Our referral numbers may be low until this process is perfected and all reports have arrived.
Plan to monitor Unit Clerks using the Order Tracking Tab in the EMR. For the referrals without a
completion date, the Unit Clerks are to call the patients to inquire if appointment was kept and
the report needs to be sent from the referral office or if the patient requires rescheduling,
Data Analyst reviewing ability to create reports for self- management goals. Clinical staff not
using the Diabetic Goal Template consistently. Self- Management requires further investigation
and planning for documentation of self- management goals.
Assessment of smoking status is readily available and Medical Assistants assesses and documents
upon rooming of patient.
Assessment of Smoking intervention requires consensus on which areas of documentation to be
PDSA
Summary
• It’s helpful to
have a
summary of
the PDSAs
you’ve been
testing in the
last part of the
report.
Comments at the End
• Feel free to add comments or questions at the end of the
report. (Please date them.)
• Challenges you are facing.
• Areas where you need support or resources.
• Things you want to learn more about.
Example:
July 2012
1. Discussion concerning Self -Management goals and innovative
ways to incorporate group visits.
2. Data integrity and creating reports remains a challenge for a
number of measures but we are improving the quality of the
reports.
Patient Centered Medical Home
Building the System
Mary Beth Byrnes, MSN, RN
PA SPREAD PCMH Initiative
July 26, 2012
Richard Byrnes, D.O. Family Practice
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Established 1974
Serving Upper Bucks & Montgomery Counties
Suburban – Semi-Rural
Patient Population 2100
97% English Speaking Caucasian
Farming – Light Industry
7.2% Community Unemployment Rate
Staff – 1 RN (CNS), 2 MA, 1 CRNP (temporary)
PACCI – 2010
Why Participate in Initiative
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Expert Guidance
Challenge
Financial
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No Cost
Meaningful Use
IBC – Incentive Payment
Better Patient Outcomes
Decision Support
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Clinical Guidelines Imbedded in EMR & Registry
Stepped Care Protocol – Medications
Standing Orders – Team Members
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Risk Stratification – Identify highest risk patients
Created a Care Management Process
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Patient Centered Communication
Proven Education Methods – Barrier to Care/Confidence
Patient Support & Report Cards
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Labs, Eye Exam, Diabetic Education, Influenza & Pneumococcal
Vaccinations, Mammograms, Colonoscopy
Sharing Guidelines – Outcomes with Patients
Patient Education Material & Resources
Delivery System Design
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Planned Care at Every Visit
 PDSA’s
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How to implement elements from Decision Support
Written Policy for PDSA’s Implemented
Job Descriptions related to the new policy
Developed a Strategy
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Mapped Office Visits
Delivery System Design
Planned Care at Every Visit
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Formed Team & Identified Roles & Responsibilities
Evaluated Method of Communication
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Self Management
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Report Card & Self Management Goals
Readiness & Confidence Rulers
Action Plan
System to Identify & Document High Risk Patients
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Motivational Interviewing Techniques
Develop Care Plan for Highest Risk Patients
Huddles, Tag Team, Warm Hand Off
Delivery System Design
Redefined Roles & Work Flows
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Put more responsibility on staff
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How to Read Charts
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Removed any “Crutch” which blocked change
Redefined Flow of Patient Visit - Mapping
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Team Effort
Team Member Responsibilities
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Written Policy
Updated Job Descriptions
Focused on Patient Education
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Tracking
Tag Team
Written Policy Based on Successful PDSA’s
MA checks patient in
and alerts RN that
patient has arrived
RN rooms patient, takes vitals, makes
initial entry in Subjective, tells
physician that patient is ready to be
seen
Physician Sees Patient
Physician sends “Superbill” to
Front Desk with orders and
instructions
MA at Front Desk Prepares Orders
reviews Orders with Patient
Sets Follow Up Appointment
MA reviews Tracking
List Daily
Tracks Test-Consults
Notes Appointment
Pre-Visit Huddle with
Physician to discuss
High Risk Patient
Plan Interventions
Physician Sees Patient
Reviews Reinforces Action Plan
Sends Orders to Front Desk
RN runs Appointment Reports
Identifies Patients for Focused Visits
48 Hours Prior to Appointment RN
reviews EMR, Flow Sheet, Risk
Status, Goals, Barriers, Preventive
Care Needs
RN reviews Labs, Vital Signs,
Medications, Report Card, SM Goals,
Barriers,
Preventive Care Needs, Patient
Education, Counseling, Standing
Orders
Interactive Action Plan
Agreed Upon Follow Up
Tracking for Follow Up
Initiated
MA at Front Desk Reviews Orders
Sets Follow Up Appointment
Reminds Patient of RN
Follow Up
RN communicates with Front Desk
Regarding Patient Needs at End
Of Visit
Self-Management Support
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Changed Method of Communication
 Provider Self Assessment
Patient Report Card
 Clinical Measures
Self Management Goals
 Process Measures
Identify Barriers to Goals & Readiness to Change
Action Plan
Impact of Self-Management Support
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Improved Patient Outcomes
Patients Taking Control
Patients Increased Confidence
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Spreading their Knowledge
Improved Patient Satisfaction
Improved Work Flow
Improved Provider/Staff Satisfaction
Development of Care Management Strategies
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Developed Relationships with Insurance Carrier Care
Managers and ABC Diabetes Education Program
Computer Information System
The Tool
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Goal
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Population Management
Data Management
Access and Continuity
Monitor Performance
Measure
Goal
12/2009 06/2012
A1c >9.0
<5%
20%
7%
LDL <100
>50%
30%
62%
Blood Pressure <130/80
>70%
36%
57%
Statin
>80%
47%
80%
ACE/ARB
>75%
62%
91%
Aspirin Use
>85%
57%
97%
Foot Exam
>90%
68%
97%
Kidney Assessment
>90%
72%
94%
Eye Exam
>80%
74%
72%
Influenza Vaccination
>75%
40%
90%
Self Management Goals
>90%
50%
97%
Smoking Status
>80%
88%
98%
Advantage of Being a Small Practice
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Small Practices can effect change faster than
larger practices
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Less Inertia
Change that occurs can result in improved
patient outcomes that are consistent with
improved patient outcomes in large practices
Questions?