PPRNet2014 Annual Meeting

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NEW PROJECT

Reducing ADEs from Anticoagulants, Diabetes Agents and Opioids in Primary Care

PPRNet2014 Annual Meeting

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GOALS

• Present newly funded medication safety project

• Discuss opportunities for practice and patient involvement

• Plan your role in the project

PPRNet2014 Annual Meeting

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PPRNet2014 Annual Meeting

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WHY?

• High priority medications

“ADEs across inpatient and outpatient settings are common, clinically signficant, preventable and measurable”– Anticoagulants– Diabetes agents– Opioids

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• Focus on high priority medications • “…address the prevention of harm, but also

promote standardized and idealized practices and behaviors”

• Include patients as a vital part of research• Target ambulatory care

Advancing Patient Safety Implementation through Safe Medication Use Research

(PA-14-002)

PPRNet2014 Annual Meeting

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PPRNet2014 Annual Meeting

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TIMELINE

June-July 2014

“Good” scoreRespond to criticisms

January 25, 2014

Application submitted

December 2013 – January 2014Project planning

Request letters of support

November 2013

Funding Announcement

posted

PPRNet2014 Annual Meeting

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PROJECT GOALS

1) Clarify risk factors for ADEs from high priority medications through a literature review and translate them into a working set of clinical quality measures that can be implemented in primary care

2) Use a community engaged action (CEA) research approach to test the impact of a refined set of preventive strategies for ADEs on practice performance on ADE clinical quality measures

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GOAL 1: DEVELOP ADE MEASURES

• Preliminary set of measures– Based on established risk

factors– Include existing or

proposed MU measures• Existing Stage 2 MU measures• Proposed Stage 3 MU measures• Proposed by research team

based on National Action Plan

– Revise based on provider input during year 1

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GOAL 1: PRELIMINARY MEASURES

ADE Risk Factor

Lack of safe prescribing and monitoring processes for new oral anticoagulants

• Example: Anticoagulants

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GOAL 1: PRELIMINARY MEASURES

ADE Risk Factor CQM

Lack of safe prescribing and monitoring processes for new oral anticoagulants

Patients on appropriate doses of new oral anticoagulants based on renal function

• Example: Anticoagulants

PPRNet2014 Annual Meeting

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GOAL 1: PRELIMINARY MEASURES

ADE Risk Factor

Application of aggressive glycemic targets in high risk patients

• Example: Diabetes Agents

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GOAL 1: PRELIMINARY MEASURES

ADE Risk Factor CQM

Application of aggressive glycemic targets in high risk patients

Patients > 65 years with diabetes on sulfonylurea or insulin AND most recent A1C > 7%

Patients with specific comorbidities* on sulfonylurea or insulin AND most recent A1C > 7%

• Example: Diabetes Agents

PPRNet2014 Annual Meeting

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GOAL 1: PRELIMINARY MEASURES

ADE Risk Factor

Higher than recommended daily doses

• Example: Opioids

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GOAL 1: PRELIMINARY MEASURES

ADE Risk Factor CQM

Higher than recommended daily doses

Patients on recommended doses of long-term opioid therapy

• Example: Opioids

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GOAL 1: MEASURE DEVELOPMENT

Activity Timeline

Confirm participation of 24 practices Today!

Clarify ADE risk factors Oct 2014

Specify measures Dec 2014

Survey providers “Is this a useful measure of quality?” Open comments

Early 2015

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GOAL 2: TEST “COMMUNITY ENGAGED” APPROACH

• Practice community = patients or non-professional caregivers, clinical staff and providers

• Site visits and regular follow-up• Purpose:

– Academic detailing on ADE risk factors

– Performance review and improvement planning

– Practice-specific integration of strategies to prevent ADEs

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YES, PATIENTS!

• Practice invites 9-12 patients or non-professional caregivers to participate – From PPRNet list of patients eligible for CQMs

• Ideal characteristics of “key informants”– Ability to communicate clearly– Interest in project goal– Willingness to participate in site visits– Together, represent diverse age groups,

race/ethnicity, medications

PPRNet2014 Annual Meeting

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Community Engaged Group(12 practices)

Control Group

(12 practices)

Provider surveys X X

Reports on ADE measures X X

Site visits with patient “key informants”

X

Regular follow-up via webinar/email

X

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WHAT IS REQUIRED OF PRACTICES?

• Open to all members!• Submit PPRNet data extracts

through Sept 2017• Complete two rounds of

measure development survey• Agree to invite patients to

participate AND host 3 site visits if randomized to intervention

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INCENTIVES TO PARTICIPATE

• Opportunity to define “meaningful” CQMs• Facilitated PPRNet quality and safety

improvement assistance• Concrete example for PCMH “Patient

Advisory Council” objective• Financial incentives for practices ($1200

each + $800/intervention) and patient advisors ($25/activity)

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LETTERS OF SUPPORT

• We received letters of support from 15 practices in attendance:

Advanzed Health Care PLCCayuga Family MedicineDutter Hufford Daley MDsFamily Medicine of Port AngelesFamily Practice Associates, LLPLovelace Family MedicineNortheast Iowa Medical Education FoundationPlymouth Family Physicians

Quality Family PracticeRavalli Family MedicineRio Grande MedicineSmoky Hill Family Medicine Residency ProgramSpringfield Health CareSummit View ClinicThe Internal Medicine and Pediatric Clinic of New Albany

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IT’S NOT TOO LATE!

Byron Center Family MedicineChatuge Family PracticeClover Fork ClinicDiana Lozano, MD, PA Family Health AssociatesFulton Family Health AssociatesGeorgia Regents Family Medicine Center Good Samaritan Health Center of CobbHilliard Family MedicineHugh D. Durrence, MDJohn A. Martin Primary Health Care Center

Lake Lansing Family PracticeMatthew White, MDMt View Family PracticeNatural Family WellnessNew London Family PracticeRobert E. Barnett, M.D. LLC Rio Grande Valley Adult and Internal MedicineSkyline Family PracticeSopris Medical PracticeSouth Park Internal Medicine UT Health Systems

PPRNet2014 Annual Meeting

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ARE YOU IN?

• Yes

• Yes, awaiting confirmation from the rest of my practice

• No because …

PPRNet2014 Annual Meeting

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