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Quality Improvement SeriesSession 10

Windy StevensonCindy Ferrell

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Today’s AgendaToday’s Agenda

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RecapRecap

AIM: >95% of patients >2yo seen by a provider in the gen peds clinic or Westside clinic (including acute care; excluding healthy lifestyles) who have a BMI >85%ile will have “BMI; category” listed on their problem list

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Current statusCurrent status

Future state

Pt >2yo checked in and ht/wt recorded

EPIC uses ht and wt to generate BMI

and flags if >85%ile

Provider sees banner under

Quality issues and clicks associated

smart set

Acute care visit-

problem added;

follow up appt made

with PCP

Family stops at desk to get appt

WCC- provider adds

problem; uses smart

set to guide care

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Next Steps

1. Assess feasibility of weights for all visits2. Align efforts with Healthy Lifestyles Clinic3. PDSA trial of BPA’s and Smart Sets (flip the

switch?)4. EPIC request to populate problem list from an

smart set 5. EPIC process for driving PCP follow up

appointments6. Exploration of adding prompt to notes template7. Options for optimizing problem list designation

for kids already identified (457 of them)

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The baseline dataThe baseline data

The pull: patients >2yo and <18yo seen by a provider in the gen peds clinic, adolescent clinic, or Westside clinic (including acute care; excluding healthy lifestyles) from 07-01-10 to 03-31-11 who have a recorded BMI >85%ile, with stratification of those who have any of the identified problems noted on their problem list

Adjustments recommended:– Exclude pts >18yo– Combine gen peds and adolescent– Clarify %ile divides to match BPA’s

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The baseline dataThe baseline data

37% overall success (457/1220 patients)

Adolescent Campus Peds West32

34

36

38

40

42

Percent of patients >2yo with BMI >85%ile with problem listed

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The Science of ReliabilityThe Science of Reliability

Reliability Level Reliability Expression

Reliability Rate Failure Rate

Level 1 10‾¹ 80-90% reliable 1-2 failures in 10 opportunities

Level 2 10‾² 95% reliable <5 failures in 100 opportunities

Level 3 10‾³ 99% reliable <5 failures in 1000 opportunities

Level 6(Six Sigma)

10‾6 <5 failures in 1,000,000 opportunities

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1 2 3 40

50

100

150

200

250

300

350

400

450

500

Number of children per BMI Category

populated not populated

85-90% 90-95% 95-99% >99%

Problem List

Baseline Data, continued

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Age and BMIAge and BMI

2-3yo 4-6yo 7-9yo 10-12yo 13-15yo 16-18yo05

101520253035404550

Percent of pts with BMI>85% with populated problem list, by age

(years)

n=191

n=230

n=241

n=213 n=212

n=121

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Future State- dataFuture State- data

Transparency- who gets it, in what form? How can we use it to motivate and maintain?

We envision monthly reports of:% pts 2-18 with BMI >85%ile who were seen in the past 30 days by a provider in clinic (DCH peds and adolescents, Westside) who have this designation on the problem list by the end of the month

With the ability to stratify by age, gender, zip code, acute vs well visit, BMI category, provider name