Disclosure I, Michael Kaiser, MD, have no relationships with commercial interests to disclose. A...

LSU Improving Quality,

Improving Outcomes,Improving Efficiency

Michael Kaiser, MDChief Medical Officer

LSU Health Care Services Division

Disclosure

I, Michael Kaiser, MD, have no relationships with commercial interests to disclose.

A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

LSU SCHOOL OF MEDICINE-NEW ORLEANS

The best of times?

Or

The worst of times?

LSU Medical HomeD

IABE

TES

DIA

BETE

SD

IABE

TES

DIA

BETE

S

CHF

CHF

CHF

CHF

HIVHIV

HIVHIV

KID

NEY

DIS

EASE

KID

NEY

DIS

EASE

CAN

CER

CAN

CER

CAN

CER

CAN

CER

ASTH

MA

ASTH

MA

ASTH

MA

ASTH

MA

THROMBOGENIC STATE CONTROL

BLOOD PRESSURE CONTROL

GLYCEMIC CONTROL

LIPID CONTROL

SMOKING CESSATION

DIET EXERCISE WEIGHT CONTROL

SCREENING

DIABETES

1097 1914

1026

20251342

1694

695

9793

.45

.5

.55

.6

.65

.7

.75

BMC

EKLLA

KLJ

CM

CLUM

CW

OM_T

OT

SITES over QUARTERSGraph uses data from quarters 200701 through 201104AWARD criterion = 0.55, GOAL = 0.65, see lines on graph

diabetes: LDL <= 100 [R]denom: PC Sustained, 6/12

1358

2311

1325

2468

1509

1959

909

11839

.15

.2

.25

.3

BMC

EKLLA

KLJ

CM

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OM_T

OT

SITES over QUARTERSGraph uses data from quarters 200801 through 201104

diabetes: A1c<7, LDL<100, BP<140/90denom: PC Sustained, 6/12

This is the diabetes “composite” control measure.

1043

1666

971

1739

1104

1431

645

8599

0

.1

.2

.3

.4

.5

.6

.7

.8

.9

1

BMC

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SITES over QUARTERSGraph uses data from quarters 200701 through 201104AWARD criterion = 0.55, see line on graph

diabetes: Eye exam in past 15 mos [R]denom: PC Sustained, 3/12

HEART FAILURE

76251

57

289

267302

1791421

.6

.65

.7

.75

.8

.85

.9

.95

1

BMC

EKLLA

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OM_T

OT


chf: on metop-s, carvedilol, or bisoprolol [R]denom: PC Sustained, 6/12

84

250

61

297

270

323

193

1478

.2

.25

.3

.35

.4

.45

.5

.55

.6

.65

.7

BMC

EKLLA

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OM_T

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chf: mod < 130/80, BP in last year [R]denom: PC Sustained, 6/12

186

318

124

419

370

368

237

2021

.1

.15

.2

.25

.3

.35

.4

.45

.5

.55

.6

.65

BMC

EKLLA

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admit: IP visits per person year - qrtdenom: CHF clinic population

Our heart failure admission rates have been steadily falling

12

15

11

14

17

1710

65

0

.1

.2

.3

.4

.5

.6

.7

.8

.9

1

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chf: PC visit w/I 20 days of all-cause IPdenom: lowEF pop 3+ mos

Although we just starting tracking this measure, the fraction of inpatient discharges with PC visits within 30 days has been increasing for some time.

ASTHMA

326

307 159

396

260199

160

1807

0

.1

.2

.3

.4

.5

.6

.7

.8

.9

1

BMC

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asthma: % with action plan ever [R]denom: Sust PC 3/12, DXconf

326

307159 396

260199

160 1807

.2

.3

.4

.5

.6

.7

.8

.9

1

BMC

EKLLA

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asthma: % with PFT in past 3 yrs [R]denom: Sust PC 3/12, DXconf

326

307159

396260

199

160

1807

.4

.5

.6

.7

.8

.9

1

BMC

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SITES over QUARTERSGraph uses data from quarters 200701 through 201104GOAL = 0.60, see line on graph

asthma: % with pneumovax imm ever [R]denom: Sust PC 3/12, DXconf

143

147

65218

13091

78 871

0

.5

1

1.5

2

2.5

3

3.5

4

4.5

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asthma: #ER+IP visits/person-year, quarterdenom: Asthma pop 3+ mos, DXconf

HYPERTENSION

4323

6732

4036

5637

6256 7189

4303

38476

.2

.25

.3

.35

.4

.45

.5

.55

BMC

EKLLA

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htn: Curr BP >= 140/90denom: PC Sustained, 3/12

4081

6425

3826

5318

59176867

4091 36525

.1

.15

.2

.25

.3

.35

BMC

EKLLA

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htn: Sustained BP > 140/90denom: PC Sustained, 3/12

CHRONIC KIDNEY DISEASE

254 316260

493

363

443

211

2340

.4

.45

.5

.55

.6

.65

.7

.75

BMC

EKLLA

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renal: LIPIDS, LDL < 100, stage 34conf [R]denom: PC sustained 6/12

324

401

336582

421519

306

2889

.2

.25

.3

.35

.4

.45

.5

.55

BMC

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renal: BP, last BP < 130/80, stage 34conf [R]denom: PC sustained 6/12

CANCER SCREENING

2725

5013 3216 4728

4814

5609

3586

29691

.5

.55

.6

.65

.7

.75

.8

.85

.9

.95

BMC

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breastcancer: Mammogram in past 2 years, age 40-75 [R]denom: PC Sustained, 6/12

2198

5391

1667

3649

4538 4899

3141

25483

.45

.5

.55

.6

.65

.7

.75

.8

.85

.9

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cervicalcancer: Pap in 2 yrs (21-29) or 3 yrs (30-69) [R]denom: PC Sustained, 6/12

3104

5000

3005

4191

5018

5440

352929287

.2

.25

.3

.35

.4

.45

.5

.55

.6

BMC

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coloncancer: Scope_10yr OR flexsig_5yr OR FOBT_1yr [R]denom: PC Sustained, 3/12

64

53493

132

607

270193 1893

.3

.4

.5

.6

.7

.8

.9

BMC

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hiv: current viral load undetectabledenom: HIV clinic 3/12 sustained

64

52795 136

613 274 201 1910

0

.1

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.8

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hiv: STDs, Chlamydia test in past 15 mos [R]denom: HIV clinic 3/12 sustained

18

235

13

36

168 86

54610

.1

.2

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.4

.5

.6

.7

.8

.9

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hiv: Pap in 2 yrs (21-29) or 3 yrs (30-69)denom: HIV clinic 3/12 sustained

18 152

23

28

154

56

31

462

.3

.4

.5

.6

.7

.8

.9

1

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hiv: mammogram in past 2 yearsdenom: HIV clinic 3/12 sustained

TOBACCO CONTROL

6427

9065

51387235 11723 9567

582654981

0

.1

.2

.3

.4

.5

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.7

.8

.9

1

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LAK

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tobacco: screening rate in past 90 days [R]denom: PC visit in past 3 month

358

235

86342

652

547

206

2426

.4

.5

.6

.7

.8

.9

1


tobacco: % selected assistance among smokers ready to quit [R]denom: PC visit in past 3 month

This is the fraction of “ready to quit” smokers who select some sort of assistance.

EMERGENCY DEPARTMENT

3617

4455

3885

40654543 4615

3292 28476

0

100

200

300

400

500

600

BMC

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LAK

LJC

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UMC

WOM

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ed: LOS, home, triage 4&5 (Median)denom: Non-BH in quarter

This is median LOS (in minutes) for non-behavior health patients, discharged to home, with triage levels 4 & 5

MEDICAL HOME

14947.00

21690.00

12100.00

20838.00

26071.00

24780.00

13755.00

10000

12000

14000

16000

18000

20000

22000

24000

26000

28000

BMC

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OM

Graph combines data from quarters 201104 through 201104.Bottom row numbers on graph are sample sizes.

mh: # in denominatorDENOM: Total PC clinic population

These are our current medical home patient population estimates. The system-wide total is 134,181. These are likely rather conservative estimate.

Initial State – Analytic Assignment

Medical Home CorrectVerified at Each Visit

0

.1

.2

.3

.4

.5

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.7

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.9

1

Average Clinic TOPBOX Fractions and Rangesall respondents

First set of results from the new medical home patient perceptions instrument. Our most positive perceptions were on “friendly.” The least positive pertained to wait times in the clinic (i.e., time spent between arrival and seeing the doctor.)

CHALLENGES• Pelican Implementation• Medicaid Managed Care• Behavioral Health Managed Care• Obama Care• Value-Based Purchasing and hundreds of new

measures and reporting requirements• Budget Cuts

Do More with Less?

Or

Do Less with Less?

• Numbers we serve – throughput• Reduce delays in primary care• Decrease utilization of ED for primary care

and primary support

• From ED Medical Home

• From Inpatient Medical Home• From Medical Home Specialty• From Specialty Medical Home

• Patient self-management skills• Medication adherence• Disease Education• Goal setting and behavior change• System navigation

IMPROVE INTERACTIONS WITH OUR PATIENTS

PatientOur Vision

Value Leader

Our MissionTreat and Teach

Our Values Information Innovation ImprovementIntegrity

Tactics

ResourcesTeaching Research Revenue

Access Quality Safety SatisfactionService

Foundational ElementsMedicalHome

IntegratedInfo Systems

Disease Management Centers of Excellence

PerformanceImprovement

Low Cost Distributed ServicesHigh Quality

Excellence Equity Execution ExplainableEmpathetic

LSU Hospitals ---------------

Strategic Overview

BETTER UNDERSTANDING AND RESEARCH OF

QUALITY IMPROVEMENT PRACTICES

Transition Care InteractionsSelf Management Education Interaction

Coordinated Care Interactions

EVIDENCE BASED STRATEGIES

COORDINATED CARE INTERACTIONS

• Targeting• In-person contact• Access to timely information on hospital and ER

admissions• Close interaction between care coordinators and

primary care physicians• Patient assessment, planning, education, monitoring,

and coaching with social support

1358

2311

1325

2468

1509

1959

909

11839

.2

.3

.4

.5

.6

.7

.8

.9

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diabetes: IMM, flu immunization this seasondenom: PC Sustained, 6/12

64527 95

136613 274

2011910

.45

.5

.55

.6

.65

.7

.75

.8

.85

.9

.95

1

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hiv: STDs, syphilis test in past 15 mos [R]denom: HIV clinic 3/12 sustained

CLIQ Documentation

557

595

380

814

635

766

364 4111

0

.1

.2

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documentation: DX, asthma DX confirmeddenom: PC Sustained, 3/12

68182

38

207

193247

161 1096

.2

.3

.4

.5

.6

.7

.8

.9

1

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documentation: DX, heart failure DX confirmeddenom: PC Sustained, 3/12

27095

37687

20785

31437

49304

4056922055 228932

0

.1

.2

.3

.4

.5

.6

.7

.8

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1

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documentation: MEDREC, fraction with medrec donedenom: PC patients in qrt

1769525595 15208

20653

33383 2705516958

156547

.3

.4

.5

.6

.7

.8

.9

1

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documentation: PP, fraction with blood pressure documenteddenom: PC patients in qrt

684710615 6537

8832

13470

9897

5729

68842

0

.1

.2

.3

.4

.5

.6

.7

.8

.9

1

BMC

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UMC

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ed: ED summary & dictation rate [R]denom: All ED visits in quarter

Current Plan

Currently we are planning to develop measures in the following domains:

1. Patient engagement2. Access to primary care3. Access to specialty care4. Primary care efficiency5. Wellness6. Chronic disease management7. Reduction of adverse events 8. Patient perceptions of MH experiences9. Provider perceptions of MH experiences

Our current medical home measures plan calls for measures in these 9 domains. The next five slides show five initial measures now being added to the site visit reports.

3749

5514

3066

5294

6712

6283

3508

34127

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.1

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mh: ER visits per person-year - qrt, x-IPdenom: Total PC clinic population

This is our ED visit rate per person-year for the total medical home patient population.

939

973

626

985

1331 1214

650

6718

0

10

20

30

40

50

60

70

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mh: Median time to appointment denom: new patients in quarter

This is the median days to wait for a new patient appointment

2609

3732

2514

2829

3225

5300

1538

21747

0

10

20

30

40

50

60

70

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mh: Median time to appointment denom: established patients in quarter

This is the median days to wait for a non-follow-up appointment for established patients.

940

973

626

985

1331

1214 650

6719

.55

.6

.65

.7

.75

.8

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mh: Show rate denom: new patients in quarter

2610 3733

2515

2829

3226

5300

1538

21751

.55

.6

.65

.7

.75

.8

.85

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mh: Show rate denom: established patients in quarter

Medical Home:Satisfaction & Patient Perceptions

• We continue to use our patient satisfaction survey which assessed post-visit impressions of the recent visit.

• We have begun using a “medical home patient perceptions” survey.– Conducted in clinics prior to visits– Assesses perceptions among existing (not new)

medical home patients– Summarized quarterly, based on surveys done one or

two days per month by each MH clinic.

Medical Home Designation and Documentation

CLIQ Summary Screen Update

CLIQ Powered by:LSU HCSD Medical Informatics Team

Initial State – No Medical Home

Medical Home Fields Blank

Medical Home Fields Populated

Two Initial States

Documenting A Medical Home

CommCare Medical Home

LSU Medical Home

Non-LSU Medical Home

LSU Medical Home

Updating/Viewing Medical Home Data

Questions

PatientOur Vision

Value Leader

Our MissionTreat and Teach

Our Values Information Innovation ImprovementIntegrity

Tactics

ResourcesTeaching Research Revenue

Access Quality Safety SatisfactionService

Foundational ElementsMedicalHome

IntegratedInfo Systems

Disease Management Centers of Excellence

PerformanceImprovement

Low Cost Distributed ServicesHigh Quality

Excellence Equity Execution ExplainableEmpathetic

LSU Hospitals ---------------

Strategic Overview

Disclosure I, Michael Kaiser, MD, have no relationships with commercial interests to disclose. A...

Documents

Transcript of Disclosure I, Michael Kaiser, MD, have no relationships with commercial interests to disclose. A...