It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement
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Transcript of It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement
UNIVERSITY OF MISSOURIFamily & Community Medicine
It Takes a Village to Change a Process:
A Health Systems Approach toPractice Improvement
Conference on Practice ImprovementSaturday, December 4
4:10-5:10 pm
UNIVERSITY OF MISSOURIFamily & Community Medicine
Presenting Today:
Karl Kochendorfer, MD
•Assistant Professor of Clinical Family and Community Medicine
•Director of Clinical Informatics
•Adjunct Faculty, MU Informatics Institute
•Medical School: University of Illinois at Chicago
•Residency: University of Illinois at Chicago
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Presenting Today:
Phil Vinyard, MHA, MBA, MDiv
•Practice Manager, Green Meadows Family Medicine Clinic, Woodrail Family Medicine Clinic, Fayette Family Medicine Clinic
•Graduate School: University of Missouri (MHA, MBA); Gordon-Conwell Theological Seminary (MDiv)
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Presenting Today:
Jan Gace, LPN
•Phone & Floor Nurse, Green Meadows Family Medicine Clinic
•Nursing School: Columbia Public School of Practical Nursing
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A Little About Us: Mizzou!
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A Little About Us: MU Health Care
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A Little About Us:Family & Community Medicine
•6 Family Medicine Clinics•100,000 Visits•46 Physicians•10 Other Providers•10 Research Faculty•2 Fellows•36 Residents•110 Nurses, Clerical Support & Management
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The Reason for Our Project:The Burden of Diabetes & Other Chronic Disease
•Half of all Americans have at least one chronic disease
•Of those with chronic disease, over 50% have multiple conditions
•Chronic disease causes 70% of all deaths
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The Reason for Our Project:The Burden of Diabetes & Other Chronic Disease
•Chronic disease causes 75% of health expenditures
•1/5 of health dollars are spent on patients with diabetes
•Only 50% of recommended care is delivered to diabetics
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A Solution: Leverage EMR Information
•Tiger Institute for Health Innovation: Living Lab
•F&CM as early adopters of the EMR
•Incentives available for Meaningful Use
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Solution: Diabetes Summary Screen
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DM Quality Measures
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Concept of Perfect Care
Healthcare IT News. 9/2008
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The Math of Perfect Care
• 3 Measures = 1/23 or 1 of 8 qualify
• 8 Measures = 1/28 or 1 of 256 qualify
~32x harder
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Quality Measures Implemented
• Information about DM Quality Measure screens discussed at Faculty meetings
• Physicians encouraged to check DM Summaries on patients and take action
• The results…
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Rampant Indifference
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Minimal Improvement after 1 Year
Clinics with Care Coordinators:• 2 FM Clinics between 10-15%• 2 FM Clinics between 5-10%
Clinics without Care Coordinators:• 4 FM Clinics close to 0%• 2 IM Clinics close to 0%
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It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement
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Our Village: Performance Improvement-Leadership Development Program
•Strategically develop and deploy performance improvement knowledge, skills and competencies of current and emerging clinical and non-clinical leaders throughout UMHC.
•Strengthen the UMHC performance improvement organizational culture.
• Improve UMHC's ability to provide high quality and safe patient care in a patient centered and cost effective manner.
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PI-LDP Program Design
•Performance Improvement Capacity Building
•Learning by Doing
•Performance Improvement Organizational Culture Building
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PI-LDP Program Design
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Members of Our Team and our Advisors
Team:• Karl Kochendorfer, MD (Director of Clinical Informatics)• Phil Vinyard, MHA, MBA (Practice Manager)• Donna Neal, RN (Nurse Manager)• Rhonda Polly, APRN (Chronic Care Nurse)• Jan Gace, LPN (Phone & Floor Nurse)
Advisors:• Carl Hooker, MHA (Finance)• Tim Hogan, PhD (F&CM Department QI Officer)
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Aim Statement
The Family Medicine Green Team will increase the percentage of our diabetic patients with perfect care from 10% to no less than 50% by June 30, 2010. This will be accomplished by using a multidisciplinary approach, process change, education and utilization of eight quality measures.
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Fishbone Diagram
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Fishbone Diagram: Computer
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Fishbone Diagram: Culture
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Fishbone Diagram: Resources
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Fishbone Diagram: Medical Practice
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Fishbone Diagram: Patients
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Fishbone Diagram: Staff
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Driver Diagram
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Interventions Considered
• Opportunistic Approach
• Proactive Approach
• Patient Engagement Approach
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Opportunistic Approach
Every time a patient with diabetes comes for a clinic visit, review their quality measures and take action
Process Flow Chart
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Proactive Approach
“Run the list” of diabetic patients and pro-actively contact them about missing items.
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Run the List: By Patient
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Run the List: By Category
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A Train Wreck…
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A Train Wreck…
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Correcting Primary Provider
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Patient Engagement Approach
Educate the patients about the types of services they should be receiving.
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Patient Letter
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Patient Letter
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Patient Letter
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Automated emails w/ graph
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Outcomes!
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Outcomes to Date
Decided to focus on diabetes quality indicators as a practice improvement project
Completed workflow process and began piloting and training for our intervention
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Lessons Learned
• Having data doesn’t mean improvement• Integrate the data into your workflow• Training needs
Learning how to use the reporting tools Documentation, e.g. eye and foot exams
• Team effort (e.g. buy-in, resources, meetings)
• Physician engagement • Automate, Automate, Automate
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Future Steps
• Re-establish new target• Add incentive payments• Integrate PDSA
Continue Ninja Group Meetings Improve “Proactive” approach Improve “Patient Engagement” approach Expand to other Family Medicine & Internal Medicine
Clinics Assist our physicians with their Board Certifications
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Questions?
Karl Kochendorfer, MD [email protected]
Phil Vinyard, MHA, MBA [email protected]
Jan Gace, LPN [email protected]
Rhonda Polly, APRN [email protected]
Donna Neal, RN [email protected]
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