It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement
description
Transcript of It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement
![Page 1: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/1.jpg)
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
![Page 2: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/2.jpg)
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
![Page 3: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/3.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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)
![Page 4: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/4.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Presenting Today:
Jan Gace, LPN
•Phone & Floor Nurse, Green Meadows Family Medicine Clinic
•Nursing School: Columbia Public School of Practical Nursing
![Page 5: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/5.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
A Little About Us: Mizzou!
![Page 6: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/6.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
A Little About Us: MU Health Care
![Page 7: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/7.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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
![Page 8: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/8.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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
![Page 9: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/9.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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
![Page 10: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/10.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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
![Page 11: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/11.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Solution: Diabetes Summary Screen
![Page 12: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/12.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
DM Quality Measures
![Page 13: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/13.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Concept of Perfect Care
Healthcare IT News. 9/2008
![Page 14: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/14.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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
![Page 15: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/15.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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…
![Page 16: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/16.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Rampant Indifference
![Page 17: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/17.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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%
![Page 18: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/18.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement
![Page 19: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/19.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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.
![Page 20: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/20.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
PI-LDP Program Design
•Performance Improvement Capacity Building
•Learning by Doing
•Performance Improvement Organizational Culture Building
![Page 21: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/21.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
PI-LDP Program Design
![Page 22: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/22.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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)
![Page 23: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/23.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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.
![Page 24: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/24.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Fishbone Diagram
![Page 25: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/25.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Fishbone Diagram: Computer
![Page 26: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/26.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Fishbone Diagram: Culture
![Page 27: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/27.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Fishbone Diagram: Resources
![Page 28: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/28.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Fishbone Diagram: Medical Practice
![Page 29: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/29.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Fishbone Diagram: Patients
![Page 30: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/30.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Fishbone Diagram: Staff
![Page 31: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/31.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Driver Diagram
![Page 32: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/32.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Interventions Considered
• Opportunistic Approach
• Proactive Approach
• Patient Engagement Approach
![Page 33: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/33.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Opportunistic Approach
Every time a patient with diabetes comes for a clinic visit, review their quality measures and take action
![Page 34: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/34.jpg)
Process Flow Chart
![Page 35: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/35.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
![Page 36: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/36.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Proactive Approach
“Run the list” of diabetic patients and pro-actively contact them about missing items.
![Page 37: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/37.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Run the List: By Patient
![Page 38: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/38.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Run the List: By Category
![Page 39: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/39.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
A Train Wreck…
![Page 40: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/40.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
A Train Wreck…
![Page 41: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/41.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Correcting Primary Provider
![Page 42: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/42.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Patient Engagement Approach
Educate the patients about the types of services they should be receiving.
![Page 43: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/43.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Patient Letter
![Page 44: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/44.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Patient Letter
![Page 45: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/45.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Patient Letter
![Page 46: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/46.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Automated emails w/ graph
![Page 47: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/47.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
Outcomes!
![Page 48: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/48.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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
![Page 49: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/49.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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
![Page 50: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/50.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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
![Page 51: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/51.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine
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]
![Page 52: It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement](https://reader035.fdocuments.us/reader035/viewer/2022081603/56815ccb550346895dcad80a/html5/thumbnails/52.jpg)
UNIVERSITY OF MISSOURIFamily & Community Medicine