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Continuous Quality Continuous Quality Improvement in Improvement in Diabetes CareDiabetes Care
Julie Day, MD – Medical Director for QualityJulie Day, MD – Medical Director for QualityAnnie Mervis, MSW – Quality ManagerAnnie Mervis, MSW – Quality Manager
University of Utah Health Care: Community ClinicsUniversity of Utah Health Care: Community Clinics
Diabetes Telehealth SeriesDiabetes Telehealth SeriesOctober 15, 2008October 15, 2008
UUHC Community ClinicsUUHC Community Clinics
►10 clinics10 clinics►70 primary care providers70 primary care providers►25 specialists25 specialists►550 support staff550 support staff►215,000 primary care visits (annually)215,000 primary care visits (annually)►110,000 active patients (18 months)110,000 active patients (18 months)►4500–5000 patient with diabetes 4500–5000 patient with diabetes
(annually) (annually)
Presentation ObjectivesPresentation ObjectivesAt the end of this presentation, participants At the end of this presentation, participants
will have an understanding of will have an understanding of ► Continuous quality improvement tools and Continuous quality improvement tools and
processes and how these were applied to processes and how these were applied to improve diabetes careimprove diabetes care
► the importance of data in evaluating the importance of data in evaluating effectiveness of interventionseffectiveness of interventions
► the need to continue through multiple cycles of the need to continue through multiple cycles of the Plan, Do, Study, Act cycle of improvementthe Plan, Do, Study, Act cycle of improvement
Presentation OverviewPresentation Overview►Key QI concepts and differencesKey QI concepts and differences►Review of FOCUS-PDSA cycleReview of FOCUS-PDSA cycle►Case study demonstrating how we Case study demonstrating how we
applied the process and toolsapplied the process and tools►Results Results ►What we learnedWhat we learned►Our next stepsOur next steps
Key QI ConceptsKey QI Concepts► Improving work processesImproving work processes► Quality is everyone’s jobQuality is everyone’s job► Teams and teamwork are criticalTeams and teamwork are critical► People doing the job know best how to improve itPeople doing the job know best how to improve it► QI uses a systematic approach to analyze QI uses a systematic approach to analyze
opportunities and design changes to drive opportunities and design changes to drive improvementimprovement
► Meeting and exceeding customer expectationsMeeting and exceeding customer expectations
New Mexico IN-FOCUS Teleconference Series, The Nuts and Bolts of QI, New Mexico Medical Review Association
Differences between QA and Differences between QA and QIQIQuality Quality
AssuranceAssuranceQuality Quality
ImprovementImprovementFocusFocus Catch “bad apples”Catch “bad apples”
Detect serious Detect serious problemsproblemsInspect and repairInspect and repair
Improve processes and Improve processes and outcomesoutcomesPrevent and resolvePrevent and resolve
MotivatioMotivationn
RegulationRegulationAccreditationAccreditation
ExcellenceExcellenceCompetitivenessCompetitiveness
GoalGoal Meet minimal Meet minimal standardsstandards
Ongoing process Ongoing process improvementimprovement
ScopeScope Departmental Departmental Within functionsWithin functions
Organization-wideOrganization-wideAcross functionsAcross functions
WhenWhen PeriodicallyPeriodically Continuous, ongoingContinuous, ongoingNew Mexico IN-FOCUS Teleconference Series, The Nuts and Bolts of QI, New Mexico Medical Review Association
FOCUS-PDSAFOCUS-PDSA► FFocus – Find an opportunity to improveocus – Find an opportunity to improve► OOrganize a teamrganize a team► CClarify understanding of process needing larify understanding of process needing
improvementimprovement► UUnderstand variation, root causes, and barriersnderstand variation, root causes, and barriers► SSelect an opportunity and strategyelect an opportunity and strategy► PPlan interventionlan intervention► DDo interventiono intervention► SStudy the resultstudy the results► AAct to hold the gains or continue to improve onct to hold the gains or continue to improve on
FFind an opportunityind an opportunityFFOCUS-PDSAOCUS-PDSA
Why?Why?►National priority from 2003 Institute of National priority from 2003 Institute of
Medicine ReportMedicine Report►UUHC priority set by Board of DirectorsUUHC priority set by Board of Directors► Impact on patient quality of life Impact on patient quality of life
(misery index)(misery index)►Ability to successfully intervene in an Ability to successfully intervene in an
outpatient settingoutpatient setting
OOrganize a teamrganize a teamFFOOCUS-PDSACUS-PDSA
The Diabetes Quality GroupThe Diabetes Quality Group► Includes:Includes:
3 Patients3 Patients 7 Providers7 Providers 3 Health Educators3 Health Educators 2 HealthInsight staff2 HealthInsight staff 1 Epic and 1 Data 1 Epic and 1 Data
Support staffSupport staff 2 Support staff2 Support staff 1 Health Plan staff1 Health Plan staff
Aim StatementAim Statement►Over the next 12 months we will Over the next 12 months we will
improve care by:improve care by: Identifying our diabetic populationIdentifying our diabetic population Establishing targets for selected diabetic Establishing targets for selected diabetic
parametersparameters Devising appropriate interventions to Devising appropriate interventions to
enable us to meet our improvement goals enable us to meet our improvement goals for our diabetic populationfor our diabetic population
CClarify understanding larify understanding of the processof the process
FOFOCCUS-PDSAUS-PDSA
Baseline Data and Goals for Baseline Data and Goals for ImprovementImprovement
Measure*Measure* Baseline (1/04)Baseline (1/04) Initial GoalInitial Goal
HgbA1c ordered 2x annually HgbA1c ordered 2x annually 71% 85% 71% 85%HgbA1c <7% HgbA1c <7% 47% 62% 47% 62%LDL <100LDL <100 43% 43% 60% 60%BP <130/80BP <130/80 28% 28% 45% 45%Microalbumin ordered annuallyMicroalbumin ordered annually 54% 54% 63% 63%
*ADA, UHC*ADA, UHC
Process Flow DiagramProcess Flow DiagramPatient accesses
care
Provider takes current history and
reviews labs
Change meds
Order new prescription
Order refill
Labs needed?
Eye exam needed?
SelfManagement
education needed?
Provider conducts physical exam.
Podiatry needed?
Provider reviews follow up
instructions with patient
Provider prints Aftervisit
Summary for patient
Order labs
Order exam
Order self management
referral
Order podiatry referral
Patient completes visit
Yes
No
Yes
No
Yes
Yes
Yes
No
No
No
No
Process Analysis – Key Process Analysis – Key QuestionsQuestions
►Are patients coming in regularly?Are patients coming in regularly?►Are providers ordering needed tests Are providers ordering needed tests
according to guidelines?according to guidelines?►Are patients following through with Are patients following through with
provider recommendations and taking provider recommendations and taking ownership of self-management?ownership of self-management?
►Are A1c, LDL and BP where patient Are A1c, LDL and BP where patient and provider would like them to be?and provider would like them to be?
UUnderstand variation, nderstand variation, root causes, and root causes, and
barriersbarriersFOCFOCUUS-PDSAS-PDSA
Cause and Effect DiagramCause and Effect Diagram
SSelect an opportunity elect an opportunity and strategyand strategy
FOCUFOCUSS-PDSA-PDSA
BarriersBarriers►Patient: ownership and self-Patient: ownership and self-
managementmanagement►Providers: competing prioritiesProviders: competing priorities►Process: variation between clinicsProcess: variation between clinics►Environment: obesity increasingEnvironment: obesity increasing►Systems: not maximizing EMR Systems: not maximizing EMR
capabilitiescapabilities
PPlan an intervention lan an intervention and and DDo ito itFOCUS-FOCUS-PDPDSASA
InterventionsInterventions►Provider CME – Feb 04Provider CME – Feb 04►EMR-based tools to support providers EMR-based tools to support providers
in the exam room – Feb 04in the exam room – Feb 04►Patient Awareness Materials – Feb 04Patient Awareness Materials – Feb 04►Monthly measurement and feedback to Monthly measurement and feedback to
providers – Feb 04providers – Feb 04►Registries – May 04Registries – May 04►Outreach letters to patients – May 04Outreach letters to patients – May 04
Diabetes Registry PCP: John Smith, MD RWC
Patient with Diabetes Diagnosis Seen from 01/01/03 As of 03/25/05 Patient Name MRN Home Birth Sex Last Last Visit BP Last A1c Last Last LDL Last Last Alb- Last Phone Date Visit Provider A1c Value A1c LDL Value LDL Micro Creat Micro Order Order Order Order Albumin Ratio Albumin Date Date Date Date Order Value Order Resulted Resulted Date Date Resulted PATIENT A XXXXX 123-4567 00/00/00 M 12/7/2004 SMITH, JOHN 140/80 12/2/2004 6.5 12/2/2004 12/2/2004 82 12/2/2004 12/2/2004 <30 12/2/2004 PATIENT B XXXXX 123-4567 00/00/00 F 10/21/2004 SMITH, JOHN 126/72 10/21/2004 8.3 10/21/2004 7/9/2004 100 7/9/2004 PATIENT C XXXXX 123-4567 00/00/00 M 1/13/2005 DOE, JANE 120/64 1/13/2005 6.4 1/13/2005 1/13/2005 142 1/13/2005 PATIENT D XXXXX 123-4567 00/00/00 F 9/10/2003 DOE, JANE 118/90 9/16/2003 0 9/16/2003 9/16/2003 136 9/16/2003 PATIENT E XXXXX 123-4567 00/00/00 M 1/31/2005 SMITH, JOHN 144/72 1/31/2005 9.6 1/31/2005 9/18/2004 155 9/18/2004 3/9/2002 >300 11/9/2003 PATIENT F XXXXX 123-4567 00/00/00 F 4/28/2004 SMITH, JOHN /
PATIENT G XXXXX 123-4567 00/00/00 M 12/28/2004 SMITH, JOHN 162/64 11/2/2004 12.5 11/2/2004 11/12/2002 11/12/2002 <30 11/12/2002 PATIENT H XXXXX 123-4567 00/00/00 F 1/27/2005 SMITH, JOHN 110/72 5/28/2040 9.7 1/27/2005 8/20/2004 254 1/27/2005 PATIENT I XXXXX 123-4567 00/00/00 M 11/19/2004 SMITH, JOHN 110/70 11/19/2004 7.2 11/19/2004 11/19/2004 110 11/19/2004 7/10/2002 <30 7/10/2002 PATIENT J XXXXX 123-4567 00/00/00 F 3/2/2005 SMITH, JOHN 116/68 3/5/2005 6.9 3/5/2005 3/5/2005 119 3/5/2005 3/5/2005 <30 3/5/2005
PATIENT K XXXXX 123-4567 00/00/00 M 1/14/2005 JONES, DAVID 118/78 3/22/2004 7.3 1/18/2005 3/22/2004 133 1/18/2005 12/2/2003 <30 12/2/2003 PATIENT L XXXXX 123-4567 00/00/00 F 5/26/2004 SMITH, JOHN 114/84 6/19/2003 0 6/19/2003 6/19/2003 154 6/19/2003 PATIENT M XXXXX 123-4567 00/00/00 M 3/18/2005 SMITH, JOHN 156/80 2/15/2005 13.4 2/15/2005 8/15/2001 88 8/15/2001 8/15/2001 30-300 8/15/2001 PATIENT N XXXXX 123-4567 00/00/00 F 3/11/2004 SMITH, JOHN 160/82 3/11/2004 9.6 3/11/2004 PATIENT O XXXXX 123-4567 00/00/00 M 4/24/2003 JONES, DAVID 130/64 4/24/2003 0 4/24/2003 PATIENT P XXXXX 123-4567 00/00/00 F 12/22/2004 SMITH, JOHN 134/72 12/28/2004 6.4 12/28/2004 12/28/2004 116 12/28/2004 5/5/2004 <30 5/5/2004 PATIENT Q XXXXX 123-4567 00/00/00 M 2/16/2005 SMITH, JOHN 130/80 3/9/2005 7.9 3/9/2005 3/9/2005 74 3/9/2005
PATIENT R XXXXX 123-4567 00/00/00 F 3/24/2005 JONES, DAVID 134/72 3/2/2004 7.4 3/24/2005 3/2/2004 101 3/24/2005 11/10/2003 <30 11/10/2003 PATIENT S XXXXX 123-4567 00/00/00 M 3/25/2004 SMITH, JOHN 144/72 5/8/2003 0 5/8/2003 3/25/2004 5/8/2003 30TP300 5/8/2003
PATIENT T XXXXX 123-4567 00/00/00 F 4/25/2003 SMITH, JOHN 139/88 11/27/2000 0 4/25/2003 4/25/2003
RegistryRegistry
Blood Sugar Control ChartBlood Sugar Control ChartName: ____________________________ Month: _______________________
BLOOD SUGAR BLOOD SUGAR
DAY OF MONTH
Diabetes Chart
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
20
405060
7080
90
100110120130
140150
160170180
190200210220
230240250
270
290300
260
280
3020
40
5060
7080
90100110120130
140150
160170180
190200210
230240250
270
290300
260
280
30
220
Feedback Reports at Clinic Feedback Reports at Clinic LevelLevel
Perce
nt O
rdered
Comparison of Clinics for A1c Ordered At Least TwiceMulti-Line - individuals
GreenwoodRedwoodSo# JordanStansburySummitWestridge
60
70
80
90
100
target = 85%
Per
cent
Ord
ered
A1c Ordered At Least Twice _ All Clinics25701830
71.21
25661811
70.58
25991829
70.37
26271858
70.73
26081861
71.36
26211876
71.58
25971916
73.78
26271943
73.96
26481950
73.64
26561975
74.36
26492005
75.69
26662023
75.88
27012081
77.05
27092062
76.12
27252086
76.55
27012039
75.49
27192039
74.99
Total PatientsA1C Ordered >= 2
Percentp chart
60
65
70
75
80
85
90
95
100
UCL = 76.33
Mean = 73.76
LCL = 71.19
Target = 85%
SStudy the resultstudy the resultsFOCUS-PDFOCUS-PDSSAA
Process ResultsProcess ResultsP
erce
nt O
rder
ed
LDL Ordered At Least Once _ All Clinics25701908
74.24
25661896
73.89
25991929
74.22
26271952
74.31
26081949
74.73
26211979
75.51
25972014
77.55
26272046
77.88
26482070
78.17
26562094
78.84
26492148
81.09
26662175
81.58
27012227
82.45
27092227
82.21
27252250
82.57
Total Patients
LDL ordered >= 1Percent
p chart
60
65
70
75
80
85
90
95
100
UCL = 80.42
Mean = 78.00
LCL = 75.58Target = 75%
1-Provider & Patient Education
2-Registries & Outreach
Outcome ResultsOutcome ResultsP
erce
nt <
100
LDL V alues Below 100 _ All Clinics1674
72343.19
1670716
42.87
1707742
43.47
1726760
44.03
1716781
45.51
1738799
45.97
1769839
47.43
1804883
48.95
1822922
50.60
1833939
51.23
1861988
53.09
1890996
52.70
19281026
53.22
19341058
54.71
19601095
55.87
LDL Resulted >= 1
<100Percent
p chart
40
45
50
55
60
65
70
UCL = 52.61
Mean = 49.08
LCL = 45.55
Target = 60%
1-Provider & Patient Education2-Registries & Outreach
Results – PDSA Cycle 1Results – PDSA Cycle 1MeasureMeasure Jan 04Jan 04 * * May May
0505**GoalGoal
HgbA1c ordered 2x HgbA1c ordered 2x annuallyannually
71%71% 75%75% 85%85%
LDL ordered annuallyLDL ordered annually 74%74% 81%81% --Microalbumin ordered Microalbumin ordered annuallyannually
54%54% 63%63% 63%63%
HgbA1c <7%HgbA1c <7% 47%47% 49%49% 62%62%LDL <100LDL <100 43%43% 56%56% 60%60%BP <130/80BP <130/80 28%28% 34%34% 45%45%
* Patients with at least 2 diabetes visits in 12 months* Patients with at least 2 diabetes visits in 12 months
AAct to hold gains or ct to hold gains or continue to improvecontinue to improve
FOCUS-PDSFOCUS-PDSAA
Next StepsNext Steps
► Identify additional barriers that may be Identify additional barriers that may be affecting improvementaffecting improvement
►Develop new interventions to address Develop new interventions to address identified barriersidentified barriers
►Expand population to include patients Expand population to include patients not see as regularlynot see as regularly
►Ongoing efforts sustain registry workOngoing efforts sustain registry work
PPlan lan PDSA Cycle 2PDSA Cycle 2
Project Overview – PDSA Project Overview – PDSA Cycle 2Cycle 2
► Initiated July 2005Initiated July 2005► System-wide approach and interventionsSystem-wide approach and interventions► Target population - patients with diabetes Target population - patients with diabetes
being seen less regularlybeing seen less regularly 1 diabetes visit in 12 months1 diabetes visit in 12 months
► 3,800 – 4,300 patients annually3,800 – 4,300 patients annually► Support for registry managementSupport for registry management► Patient self-efficacy and self-managementPatient self-efficacy and self-management
Baseline – PDSA Cycle 2Baseline – PDSA Cycle 2MeasureMeasure Jan 06 Baseline Jan 06 Baseline
**HgbA1c ordered 2x annuallyHgbA1c ordered 2x annually 31%31%LDL ordered annuallyLDL ordered annually 64%64%Microalbumin ordered Microalbumin ordered annuallyannually
50%50%
HgbA1c <7%HgbA1c <7% 34%34%LDL <100LDL <100 33%33%BP <130/80**BP <130/80** 55%55%* Patients with 1 diabetes visit in 12 months.** Definition of BP measure changed from compliance 2 out of last 3 BPs to compliance at most recent BP reading
Barriers – PDSA Cycle 2Barriers – PDSA Cycle 2►RegistriesRegistries
Inaccurate or out-dated PCPsInaccurate or out-dated PCPs►Patients followed elsewhere for Patients followed elsewhere for
diabetes carediabetes care►Time and support for registry Time and support for registry
managementmanagement►Barriers to enhanced self-management Barriers to enhanced self-management
skillsskills►Limited exam room time and time for Limited exam room time and time for
visit planningvisit planning
DDooPDSA Cycle 2PDSA Cycle 2
Interventions – PDSA Cycle 2Interventions – PDSA Cycle 2►Provider Training – Jul 05Provider Training – Jul 05►On-site Diabetes Education Courses – Nov On-site Diabetes Education Courses – Nov
0505►Centralized Support for Registry Centralized Support for Registry
Management – Feb 06Management – Feb 06 Provider feedback and flag on registry for Provider feedback and flag on registry for
patients followed elsewherepatients followed elsewhere►PCP Assignment – MA workflow – Feb 06PCP Assignment – MA workflow – Feb 06►Shared Medical Appointments – Feb 06Shared Medical Appointments – Feb 06►Screening for Depression (PHQ9) – Apr 06 Screening for Depression (PHQ9) – Apr 06
Interventions – PDSA Cycle 2Interventions – PDSA Cycle 2► Practice Redesign “Care by Design” - ongoingPractice Redesign “Care by Design” - ongoing► Templates and workflows for Pre-Visit and Templates and workflows for Pre-Visit and
Visit Planning (acute and chronic) – Oct 06Visit Planning (acute and chronic) – Oct 06► Patient Activation through mutual goal Patient Activation through mutual goal
setting and motivational interviewing - Oct 06setting and motivational interviewing - Oct 06 System-wide Staff Development InstituteSystem-wide Staff Development Institute Templates for goal settingTemplates for goal setting Patient education information imbedded in EMRPatient education information imbedded in EMR
► ““Pay for Performance” incentive plan to work Pay for Performance” incentive plan to work registries - Jan 07registries - Jan 07
SStudytudyPDSA Cycle 2PDSA Cycle 2
Results – PDSA Cycle 2Results – PDSA Cycle 2
Patients with at least 1 diabetes visit in 12 months, BP Measure changed to reflect most recent BP, instead Patients with at least 1 diabetes visit in 12 months, BP Measure changed to reflect most recent BP, instead of 2 of last 3of 2 of last 3
Results – PDSA Cycle 2Results – PDSA Cycle 2Diabetes Bundle
Feb 2007
0%10%20%30%
40%50%60%70%
Labs Ordered* Labs Resulted* Clinical Values inCompliance**
Care Team Model
Traditional Model
*A1c, LDL, Microalbumin**A1c<7, LDL<100, BP<130/80
Lessons LearnedLessons Learned► Provider and MA commitment to Shared Provider and MA commitment to Shared
Medical Appointments is critical to ongoing Medical Appointments is critical to ongoing successsuccess
► Registries and visit planning should be part of Registries and visit planning should be part of care process, not an add-onscare process, not an add-ons Incentive provides initial boost, but hard to sustainIncentive provides initial boost, but hard to sustain
► Implementation of new tools and processes Implementation of new tools and processes requires consistent (and constant) support and requires consistent (and constant) support and feedback feedback Need regular on-site supportNeed regular on-site support More timely and meaningful feedback reportsMore timely and meaningful feedback reports
Lessons LearnedLessons Learned►Hard to compare our performance to Hard to compare our performance to
others when everyone uses different others when everyone uses different measurement definitions measurement definitions
►Practice redesign (Care by Design) Practice redesign (Care by Design) appears to support expanded care appears to support expanded care processes better than traditional modelprocesses better than traditional model
►Need to begin addressing need for Need to begin addressing need for cross-condition care, rather than cross-condition care, rather than condition-specific siloscondition-specific silos
AActctPDSA Cycle 2PDSA Cycle 2
Next StepsNext Steps►Sustain the work started by centralized Sustain the work started by centralized
registry support and clinic incentivesregistry support and clinic incentives►Address time and competing prioritiesAddress time and competing priorities►Maintain accurate PCPsMaintain accurate PCPs►Continue expansion of SMAsContinue expansion of SMAs►Consistently implement “Care by Consistently implement “Care by
Design” with visit planning processes Design” with visit planning processes and tools delivered by Care Teams in and tools delivered by Care Teams in all 10 clinicsall 10 clinics
PPlanlanPDSA Cycle 3PDSA Cycle 3
Project Overview – PDSA Project Overview – PDSA Cycle 3Cycle 3
► Began participating in CMS Care Management Began participating in CMS Care Management Demonstration Project (P4P) in July 07Demonstration Project (P4P) in July 07 DM, CAD, HF, and Preventive Care DM, CAD, HF, and Preventive Care
► Project provided standardized definitions for Project provided standardized definitions for 26 measures26 measures We revised our quality reports to be consistentWe revised our quality reports to be consistent
► Provided visibility and priority status for Provided visibility and priority status for system-wide quality improvement and system-wide quality improvement and resource allocationresource allocation
► Initiated assessment of implementation status Initiated assessment of implementation status of Care by Designof Care by Design
► Obtained resources to support SMAs and Obtained resources to support SMAs and patient self-managementpatient self-management
Baseline – PDSA Cycle 3Baseline – PDSA Cycle 3MeasureMeasure Feb 08 Baseline*Feb 08 Baseline*Diabetes IndexDiabetes Index 43%43%Coronary Artery Disease Coronary Artery Disease IndexIndex
71%71%
Heart Failure IndexHeart Failure Index --Preventive Care IndexPreventive Care Index 54%54%
* Industry standard definitions by NCQA, CMS, AMA
Barriers – PDSA Cycle 3Barriers – PDSA Cycle 3►RegistriesRegistries
Quarterly paper registries cumbersome and not Quarterly paper registries cumbersome and not timelytimely
Diabetes only - contributing to silos rather than Diabetes only - contributing to silos rather than integrated careintegrated care
Registry work not a priority for clinic staffRegistry work not a priority for clinic staff►Hard to keep track of everything needing Hard to keep track of everything needing
to be done for each patient at the time of to be done for each patient at the time of visitvisit
►Practice Redesign not fully implemented Practice Redesign not fully implemented in every clinicin every clinic Visit planning tools and goal setting not being Visit planning tools and goal setting not being
consistently utilizedconsistently utilized No formalized process to assess implementation of No formalized process to assess implementation of
Care by DesignCare by Design
Barriers – PDSA Cycle 3Barriers – PDSA Cycle 3►Limited support for patient self-Limited support for patient self-
efficacy and self-management efficacy and self-management training training
►Performance feedback not Performance feedback not provider specificprovider specific
►PCPs out-dated (again)PCPs out-dated (again)
DDooPDSA Cycle 3PDSA Cycle 3
Interventions – PDSA Cycle 3Interventions – PDSA Cycle 3► Expanded Best Practice Alerts in EMR to Expanded Best Practice Alerts in EMR to
support 26 key aspects of care – Jan 08support 26 key aspects of care – Jan 08► Evaluation of level of implementation of Care Evaluation of level of implementation of Care
by Design – May 08by Design – May 08► On-line clinic and provider feedback reports – On-line clinic and provider feedback reports –
Aug 08Aug 08► Hired Practice Enhancement Coordinator – Hired Practice Enhancement Coordinator –
Sep 08Sep 08 Oversight of registries and visit planning processes and toolsOversight of registries and visit planning processes and tools Patient self-management trainingsPatient self-management trainings Shared Medical AppointmentsShared Medical Appointments
► On-line, multi-condition registry integrated at On-line, multi-condition registry integrated at patient level – Oct 08patient level – Oct 08
► Un-blinded provider detail reports – Nov 08Un-blinded provider detail reports – Nov 08
SStudytudyPDSA Cycle 3PDSA Cycle 3
Measurement – PDSA Cycle 3Measurement – PDSA Cycle 3► In progress nowIn progress now
CBD Implementation Status assessmentCBD Implementation Status assessment Team SurveyTeam Survey Measurement of Q indicators (new Measurement of Q indicators (new
reports)reports)
SummarySummary►Challenges:Challenges:
Using EMR data in new ways than beforeUsing EMR data in new ways than before Changing measure definitionsChanging measure definitions Limited programming support slowed Limited programming support slowed
progress on reports and registriesprogress on reports and registries Resources for vision and planning, but Resources for vision and planning, but
limited for implementation support across limited for implementation support across systemsystem
SummarySummary►SuccessesSuccesses
Increased provider and staff awareness of Increased provider and staff awareness of quality improvement effortsquality improvement efforts
Some incremental improvement over time Some incremental improvement over time in traditional modelin traditional model
Preliminary data suggests Care by Design, Preliminary data suggests Care by Design, when fully implemented, supports better when fully implemented, supports better care and outcomescare and outcomes
Preparation for the future if payors move Preparation for the future if payors move to models of pay for performance to models of pay for performance
Questions?Questions?►Contact InformationContact Information
Julie Day, MD, Medical Director for QualityJulie Day, MD, Medical Director for QualityUniversity of Utah Health Care: Community ClinicsUniversity of Utah Health Care: Community [email protected]@hsc.utah.edu(801) 587-6307(801) 587-6307
Annie Mervis, MSW, Quality ManagerAnnie Mervis, MSW, Quality ManagerUniversity of Utah Health Care: Community ClinicsUniversity of Utah Health Care: Community [email protected]@hsc.utah.edu(801) 587-6327(801) 587-6327
