Quality Peer Group UDS Best Practices and Data Sharing 9/9/16. ohiochc.org

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1 1 Quality Peer Group UDS Best Practices and Data Sharing 9/9/16 ohiochc.org

2 Presenters 2 Ashley Ballard Director of Clinical Quality Tiffany Blair Quality Improvement Coordinator Dr. Wymyslo Chief Medical Officer ohiochc.org

3 Data Sharing Survey ohiochc.org

4 SURVEY SAYS 4 18 respondents for Data Sharing Survey 61% would like to share UDS data Quarterly 44% would like to share Patient Satisfaction data Annually 66% would like to share No Show Rates Quarterly 50% would like to share Incident Reports Quarterly ohiochc.org

5 5 No Shows Definition Percentage of appointments for which patients did not show Total number of no-show appointments divided by the total number of appointment slots. Multiply the result by 100. On the last day of the month, count the total number of appointment slots (denominator). Then count the number of noshow appointments (numerator). Organizational level, or site level data ohiochc.org

6 No Show Reporting 6 Preliminary report to start and let s learn together! Submit first report by October 15, 2016 (July September 2016 data) No Show appointments will be divided by: Total (all appointment types) Preventative Visit (Well Child / Adult annual physical) Sick Visit / Acute Care Visit Follow up / Recheck ohiochc.org

7 2015 UDS Best Practices ohiochc.org

8 2015 UDS Best Practices Health Centers by Patient Volume 8 Small : 7,000 patients or less per year Medium : 7,001 to 17,000 patients per year Large : 17,001 patients or more per year ohiochc.org

9 Trimester of Entry into Prenatal Care 9 Statewide 67.6% 7,000 pts or less 7,001 to 17,000 pts 17,001 and more

10 Trimester of Entry into Prenatal Care, cont. 10 At pregnancy test visit, prenatal care is initiated Presumptive eligibility for early Medicaid Increased community awareness of prenatal care through networking and community organization participation Patients calling to schedule an appointment for a pregnancy test are ensured an appointment within 1 week OB visit is minutes in length Risk assessment and assessment of barriers to care is completed First Trimester education is provided GYN/OB history is obtained and reviewed Prenatal vitamins are prescribed OB diagnostics are ordered based upon gestational age

11 Childhood Immunizations 11 Statewide 77% 7,000 pts or less 7,001 to 17,000 pts 17,001 pts or more

12 Childhood Immunizations, cont. 12 Templates for the rooming process are built in EPIC, creating a standard checklist. Within the template is the immunization checklist which is reviewed at every visit, both ill and well Reminder calls and letters are sent when a well visit is missed that would have required immunizations Receive and follow up on IMPACT reports Provide immunization-only appointments Immunization status of patient is reviewed as part of daily huddles and at every patient visit Educate parents on immunization importance Provide a copy of shot record for pediatric patients at every visit

13 Cervical Cancer Screening 13 Statewide 45.4% 7,000 pts or less 7,001 to 17,000 pts 17,001 pts or more

14 Cervical Cancer Screening, cont. 14 Appointment Related: Daily follow up calls to patients who no show If scheduled for a PAP have patient undresses before provider goes in Hold a PAP clinic weekly with a CNM Medical assistants send out reminder post cards to patients in collaboration with American Cancer Society (Template received ACS and can be cobranded) Nurses outreach via phone for patients in need of PAP, discuss with patient, then pass on for scheduling of appointment Use PAP code diagnosis /preference list to order PAP smear Adopt and follow ACOG guidelines- Pap every 3 years for year olds pap every 5 years Pre visit planning for those who need PAP Quality Compliance and Credentialing Officer runs an overdue PAP list to management at each site

15 Colorectal Cancer Screening 15 Statewide 37.4% 7,000 pts or less 7,001 to 17,000 pts 17,001 pts or more

16 Colorectal, cont. 16 Colorectal Screening component added to annual FLU clinic Patients 50 & older were asked about last Colonoscopy Non-Compliant patients were asked to schedule Patients who refused a) Medicare patients offered Cologaurd b) commercial insurance offered a FIT This year incorporate breast/cervical/colorectal with FLU clinic Population health management is conducted through non-compliance reports and routine measuring. Monitoring a large metric base. MA/Nurse checks for compliance during appt. intake. If due places order for FIT test. The population health team runs monthly report to see who has not sent in their kit and calls those patients

17 Child Weight Assessment & Counseling 17 Statewide 55.3% 7,000 pts or less 7,001 to 17,000 pts 17,001 pts or more

18 Child Weight, cont. 18 All patients under 18 years are measured and weighed with a BMI calculation done by our EMR. A template in the note and visit summary has educational info about healthy living, diet, exercise and limiting screen time If the calculated BMI is out of range, then nurse adds the appropriate ICD10 detailing the obesity status and BMI Height and Weight is taken at every visit, if BMI is out of range provider is alerted via EMR BMI out of range is highlighted in RED in EMR Documented in History of Present Illness. Provider assigns diagnoses and creates follow up plan The provider will then give the patient a diagnosis and a follow up plan. The patient will be asked to return specifically to address BMI. Random monthly chart audits to ensure that our goals are being met. Ounce of Prevention material is used at every visit to educate about proper nutrition physical activity

19 Adult Weight Screening & Follow up 19 Statewide 54.2% 7,000 pts or less 7,001 to 17,000 pts 17,001 pts or more

20 Adult Weight Cont. 20 Height and weight is obtained on every patient at every visit BMI out of range is highlighted in RED in EMR Documented in HPI (History of Present Illness). Provider assigns diagnoses and creates follow up plan Clinical asst. educates patient with ChooseMyPlate.gov

21 Depression Screening 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 21 LIFECARE FAMILY HEALTH & DENTAL ASIANS IN ACTION FAIRFIELD COMMUNITY HEALTH CENTER COMMUNITY MENTAL HEALTH INC WOOD COUNTY COMMUNITY HEALTH SOUTHEAST, INC CENTERPOINT HEALTH CENTER STREET COMMUNITY HEALTH FAMILY HEALTH OF ERIE COUNTY FREE MEDICAL CLINIC OF GREATER FAMILY HEALTH CARE OF NORTHWEST COMPASS COMMUNITY HEALTH COMMUNITY HEALTH & WELLNESS HEART OF OHIO FAMILY HEALTH CENTERS ERIE COUNTY COMMUNITY HEALTH CINCINNATI HEALTH NETWORK LOWER LIGHTS CHRISTIAN HEALTH WINTON HILLS MEDICAL & HEALTH CENTER ROCKING HORSE CENTER LORAIN COUNTY HEALTH & DENISTRY COMMUNITY HEALTH SERVICES (FREMONT) CROSSROADS HEALTH CENTER NEIGHBORHOOD HEALTH ASSOCIATION CAO FAMILY MEDICAL CENTERS OHIO HILLS HEALTH SERVICES CAA OF COLUMBIANA COUNTY COMMUNITY HEALTH CENTERS OF VALLEY VIEW (CAC OF PIKE COUNTY) CARE ALLIANCE THIRD STREET FAMILY HEALTH SERVICES TOLEDO-LUCAS COUNTY HEALTH CENTER AXESSPOINTE COMMUNITY HEALTH THE HEALTHCARE CONNECTION ONE HEALTH OHIO NEIGHBORHOOD FAMILY PRACTICE MUSKINGUM VALLEY HEALTH CENTERS HEALTH PARTNERS OF WESTERN OHIO HOPEWELL HEALTH CENTERS NORTHEAST OHIO NEIGHBORHOOD CITY OF CINCINNATI PRIMARY CARE FIVE RIVERS HEALTH CENTERS FAMILY HEALTH SERVICES OF DARKE PRIMARY HEALTH SOLUTIONS (BUTLER CO) PRIMARYONE HEALTH HEALTHSOURCE OF OHIO Derpession Screening and Follow Up ,000 pts or less 7,001 to 17,000 pts 17,001 pts or more Statewide 52.2%

22 Depression Screening 22 Nurse/MA complete annual SBIRT. If PHQ-2 is positive then PHQ-9 is completed Score evaluated by Nurse/MA Below 10 = evaluation = brief intervention Above 15 = behaviorist or PCP will assess, treat, refer Everything documented in the SBIRT template in EHR and previous scores show up on huddle report at next visit. Alerts team to review.

23 Tobacco Use Screening & Cessation Intervention 23 Statewide 81.2% 7,000 pts or less 7,001 to 17,000 pts 17,001 pts or more

24 Tobacco cont. 24 The EHR template is customizable to allow for tobacco use screening to be done by anyone (MA, LPN, social worker, pharmacist, PCP, dental providers, behavioral health provider, etc.) Tobacco Cessation counseling is completed by a variety of disciplines (PCP, behavioral health provider, pharmacist, etc.) QI indicators for all UDS measures are shared with staff and board members on a quarterly basis Recently been changed to monthly reports for preventive measures, including tobacco use screening and cessation Every Patient over 18 is asked about Tobacco use. A modified version of the 5A s is used. Our providers offer pharmaceutical assistance for smoking cessation or we refer our patients to a National Hotline Investigating more training including Certified Tobacco Cessation Training, and for Wellness Coordinator Conduct random monthly chart audits to ensure goals are met

25 Hypertension Patients with controlled blood pressure 25 Statewide 65.9% 7,000 pts or less 7,001 to 17,000 pts 17,001 pts or more

26 Hypertension, cont. 26 When a patient's blood pressure is high, we then have the patient relax for 10 minutes, then retake. Onsite pharmacies have pharmacy residents who act as Health Educators and meet with patients to discuss diet, medications, etc. We have been referring difficult hypertensive cases to our Home Health Department so that nurses can go to the home and work with the patient directly

27 Diabetic Patients with Controlled HbA1c <8% 27 Statewide 59.2% 7,000 pts or less 7,001 to 17,000 pts 17,001 pts or more

28 Diabetic Patients with Controlled HbA1c > 9% 28 Statewide 28.3% 7,000 pts or less 7,001 to 17,000 pts 17,001 pts or more

29 Diabetes, cont. 29 Purchased Point of Care testing equipment for HbA1C Implementation of pre-visit planning to identify need for testing or intervention at the time of the visit Onsite pharmacies have pharmacy residents who act as Health Educators and meet with patients to discuss diet, medications, etc.

30 Birthweights, cont. 30

31 Asthma 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Asthma Treatment Plan ASIANS IN ACTION CENTERPOINT HEALTH ERIE COUNTY COMMUNITY HEALTH CENTER WOOD COUNTY COMMUNITY HEALTH AND LIFECARE FAMILY HEALTH & DENTAL CENTERS FAIRFIELD COMMUNITY HEALTH CENTER FREE MEDICAL CLINIC OF GREATER CLEVELAND CENTER STREET COMMUNITY HEALTH CENTER FAMILY HEALTH CARE OF NORTHWEST OHIO COMPASS COMMUNITY HEALTH SOUTHEAST, INC COMMUNITY HEALTH & WELLNESS PARTNERS HEART OF OHIO FAMILY HEALTH CENTERS FAMILY HEALTH OF ERIE COUNTY COMMUNITY MENTAL HEALTH INC LOWER LIGHTS CHRISTIAN HEALTH CENTER LORAIN COUNTY HEALTH & DENISTRY CROSSROADS HEALTH CENTER WINTON HILLS MEDICAL & HEALTH CENTER NEIGHBORHOOD HEALTH ASSOCIATION CINCINNATI HEALTH NETWORK COMMUNITY HEALTH CENTERS OF GREATER THIRD STREET FAMILY HEALTH SERVICES CAA OF COLUMBIANA COUNTY CAO FAMILY MEDICAL CENTERS (IRONTON COMMUNITY HEALTH SERVICES (FREMONT) ROCKING HORSE CENTER CARE ALLIANCE TOLEDO LUCAS COUNTY HEALTH CENTER OHIO HILLS HEALTH SERVICES VALLEY VIEW (CAC OF PIKE COUNTY) ONE HEALTH OHIO FAMILY HEALTH SERVICES OF DARKE COUNTY HEALTH PARTNERS OF WESTERN OHIO PRIMARYONE HEALTH HEALTHSOURCE OF OHIO THE HEALTHCARE CONNECTION CITY OF CINCINNATI PRIMARY CARE HOPEWELL HEALTH CENTERS NEIGHBORHOOD FAMILY PRACTICE NORTHEAST OHIO NEIGHBORHOOD HEALTH MUSKINGUM VALLEY HEALTH CENTERS PRIMARY HEALTH SOLUTIONS (BUTLER CO) FIVE RIVERS HEALTH CENTERS AXESSPOINTE COMMUNITY HEALTH CENTER 7,000 pts or less Statewide 88.8% 7,001 to 17,000 pts 17,001 pts or more

32 Asthma, cont. 32 We complete the Chronic Care Template with our patients who have persistent asthma. Includes patient treatment goals and self management goals. Our providers attended a presentation by our Allergy/Asthma provider regarding the National Asthma guidelines and The Care of the Patient with Asthma.

33 Live Births <2500 grams 33 Statewide 9.3% 7,000 pts or less 7,001 to 17,000 pts 17,001 pts or more

34 Dental Sealants 34 Statewide 59.7% 7,000 pts or less 7,001 to 17,000 pts 17,001 pts or more

35 Oral Health Blood Pressure Reporting ohiochc.org

36 36 36 ohiochc.org

37 Check In Call 37 September 23, 2016 Noon 1:00 pm code: # This is an informal check in to see how everyone is doing with the Dental Blood Pressure Initiative. There will be a chance for you to ask questions and share your success stories with the group. First quarter is over September 30, 2016!! First REPORT is due on October 15, 2016 ohiochc.org

38 38 Quality Improvement Project Opportunities with OACHC ohiochc.org

39 Name of Project Brief overview FQHC Investment FQHC Incentive Timeline OACHC Contact 39 Infant Vitality: Birth Spacing (LARC) A training and QI project to increase access to and utilization of LARCs 3 to 4 FQHCs will be selected participate in intensive CME/CEU onsite training and ongoing Quality Improvement Selected FQHCs will receive monetary stipend for their time invested in training -CEUs Project to begin this fall. Selection process live by 9/15/2016 (subject to change) Teresa Rios-Bishop tbishop@ohiochc.org Infant Vitality: Safe Sleep Ohio AAP Injury Prevention & Safe Sleep Collaborative featuring online, ondemand training FREE to all members MOC Parts II & IV- CMEs- A randomly selected participating FQHC will receive 150 sleep sacs - In-person launch at OH AAP Annual meeting Sept. 24; or - OACHC to host member kick-off webinar by Sept. 15 Teresa Rios-Bishop tbishop@ohiochc.org Smoke Free Families (SFF) SFF aims to improve quality through a QI focused learning collaborative on smoking cessation Up to 18 FQHC sites will participate in smoking cessation counseling and training - Access to technical assistance calls with national experts - Coaching calls with QI Specialist - September 2016 to June Half day meeting in September 2016 with interested FQHC s Ashley Ballard aballard@ohiochc.org Chronic Disease Management Project Ohio Dept. of Health project to improve management of adult patients with undiagnosed hypertension and prediabetes A selected 2 to 3 FQHCs within a CDC recognized Diabetes Prevention Program area will improve care of patients with undiagnosed hypertension, prediabetes, and improve use of EHR Selected FQHCs will receive monetary stipend October 2016 Ashley Ballard aballard@ohiochc.org ohiochc.org

40 40 Clinical Quality Measures Crosswalk ohiochc.org

41 ohiochc.org 41

42 Update to the Clinical Quality Measures Crosswalk Link to the crosswalk here: M_Crosswalk_OACHC_.pdf Updates were made on UDS, CPC, and ODM measures ohiochc.org

43 Questions??? ohiochc.org