Laying the Groundwork for Meeting QI/QA Program Expectations in an HCH Setting Webinar: Lessons Learned from the San Francisco HCH Program

Transcription

1 + Welcome Laying the Groundwork for Meeting QI/QA Program Expectations in an HCH Setting Webinar: Lessons Learned from the San Francisco HCH Program March 6, 2012 We will begin 1 PM EST Event Host Juli Hishida Technical Assistance Coordinator National HCH Council Tech Support: Patrina Twilley This publication was supported by Grant/Cooperative Agreement Number U30CS from the Health Resources and Services Administration, Bureau of Primary Health Care (HRSA/BPHC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of HRSA/BPHC.

2 + Presenter 2 Amy Petersen, MPH Healthcare Analyst, Quality Improvement San Francisco Department of Public Health Community Oriented Primary Care

3 LAYING THE GROUNDWORK FOR MEETING QI/QA PROGRAM EXPECTATIONS IN AN HCH SETTING: CASE STUDIES FROM SAN FRANCISCO Amy Petersen, MPH Healthcare Analyst San Francisco Department of Public Health

4 Learning Objectives Provide 2-3 examples for how 330(h) Program Expectations can be operationalized into day-today quality infrastructure Describe 2-3 ways health information technology and decision support tools can be used to report on HCH outcomes of interest Analyze and compare known and emerging QI approaches Formulate a business case for how HCH QI work is relevant to PCMH activities

5 330 Program Requirements Ongoing QI/QA Plan Focused Responsibility for QI Periodic Assessment of Service Use and Quality

6 Health Center Program Reqs and PCMH (NCQA) Standard 6: Measure and Improve Performance: Use performance and patient experience data for continuous quality improvement The practice uses performance and patient experience data to continuously improve The practice tracks utilization measures such as rates of hospitalizations and ER visits The practice identifies vulnerable patient populations The practice demonstrates improved performance

7 Case Studies

8 SFDPH CHN Primary Care Clinics TOTAL Patients 7,500 homeless patients 360,000 encounters 5+% of visits with patients who are homeless Maxine Hall Health Center (MHHC) Medical Respite and Sobering Center (Fell St) CHPY Cole Street Clinic Ocean Park Health Center (OPHC) Castro Mission Health Center (CMHC) Special Programs for Youth (SPY) CHPY Hip Hop to Health Clinic Medical Respite and Sobering Center (Polk St) CHPY Balboa Teen Health Center Chinatown Public Health Center (CPHC) Housing & Urban Health Clinic (HUHC) Curry Senior Center Tom Waddell Health Center (TWHC) Community Oriented Primary Care Administration CHPY Hawkins Clinic CHPY Larkin Street Clinic San Francisco General Hospital Campus Clinics (SFGH PC) Potrero Hill Health Center (PHHC) Silver Avenue Family Health Center (SAFHC) Southeast Health Center (SEHC) Last Revised: 09/16/2009

9 Ongoing QI/QA Plan

10 Dust off QI Plan or Find a New One

11 Focused Responsibility for Program

12 What is the Overall Purpose of a Quality Management Program? Form a sustainable quality infrastructure Develop a performance measurement system Initiate quality improvement activities Involve consumers and their families

13 People Infrastructure Large Network with multiple sites Who? How Often? Ongoing Singlesite training

14 Leaders Need to be Involved in all Areas of Improvement Role Description Data and Measurement System Thinking Developing Changes Testing and Making Changes Cooperatio n Leader's Job: Generally: Creating a system in which change can be made and sustained Clarify the aim Constantly assess progress towards the aim Help staff to improve Overco me inertia in the present system Provide the will for change Find and present new knowledge and ideas for how it can be used Encourage experimentat ion Implement support structures Offer consistent support to change Develop / inculcate / reinforce a sense of common purpose Source: Brooklyn Alliance Clinical Collaborative, 2003 Leading Improvement Slide from National Quality Center

15 Periodic Assessments

16 Reporting Infrastructure What are you reporting now? HEDIS, UDS, Meaningful Use, local P4P initiative How accessible are your data? EHR timeline Availability of canned reports Disease registry Goals Frequency of reporting

17 Set Goals National benchmarks for standard performance measures Relative improvement and thresholds 2-3 measures, no more than 5 Quarterly as standard, more frequently if testing changes Find your baseline, use run charts, set goal lines

18 Evaluate Performance Dashboards Provider Report Cards Data Wall Review Outcomes Tracking a population of interest Meeting Goals? Action Planning Document, Systematize, Maintain

19 Clinic 2 Primary Care DataWall Who is in our active patient panel? Clinic 2 (COPC7 range) 0.05 TRUE # of active PCC panel patients # of active PCC panel patients 1250 per clinical FTE % of active PCC panel patients 98.0 with PCP assignment Age Groups 30% 25% 20% 15% 10% 5% 0% 100% 50% 0% Gender Race Clinic 2 COPC7 01/00 01/00 01/00 COPC Goal The adjusted panel size for Clinic 2 is 4486 This means that our 4265 patients have the expected number of visits of a panel that has 4486 patients. Expected visits are affected by demographics and health conditions. Panel data updated: 05/2011 Adjusted panel data updated: 05/ Female Male White Black Asian Hispanic Other 7% 10% COPC7 Comparisons include the 7 DPH Primary Care Clinics: Castro Mission, Chinatown, Maxine Hall, Ocean Park, Potrero Hill, Silver Avenue, and Southeast Health Centers. Your Health Center is represented in blue. Data is for adult primary care patients 18 and older. 21% 31% 30% Age Group Information Clinic 2 COPC7 Range Average Median % 57% Access & Operations Clinic 2 patients waited 5 days for the next available appointment /10 04/11 Apr 2011 days Clinic 2 #N/A 5 COPC7 #N/A 4 COPC7 min & max Clinic 2 has 1250 patients per primary care provider FTE Dec 2010 paid FTE panel/fte 1500 Clinic COPC Clinic 2 has a 90% appointment show rate 100% 80% 60% 40% 20% 04/10 04/11 0% 04/10 04/ COPC7 min & max COPC Goal 1125 Mar 2011 total appts % Clinic COPC COPC7 min & max 90% of Clinic 2 patients saw their own provider at their most recent visit Apr 2011 clinical hrs % 100% Clinic 2 #N/A 90.0 COPC7 #N/A 95 80% 60% 40% 20% 0% 04/10 04/11 COPC7 min & max Quality of Care 90% of diabetics at Clinic 2 had an A1c test last year 100% 80% 60% 40% 20% 0% Apr 2011 # eligible % Clinic COPC COPC7 min & max COPC Goal 90 HEDIS- Medicaid % of diabetics at Clinic 2 had an A1c value < 8 last year Apr 2011 # eligible % 100% Clinic % COPC % 40% 20% 0% 04/10 04/11 COPC7 min & max HEDIS- Medicaid % of diabetics at Clinic 2 had an LDL less than 100 last year Apr 2011 # eligible % 100% Clinic % COPC % 40% 20% 04/10 04/11 COPC7 min & max HEDIS- Medicaid Financial Class Healthy SF 36% Healthy Worker 19% Medi-Cal FFS 14% Uninsured 14% Medicare 11% Medi-Cal Cap 5% Clinic 2 Commercial 1% COPC7 Healthy Kids 0% Other 0% Healthy Family 0% 0% 10% 20% 30% 40% 50% 60% 70% Demographics data updated: 10/2010 Who came in for a medical visit at Clinic 2 from Jul 2010 to Jun 2010? * 3000 individual patients were * Top diagnoses were: seen by a medical provider HYPERTENSION NOS HYPERLIPIDEMIA NEC & NOS * 2.1 average medical visits DM2/NOS UNCOMP NSU per individual patient DEPRESSIVE DISORDER NEC DM2/NOS UNCOMP UNC * 500 patients were new to BACKACHE NOS Clinic 2 in the last 3 years OBESITY NOS 8. V65.40 COUNSELING NOS * Of these, 200 were new 9. V04.81 INFLUENZA VACCINE to any DPH clinic site TOBACCO USE DISORDER 90% of our patients would recommend us to a friend or family member 100% Apr 2011 # eligible % 80% Clinic % COPC % 20% COPC7 min & max % 04/10 04/11 90% of patients said they received timely after- hours medical advice 100% Apr 2011 # eligible % 80% Clinic COPC % 40% COPC7 min & max % 0% 04/10 04/11 0% 90% of our patients had smoking status documented in the LCR last year Apr 2011 # eligible % 100% Clinic % COPC % 40% 20% 04/10 04/11 COPC7 min & max Primary Care DataWall Mock-Up Actual scale is 3:1

20 Case Studies! San Francisco Community Clinic Consortium SF Department of Public Health COPC Tom Waddell Health Center (SF)

21 San Francisco Community Clinic Consortium Case Study #1 QI/QA Plan Periodic Assessments

22 SFCCC Opportunities for Infrastructure Enhancements Loosely Defined Indicators for Assessing Quality 23 Core Indicators Finalized In depth Audit conducted (help from VISTA Program) 2010 Indicators align with electronic reporhng goal Performance Targets and Thresholds Adopted Electronic Audit

23 HCH Quality Measures Evaluated list of indicators from previous years against current guidelines and recommendations from a variety of organizations, including: CDC U.S. Preventive Services Task Force National Health Care for the Homeless Clinicians Network General Recommendations document San Francisco Department of Public Health And sought additional feedback from local practitioners and Medical Directors clinic managers clinic quality improvement staff

24 SFCCC Core Set: HCH Indicators Emergency Contact Living Conditions Assessment Domestic Viol. Assessment Sexual History Assessment Sexual Health Education Family Planning Services HIV Testing Referral Syphilis Screening Cervical Cancer Screening Influenza Vaccination Pneumococcal Vaccination Td/Tdap Vaccination Mental Health Screening Mental Health Treatment Drug & Alcohol Use Screening Drug & Alcohol Abuse Treatment Tobacco Use Screening Tuberculosis Screening Tuberculosis Chest X-Ray Dental Assessment

25 SFCCC - High Hopes and Dashed Expectations: Quality Audit Teams

26 i2itracks Disease Registry Registry is acceptable tool Data entry/reporting known Less time than manual review

27 Did you have a HCH Audit team at your clinic? (2010 Survey Results)

28 The HCH Audit provided a learning opportunity for our clinic.

29 San Francisco Department of Public Health Case Study # 2 Focused Responsibility Periodic Assessments Community Oriented Primary Care 14 primary care clinics 42,000 patients 2011 Quality Culture Series 2012 Initiatives Team Based Care Patient Experience Staff Experience and Alignment

30 PERFORMANCE IMPROVEMENT & PATIENT SAFETY PROGRAM GOVERNING BODY Nursing Executive Committee Outcomes Clinical Practice Guidelines Priority Actions Staff/ Pt/ Res Educ. Clinical Practice Guidelines Priority Actions Identified Issues Medical Executive Committee Recommendations Performance Improvement & Patient Safety (PIPS) Committee Staff / Pt / Res Educ Risk Assessment Indicators Quality Council Outcomes QI Task Forces Strategic Initiatives Priority Actions Staff/Pt/Res Educ Primary Care Quality Improvement Committee (PCQI) Risk Management Subcommittee Annual Reports and QI Plans Data/Outcome Reporting COPC & SFGH Clinics Sentinel/ Significant Events Unusual Occurrences Other identified risks

31 Primary Care QI Rep Leadership abilities Good working knowledge of clinic At least 70% FTE Part of Management Team

32 SFDPH-COPC: Primary Care QI Toolkit Template to describe services provided and management structure QI Plan Template with section to name vision, goals, & committee structure Standard Reporting template and PPT presentation

33 Display Improvement Data

34 Display Improvement Data

35 Tom Waddell Health Center Case Study #3 Ongoing QI/ QA Plan Focused Responsibility Use your mission to determine how you will do quality. How do we do justice to the things that are unique about our work?

36 On-going QI/QA Plan Measures Chronic Pain TB Testing HIV Testing Flu Shot BP Control DM Control 1 X per Yr - Planning Meeting to Choose QI Priorities Message Outreach and retention in care efforts Focus on patients with assigned a primary care provider General health care measures allow QI program to develop

37 Focused Responsibility QI Committee Accountability Structure MD Social Worker Nurse Manager Asst MD Admin Team (2) Health Workers (2) Operations Manager Clerk Align QI priorities with Management Team goals Performance Appraisals assess participation in QI work Training opportunities

38 Population Characteristics 38 Where did HCH patients live during the measurement period 160 Number of Patients Living Location

39 Case Studies Summary

40 THOUGHTS ABOUT IMPROVEMENT EFFORTS Before you try to solve a problem, define it. Before you try to control a process, understand it. Before trying to control everything, find out what is important, and work on the most important or on that process having the biggest impact. Recognize that we can learn from failures, so respect meaningful failures

41 + Questions & Answers 41 Amy Petersen, MPH Healthcare Analyst, Quality Improvement San Francisco Department of Public Health Community Oriented Primary Care

42 + Resources National HCH Council website 42 National Quality Center HCH Clinicians' Network San Francisco Health Plan - Strength in Numbers SFCCC Quality Measures - public reporting %20SFCCC%2010%2012%2011.pdf SFCCC website SFDPH Community Oriented Primary Care - Health Care & Housing Are Human Rights

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