Secrets for Performance Improvement with Data Driven Practice Transformation. Jessica Henderson Boyd, MD, MPH Chief Medical Officer

Transcription

1 Secrets for Performance Improvement with Data Driven Practice Transformation Jessica Henderson Boyd, MD, MPH Chief Medical Officer

2 The Story Introduction to BMS Role of leadership Strategic alignment DRVS implementation Building trust in the data Workflow Documentation Quality metric Provider and staff engagement Translating data to patient care Results 2

3 Baltimore Medical System Established in 1984 in Baltimore, MD 5 Health Centers, 7 School Based Health Clinics ~46,000 patients, ~140,000 visits clinical providers, 365 total staff FP, Peds, IM, OB/Gyn, BH Commitment to Quality The Joint Commission accredited since 1987 Strategic plan for : shift from volume focused quality focused culture 3

4 Quality Plan 2013: Elements of Quality NPS Patient Complaints Model of Care: PCMH The Patient Experience Accreditation TJC NCQA Quality Indicators QUALITY Risk Management Mortality Reports Incident Reports Competency Peer Review Credentialing Support Staff Competency 4

5 The Beginning BMS implemented an E.H.R. (Misys) in 2006 Programmer on staff Manual audits electronic reporting by 2009 Each year, UDS report would be a surprise with data we didn t believe Several ideas, processes, grants in place to improve health outcomes but no idea about how we were performing Reactive not proactive around performance Next Step: Quality Program + HIT= Synergy!! 5

6 A Change is Gonna Come 2011: Switch to new E.H.R. (NextGen) Reporting was a major factor in selection Dashboard, Report writer, Menu reports, Crystal Reports Reporting challenges Inconsistent Upgrades and changes in definitions = lots of work Difficult to capture the information in the charts Unintended consequence of the switch? UDS: Back to manual audits for two years Year 1: Data from two systems was difficult to integrate Year 2: Too many reports to develop and ensure accuracy; UDS tool was generic, regimented and focused on billing codes 6

7 On the Road Again The switch to NextGen was the first step Significantly more capabilities More structured fields An external reporting system (DRVS) was the second step Data at our fingertips Organization, Center, and Provider level data Allowed us to map our exact workflow (how we document) to the reports Many reports available out of the box (over 65) which were in line with our reporting needs Upgrades and changes to the measure definitions are managed by Azara 7

8 Let s Stay Together: Strategic Alignment As a FQHC, we are always managing limited resources so we had to choose a few things to focus on from our exhaustive list: Key results Quality turtle Organization Dashboard Quality Improvement UDS Meaningful Use HbA1c Paps 2yo HEDIS Imm Smoking Provider Scorecards Clinician Compensation Plan Patient Centered Medical Home and direct patient care 8

9 Alignment of Clinical Metrics 9

10 Life is a Highway: DRVS Implementation Features Primary implementation team: Health informatics team, two clinicians, performance improvement coordinator Each report tested by at least two team members 20 non compliant and 20 compliant Identified mapping issues, definition issues Iterative process with Azara Ongoing End user testing: clinicians, medical assistants Provider training/ re training How to use DRVS and where to document Support staff training Result Each report was the best that we could get it, and each of us involved had a better understanding of the report 10

11 A Matter of Trust Building trust in the data People working with the data trusted and understood the reports We recognized an issue as a report failure v. a user error Ex: cervical cancer screening Physicians personally audited >10 key reports and vouched for them Performance improvement coordinator monitors this regularly The process of workflow documentation for each metric is both defined and documented Instructions/ user guide with screen shots provided by Azara Cheat sheets maintained by us If a provider doesn t think their results are correct: Collect specific patient examples Win Win opportunity: Get their buy in and/or improve our report! We walk them through a sample of patients so they understand 11

12 Diabetic Control HbA1c < 9 January 2012 July 2014 BMS BE AR MX OS SA HT Tier 1 Tier Jan 12 Mar 12 May 12 Jul 12 Sep 12 Nov 12 Jan 13 Mar 13 May 13 Oct 12 Jan 13 Apr 13 Jul 13 Oct 13 Jan 14 Apr 14 Jul 14 January 2012 May 2013 Captured 5/2013 October 2012 July 2014 Captured 7/2014

13 Sugar, We re Goin Down Hemoglobin A1c pitfalls and opportunities Multiple labs utilized by our system Test names can change or have many permutations impacting mapping. (Ex: Hgba1c. and HgbA1c) Labs on paper (from specialists, non interfaced labs) requires manual entry of lab results This also occurs with paper lab requisitions instead of CPOE Lab tracking and registries helps with building trust in the data 13

14 Diabetes Registry

15 Unwritten: Linking Documentation & Data Data mapping allows us to link our workflow as providers (what makes sense) to something concrete Multiple possible locations to document As few extra clicks as possible If you didn t document it, you didn t do it Get credit for the work that you do Standardization of documentation allows for accurate data capture and more representative quality metrics 15

16 Weight Assessment, Counseling on Diet and Activity in Children 80% 70% 60% % Compliant 50% 40% 30% Monthly Trailing Year 20% 10% 0% DRVS Scorecard Documentation Training Provider Comp Plan Turtle Team 16

17 Get Up, Get Into It, Get Involved (Pt 1): Provider and Staff Engagement Provider scorecards Regular feedback DRVS put results (and the data to back it) at their fingertips Friendly competition Involvement in turtle teams (PDSA teams) Teaches how to do something about improving their scores Clinician compensation plan Productivity, quality, citizenship Show me the money Clinical support staff buy in MA audits MA PCMH incentive 17

18 Provider Score Card 18 18

19 Clinician Compensation Plan 19

20 Breast Cancer Screening 60% 50% Monthly Trailing Year % Compliant 40% 30% 20% Provider Comp Plan Turtle Team 10% DRVS 0% 20 20

21 Depression Screening 100% 90% 80% 70% Trailing Year Monthly 60% 50% 40% 30% 20% 10% 0% Dashboard DRVS MA Audits PCMH MA incentive 21

22 Keeps Gettin Better: Process Improvement PDSA is our primary process improvement method Used in our organization for PCMH/ NCQA, quality improvement, any reportable outcome Focused on tests of small incremental changes Need data to determine how we did and next steps DRVS allows providers, managers, nurses, etc. to access the data for a single provider, group of providers or all providers For the specific time period they are measuring Registries and report details can help to provide the information to develop the next test of change Identify gaps and opportunities 22

23 Asthma Action Plans in Children 70% 60% 50% Monthly Trailing Year 40% 30% 20% 10% 0% DRVS Grant renewal; Training, feedback; PDSA project Updated asthma toolkit 23

24 Asthma Status and Management Registry 24

25 Team: Data Makes PCMH Possible Pre Visit Planning report Provided by administrative assistants Utilized by medical assistants Reviewed by providers and staff in huddles This information is key to identifying opportunities to improve care and workflow with minimal added work Registries Supports ownership for a panel of patients and their health outcomes Outcomes or opportunities can be identified outside of the context of a visit Better application of standing orders and outreach to meet outcomes 25

26 Pre Visit Planning Report 8:00 Moderate Risk Risk Factors: Tobacco Use 8:15 High Risk Risk Factors: SMIP, SAD 8:45 Risk Factors: Pregnancy 9:00 Moderate Risk Risk Factors: Obesity 26 26

27 Diabetes Registry

28 2013 Quality Turtle Results One of four Key Results for the organization Presented to staff monthly Posted in centers, featured in the newsletter, discussed at staff meetings Turn our turtle green! HbA1c Paps 2yo Imm Smoking Calypso 28

29 Quality Turtle Reporting 29

30 Lessons Learned Keys to our success: Data validation was important to build trust Provider champions helped ease the way Training and re training (and a lot of patience) Providers, managers, clinical and admin support staff Teach them to fish Baby steps Continued providing paper scorecards with help of DRVS Anonymous reporting Transparency Strategic alignment Focus on what people can handle Can reduce friction, minimize wasted work, and create synergy! 30

31 Questions?

32 The Playlist The Story Brandi Carlile (Sara Ramirez) The Beginning John Legend A Change is Gonna Come Sam Cooke On the Road Again Willie Nelson Let s Stay Together Al Green Life is a Highway Tom Cochrane A Matter of Trust Billy Joel Sugar We are Goin Down Fall Out Boy Unwritten Natasha Bedingfield Get Up, Get Into It, Get Involved Pt. 1 James Brown Keeps Getting Better Christina Aguilera Team Lorde Lessons Learned Carrie Underwood