Developing Competence in System- and Practice-Based Learning and Improvement: The OK Primary Healthcare Cooperative F. Daniel Duffy, MD, MACP Daniel-duffy@ouhsc.edu 918-740-0433 AD Conference
Relevant Disclosure and Resolution Under Accreditation Council for Continuing Medical Education guidelines disclosure must be made regarding relevant financial relationships with commercial interests within the last 12 months. Daniel Duffy, MD, MACP Commercial Interest Example: Name of Commercial Interest Nature of Relevant Financial Relationship What was received? Example: Speaker Fee For what role? Example: Promotional Speaker None N/A N/A The conflict was resolved by
Relevant Disclosure and Resolution Under Accreditation Council for Continuing Medical Education guidelines disclosure must be made regarding relevant financial relationships with commercial interests within the last 12 months. Daniel Duffy, MD, MACP I have no relevant financial relationships or affiliations with commercial interests to disclose.
Experimental or Off-Label Drug/Therapy/Device Disclosure I will NOT be discussing experimental or off-label drugs, therapies and/or devices that have not been approved by the FDA.
Learning Objectives Upon completion of this session, participants will improve their competence and performance by being able to: Describe the impact H2O ADs and PEAs have in helping practices develop competence in practice-based learning and improvement. Describe how feedback on ABCS performance measures stimulates practice system change. Explain how systems-based practice affects quality of care.
System-Based Practice All healthcare is created and delivered by complex human-technical systems made up of policies, processes, hand-offs, interactions, and use of information, biochemical, pharmaceutic, physical, and other technology. The site of all healthcare, quality, and safety is the clinical microsystem a small number of professionals working together to provide care to a panel of patients. To improve healthcare the change must occur at the clinical microsystem.
Practice-Based Learning & Improvement Learning that transforms clinical quality, safety, and satisfaction occurs in a learning organization that acts on feedback from performance measurement to change it s microsystem processes, people, and technology in order to achieve better performance. Feedback, application of improvement science, skills training, in-practice coaching and change facilitation are the elements of PBLI. PBLI occurs within a learning organization, the clinical microsystem.
System of OK Practice Transformation Initiatives CMS Community Integration Award?2017 Integrate social services and primary care referral. AHRQ Evidence Now H2O Grant 5/15 Demonstrate implementation of guidelines through feedback, detailing and practice facilitation.. AHRQ IMPaCT 9/11 Implement State-level primary care extension agents. Medicaid PCMH & HAN Waiver 1/09 Bonus payment to PCMH certified Medicaid providers. & community care-coordination for high risk patients Comprehensive Primary Care Plus (CPC+) 1/17 Multi-payer prospective payment to transform primary care Comprehensive Primary Care Initiative (CPCi) 10/12 Multi-payer prospective payment shared savings primary care transformation Beacon Community 5/10 Show how health IT leads to community breakthroughs in healthcare quality TIMELINE
OK Primary Healthcare Extension System 245 Primary Care Practices PA PEA AD
OPHIC Model of Practice Change Support (New CME: SB-PBLI) PEA PEA Sustain Improvement Define Opportunity AD Measure Performance PA MyHealth PEA PA MyHealth Measure & Analyze Effect Change Work Processes Feedback & Analyze PEA AD PEA
5 4 11 2 14 60 11 30 30 17 10 2 7 9 8 10 8 10 May 6, 2016 Map of Enrolled Practices
Number of H2O Practices By Owners 66 13 10 16 7 53 98 AMC Clinician FQHC HIS-Tribe Hospital Private Corp RHC
1600 1400 Number of Encounters per Support Type 1449 1200 1000 800 600 546 400 200 215 20 329 62 166 8 0 Academic Academic Detailing (1) Detailing (2) EHR Data Extraction Enrollment Practice Facilitation Recruitment Technology Support Withdrawal Note
Support Type Per Wave 10/16-10/17 Number of Encounters 1200 1000 800 600 400 200 0 1 2 3 4 Wave Withdrawal Note Technology Support Survey/Research Data Recruitment Practice Facilitation Enrollment EHR Data Extraction Academic Detailing (2) Academic Detailing (1)
System-Based Learning & Improvement Support Goal Strategy-1 Strategy-2 Strategy-3 Performance Measurement Get data from EHR PA work with vendor/myhealth PEA chart abstraction Quality of Data EHR entry PA-PEA teach team Templates Blood Pressure Technique Medications Gap-Risk-list Smoking Document 5As - Referral Counsel code Aspirin Risk calculator Medication list Patient ed Cholesterol Risk calculator Medication list Chart Review Other Coding Teamwork Delegation
H2O Performance in MyHealth 9/2/2016
References Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance: a systematic review of continuing medical education strategies. JAMA 1995; 274:700-705. Moore DE, Pennington FC. Practice-Based Learning and Improvement. The Journal of Continuing Education in the Health Professions 2003; 23: S73-S80. Weiss KB, Wagner R. Performance Measurement Through Audit, Feedback, and Profiling as Tools for Improving Clinical Care. Chest 2000; 118:53S 58S Nagykaldi Z, Mold JE, Robinson A, Niebauer L, Ford A. Practice Facilitators and Practice-based Research Networks. J Am Board Fam Med 2005;19:506-510.