Using Data for Quality Improvement in a Clinical Setting Wadia Wade Hanna MD, MPH Technical Assistance Consultant Georgia Health Policy Center Dr. W. Hanna, PLS, November 2015
Quality An organizational culture using data to make decisions A continuous and permanent way of thinking Incorporated in every process of the health care delivery system to impact patient outcomes Of greater importance now because of Meaningful Use, PCMH Accreditation, Reimbursement Dr. W. Hanna, PLS, November 2015
Data is Wasted if it s Not Used Dr. W. Hanna, PLS, November 2015
Data Flow- Mining and Utilization Apply Evidence Based Process to Improve Patient Outcomes Utilize data: Strategies to build partnerships with providers and encourage data utilization Continuously mine data Providers must use mined Data in Evidence Based Decision-Making to impact Patient care and health care delivery process Dr. W. Hanna, PLS, November 2015 Mined data: Good IT infrastructure Adequate staff capacity
Market areas of specialized care and excellence to Community and population served. There is increasing competition for patients from pop up clinics in supermarkets and drugstores. Provide information in an understandable format on appropriate measures in form of a dashboard for Advisory Board Discuss data on measures (both reportable ((PIMS)) as well as for internal research) with providers at all sites. Use this to implement appropriate strategies to improve outcomes Dr. W. Hanna, PLS, November 2015 Provide regular updates to local politicians and decision makers who can help with resource allocation and partnership activities with other agencies/organizations
Dr. W. Hanna, PLS, November 2015 OMG I m dizzy from all this swimming in circles!
Transition Care Clinics Roxanne Elliott, MS FirstHealth of the Carolinas
Overview of Organization Health Care System South Central North Carolina 4 hospitals Serve four county primary care region Core purpose: To Care For People
Project Background Emergency Department and Hospital Readmission penalties Future Population Health Management Model Developed proposal to create chronic disease clinics ; Transition Care Clinics (TCCs) Focus on moving towards self-management, behavior modification, care coordination, education, monitoring
Creative Solution for Service Delivery Chronic Disease Clinics (Transition Care Clinics) Multidisciplinary approach to care RN, Pharmacist, RD/CDE, health coach, respiratory therapist, financial aid, healthnet, medication assistance, behavioral, MLP Chronic Care model 6 Core Components Focus on Quality measures and processes
Project Implementation with Data Focus Formed Small Quality Committee Included Information Systems and Clinical Practice individuals Provider champion Built data systems to address project challenges Built data systems to monitor project progress, engage multidisciplinary team and analyze data to implement change
Project Challenges Data and Systems Answers Data Tracking and Collection (PIMS) Calendars Allows data to be pulled on encounters with team Encounter plans Reinforces PIMS data collection Ensures multidisciplinary team is engaged Discussed at huddle Run reports from EMR on orders cued by encounters
Project Challenges Data and Systems Answers Use flowsheets Provides ability to run EMR reports on specific PIMS measures Disease specific flowsheets to collect PIMS measures Developed a PIMS measure flowsheet to track ongoing data through project Discharge Order Sets (primary care) Cues up when to request follow-up PIMS data Provides information on patient primary care provider Reports run and monitored on regular basis
Data Reports/Monitoring Run data reports at least quarterly Run reports by clinic to determine any trends (good or needs improvement) Use data to determine if systems need to be changed Use data to demonstrate project successes and challenges Process, perception and outcome measures Developing concrete system for monitoring readmission data specific to TCC patients to determine ROI for project
Lessons Learned Need to create systems to capture data Train staff and providers on importance of data input and reports Provide staff with periodic reports that demonstrate gaps in data and problem solve involving their input Utilize data to monitor staff compliance Utilize data to monitor project outcomes Utilize data to provide ROI for project Utilize data to make project adjustments
Data Example Surprising Outcome Predicted clinics would be predominantly Medicaid and Medicare patients with focus on preventing readmissions incorrect assumption 55 percent of population served is uninsured (447 of 819 patients) Top diagnosis reports Hypertension Diabetes Tobacco use
Data Example Staff Compliance Data Entry Ran report showed staff were non-compliant entering discharge order set, which cues up PIMS follow-up data orders Hosted meeting Shared results Problem solved Ensured compliance for future Continue to monitor
Data Example What Does Readmission Data Say Regarding TCC Operations Initial data indicates in-hospital system readmissions declined significantly (19.4% to 6.9%) Initial data indicates ED utilization rates declined system wide (16.7% to 7.3%) TCC specific data hospital readmissions 2.7% and ED utilization 14% TCCs open limited hours Patients still seeking services in ED (but less than benchmark) Expanded clinic hours in two locations
Next Steps Continuing to monitor reports Continuing meeting with clinical staff Methodically determining best means of monitoring readmission data (system level vs. TCCs) Journal articles Taking time to evaluate future data needs Discussed this week adding fields to athena for future data reports (separating referral sources)
NorthLakes Community Clinic Jessica Fairbanks Clinic Director
NorthLakes FQHC in Rural northern Wisconsin Medical, Dental, Behavioral Health, AODA (including Medication Assistant Therapy for opiate addiction), Occupation Therapy, Speech Therapy, Chiropractic, Pharmacy, and support services. Merged with another FQHC in 2013
NorthLakes and QI Grant Funds Applied for QI Grant at the same time as merger Goals from initial work plan Combining QI Programs Unified EMR & Reporting Software PCMH Improving Metrics
Where We Are Now Implemented EMR at southern sites I2i Tracks QI Committee PCMH Site-Level QI projects/pdsas
How we were using data Southern Locations No access to any data Metrics All Chart Audits No structured data review Registries just went to providers, not support staff Northern Locations simple reports, patient lists.
How we utilize data now Patient Data, Service Utilization, Records CMO, Providers & QI Committee review data evaluate progress, set guidelines and priorities. Data mined by front line staff morning huddles, open orders report, patient letters/reminders Outreach letters, reminders, care management, increase support services Data mined by QI staff, providers quarterly reports, patient panel, yearly reports
Successes Preventative Care Measures Cervical Cancer Screening - 46% to 65% Breast Cancer Screening - 29% to 41% Colorectal Cancer Screening 23% to 61% Increase in ifobt utilization & tracking New process of tracking orders & follow up Reminders
Challenges Merge EMR implementing EMR at two sites while developing QI infrastructure at others Providers Geographically disparate PCMH Multi-site application QI project, PDSAs, etc. different at each site
Take Home Where do we go from here? Chronic Disease Work PCMH Take Home from grant experience Importance of developing the QI infrastructure integration of data mining and utilization Front Line Staff s role in QI
Making a difference with data & QI By Becky Moss
Moving Beyond Data for Data s Sake Choosing data wisely Grant reporting deliverables are a great place to build up QI confidence KCHC has implemented 4 projects around PIMs Clinical depression screening, diabetic charting, tobacco cessation coding & adult BMI followup plan We were doing these, but the data was hard to find Improved charting and coding has enhanced patient care through real time alerts Operational performance measures are great for bigger QI projects No Show rate reduction, improving revenue cycle, provider capacities Data is reviewed monthly & posted on the QI bulletin board
Building a Culture of QI Finding the right tool to measure QI culture TransforMED Clinician Staff Questionnaire covers 17 different categories Assess components of a culture of QI: teamwork, leadership, learning culture, communication, sensemaking Measures progress towards Meaningful Use & Patient Centered Medical Home compliance Annual survey has had 100% completion rate for 2 years! Evaluation of the survey is transitioning to in-house evaluation team Results are reported to the group annually
Ease into QI Lessons Learned Year 1 closed the clinic for 1.5 days to involve everyone in QI training & projects Year 2 QI projects monitored by Quality Council & have targeted implementation Not everyone loves QI as much as a QI coordinator Find your champions and work with them to create interest Start small and have the smaller projects feed into a bigger QI goal Smaller projects have timely results & remain in the forefront
Lessons Learned Continued Have a source for an unbiased opinion Connecting cultural QI components with something tangible for staff Sensemaking