PPS Performance and Outcome Measures:
PPS Performance and Outcome Measures: This document includes supplemental resources to the content on PPS Performance and Outcome Measures presented at the December 6th PAC meeting Resources Include: Improvement for Phase II CSB Outcome Measures PPS Outcome Measures s* by Domain Quality Improvement Framework * Excludes outcome measure results for five Palliative Care measures because the data is not available 2
Phase II CSB Outcome Measure Improvement Behavioral Health Measure Name Diabetes Monitoring for People with Diabetes and Schizophrenia Diabetes Screening for People with Schizophrenia or Bipolar Disease who are Using Antipsychotic Medication Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia Follow-up after hospitalization for Mental Illness - within 30 days Follow-up after hospitalization for Mental Illness - within 7 days s versus Baseline +/- +/- MY3 M9 s MY3 +/- Performance s 79.93% 69.09% 80.92% 10.84% 69.50% 71.16% -1.66% 72.12% 71.53% 0.59% Integrate primary care services into behavioral and/or substance abuse treatment services, using a co-location model Integrate behavioral health services into the primary care setting through a collaborative care model or colocation model Improvement Conduct quality improvement activities related to primary care and behavioral health integration Implement protocols (e.g. outreach for broken lab appointments, point of care testing) in primary care and behavioral health settings to ensure patients with schizophrenia receive HbA1c tests regularly Performance s 77.69% 77.96% 78.82% -0.86% 79.10% 79.06% 0.04% 79.06% 80.09% -1.03% Improvement Integrate primary care services into behavioral and/or substance abuse treatment services, using a collaborative care model or co-location model Integrate behavioral health services into the primary care setting through a collaborative care model or colocation model Conduct quality improvement activities related to primary care and behavioral health integration Implement protocols (e.g. outreach for broken lab appointments, point of care testing) in primary care and behavioral health settings to ensure patients with bipolar disease and schizophrenia on antipsychotic medications are regularly screened for diabetes Performance s 69.92% 71.23% 72.15% -0.91% 73.63% 73.33% 0.30% 74.02% 75.49% -1.47% Integrate primary care services into behavioral and/or substance abuse treatment services, using a co-location model Integrate behavioral health services into the primary care setting through a collaborative care model or colocation model Improvement Conduct quality improvement activities related to primary care and behavioral health integration Implement protocols (e.g. outreach for broken lab appointments, point of care testing) in primary care and behavioral health settings to ensure patients with schizophrenia receive LDL-C tests regularly Performance s 46.97% 51.59% 51.10% 0.49% 52.49% 55.26% -2.77% 59.05% 56.06% 2.99% Improvement Implement care transition interventions for patients admitted for a behavioral health condition Ensure all hospitalized patients have follow up visit scheduled within 30 days of discharge and address barriers before discharging patient from the hospital Conduct proactive outreach to post-discharged patient and for rescheduling of broken follow up appointments Performance s 33.28% 37.19% 37.37% -0.18% 37.85% 40.89% -3.04% 43.66% 41.48% 2.18% Improvement Implement care transition interventions for patients admitted for a behavioral health condition Ensure all hospitalized patients have follow up visit scheduled within 7 days of discharge and address barriers before discharging patient from the hospital Conduct proactive outreach to post-discharged patient and for rescheduling of broken follow up appointments Data Source: New York State Department of Health n/a = value is not available = 7/2014 6/2015; = 7/2015 6/2016; MY3 M3 = 7/2016 3/2017 3
Phase II CSB Outcome Measure Improvement Chronic Disease Management Measure Name Controlling High Blood Pressure s versus Baseline +/- +/- MY3 M9 s MY3 +/- Performance s n/a n/a n/a n/a 42.37% n/a n/a n/a 45.46% n/a Improvement Reinforce hypertension and cholesterol guidelines to all relevant providers and staff Standardize process for proper blood pressure measurement and provide ongoing retraining for all staff that measure blood pressure Develop registry of patients with hypertension that supports population management functions (e.g. outreach for follow up visits) Develop linkages to social support services and resources; examples of community-based programs include Stanford model, community health workers, peer programs, programs promoting healthy eating or exercise, or self-management groups Document patient driven self-management goals in the medical record and review with patients at each visit Implement a workflow to support home blood pressure monitoring as an element of hypertension management Data Source: New York State Department of Health n/a = value is not available = 7/2014 6/2015; = 7/2015 6/2016; MY3 M9 = 7/2016 3/2017 4
Phase II CSB Outcome Measure Improvement Utilization Measure Name Potentially Preventable Readmissions Potentially Preventable Emergency Room Visits (per 100 members) PQI 90 - Composite of all measures PDI 90 - Composite of all measures (per 100,00 members) Baseline MY3 M9 MY3 s versus +/- +/- +/- s Performance s 1,177.51 999.25 1,059.76-60.51 888.94 917.39-28.45 837.31 818.11 19.20 Proactively identify high-utilization and/or high-risk patients and inform care team Implement transitions management interventions for patients identified as being at high risk of readmission Conduct quality improvement activities for care management interventions including documentation of comprehensive assessment, care plan, case conference and linkage to services Improvement Ensure timely access to primary care and behavioral health services and develop linkages to social support services Establish RHIO connectivity to receive and/or share information on recent admissions and/or ER visits Assist in medication reconciliation and provide self-management support Ensure patients understand early signs of worsening condition, what to do and how to access 24/7 care if needed Performance s 57.60 47.52 54.27-6.75 42.14 43.38-1.24 42.45 38.53 3.92 Proactively identify high-utilization and/or high-risk patients and inform care team Deploy ED Care Management team(s) including an RN, licensed social worker, licensed pharmacist and CLW in the emergency department and facilitate integration into emergency department-based processes such as triage and discharge Identify opportunities to improve primary care linkage in the emergency department and develop interventions to address Improvement resource gaps, system level barriers and facility-specific solutions Ensure timely access to primary care and behavioral health services and develop linkages to social support services Establish RHIO connectivity to receive and/or share information on recent admissions and/or ER visits Develop a consistent process to assign Emergency Severity Index (ESI) levels for all patients that present in the ED and a process to educate all ESI level 4 and 5 patients of more appropriate care settings Performance s 2,339.16 1,884.64 2,105.24-220.60 1,610.63 1,728.29-117.66 1,604.29 1,474.11 130.18 Proactively identify high-utilization and/or high-risk patients and inform care team Implement transitions management interventions for patients identified as being at high risk of readmission Conduct quality improvement activities for care management interventions including documentation of comprehensive assessment, care plan, case conference and linkage to services Improvement Ensure timely access to primary care and behavioral health services and develop linkages to social support services Establish RHIO connectivity to receive and/or share information on recent admissions and/or ER visits Assist in medication reconciliation and provide self-management support Ensure patients understand early signs of worsening condition, what to do and how to access 24/7 care if needed Performance s 561.80 593.31 505.62 87.69 497.91 538.12-40.21 532.43 452.25 80.18 Proactively identify high-utilization and/or high-risk patients and inform care team Implement transitions management interventions for patients identified as being at high risk of readmission Conduct quality improvement activities for care management interventions including documentation of comprehensive assessment, care plan, case conference and linkage to services Improvement Ensure timely access to primary care and behavioral health services and develop linkages to social support services Establish RHIO connectivity to receive and/or share information on recent admissions and/or ER visits Develop linkages to social support services to address actionable risk factors Assist in medication reconciliation and provide self-management support Ensure patients understand early signs of worsening condition, what to do and how to access 24/7 care if needed Data Source: New York State Department of Health n/a = value is not available = 7/2014 6/2015; = 7/2015 6/2016; MY3 M9 = 7/2016 3/2017 n/a = value is not available 5
Phase II CSB Outcome Measure Improvement Utilization Measure Name Pediatric Quality Indicator # 14 Pediatric Asthma +/- Prevention Quality Indicator # 15 Younger Adult Asthma +/- Prevention Quality Indicator # 7 (HTN) +/- Prevention Quality Indicator # 8 (Heart Failure) +/- s versus Performance s Improvement Performance s Improvement Performance s Improvement Performance s Improvement Baseline +/- +/- MY3 M9 s MY3 +/- 636.11 710.03 572.50 137.53 565.86 643.28-77.42 599.34 513.53 85.81 Identify patients with chronically poor asthma control and review and update clinical treatment recommendations Conduct quality improvement activities for classification of asthma severity, guidelines-based medication treatment, use of Asthma Action Plan, and assessment of asthma control Counsel the patient or family as to the benefit of CHW services and refer to CHW services Offer CHW services which include in-home environmental assessment, support to follow clinical recommendations, and linkage to home remediation services and other services 231.98 256.97 208.79 48.18 171.92 232.63-60.71 148.81 156.09-7.28 Identify patients with chronically poor asthma control and review and update clinical treatment recommendations Conduct quality improvement activities for classification of asthma severity, guidelines-based medication treatment, use of Asthma Action Plan, and assessment of asthma control Counsel the patient or family as to the benefit of CHW services and refer to CHW services Offer CHW services which include in-home environmental assessment, support to follow clinical recommendations, and linkage to home remediation services and other services 147.85 101.70 133.06-31.36 78.54 92.76-14.22 49.08 71.92-22.84 Reinforce hypertension and cholesterol guidelines to all relevant providers and staff Standardize process for proper blood pressure measurement and provide ongoing retraining for all staff that measure blood pressure Develop registry of patients with hypertension that supports population management functions (e.g. outreach for follow up visits) Develop linkages to social support services and resources; examples of community-based programs include Stanford model, community health workers, peer programs, programs promoting healthy eating or exercise, or self-management groups Document patient driven self-management goals in the medical record and review with patients at each visit Implement a workflow to support home blood pressure monitoring as an element of hypertension management n/a n/a n/a n/a 304.89 n/a n/a 303.98 279.31 18.28 Develop a standard clinical management model for patients with congestive heart failure in order to reduce the risk of readmission; and a timeline for planned implementation at hospital facilities Data Source: New York State Department of Health n/a = value is not available = 7/2014 6/2015; = 7/2015 6/2016; MY3 M9 = 7/2016 3/2017 n/a = value is not available 6
PPS Outcome Measure s* by Domain - Utilization Measure Name Domain Baseline +/- +/- MY3 M9 s MY3 +/- MY3 ED use by uninsured (ratio) PDI 90 - Composite of all measures Pediatric Quality Indicator #14 Pediatric Asthma Potentially Preventable Readmissions Potentially Preventable Emergency Room Visits (per 100 members) Potentially Preventable Emergency Department Visits (for persons with BH diagnosis) (per 100 members) PQI 90 - Composite of all measures Prevention Quality Indicator #15 Younger Adult Asthma (per 100,000 members) Prevention Quality Indicator #7 Hypertension Prevention Quality Indicator #8 Heart Failure Non-use of Primary and Preventive Care Services (ratio) Utilization Utilization Utilization Utilization Utilization Utilization Utilization Utilization Utilization Utilization Utilization n/a 25.96 n/a n/a 31.84 n/a n/a n/a n/a n/a 561.80 593.31 505.62 87.69 497.91 538.12-40.21 532.43 452.25 80.18 636.11 710.03 572.50 137.53 565.86 643.28-77.42 599.34 513.53 85.81 1,177.51 999.25 1,059.76-60.51 888.94 917.39-28.45 837.31 818.11 19.20 57.60 47.52 54.27-6.75 42.14 43.38-1.24 42.45 38.53 3.92 152.43 111.61 137.18-25.58 102.85 103.98-1.13 99.03 96.10 2.93 2,339.16 1,884.64 2,105.24-220.60 1,610.63 1,728.29-117.66 1,604.29 1,474.11 130.18 231.98 256.97 208.79 48.18 171.92 232.63-60.71 148.81 156.09-7.28 147.85 101.70 133.06-31.36 78.54 92.76-14.22 49.08 71.92-22.84 n/a n/a n/a 0.00 304.89 n/a 304.89 303.98 279.31 18.28 n/a 11.19 n/a 0.00 11.27 n/a 0.00 n/a n/a n/a Data Source: New York State Department of Health = Phase II CSB Outcome Measure = 7/2014 6/2015; = 7/2015 6/2016; MY3 M9 = 7/2016 3/2017 * Excludes outcome measure results for five Palliative Care measures because the data is not available n/a = value is not available 7
PPS Outcome Measure s* by Domain - Access to Primary Care Measure Name Domain Baseline +/- +/- MY3 M9 s MY3 +/- MY3 Adult Access to Preventive or Ambulatory Care - 20 to 44 years Adult Access to Preventive or Ambulatory Care - 45 to 64 years Adult Access to Preventive or Ambulatory Care - 65 and older Children's Access to Primary Care - 12 to 19 years Children's Access to Primary Care - 12 to 24 Months Children's Access to Primary Care - 25 months to 6 years Children's Access to Primary Care - 7 to 11 years Access 80.9% 80.8% 81.9% -1.1% 80.9% 81.8% -0.9% 80.1% 81.9% -1.8% Access 89.8% 90.3% 90.3% 0.1% 90.1% 90.8% -0.6% 90.5% 90.5% 0.0% Access 88.3% 90.5% 88.9% 1.6% 91.8% 90.9% 0.9% 93.0% 92.0% 0.9% Access 82.9% 94.1% 84.5% 9.6% 94.4% 94.6% -0.2% 94.5% 94.9% -0.3% Access 93.6% 92.5% 94.3% -1.8% 91.3% 93.2% -1.9% 92.2% 92.2% 0.0% Access 91.0% 90.8% 91.7% -0.9% 91.0% 91.6% -0.6% 90.4% 91.8% -1.4% Access 87.8% 96.5% 89.0% 7.5% 96.5% 96.8% -0.3% 96.6% 96.9% -0.3% Data Source: New York State Department of Health = Phase II CSB Outcome Measure = 7/2014 6/2015; = 7/2015 6/2016; MY3 M9 = 7/2016 3/2017 * Excludes outcome measure results for five Palliative Care measures because the data is not available n/a = value is not available 8
PPS Outcome Measure s by Domain - Behavioral Health Measure Name Adherence to Antipsychotic Medications for People with Schizophrenia Antidepressant Medication Management - Effective Acute Phase Treatment Antidepressant Medication Management - Effective Continuation Phase Treatment Cardiovascular Monitoring for People with Cardiovascular Disease and Schizophrenia Diabetes Monitoring for People with Diabetes and Schizophrenia Domain Baseline +/- +/- MY3 M9 s MY3 +/- MY3 Behavioral Health 60.9% 55.0% 62.4% -7.4% 57.1% 57.1% 0.0% 59.0% 59.1% 0.0% Behavioral Health 45.5% 53.6% 46.9% 6.6% 51.9% 54.2% -2.4% 53.0% 52.7% 0.3% Behavioral Health 35.8% 38.4% 36.5% 1.9% 37.5% 38.9% -1.4% 38.6% 38.1% 0.5% Behavioral Health 69.9% 71.2% 72.1% -0.9% 73.6% 73.3% 0.3% 74.0% 75.5% -1.5% Behavioral Health 79.9% 69.1% 80.9% -11.8% 69.5% 71.2% -1.7% 72.1% 71.5% 0.6% Diabetes Screening for People with Schizophrenia or Bipolar Disease who are Using Antipsychotic Medication Behavioral Health 77.7% 78.0% 78.8% -0.9% 79.1% 79.1% 0.0% 79.1% 80.1% -1.0% Engagement of Alcohol and Other Drug Dependence Treatment (Initiation and 2 visits within 44 days) Follow-up after hospitalization for Mental Illness - within 30 days Follow-up after hospitalization for Mental Illness - within 7 days Follow-up care for Children Prescribed ADHD Medications - Continuation Phase Follow-up care for Children Prescribed ADHD Medications - Initiation Phase Initiation of Alcohol and Other Drug Dependence Treatment (1 visit within 14 days) Behavioral Health 17.1% 15.8% 18.0% -2.1% 14.1% 17.1% -3.0% 17.6% 15.5% 2.1% Behavioral Health 47.0% 51.6% 51.1% 0.5% 52.5% 55.3% -2.8% 59.1% 56.1% 3.0% Behavioral Health 33.3% 37.2% 37.4% -0.2% 37.9% 40.9% -3.0% 43.7% 41.5% 2.2% Behavioral Health 67.5% 74.9% 68.6% 6.3% 78.4% 75.3% 3.1% 79.7% 78.5% 1.2% Behavioral Health 62.0% 70.7% 63.0% 7.7% 67.7% 70.8% -3.1% 66.6% 68.2% -1.6% Behavioral Health 54.6% 51.2% 54.8% -3.6% 46.5% 51.8% -5.3% 49.1% 47.5% 1.5% Screening for Clinical Depression and follow-up Behavioral Health n/a 35.5% n/a n/a 40.4% 37.6% 2.8% n/a 42.0% n/a Data Source: New York State Department of Health = Phase II CSB Outcome Measure = 7/2014 6/2015; = 7/2015 6/2016; MY3 M9 = 7/2016 3/2017 * Excludes outcome measure results for five Palliative Care measures because the data is not available n/a = value is not available 9
PPS Outcome Measure s* by Domain - Chronic Disease Management Measure Name Domain Baseline +/- +/- MY3 M9 s MY3 +/- MY3 Aspirin Use Asthma Medication Ratio (5-64 Years) Controlling High Blood Pressure Medication Management for People with Asthma (5-64 Years) - 50% of Treatment Days Covered Medication Management for People with Asthma (5-64 Years) - 75% of Treatment Days Covered Statin Therapy for Patients with Cardiovascular Disease Received Statin Therapy Statin Therapy for Patients with Cardiovascular Disease Statin Adherence 80% Chronic Disease Management Chronic Disease Management Chronic Disease Management Chronic Disease Management Chronic Disease Management Chronic Disease Management Chronic Disease Management n/a 33.3% n/a n/a 40.9% 36.3% 4.6% n/a 43.1% n/a 56.6% 52.7% 58.5% -5.8% 56.8% 55.0% 1.8% 57.7% 58.7% -1.1% n/a n/a n/a n/a 42.4% n/a n/a n/a 45.5% n/a 58.8% 58.7% 59.8% -1.1% 61.0% 59.7% 1.3% 61.2% 61.7% -0.6% 33.0% 32.4% 34.2% -1.8% 33.9% 33.7% 0.2% 35.5% 35.0% 0.6% n/a n/a n/a n/a 75.5% n/a n/a 77.4% 78.0% -0.6% n/a n/a n/a n/a 58.5% n/a n/a 58.1% 62.6% -4.5% Data Source: New York State Department of Health = Phase II CSB Outcome Measure = 7/2014 6/2015; = 7/2015 6/2016; MY3 M9 = 7/2016 3/2017 * Excludes outcome measure results for five Palliative Care measures because the data is not available n/a = value is not available 10
PPS Outcome Measure s* by Domain - Patient Activation and Health Literacy Measure Name Domain Baseline +/- +/- MY3 M9 s MY3 +/- MY3 C&G CAHPS: Health Literacy Describing How to Follow Instructions C&G CAHPS: Health Literacy Explained What to do if Illness Got Worse C&G CAHPS: Health Literacy Instructions Easy to Understand PAM Score Patient Activation & Health Literacy Patient Activation & Health Literacy Patient Activation & Health Literacy Patient Activation & Health Literacy n/a 77.8% n/a n/a 79.4% 79.0% 0.4% n/a 80.4% n/a n/a 83.1% n/a n/a 89.1% 84.2% 4.9% n/a 89.6% n/a n/a 92.4% n/a n/a 94.1% 93.0% 1.1% n/a 94.6% n/a n/a n/a n/a n/a 0.6% n/a n/a n/a n/a n/a Data Source: New York State Department of Health = Phase II CSB Outcome Measure = 7/2014 6/2015; = 7/2015 6/2016; MY3 M9 = 7/2016 3/2017 * Excludes outcome measure results for five Palliative Care measures because the data is not available n/a = value is not available 11
PPS Outcome Measure s* by Domain - Patient Experience Measure Name C&G CAHPS Measures: Care Coordination with provider up-to-date about care received from other providers C&G CAHPS Measures: Getting Timely Appointments, Care and information (Q6, 8, 10, and 12) CAHPS Health Plan: Discussion of Risks and Benefits of Aspirin Use CAHPS Health Plan: Flu Shots for Adults Ages 18-64 H-CAHPS: Care Transition Metrics (Q23, 24, and 25) CAHPS Health Plan: Medical Assistance with Smoking and Tobacco Use Cessation - Advised to Quit CAHPS Health Plan: Medical Assistance with Smoking and Tobacco Use Cessation - Discussed Cessation Medication CAHPS Health Plan: Medical Assistance with Smoking and Tobacco Use Cessation - Discussed Cessation C&G CAHPS: Primary Care - Length of Relationship - Q3 C&G CAHPS: Primary Care - Usual Source of Care - Q2 Domain Patient Experience Patient Experience Patient Experience Patient Experience Patient Experience Patient Experience Patient Experience Patient Experience Patient Experience Patient Experience Baseline +/- +/- MY3 M9 s MY3 +/- MY3 n/a 77.8% n/a 77.8% 80.3% 79.2% 1.1% n/a 81.5% n/a n/a 78.1% n/a 78.1% 77.2% 79.5% -2.3% n/a 78.7% n/a n/a 42.9% n/a 42.9% 51.2% 45.3% 5.9% n/a 52.8% n/a n/a 40.4% n/a 40.4% 51.5% 42.7% 8.8% n/a 52.7% n/a n/a 90.8% n/a 90.8% 91.2% 91.5% -0.2% n/a 91.8% n/a n/a 82.8% n/a 82.8% 82.2% 84.0% -1.9% n/a 84.2% n/a n/a 66.7% n/a 66.7% 67.5% 68.4% -0.9% n/a 69.2% n/a n/a 62.1% n/a 62.1% 61.5% 63.4% -1.9% n/a 62.9% n/a n/a 73.6% n/a 73.6% 76.4% 74.8% 1.6% n/a 77.2% n/a n/a 85.6% n/a 85.6% 85.6% 86.3% -0.7% n/a 86.3% n/a Data Source: New York State Department of Health = Phase II CSB Outcome Measure = 7/2014 6/2015; = 7/2015 6/2016; MY3 M9 = 7/2016 3/2017 * Excludes outcome measure results for five Palliative Care measures because the data is not available n/a = value is not available 12
Evaluation of the Impact of Improvement on Outcomes Many of the improvement strategies can be measured through process metrics which are incremental steps in driving transformation activities and the PPS success in achieving outcomes Example Improvement Strategy: Implement transitions management interventions for patients identified as being at high risk of readmission Example Process Metric: # of patients referred to transition management teams Readmissions Example Improvement Strategy: Develop linkages to social support services to address actionable risk factors Example Process Metric: # of social services referrals generated and/or received on a social services referral platform Example Improvement Strategy: Deploy ED Care Management team(s) including an RN, licensed social worker, licensed pharmacist and CLW in the emergency department and facilitate integration into emergency department-based processes such as triage and discharge Example Process Metric: # of ED care management teams deployed at each facility Potentially Preventable Emergency Room Visits 13
Conducting Quality Improvement Activities Quality Improvement Consists of systematic and continuous actions that lead to measurable improvement in health care services and the health status of targeted patient groups. https://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/index.html 14
One Quality Improvement Methodology for Engaging in Change: The Model for Improvement A framework to help organize and execute improvement work Tests are small, simple, and reversible Significant opportunity for learning Follow-Up Tests Wide-Scale Tests of Change Implementation of Change Very Small Scale Test Source: The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd Edition). Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP, 2009. Note: This is just one performance improvement methodology; Lean Breakthrough has been frequently used at NYC Health + Hospitals. 15
One Quality Improvement Methodology for Engaging in Change: The Model for Improvement What are we trying to accomplish? Team Aims How will we know that the change is an improvement? Measurement What changes can we make that will result in an improvement? Tests of Change ACT STUDY PLAN DO Source: http://www.ihi.org/resources/pages/howtoimprove/scienceofimprovementhowtoimprove.aspx Note: This is just one performance improvement methodology; Lean Breakthrough has been frequently used at NYC Health + Hospitals. 16
Developing an AIM Statement: A Quick Review of General Guidelines State Aim clearly Describe what needs to be improved Include numerical goals Creates the need for change and directs measurement Set stretch goals, but don t be too ambitious Communicates that maintaining status quo is not an option Be prepared to refocus the Aim if you find it is unrealistic Keep within a manageable scope Focus on a smaller part of issue Be realistic Avoid Aim Drift Make sure you don t slip back on your goals; continue to repeat Aim 17
Establish Measurement Monitoring Determine process and outcomes measures to be used to monitor progress and impact of implementation based on your program design and goals Evaluate potential data sources that can be used to regularly report on measures: Clinical data from the EHR or registries Operational/administrative data Scheduling and billing data Claims data from payers Aggregated data sources (e.g. PSYCKES, ACOs, RHIO) Care management or social service referral platforms Surveys 18
Example: Project Charter focused on Diabetes Screening in Patients with Schizophrenia or Bipolar Disorder What are we trying to accomplish? Increase the percentage of diabetes screening tests to 82%* over the next 6 months for adult patients diagnosed with schizophrenia or bipolar disorder that are dispensed antipsychotic medications. We will accomplish this by: Developing a protocol in one clinic setting to ensure these patients obtain a screening for diabetes at least annually. In-servicing clinicians to obtain necessary information about the protocol to ensure their understanding. Creating outreach strategies to effectively communicate the need to patients that they must come to the clinic to complete the test. How will we know that the change is an improvement? % of diabetes screening tests given to adult patients with schizophrenia or bipolar disorder that are dispensed antipsychotic medications % of providers in-serviced about the screening protocol % of patients contacted to come to the specific clinic setting to complete the diabetes screening test What changes can we make that will result in an improvement? ACT STUDY PLAN DO Source: *eqarr Report 2016 State Medicaid Average for this measure is 82% https://www.health.ny.gov/health_care/managed_care/reports/eqarr/2016/statewide/medicaid/behavioral_health.htm 19
Quality Improvement General Rules for Engagement Form an Interdisciplinary Team Set Aims/What Your Team Hopes to Accomplish Establish Measures* to Determine Improvement Select Tests to Make Changes Keep it Simple Conduct Small Tests of Change Implement Changes on a Larger Scale, with Tweaks, Based on What s Been Learned from the Tests *A note about data collection for measurement in quality improvement How much data is really enough? Measurement for improvement is different from measurement used in research (see next slide) Sources: Institute for Healthcare Improvement (IHI): www.ihi.org World Health Organization (WHO): http://www.who.int/patientsafety/education/curriculum/who_mc_topic-7.pdf?ua=1 20
A Note About Measurement for Research vs. Measurement for Quality Improvement Measurement for Research Measurement for Quality Improvement Purpose To discover new knowledge To bring new knowledge into daily practice Tests One large blind test Many sequential, observable tests Biases Control for as many biases as possible Stabilize the biases from test to test Data Duration Gather as much data as possible, just in case Can take long periods of time to obtain results Gather just enough data to learn and complete another cycle Small tests of significant changes accelerates the rate of improvement Source: World Health Organization (WHO): http://www.who.int/patientsafety/education/curriculum/who_mc_topic-7.pdf?ua=1 21
Experimenting/Testing versus Implementing Experimenting/Testing Implementing Very Small Scale Test Follow-Up Tests Wide-Scale Tests of Change Implementation of Change Changes are not permanent Significant opportunity for learning Does not require universal awareness Supporting processes are required in order to become routine Requires increased awareness Takes longer Requires additional support Must address social aspects Source: The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2 nd Edition). Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP, 2009. 22