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Strategies for Care Improvement Sandra Serrano, RN,MPH

Clinical Affairs Program Manager

Clinical Measures Improvement for Quality

HealthcareSymposium 2013

Embassy Suites Hotel , Isla Verde, Carolina, Puerto Rico23 de mayo de 2013

New

Innovation

Effectively

Efficiently

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High Quality of Care is safe, effective, patient-centered, timely, efficient and equitable. IOM, 2000

+Primary and Preventive Care Clinics in the Center

Other Clinical services

Other enabling services for support patient & families in their care

Preventive Care Activities In the Center In the Community

Our efforts to improve the care of the patient and family must be framed within the definition of primary and preventive care. To meet the mission of the Center and to do the improvement of care quality a comprehensive program.

+Primary Care Primary care is that care provided by physicians specifically trained for

and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern (the "undifferentiated" patient) not limited by problem origin (biological, behavioral, or social), organ system, or diagnosis.

Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings (e.g., office, inpatient, critical care, long-term care, home care, day care, etc.). Primary care is performed and managed by a personal physician often collaborating with other health professionals, and utilizing consultation or referral as appropriate.

Primary care provides patient advocacy in the health care system to accomplish cost-effective care by coordination of health care services. Primary care promotes effective communication with patients and encourages the role of the patient as a partner in health care.

http://www.aafp.org/online/en/home/policy/policies/p/primarycare.htmlAmerican Academy of Family Physicians (AAFP)

+ Strategies for Improve the Service at Clinics

Redesigning the waiting areas to make them more comfortable and private Children's areas Mothers w/ babies Elderly patients areas Pregnant woman areas aids and facilities for people with physical disabilities, not just what ADA Law

requires Waiting rooms appropriate for persons w/ substance abuse problems

To ensure that the patient has a waiting time with minimum inconvenience, and that motivates not to be away from next appointment (excessive noises, too cold or heat, availability of water for drinking and clean bathrooms, etc. )

Use the technology of the Electronic Health Record (EHR) for send reminders: by email, by text message for medical appointments, laboratory appointments, appointments for procedures and others.

Or sent by traditional mail

Review and update medical management guidelines with all PCP, meetings for discussion of clinical cases and keep up to date.

+Strategies for Improve the

Service at Clinics Use the EHR technology for prepared reports of absenteeism percent to

appointments

Establish a procedure in clinics for call patients in an specific timeframe after the non-attendance and to know the reason. (the next day, within 48 hours, etc.). This is an Standing Operating Procedure (SOP).

Move towards the integration of physical health and mental health / placing health educators and behavior practitioners in clinics together with other providers (PCP). Not in separate clinics or areas , except if there is a high volume of patients.

Have trained staff in clinics to coordinate services and referrals to other facilities at the center or outside the center (studies, specialists, specialized testing, home services, food, etc..)

Nurses Case Managers Clerical Staff Computers and telephones facilities, Internet available, capacity to

produce reports the same day from the system for support the need of care of the patient and families (PCMH)

+Strategies for Improve Care in Specific Population of Patients

Establish short sessions of health education to create awareness on various aspects of the prenatal care

Call woman’s before the appointment (clinics establish the timeframe to call)

make appointments in the morning and afternoon as patient preference

accommodate the number of patients per hr. according the capacity of physicians and examination rooms available, to reduce waiting time and patient discomfort

develop a formal educational program w/ issues related to prenatal care, development of pregnancy, childbirth and related issues, and separate the women who are in their first pregnancy of which are in the second or more pregnancy.

Use the EHR for sent reminders to patients and caregivers of patients

Use any type of visit for review the immunization status / Elderly patients needs vaccines!

Use any type of clinic visit to ask, offer and administer vaccines

Be patient and responsive to listening to the patient and speak slowly to give instructions

When coordinate appointments take into account the availability of the caregiver and the source of transportation of the patient

Bring assistance with transportation services from home to the clinic

Pregnant Woman's Elderly Patients

+Strategies for Improve the Immunization rates in Adolescents

Use electronic health record for sent reminders to patients and parent’s by email, text messages to cell phones (adolescents loves cell phones!)

Use electronic health record (EHR) for sent reminders to provider

Use any type of visit to review the immunization status (on electronic or paper record)

Use any type of visit to clinic for ask, offer and administer vaccines

Establish Standing Order Procedures (SOP) and Standing Orders (SO) for Nurses in Clinics

Promote the immunization at schools

Update the OB-GYN’s providers attending adolescents patients in their clinics in immunization schedules

Provide education across the organization programs for all patients

Allocate more nurses in clinics

Allocate more clerical staff for maximize the capacity of the Immunization Registry (PRIR ) System

Maintain available spaces in the day for received patients from other clinical service at the Center , No previous appointment require

+Strategies for Improved the Cervical Cancer Screening

Develop strong educational programs to inform about the importance of Pap Test across the Center clinics and services

Motivate womans with fashion and beauty promotions ( nail color free, free blower, scent candle gift , etc.)

Use any type visit for review the Pap Test Result at the record YES or NO

Use the visit to clinic for ask, offer and TAKE the Pap Test

Establish Standing Operating Procedures (SOP) and Standing Orders (SO) for Nurses in Clinics

Re-Train all providers in the procedure of taking the Pap Test Smear ( Doctors and Nurses)

Allocate more examination rooms equipped and comfortable for woman's

Sent reminders to woman's by Email, Text messages or traditional mail.

+Strategies for Improve the

Service at Clinics

Show interest and compassion for the patient experiences , it will help the patient and family decide to return to the appointment and follow their treatment

Redesign appointment programs, providing opportunities for same-day appointments in the morning and afternoon.

Offer full explanations, detailed and clear. And ask if understood.Say if a question arises in home he or she can call the Center (give the correct phone number and that some who will respond)

+Strategies for Improve the

Service at Clinics

Offer the patient an option to coordinate the referral appointment with a specialist or a specialized study, to ensure that attend and follow up.If you give the papers without an explanation, they all bring into the wallets, purses, drawers

and forgotten.

Take at moment of evaluate the patient, their entire medical record with the documents that the provider will evaluate and discuss with the patient: laboratory, results of studies, consultations of specialists, among others.

+Strategies for Improve the

Service at Clinics

Reduce disruptions to Primary Care Provider (PCP) (telephone calls, speaker, noise, in and out of staff).

Having educational materials many according to the level of literacy and understanding of the patient.

attractive, colorful and good quality, our patients deserve the best

More exam roomsEnough nursing staffIf you are using the electronic record, you must have a trained and qualified personnel in this technology, and equipment robust in its operations

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Tobacco Free Living

Preventing Drug Abuse and Excessive Alcohol Use

Healthy Eating

Active Living

Injury and Violence Free living

Reproductive and Sexual Health

Mental and Emotional Well-Being

The National Prevention Strategy

June 16,2011

The Seven Priorities

In 2005, 133 million Americans – almost one in two adults – had at least one chronic illness. Furthermore, injuries are the leading cause of death among infants, youth, and young adults. Most of these early deaths can be avoided, adding extra years of productivity and enjoyment for millions of people.

+Preventive Care is an important part of the Primary Care for all persons in the Community

Increase physician education about current preventive care and screening guidelines

Consider every visit an opportunity for prevention

Move away from annual physical exam visits to revolving health screening visits. Rather than going head to toe in one hour once a year, seasonal visits give you more opportunities to make timely interventions.

Increase patient education. Physicians can counter patient misinformation and education deficits with appropriate patient information in the form of handouts, even videos, that explain the importance of certain screenings and when they are recommended. www.aafp.org

American Academy of Family Physicians

+ Improve your reminder systems. Reminder postcards, chart

alerts and waiting-room posters are just a few ideas that may help. A computerized system that automatically generates reminders would be ideal.

Utilize nonphysician staff. Your staff can help you boost your preventive screening rates by encouraging or initiating screenings. Empower them to do so.

Consider group delivery of screening/intervention. For example, you could assign every Wednesday in October and November as flu shot day. It's efficient for your office and easy for patients.

Offer your patients incentives, perhaps even cost reductions, for staying current on preventive screenings. The incentives could be anything from a free flu shot to a “buy one, get one free” coupon from your local coffee shop. In other words, be creative.

www.aafp.orgAmerican Academy of Family Physicians

Creative

Innovations

Systematic Evaluation

Document information

Consistent

+You know your Doctor?

+References:

American Academy of Family Physicians – www.aafp.org

SAMHSA – www.samhsa.gov

Institute of Medicine – www.iom.edu

Institute of Health Improvement – www.IHI.org

HRSA – www.hrsa.gov

Health Care Communities – www.healthcarecommunities.org