Date post: | 12-Jun-2015 |
Category: |
Health & Medicine |
Upload: | group-health-cooperative |
View: | 561 times |
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David K. McCulloch, MD, FRCP Medical Director, Clinical Improvement, and Diabetologist, Group Health PhysiciansClinical Professor of Medicine, University of Washington
Best Practices in Hypertension and Hyperlipidemia
General principles for quality improvement
• The effectiveness of any intervention is dependent on the
baseline risk, so identify those at highest risk and target them.
• Embed evidence-based interventions into routine standard work
so that doing the right care is easy.
• Develop robust tracking systems for both process measures and
outcome measures, make the data transparent, expect constant
improvement, and help develop countermeasures when targets
are not being met.
Cascade Dashboard
Philosophy of Patient Centered Care
Opportunistic Care Outreach
Feedback
Provider andTeam Strategies
• Post Bday Letter outreach• Case Management• CNS outreach
Provider IndexIncentive CompMissed Opportunities Report
Patient ActivationStrategies
• Birthday Letters• Interactive Voice Recognition• My Group Health• Health Profile• Health Coaching• HPD letters: Mam/Pap, Fx f/u
Provider andTeam Strategies: GPD
• Health Maintenance • Planned Care Exception Report• MHM Visit Prep
Contracted Provider Engagement/Interventions(Clinical Integration Model)•Relationship Management•Pay for Performance (P4P•Reporting•QI Consultation
Patient Activation • HM based Patient Handout• After Visit Summary
How do we track how we are doing?
• We use HEDIS measures plus ACE-inhibitor and Statin usage.
• Using LEAN we have developed standard work in primary care
teams.
Tier 1: Individual primary care provider
Tier 2: Each primary care clinic
Tier 3: Primary care overall
Tier 4: GPD overall
Tier 5: GH overall
The Number Needed to Achieve Target (NNAT)
• At the start of every year we get new enrollment and lose some
previous enrollees. Using HEDIS definitions we identify how many
“gaps in care” each of our members has (not just in hypertension
and lipids but in all HEDIS areas of prevention and treatment).
• Some enrollees have no gaps, others might have 1 or many more
than that. We set our targets for each of the 40+ measures to be
above the 90th percentile in the nation. The overall NNAT is the
number of “gaps” that need to be closed to achieve those targets.
• We challenge ourselves to be able to close at least 50% of that gap
during the upcoming year.
Tier 5 rollup of HEDIS prevention measures
Tier 3 time trend within primary care
Tier 3 time trend within primary care
Tier 3 time trend within primary care
Tier 3 time trend within primary care
Tier 1: Individual providers can track their own performance over time
Diabetic patients with BP<140/90
Initiative in Q4 to focus on BP management
This shows how many of his/her patients are >140/90
Individual providers can sort their own panel of patients to identify patients who need attention
Sorted by those patients with diabetes who BP is >140/90
Each row shows an individual patient with ALL of his/her unmet “gaps”
THANK YOU