Sponsored by the Sponsored by the National Association of Community Health Centers National Association of Community Health Centers Presented By Shoreline Health Solutions, LLC Presented By Shoreline Health Solutions, LLC Trudy Brown Ripin, MPH Trudy Brown Ripin, MPH President & Founder President & Founder Molly K. Gwisc, MPH Molly K. Gwisc, MPH Associate Associate Implementing Quality Improvement Implementing Quality Improvement Activities Activities at Your Community Health Center at Your Community Health Center
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Sponsored by the Sponsored by the National Association of Community Health CentersNational Association of Community Health Centers
Presented By Shoreline Health Solutions, LLCPresented By Shoreline Health Solutions, LLC
Trudy Brown Ripin, MPHTrudy Brown Ripin, MPH President & FounderPresident & FounderMolly K. Gwisc, MPHMolly K. Gwisc, MPH AssociateAssociate
Implementing Quality Improvement Activities Implementing Quality Improvement Activities at Your Community Health Centerat Your Community Health Center
Components of PI ProgramProactive / preventative
strategiesBefore something goes wrong
Peer Review Chart Completeness High Risk Procedures Patient Satisfaction
Peer Review GoalsAnswer Specific Clinical Quality Questions
How well do we handle acute visits for otitis media?
Are we addressing substance abuse and mental health needs in the context of routine clinical visits?
Are we providing HIV counseling for patients on birth control?
Compare Quality Indicators to External / Internal Data
National or State benchmarks compare our care with other CHCs
Internal historical data evaluates changes over time
Peer Review Implementation• Providers Review Random Sampling of Each
Other’s Charts
• Peer Review Cycles Done Quarterly or Monthly
• Definition of Peer
• Standardized Audit Tool
• For each chart, each question is compliant, deficient, or not applicable
• General vs. Topic-Specific Audits
• Selecting Audit Criteria www.guidelines.gov
• Audit of Individual Visit, Past Year, Full Chart
How to Use Your DataAnalyze Individual Trends
Measure Individual Provider Performance Over Time
Compare Individual Results to Aggregate Data
Analyze Clinical Practice Trends Are We Meeting Basic Quality Goals?
How Are We Doing Compared with Last Year?
Are We In Line With National Goals?
Educate Provider Staff What Level Of Quality Can Realistically Be Achieved?
What Specific Areas Of Care Can I Improve?
Peer Review Data Response• Individual Patient Follow-Up
• Provider Performance Review Develop Provider-Specific Action Plan if Appropriate
• Quality-Related Systems Changes Develop Systems-Level Quality Improvement Activities if Appropriate
Chart Completeness Audits
Protects patient safety
Provides continuity of care
Measures accuracy, completeness, and legibility of medical records
Uses standardized tool
Sample Chart Completeness Questions
Is there an up to date problem list in the chart? Is there an up to date medication list in the chart?Are flow sheets current?Are any lab reports up to date, initialed and dated? Are all immunizations documented?Does each form have the patient’s name on it? Is there a signed consent to treat in the chart?Are all entries signed?Are drug allergies conspicuously documented?
Set goal for number of charts to review each audit
Can be done by non-clinical staff
Need immediate and systems-level response
High Risk Procedure Audits
• Definition of high-risk procedure
Risk of serious complications
Examples include perforation & infection
Benefits of high-risk procedure audits
Identifies individual concerns
Identifies systemic concerns
High Risk Procedure AuditsAudit questions may include:
Was there excessive bleeding?
Was there an infection?
Was there perforation?
Was appropriate follow up conducted and
documented?
Informed Consent for High Risk Procedure Audits
All Patients Should Sign Before High Risk Procedure
Understand Benefits & Risks
Be Informed Of Alternatives
Good Clinical Care
Liability Protection/ Risk Management
Patient SatisfactionWhy is Patient Satisfaction Important?
Customer Satisfaction
Measures Patient Care Quality
Demonstrates Commitment To Quality Care
Patient Satisfaction SurveyCulturally, linguistically, and reading-level appropriate
Typically annually
Results aggregated overall and by service / site
Present results to leadership and Board
Initiate PI projects to address most significant issues
Provide feedback to patients
Survey Topic AreasEnsure representative sample Maintain patient confidentialityTopic Areas Include:
Appointments (Phone hold time; Same-day for urgent needs; Provider of Choice / PCP)
Staff (Courteous, helpful, and respectful; Ability to communicate well; Confidentiality and privacy)
Facilities (Clean and comfortable; Feeling of safety inside and outside; Clear signage)
Wait Time (Waiting room, exam room, check-out area; Information provided about wait time or if delays expected)
Other Patient Satisfaction StrategiesPatient suggestion/comment box
Staff training on de-escalation techniques
Ongoing consumer feedback – “How are we doing?” cards Patient focus groups
Board consumer member leadership
Patient complaint response and tracking systems
Patient Complaints
Patient Complaint Response Program
Document the complaint Standardized complaint form Who can complete form When to complete form, “when in doubt, fill it out” Where to place the completed form
Immediately rectify problem Urgent medical need Dirty rest room Feedback to staff Feedback to patient
Patient Complaint Response ProgramReview handling of individual complaint
Handled with respect, efficiently, and effectively Patient seems to feel better Proper documentation Appropriate follow-up
