Enhancing The Intersection Between Production and Promoting Quality Improvement: Focus on Quality Nina Brown, MPH, CHES National Health Care for the Homeless Council Regional Training Regional Meeting: Albuquerque, New Mexico November 11, 2011 Public Health Analyst, Office of Quality and Data U.S. DHHS/HRSA/BPHC 1
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Enhancing The Intersection Between Production and Promoting Quality
Improvement: Focus on Quality
Nina Brown, MPH, CHES National Health Care for the Homeless Council Regional Training Regional Meeting: Albuquerque, New Mexico November 11, 2011 Public Health Analyst, Office of Quality and Data U.S. DHHS/HRSA/BPHC
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Learning Objectives
At the end of this presentation participants will be able to:
1. Understand the role of quality within healthcare delivery system reform;
2. Understand the importance of using data in Quality Improvement efforts;
3. Locate data within EHB and the HRSA website to assist in Quality Improvement activities;
4. Be able to access and utilize BPHC’s Quality Improvement resources.
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HCH Grantee Patients - 2010
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Health Center Snapshot
No. of Patients
Patients 805,064 Male Patients
56%
Female Patients
44%
Age <= 19
16%
Age 20-64 81%
Age 65 and Over 3%
HCH Grantee Patients - 2010
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Hispanic 21%
Asian 2%
American Indian/Alaskan
Native 1%
Black/African American
31%
Native Hawaiian/Other Pacific Islander
1%
White 41%
More Than One
Race 3%
HCH Grantee Patients - 2010
5
79%
5% 2%
1%
13%
100% and Below 101%-150% 151%-200% Over 200% Unknown
Health Care Delivery System Reform
• Current system lacks a single entry point • Affordable Care Act
– Allows Health Care to move towards a patient-centered, clinically integrated, accountable system.
– Modernization of Health Information Technology (HIT) – Development of new patient care models
o ACOs – Strengthen Quality Infrastructure
o National Quality Strategy – Supportive services delivered at home and in the
community
6 Source: The Heller School for Social Policy and Management. Foundations and Healthcare Reform 2010 Policy Brief. July 14, 2010
QI Critical for Delivery System Redesign
• IOM’s top challenges for delivery system redesign: – Use of performance measures/outcomes for
continuous quality improvement and accountability • What is quality health care?
• Data collected depends on expectations of 3rd parties • Process vs. performance: Measure should reflect 3 things:
– WHAT you do – HOW you do it – HOW EFFECTIVE you are
• Include measures that you Aspire to achieve. • Challenges
– Ease and access of use – EHR Levels differ – Free Text
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Using Data is a Team Effort!
• Staff on the floor are part of the process. They need to understand the process. – Aligned process that ties into your strategic plan
• Involve your Medical Director – Critical in gaining understanding of data and system
level performance Picture: 3 individuals holding hands united
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Using Your Data
• Start with the end in mind – Collect it ONCE and use it MANY times – Try using data that are shared and accessed easily – Data need to be structured the same way – Weekly, quarterly pull of data if possible
• Linking data – Ex. Meaningful Use data are standardized, but the data
entry isn’t… Training of staff
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Using Your Data
• Align – How to prevent failure – Identify the failure – Bring into balance
• Balanced Measures – Strategic plan… Align measures – Plan Do Study Act (PDSA) – Scorecards: Determining who’s responsible for what
measure
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Using Your Data
• Measure the process to drill down to the outcome • Achieve your goals
– Through processes and structure using root cause analysis (contributing and restricting factors)
• Case studies help! – Select 20 patients & the data points that stand out – Stories personalize the data
• Utilize your consumer board members to help you know if the process is working.
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Data Sources for Quality Improvement
• Public site for UDS data: http://bphc.hrsa.gov/healthcenterdatastatistics/index.html
• HRSA Data Warehouse: http://datawarehouse.hrsa.gov/
• Reports Available in EHB – Health Center Trend Report (National/State/Grantee) – Health Center Summary Report (National/State/Grantee) – Performance Profile (National/State) -- Number &
Percent of Health Centers
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EHB Reports
• This graphic highlights the EHB home page and directs participants to the area they can access reports within EHB. It is denoted by a red circle
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UDS Health Center Performance Comparison Report
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• This graphic shows the report that grantees can access within EHB. The report shows the specific grantee and how their clinical performance compares to their state and national. It also shows comparison amongst grantees of different sizes and special populations.
UDS Health Center Performance Comparison Report
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• This is a continuation of the previous report. It highlights how the grantee compares on costs to their state and national. It also shows comparison amongst grantees of different sizes and special populations.
UDS Health Center Performance Comparison Report
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• This is a continuation of the previous report. It highlights how the grantee compares on costs to their state and national. It also shows comparison amongst grantees of different sizes and special populations.
UDS Health Center Trend Report
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• This is an EHB report that shows the three year trend for the specific grantee on key performance measures.
Plan Your Quality Intervention
• Establish project-specific QI team that represents all staff integral to the service or issue
• Utilize QI tools and techniques to understand the problem that you are facing – Flow charts, root cause analysis, cause and effect
diagrams, facilitated brainstorming
• Identify potential solutions to make improvement to the systems of care, both short and long term
• Develop timeline for reporting findings and improvement strategies
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Evaluation of the Intervention
• Document and track progress in activity logs, workplans, meeting minutes
• If historical data are available, trend analysis • Display and distribute data to communicate
findings and results. – Plan to inform CQI committee and staff of results – Graphic presentation of data readings over time
• Report progress to the rest of the organization on a regular basis
• Celebrate and share beyond your four walls
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HIT and Quality
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Role of HIT in QI
• Neither necessary nor sufficient, but can really make QI a lot easier
• Can’t just use EHRs like paper charts – Interoperability and standard terminology
and codes • Consensus-based quality measures: e-
specification • HIT adoption: what is needed for MU? • UDS and Patient Experience
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Key Features of EHR for QI
• Population management/registries • Clinical quality dashboards • Decision support • Integration with other clinical record systems (lab, oral, BH) • Health Information Exchange, e-prescribing • Patient self-management support • Enhanced access and communication with patients • Reporting quality measures
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Benefits of HIT
• Provider-to-provider communication • Safety enhancements: drug interactions, handwriting
foibles • Better prepared providers, with the right information
and evidence-based practice guidelines or clinical protocols
• Family and personal health history collected and used
• Information on the whole person: what about oral and behavioral health?
• Patient encounters with providers can be more productive
• Goal: 100% of Health Centers strive to receive national quality recognition, starting with 25 percent of grantees by 2013
• Where are we? – Accreditation (~25%) – Patient Centered Medical Home Recognition (16
grantees representing 46 sites) o Enhance access & continuity o Track and coordinate care o Identify and manage patient populations o Provide self care support & community resources o Track and coordinate care
• A complete initial or redeeming application must include:
1. An Application Form completed in EHB 2. An approved Quality Improvement/Quality
Assurance Plan, including governing board signature and approval date
3. Summary of professional liability history for cases filed or closed within the last 5 years, if applicable
v Name of provider(s) involved v Area of practice/Specialty v Date of Occurrence v Summary of allegations v Status and outcome of claim
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Additional Application Requirements (continued)
4. Explanation of any “NO” responses 5. Deeming applications for any sub-recipients (as
documented on the organization’s most recent approved scope from FORM 5B - see “sub-recipient submission instructions.”)
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Additional Application Requirements (continued)
6. Credentialing list (in an excel spreadsheet) of all licensed and/or certified health care personnel employed and/or contracted by the health center, with the following information: o Name & Professional Designation (e.g., MD/DO, RN, CNM,
DDS) o Title/Position o Specialty o Employment Status (full-time employee, part-time
employee, contractor, volunteer) o Date of Hire o Initial Credentialing Date (the first time the individual was
credentialed by your organization) o Most Recent Credentialing Date o Next Expected Credentialing Date
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Health Information Technology
• Health Information Technology – Coordinating adoption, meaningful use, health info
exchange – Health Center Controlled Networks
o 3 or more health centers o Increased buying power o Collaboration to improve access to care, enhance quality
of care, and achieve cost efficiencies. – Supplemental funding for health centers in Beacon
communities o Part of the HITECH Act o Comprised of different health care systems, clinicians,
payers, employers, patient advocates, and IT leaders
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Adoption and Meaningful Use of HIT
• Goal: 100% of Health Centers meaningfully use a certified EHR system – 50.7% report having EHR in use at all sites for all providers, and
14.1% report having EHR in use at some sites or for some providers.
• Where are we? – Baseline data collection – EHR questions in UDS, HCs participating
in HCCNs – Other data sources – REC program, GW/NACHC Survey, NAMCS
survey
• Strategy – Support for and TA from HCCNs/PCAs/NACHC.
• Partnerships/Collaborations – CMS EHR Incentive Program – ONC REC Program, State HIE Program, Beacon Communities,
Community College Program 54
Other Focus Areas
• Patient experience measurement • The role of mental health and substance abuse
services in the medical home – SAMHSA/HRSA Center for Integrated Health Solutions
• Integration with local health care, public health, and social services landscape
• Telehealth • National priorities: tobacco, healthy weight, HIV,
oral health • Supporting Affordable Care Act implementation
and delivery system reform 55
Conclusion
• Focus on quality • Support for planning and implementation of
Quality Improvement strategies – QI Plan Learning Series – Further guidance – Resources and technical assistance – Third-party quality recognition
• Invest in your QI infrastructure – Clinical quality and beyond
• Effectively use your data to achieve your goals • Focus on implementation
– This work never ends 56
Resources
• Technical assistance through HRSA, NCAs • Third-party quality recognition