UNIVERSITY OF MISSOURI Family & Community Medicine It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement Conference.

UNIVERSITY OF MISSOURI

Family & Community Medicine

It Takes a Village to Change a Process:

A Health Systems Approach toPractice Improvement

Conference on Practice ImprovementSaturday, December 4

4:10-5:10 pm

UNIVERSITY OF MISSOURIFamily & Community Medicine

Presenting Today:

Karl Kochendorfer, MD

•Assistant Professor of Clinical Family and Community Medicine

•Director of Clinical Informatics

•Adjunct Faculty, MU Informatics Institute

•Medical School: University of Illinois at Chicago

•Residency: University of Illinois at Chicago


Presenting Today:

Phil Vinyard, MHA, MBA, MDiv

•Practice Manager, Green Meadows Family Medicine Clinic, Woodrail Family Medicine Clinic, Fayette Family Medicine Clinic

•Graduate School: University of Missouri (MHA, MBA); Gordon-Conwell Theological Seminary (MDiv)


Presenting Today:

Jan Gace, LPN

•Phone & Floor Nurse, Green Meadows Family Medicine Clinic

•Nursing School: Columbia Public School of Practical Nursing


A Little About Us: Mizzou!


A Little About Us: MU Health Care


A Little About Us:Family & Community Medicine

•6 Family Medicine Clinics•100,000 Visits•46 Physicians•10 Other Providers•10 Research Faculty•2 Fellows•36 Residents•110 Nurses, Clerical Support & Management


The Reason for Our Project:The Burden of Diabetes & Other Chronic Disease

•Half of all Americans have at least one chronic disease

•Of those with chronic disease, over 50% have multiple conditions

•Chronic disease causes 70% of all deaths


The Reason for Our Project:The Burden of Diabetes & Other Chronic Disease

•Chronic disease causes 75% of health expenditures

•1/5 of health dollars are spent on patients with diabetes

•Only 50% of recommended care is delivered to diabetics


A Solution: Leverage EMR Information

•Tiger Institute for Health Innovation: Living Lab

•F&CM as early adopters of the EMR

•Incentives available for Meaningful Use


Solution: Diabetes Summary Screen


DM Quality Measures


Concept of Perfect Care

Healthcare IT News. 9/2008


The Math of Perfect Care

• 3 Measures = 1/23 or 1 of 8 qualify

• 8 Measures = 1/28 or 1 of 256 qualify

~32x harder


Quality Measures Implemented

• Information about DM Quality Measure screens discussed at Faculty meetings

• Physicians encouraged to check DM Summaries on patients and take action

• The results…


Rampant Indifference


Minimal Improvement after 1 Year

Clinics with Care Coordinators:• 2 FM Clinics between 10-15%• 2 FM Clinics between 5-10%

Clinics without Care Coordinators:• 4 FM Clinics close to 0%• 2 IM Clinics close to 0%


It Takes a Village to Change a Process:

A Health Systems Approach to Practice Improvement


Our Village: Performance Improvement-Leadership Development Program

•Strategically develop and deploy performance improvement knowledge, skills and competencies of current and emerging clinical and non-clinical leaders throughout UMHC.

•Strengthen the UMHC performance improvement organizational culture.

• Improve UMHC's ability to provide high quality and safe patient care in a patient centered and cost effective manner.

http://healthcare.missouri.edu/index.html


PI-LDP Program Design

•Performance Improvement Capacity Building

•Learning by Doing

•Performance Improvement Organizational Culture Building

http://healthcare.missouri.edu/index.html


PI-LDP Program Design


Members of Our Team and our Advisors

Team:• Karl Kochendorfer, MD (Director of Clinical Informatics)• Phil Vinyard, MHA, MBA (Practice Manager)• Donna Neal, RN (Nurse Manager)• Rhonda Polly, APRN (Chronic Care Nurse)• Jan Gace, LPN (Phone & Floor Nurse)

Advisors:• Carl Hooker, MHA (Finance)• Tim Hogan, PhD (F&CM Department QI Officer)


Aim Statement

The Family Medicine Green Team will increase the percentage of our diabetic patients with perfect care from 10% to no less than 50% by June 30, 2010. This will be accomplished by using a multidisciplinary approach, process change, education and utilization of eight quality measures.


Fishbone Diagram


Fishbone Diagram: Computer


Fishbone Diagram: Culture


Fishbone Diagram: Resources


Fishbone Diagram: Medical Practice


Fishbone Diagram: Patients


Fishbone Diagram: Staff


Driver Diagram


Interventions Considered

• Opportunistic Approach

• Proactive Approach

• Patient Engagement Approach


Opportunistic Approach

Every time a patient with diabetes comes for a clinic visit, review their quality measures and take action

Process Flow Chart



Proactive Approach

“Run the list” of diabetic patients and pro-actively contact them about missing items.


Run the List: By Patient


Run the List: By Category


A Train Wreck…


A Train Wreck…


Correcting Primary Provider


Patient Engagement Approach

Educate the patients about the types of services they should be receiving.


Patient Letter


Patient Letter


Patient Letter


Automated emails w/ graph


Outcomes!


Outcomes to Date

Decided to focus on diabetes quality indicators as a practice improvement project

Completed workflow process and began piloting and training for our intervention


Lessons Learned

• Having data doesn’t mean improvement• Integrate the data into your workflow• Training needs

Learning how to use the reporting tools Documentation, e.g. eye and foot exams

• Team effort (e.g. buy-in, resources, meetings)

• Physician engagement • Automate, Automate, Automate


Future Steps

• Re-establish new target• Add incentive payments• Integrate PDSA

Continue Ninja Group Meetings Improve “Proactive” approach Improve “Patient Engagement” approach Expand to other Family Medicine & Internal Medicine

Clinics Assist our physicians with their Board Certifications


Questions?

Karl Kochendorfer, MD [email protected]

Phil Vinyard, MHA, MBA [email protected]

Jan Gace, LPN [email protected]

Rhonda Polly, APRN [email protected]

Donna Neal, RN [email protected]

mailto:[email protected]






UNIVERSITY OF MISSOURI Family & Community Medicine It Takes a Village to Change a Process: A Health Systems Approach to Practice Improvement Conference.

Documents

family medicine clinics

university of missouri

family medicine green

university of illinois

chicago slide

practice improvement

pm slide

harder slide