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Spread of The Planned Care Initiative at NPN

Spread of The Planned Care Initiative at NPN. Cathy Irby, Mgr QI Initiatives Jean Gambrielle, Mgr Credentialing, Kelly LaRue, RN Shari Peterson, RN Jim Strawn, IT Liana Pence, BA Community Health Improvement Coordinator. Northwest Physicians Network.

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Spread of The Planned Care Initiative at NPN

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  1. Spread of The Planned Care Initiative at NPN Cathy Irby, Mgr QI Initiatives Jean Gambrielle, Mgr Credentialing, Kelly LaRue, RN Shari Peterson, RN Jim Strawn, IT Liana Pence, BA Community Health Improvement Coordinator

  2. Northwest Physicians Network • Independent Physician’s Association with 400+ members. South King and Pierce Counties • Pay claims for Managed care products • PacifiCare Secure Horizons and Commercial • Molina Healthy Options • Savings from these lines of business created the Quality Improvement Dept at NPN in 2001 • Initiatives – Value Add for Providers • Chronic Care Improvement –registries in 20+ offices

  3. NPN QI Staff Grew • Rick MacCornack – Jan. 2001 • Cathy Irby – Sept. 2001; .8 FTE • Jean Gambrielle – Oct. 2003; .2 FTE • Jim Strawn, IT – Oct. 2003; PRN • Kelly LaRue, RN – Dec. 2003; .2 up to .4 FTE • Shari Peterson, RN – Sept. 2005; .2 FTE • Liana Pence – Oct. 2004; PRN

  4. Wilson – 173 1/02 Kennel – 299 2/02 Vance – 135 3/02 Morgan – 121 5/02 Scherbarth – 264 5/02 Samms – 68 9/02 Craddock – 72 9/02 Harris – 21 9/02 Alleman – 131 7/03 Roscetti – 113 7/03 Ziemann – 85 7/03 Millik – 60 3/04 Roes – 145 7/04 Smith – 32 1/05 Lamba – 54 8/05 Dacus – 12 9/05 Fircrest – 163 9/05 Braun – 9 9/05 Lukens – 12 about to install Leverett – new 11/05 Jin – 2003-8/04 Allchin – 95 retired 11/05 Spread - 1,969

  5. Persuasions for Adopting this change • More “control” • Increase job satisfaction • Empowerment • Reduce faxes • Looking forward to the future in different areas. Offering new procedures and tools. • Most important, better care for patients

  6. Independent PCP Personality • Autonomous – The final say in matters, they think. (Staff often control decisions.) • Very protective of what they feel is working. “If it isn’t broken, why fix it.” • Very protective of staff’s time. • Very thoughtful in their decisions. They do not have committees to go to.

  7. Independent PCP Personality • Highly value “control”: money, time and decisions. • Resentful of recent changes. They went to school a long time and they deserve better from insurance, hospitals etc.

  8. Independent PCP Personality • Advice, outside ideas or programs • Even for the right reason (patient care) • With tools they are unsure of (computers and a different kind of work) and • Not reimbursed for, from anywhere besides the government (i.e. mandates) NOT TAKEN WELL.

  9. Value Added • More appointments generated • More control given back to providers and staff • Improve flow of information – reduce faxes • Improved job satisfaction with less turnover • Overall health of patient’s is improved • Less time involved in gathering information

  10. Spread – First Steps in Offices • Build registry with NPN staff • Establish route within the office of the flow sheet • Best place in chart • Filling out of flow sheet • Queries driven by summary reports • Appointments/Planned Visits

  11. Office Changes • Schedule must project at least 6 months ahead to accommodate f/u visits • Not scheduled just as f/u but chronic condition specific. • “Meds by Appointment” • Reduce faxes • Reduce triage phone calls for med refills • Save 2 hours/day +tracking charts down and phone tag • Providers are not the only ones who can have patient appointments

  12. Information Technology (IT) • Computers are just a tool like anything else. • Spirometry, EKG, Scheduling • Individual charts do not give aggregate population based data. • It’s a tool to find who is being missed. • NPN IT staff are not practice’s employee • Standardization vs. customization of forms

  13. Lessons • Focus on simplicity and practicality • Patient Education component • Staff turnover • Staff and or provider running a race without a finish line, no time • Staff meetings and communications

  14. Lessons • Support staff vs Mentor to staff • Outside IT staff is another layer to deal and navigate around – Physician or OM to direct IT for importance of work. • Take time to make time” – If you plan a trip it’s more enjoyable. • Abstracting chart vs. inputting from filled out flow sheet

  15. Patient Education, Preparation and Expectation of Outcome of Appt. • Starts with person making appointments • Specific follow up appointments • 15-30 minute concentrated appt. • Moving away from feeling rushed: provider and patient. • More benefit for both provider and patient from a focused appointment.

  16. Spread • Group Visits – 2003 (3) • TCC students for intermittent data entry • Quest interfaces • Labs NW interface • Join existing or initiate staff meetings • Diabetes classes at NPN targeting different office registries (4)

  17. Goal • 50 PCP registries by 2008 • Begin adding second conditions • Specialists registries • Asthma registries • Offices independent with data entry and using reports and queries

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