MaineHealth Clinical Integration Annual Reports FY2008 Evaluation (October 2007 – September 2008)

1. MaineHealth Clinical Integration Annual Reports FY2008 Evaluation (October 2007 – September 2008)

2. AMI/PCI Improvement • Goals / Aims • Individuals who experience an ST-Elevation Myocardial Infarction (STEMI) in the MaineHealth community will receive the highest quality of care and achieve the best possible outcomes, regardless of their point of entry into the system. • Outcomes • Increased the percent of patients that received timely diagnosis and treatment. • All hospitals are following best practice guidelines from the ACC/AHA. • Activities • Analyzed and trended hospital-specific data quarterly and fed back to respective hospitals • Updated and customized treatment tools. • Built new relationships with EMS providers. • Lessons Learned / Next Steps • Using EMS providers as an extension of the ED improves STEMI patient care. • Prompt feedback to hospital providers encourages continuous quality improvement.

3. AH! Asthma Health • Goals / Aims • Improve asthma diagnosis and increase asthma self-management education • Support and train providers in quality care • Reduce hospitalizations and emergency visits • Outcomes • Patients receiving asthma education increased 20% • ACT utilization increased by 7% • MMC admissions decreased 23.8% to 0%; ED visits decreased 22.2 to 4.6% in 6 mo. post education • Pediatric patients receiving complete care increased from 30 – 49% • Activities • Update, redesign and distribute Asthma Clinical Guidelines flipchart; revise provider and patient tools based on new clinical guidelines • Encourage automatic asthma education referral • Encourage assessment of asthma control • Create & select provider & patient COPD tools; distribute on MH, PHO and JS McCarthy websites • Lessons Learned / Next Steps • Support development of AH! Program at Stephens and Waldo County • Obesity in AH! Program patients is high; collaborate with healthy weight initiatives • Collaborate with statewide COPD partners; Healthy Homes partners for asthma environmental intervention

4. Cardiovascular Health • Goals / Aims • Reduce the burden of CVD in Maine • Contribute to the continuing enhancement of CVH care delivery design and support healthcare team education • Outcomes • Successful completion of Healthy Living Club; membership was 389 at closure, 49% above goal • Distribution of over 22,356 patient education materials in 2008; 17,000 were CVD Patient + Family Ed booklets • Lessons Learned / Next Steps • Healthy Living Club well-received; model needs to be modified for sustainability and cost reduction • Cardiac Rehab data collection challenge due to lack of clinician time/support • Focus on collaborative projects related to cross-cutting topics of primary prevention + back-to-basics • Activities • Healthy Living Club ~ innovative employee health improvement pilot • Development of materials and services for patients and providers • Cardiac Rehab Sub-Committee

5. ED Psychiatric Care • Goals / Aims • Improve quality of psychiatric patient care in all MaineHealth EDs. • Standardize care of psychiatric patients across all MaineHealth EDs. • Outcomes • Reduction in orders for unnecessary labwork. • Standardization of medications used to treat agitated patients. • Activities • Developed Medical Clearance Protocol for IP transfers • Developed Treatment of the Agitated Pt • Lessons Learned / Next Steps • Measuring incidents of restraint • Working to lower length of stay

6. Heart Failure • Goals / Aims • Sustain support for high quality HF care within acute care facilities • Expand program to outpatient management of HF patients • Standardized approach to HF care • Outcomes • Rate of discharge instructions  from 70.8% in 2007 to 86.3% in 3Q08 • Workgroup endorsement of Home Health Clinical Pathway for HF Care • 932 scales distributed to pts. since 2002 • Lessons Learned / Next Steps • Strengthen patient-centered care by focusing on outcome measures (e.g. readmission rates) and outpatient services • Collaboration across the care continuum, senior level support and workgroup composition is critical to program success • Innovative provider + pt. offerings, i.e. home health nurse ed modules • Activities • Creation of Home Health Clinical Pathway for HF Care • Develop + support materials/ programs for patients: Weigh Every Day Scales Program, Healing Hearts Newsletter • Collect + assess data to act on areas in need of improvement ~ focus on discharge instructions in ’08

7. Infection Prevention • Goals / Aims • Develop hand hygiene improvement plan • Establish statewide infection prevention and control consortium • Outcomes • Hand Hygiene plan, tools, protocols developed • Statewide infection prevention group established • Activities • Engaged every hospital in S. ME in hand hygiene efforts • Worked with Maine Quality Forum to develop strategy to inform Maine Legislature • Lessons Learned / Next Steps • Clearly agreed-upon, effective process is vital • Begin gathering hand hygiene data systematically • Employ PDSA cycles to apply hand hygiene data to quality improvement

8. MaineHealth Learning Community • Goals / Aims • To support primary care practices in making improvements in care and outcomes for the patients and families they serve. • Outcomes • % of MPHO Members Reached: 64% • Overall Satisfaction Results:* 92% • * Participants who completed the evaluation that agreed or strongly agreed with the overall quality of the program. • Activities • Practice Improvements Series Mtgs. (PRISM) • Regional Improvement Mtgs. (RIM) • Practice Networking • Quarterly E-News Letters • Lessons Learned / Next Steps • High demand, satisfaction and demonstrated growth • Obsolete operational processes in place • Single prong delivery method • Expand beyond traditional approach • Invest in new technology to increase efficiencies and better serve our customer

9. Primary Care Mental Health - Depression • Goals / Aims • Improve care for patients with depression cared for by PCPs by: • Screening adults at risk for depression • Improving PCP knowledge and skills in depression care • Outcomes • PCPs trained in the use of SM & CM in depression treatment • Patients with depression engaged in Self-Management (SM) & Care Management (CM) • Patients with diabetes or CVD screened annually for depression by their PCPs • Activities • eLearn Module 3: Use of Care Management and Self-Management in Depression Treatment • Depression care training for PCPs at Regional Improvement Meetings (RIMs) and Practice Improvement Series Meetings (PRISMs) • Lessons Learned / Next Steps • eLearning, RIMs, and PRISMs are effective ways of training large numbers of PCPs • Brief screening and treatment for common mental health comorbidities of depression will enhance care for patients by PCPs

10. Oncology • Goals / Aims • Complete strategic planning process • Identify Priorities • Gain endorsement of plan from each MaineHealth member & affiliate hospital • Outcomes • Strategic plan developed • Process of gaining endorsement is under way • Activities • TBD • Next Steps • Outline set of priorities with strategies • Find champions / leaders to lead each initiative

11. Palliative Care • Goals / Aims • Complete strategic planning process • Identify priorities • Outcomes • Identified priorities in Maine • Activities • TBD • Next Steps • Advance the use of POSLT in Maine • Increase clinical & community awareness of palliative care • Identify quality metrics for use in hospice and palliative programs

12. Stroke • Goals / Aims • Develop patient & family education tool • Provide MH providers with tools to improve efficiency and effectiveness • Outcomes • Developed and implemented practice 3 new stroke practice tools • Developed MaineHealth stroke guide for patients and families • Activities • Collaborated with hospitals to develop and apply practice tools • Collaborated with stakeholders to in development of stroke guide • Assisted in development of MMC – MGMC telestroke project • Lessons Learned / Next Steps • Centralization of data collection & analysis will be valuable • Develop new practice tools for TIA and hemorrhagic stroke • Assist hospitals in QI and primary stroke center certification

13. Target Diabetes • Goals / Aims • Prevention • Public Awareness • Patient Education • Provider Support • Outcomes • Diabetic patients in the Maine PHO • Process: 55% recorded on all 6 specified measures • Outcomes: 15% = optimal range • 31% = intermediate range • Activities • Increased focus upon Inpatient Glycemic Management among all MH hospitals; IpGC conference October 2008 • Patient Self-Management support via development of education tools • Provider support via development of clinical tools • Lessons Learned / Next Steps • Outcomes data key to assisting improvement processes within MH community - Inpatient/Outpatient. • Continue development of IpGC initiative throughout MH hospitals