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Complexity at Northeast

Complexity at Northeast. Integrating Population Health Inquiry Transforms (IPHIT) Family Medicine. Northeast Education Afternoon March 27, 2014 Jennifer Edgoose. Do you feel like this?. Email on 1/21/4 to Lou and Jennifer. We deal with complexity. Trying to quantify the work we do:.

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Complexity at Northeast

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  1. Complexity at Northeast Integrating Population Health Inquiry Transforms (IPHIT) Family Medicine Northeast Education Afternoon March 27, 2014 Jennifer Edgoose

  2. Do you feel like this?

  3. Email on 1/21/4 to Lou and Jennifer We deal with complexity

  4. Trying to quantify the work we do: The arndt scale

  5. Why? • Fair distribution of patients • Appropriate scheduling of patients • Appropriate distribution of staff • Quality measures could include attention to effort as well as outcome • Burnout

  6. Trying to quantify complexity • Current measures • Face-to-face workload • E.g. work relative value units (wRVUs) based on the Centers for Medicare and Medicaid Services Resource Based Relative Value Scale • Insurance claims data try to predict future utilization, cost, mortality and quality of life • Chronic Disease Score, Charleston Index, etc. • What about non face-to-face work? • E.g. Telephone calls, electronic communication, supervision of nurse visits, medication refills • Increased work associated with poverty • Patient characteristics

  7. Perceived Overall Encounter Workload

  8. Ranking of Challenging Patient Characteristics

  9. How to Calculate Arndt Scale (Step 1) • The encounter workload score for a patient is equal to the sum of all individual encounter scores computed during a time period. Example: A patient had 1 emergency department visit, 4 office visits, 6 phone calls, 10 medication refills, 2 lab orders, and 2 lab results letters Encounter Score: (11.48 + 41.00 + 60.45 + 100.26 + 20.30 + 20.24) = 11.86 * Look up weights in the “Overall Encounter Workload” table

  10. How to Calculate Arndt Scale (Step 2) • The challenging characteristics scorefor a patient is equal to the sum of all chronic conditions, medications burden, and socioeconomic characteristics computed during a time period. Example: An uninsured patient with diabetes and chronic kidney disease who has no-showed or cancelled five or more appointments. Challenging Characteristics Score: (1.25 + 1.05 + 1.03 + 1.14) = 4.47 * Look up weights in the “Ranking of Challenging Patient Characteristics” table

  11. How to Calculate Arndt Scale (Step 3) • The overall complexity scorefor a patient is determined by adding the encounter workload score to the total patient characteristics score. In this example, the patient would have a total complexity score of 16.33 (=11.86 + 4.47).

  12. The 30 most complex patient panels in the entire statewide DFM • Northeast has 33 % • Wingra has 13%

  13. Northeast

  14. What does this mean? • Systematic QI processes are important • We could ask further questions of the data. What primarily drives our high complexity? • Examples: • Number of ED visits? • % of patient under 65 who are disabled? • The mental health comorbidity of our patients? • Should we use this to leverage more support • E.g. more staff?

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