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All Hands Meeting . June 10, 2010. Agenda. NCQA Medical Home Certification – Robb Malone Resident Introductions - Dr. Chelminski , Krista Fajman Staffing changes - Janie Dail Carolina Cares update - Janie Dail High 5 board – Steve Desper Visit planners – Cristin Colford
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All Hands Meeting June 10, 2010
Agenda • NCQA Medical Home Certification – Robb Malone • Resident Introductions - Dr. Chelminski, Krista Fajman • Staffing changes - Janie Dail • Carolina Cares update - Janie Dail • High 5 board – Steve Desper • Visit planners – CristinColford • QI team projects – CristinColford, Tom Miller
Congratulations! NCQA Medical Home Certification level 3! First UNC clinic to receive this level of recognition
NCQA 3-Tiered Recognition • 9 Standards, 30 Elements,180 Factors
A score of ≥75 points is required for Level III. Our application was submitted with 93.5 points.
Preparing for new residents Paul Chelminski and Krista Fajman
Staffing updates Janie Dail
Carolina Cares update Janie Dail
What Is Carolina Cares? • A program to improve patient satisfaction & staff work experience, as measured by Press Ganey scores • Defined set of service behaviors patients can expect at UNC Health Care Clinics and Practices • A tool kit of processes and words developed to convey Carolina Care is consistently demonstrated
Who will attend the Carolina Care meetings and distribute the information to clinic staff? • Janie Dail & Lisa Beaver
High 5 Board Steve Desper
What is a High Five Board? • A High Five Board is a tool used to publicly display a thank you to someone whom you wish to say thank you for doing a good job or going above and beyond your expectations.
Visit planners CristinColford
Visit Planner Review • All patients receive Visit Planners, except SDC • 3 sections: 1 each for Front Desk, Nursing, Providers • Driven off data from webCIS, GE, and IMC databases • Scannable form for quicker data capture and turn-around • Prioritized for “Needs Action” items • Front Desk Priorities: A1c, Lipids (TC/HDL/TH/dLDL) • Nurse Priorities: Depression, Ophthalmology, Tobacco Use, Foot History, Foot Exam, Pneumovax, Dietician, Patient Education, Domestic Violence • Provider Priorities: Depression, High Risk Foot, Antithrombotic, Aspirin, Contraception Assessment, Contraceptive Education, Statin, Ace/Arb, Urine Micral (Nephropathy Assessment), Insulin (Uncontrolled DM), CRC Screen, Tobacco Abuse • For detail on each prompt – What it looks like, what it means, and what you should do, plus links to related algorithms. Look on IMC website (www.med.unc.edu/im) Faculty & Staff Section ► Internal Medicine Clinic ► Visit Planner Care Management Tool►Provider/Nurse/PBA prompts http://www.med.unc.edu/im/staff/clinic/visit-planner-care-managemet-tool/
Filling out the Visit Planner Neatness Counts • Color within the circles • Write inside the boxes • Don’t scribble along the right scan area. Picture an imaginary box around answer choices
Visit Planner Run Chart (Nurse) • It is important that nursing utilize the visit planner to guide patient care at each visit. • Currently, when the nursing staff indicates they have started the visit planner, they receive credit. • In the future, nursing staff will receive credit only when they have completed each section of the visit planner. • Visit planner run charts are posted on the IM website(www.med.unc.edu/im) Faculty & Staff Section ► Quality Improvement► Monthly Quality Reports ►Visit Planner Monthly Process Measures Report http://www.med.unc.edu/im/files/quality-improvement-files/AprilReport.pdf
QI team projects CristinColford Tom Miller
Team A: The late patient • Team Members (Team 2 Team A) Cristin, Kim F., Donna, Holly, Amy S., Maria, Jo, Robin, Annie, Amy A., Darren, Katrina, Faye, Dionne, Phillis, Lisa W.) • Letter to patients in March outlining late policy • We learned some lessons about how to send letters! • Implementation of scripts/late policy in March • Decrease in % of late patients from March to June from 10% to 8% • Other things tried: • Bypassing POC lab pilot • Data about preclinic conference start and end times • Nurse/doc huddles
Team B: no show management • Team Members (Team 3 Team B) Cole, Amy A., Erika, Penny, Angela C., Faye, Carmen, Tom, Carrie, Kim Y-W, Malinda, Carla, Lisa, Wanda, Theresa, Rob, Natalie, Patsy • Problem: A relatively small number of patients have a large number of missed appointments. • Hypothesis: • These patients have fewer resources • They may be sicker • Missed appointments may compromise their care resulting in more hospitalizations and ED visits • Enhance case management could reduce no shows in the group • Improve other health outcomes
No Shows – a quick history • Over the past 5 years the no show rates have dropped significantly • Important interventions • Real time scheduling • 6 week window for return visits in resident’s clinic • Reminder prompts • At check out • Mailed reminder • Televox • Next day appointments for new patients in resident’s clinic
Interventions • Identified the 100 patients with 4 or more no shows and entered a scheduling prompt in GE. • Scripting for schedulers, check in, check out, nurses • PBA training on using GE preferred scheduling times • Carrie’s 2 day advance calling • Transportation brochures developed • UNCH appointment reminder letters, televox calls, letters sent after no show • Advanced case management/problem solving
Goal: Increase attendance in a population of patients that have a history of 4 or more no shows in the past year • Focus: Resident and Attending Clinics • Intervention: Telephone call 5 days before discussing common barriers – transportation, finances, time of appointment, etc • Data: Track show and no show rates between those patients called and those not called
Results • No call group – 28 patients • Show rate: 61% (17/28) • Intervention group – 20 patients • Show rate: 55% (11/20)
Conclusions • Enhanced case management does not reduce no shows in this high risk group. • Transportation problems, financial issues and other factors beyond our control lead to no shows in this group of patients.
