CAP as a Teaching Tool: The WVSOM Experience

1. CAP as a Teaching Tool: The WVSOM Experience Gary L. Knepp, DO FACOFP Assistant Dean & Professor of Geriatrics West Virginia School of Osteopathic Medicine Director of Medical Education Greenbrier Valley Medical Center

2. Objectives • Recognize need for HIT education in the medical curriculum • Understand that HIT is a tool for physicians to use in the delivery of healthcare • Begin to plan for the sustained impact of HIT on the practice of medicine • Demonstrate one model for teaching fundamental concepts of HIT utilization

3. HIT Education • Practicing physicians • CME • Extension Service • Residents and Interns • Accreditation curriculum standards • Students • Medical School curriculum

4. Technology is a Tool • HIT education is teaching students and physicians: • How to use the tool • How the tool functions • How the tool is built • What the advantages of the tool are • What the limitations of the tool are

5. What is HIT? • EHR • EMR • PHR • Diagnostic Instruments • Communication Tools • Educational Tools • Basic Hardware/Software development • Clinical Application

6. HIT Basic Science • Hardware • Networking • Software • Database Design • Programming • Process Analysis • Statistical Analysis • Quality Improvement

7. HIT Clinical Skills • Computer use • EMR/EHR Basic Skills • Selecting Systems • Implementing Systems • Knowledge Systems • Process improvement • Outcome reporting

8. HIT Advanced Content • Reimbursement methodology • Guideline development • Process Improvement

9. Educational Competencies • Osteopathic Principles • Medical Knowledge • Patient Care • Professionalism • Interpersonal Communications • Practice Based Learning • System Based Learning

10. WVSOM Challenge – Incorporating HIT into the medical curriculum • Osteopathic Principles

11. WVSOM Challenge – Incorporating HIT into the medical curriculum • Medical Knowledge

12. WVSOM Challenge – Incorporating HIT into the medical curriculum • Patient Care

13. WVSOM Challenge – Incorporating HIT into the medical curriculum • Professionalism • Interpersonal Communications

14. WVSOM Challenge – Incorporating HIT into the medical curriculum • How to provide curriculum content related to the AOA core competencies of: • Practice-Based Learning and Improvement • Systems-Based Practice

15. Answer - develop a Lecture program series for residents to help them: • Understand what CAP is. • Understand why a clinical practice would want to participate in CAP. • Understand how to participate in CAP. • Provide recommendations on how to interpret and act on the results of a CAP Survey.

16. Accountability • How do we know if we are taking the best care of the patients we possibly can? • Do patients have the expectation that we are? • If we discover that we could be providing better care, how do we improve our care? • If we make a change in the care we deliver, how do we know if the change was successful?

17. How do we measure the care we deliver? • If we do decide to try to measure the care we deliver, we have many questions to answer. • Who do we include in the measurement? • How many patients do we include? • Is the patient willing to let us use their health information in our study? • What patient care outcomes or process steps are we going to use in the study? • Against what standards do we measure our care?

18. Clinical Assessment Program -CAP • CAP was designed to give us an answer to all of our questions. • Many entities are asking the same questions and are developing tools to assist in the process of Continuous Quality Improvement. • CMS Physician Quality Reporting Initiative (PQRI) • National Committee for Quality Assurance (NCQA) • Healthcare Effectiveness Data and Information Set (HEDIS)

19. Clinical Assessment Program -CAP • Initially designed as a quality improvement research data base and teaching tool for AOA residency programs. • Has been adopted for that purpose by ACOFP and ACOI and is a residency accreditation requirement. • A second arm has been developed for practicing physicians and certified by CMS as a qualified reporting tool.

23. About CAP • Describes the program background • References Evidence Based Guideline • References HEDIS • References Healthy People 2010 • Outlines CAP Objectives

24. About CAP What is CAP?Who do I contact with questions about CAP?Who sponsors CAP?How is CAP paid for?What is CAP measuring?What comparative analysis does CAP provide?

25. Participating in CAP How can I sign up my residency program to participate?Do I need to sign up my residency program every time we want to enter data into different measures sets and/or every academic year?What is required of CAP participating programs?How do I choose measurement sets for my program?How many abstractors can there be for my residency program?When do I start abstracting patient data?How do I determine which patient records to abstract for each measurement set?Do we need IRB approval to participate in CAP?Does ACOFP require family medicine programs to participate in specific measures?Does ACOI require internal medicine programs to participate in specific measures?

28. Data Sets • CORONARY ARTERY DISEASE • DIABETES • HYPERTENSION • IMMUNIZATIONS • LOW BACK PAIN • WOMENS HEALTH • COPD • ASTHMA

30. Diabetes Measurement Set • Data Dictionary • Paper Abstraction Form • IRB Material • Sampling • Abstractor Training • Pharmaceutical Appendix

31. Insurance Type Sex/Gender Ethnic Origin Number of Office Visits Missed Office Visits Weight Control Educ. Type of DM Control Age at Diagnosis HTN Diagnosis Blood Pressure Value ACE/ARB Prescribed GFR Body Mass Index Foot Examination HgbA1c Done HgbA1c Value Dilated Eye Exam Eye Exam in last 2 yrs.. Albuminuria Screen Nephropathy Present LDL done and level. Smoking History Influ & Strep Vaccines OMT Measurement Set

32. IRB Approval • Recommended if you plan to publish your results as a part of research or case study paper. • Recommended if you plan to use the study as part of your residency research project. • Usually considered an exempt quality monitoring project. • Can submit to WVSOM IRB as an affiliated partner of the MSOPTI is your hospital does not have an IRB. • Web Site includes a sample application form.

33. Data Abstraction • Step 1 – identify patients that will be included in the study – inclusion diagnosis. • Step 2 – identify range of dates to be included. • Step 3 – identify physicians who will be included in the study. • Use billing or EMR data to identify patient charts for abstraction.

34. Step 1 – Inclusion Diagnosis List

35. Step 1 – Inclusion Criteria

36. Pharmaceutical Appendix

39. Who does the abstraction? • The fewer the abstractors, the more reliable the data abstraction will be. • Balance the reliability off the educational value of the process. • Consider a group process with one or two data sets to learn the process, then divide the remaining six data sets to individuals or small groups. • A comprehensive guide is on-line.

41. Enter Data • Must be logged in to members only do-online web page. • Will need Program ID number assigned at registration. • If your program has entered data in the past, you already have a Program ID number. • Data is processed monthly on the Residency Site.

42. Results • Results are returned via email in the form of a .pdf file. • Results are compared to the composite data of other programs that have previously submitted data.

47. Post Data Review • Review results with entire clinic staff. • Design interventions to improve results. • Educate staff on interventions. • Implement interventions. • After six to twelve months, reabstract data to learn if intervention was successful. • Repeat the process – CQI in action!

48. Objectives • Recognize need for HIT education in the medical curriculum • Understand that HIT is a tool for physicians to use in the delivery of healthcare • Begin to plan for the sustained impact of HIT of the practice of medicine • Demonstrate one model for teaching fundamental concepts of HIT utilization

49. References: All available at/or linked from www.do-online.org