July 2012 Webinar

1. July 2012 Webinar PDSA Sharing Month 1 Reporting CCI Practice: Byrnes Family Medicine

2. Testing on a Small Scale • Conduct the test with one provider in the office, or with one patient • Conduct the test over a short time period • Test the change with the members of the team that helped develop the plan • Test the change on a small group of volunteers • Minimize confusion, frustration until bugs are worked out, then spread

3. PDSA Sharing • Pre-visit planning: Eastbrook, Oyster Point, Green Hill • Use of diabetes template: Seneca • Population alerts: Warren, Corry, General Internal Medicine • Outreach for overdue patients: Manor, Mountville • Data capture/reporting: Hamilton Health • Patient education/Self management support: Oil Valley, Hamilton Health • Complication screening (feet, eyes, kidneys): Carlisle, Sandrowicz, Oyster Point

4. Super Strategies • Staff education/training • Staff meetings • Standing orders • Process auditing • Small, rapid PDSA cycles

5. PDSA Assistance, Reporting • Talk with your practice facilitator about your PDSAs – they are there to help you! • South Central – Sharon Adams 814-344-2222, sadams@scpa-ahec.org • North West – Patty Stubber 814-217-6029, pstubber@nwpaahec.org • Please fill out your entire PDSA worksheet, including what you’re learning (not just what you plan to do). • Submit your PDSA worksheets ongoing or with your monthly reports.

6. Monthly Reporting • We’ve simplified the reporting form, so there is just 1 column for you to add the monthly data. • We are sending everyone a new report form with your old information copied into it. Please use the new form. • Double-click on the form to enter data. • Percentage column (blue) will auto-calculate.

7. Rest of the Report • Please update the “critical changes” section as you test and implement these changes.

8. PDSA Summary • It’s helpful to have a summary of the PDSAs you’ve been testing in the last part of the report.

9. Comments at the End • Feel free to add comments or questions at the end of the report. (Please date them.) • Challenges you are facing. • Areas where you need support or resources. • Things you want to learn more about. Example:July 2012 1. Discussion concerning Self -Management goals and innovative ways to incorporate group visits. 2. Data integrity and creating reports remains a challenge for a number of measures but we are improving the quality of the reports.

10. Patient Centered Medical HomeBuilding the System Mary Beth Byrnes, MSN, RN PA SPREAD PCMH Initiative July 26, 2012

11. Richard Byrnes, D.O. Family Practice • Established 1974 • Serving Upper Bucks & Montgomery Counties • Suburban – Semi-Rural • Patient Population 2100 • 97% English Speaking Caucasian • Farming – Light Industry • 7.2% Community Unemployment Rate • Staff – 1 RN (CNS), 2 MA, 1 CRNP (temporary)

12. PACCI – 2010Why Participate in Initiative • Expert Guidance • Challenge • Financial • No Cost • Meaningful Use • IBC – Incentive Payment • Better Patient Outcomes

14. Decision Support • Clinical Guidelines Imbedded in EMR & Registry • Stepped Care Protocol – Medications • Standing Orders – Team Members • Labs, Eye Exam, Diabetic Education, Influenza & Pneumococcal Vaccinations, Mammograms, Colonoscopy • Risk Stratification – Identify highest risk patients • Created a Care Management Process • Patient Centered Communication • Proven Education Methods – Barrier to Care/Confidence • Patient Support & Report Cards • Sharing Guidelines – Outcomes with Patients • Patient Education Material & Resources

15. Delivery System Design • Planned Care at Every Visit • PDSA’s • How to implement elements from Decision Support • Written Policy for PDSA’s Implemented • Job Descriptions related to the new policy • Developed a Strategy • Mapped Office Visits

16. Delivery System DesignPlanned Care at Every Visit • Formed Team & Identified Roles & Responsibilities • Evaluated Method of Communication • Motivational Interviewing Techniques • Self Management • Report Card & Self Management Goals • Readiness & Confidence Rulers • Action Plan • System to Identify & Document High Risk Patients • Develop Care Plan for Highest Risk Patients • Huddles, Tag Team, Warm Hand Off

17. Delivery System Design Redefined Roles & Work Flows • Put more responsibility on staff • How to Read Charts • Tracking • Removed any “Crutch” which blocked change • Redefined Flow of Patient Visit - Mapping • Team Effort • Team Member Responsibilities • Written Policy • Updated Job Descriptions • Focused on Patient Education • Tag Team • Written Policy Based on Successful PDSA’s

18. Work Flow before Planned Care Process MA checks patient in and alerts RN that patient has arrived RN rooms patient, takes vitals, makes initial entry in Subjective, tells physician that patient is ready to be seen Physician Sees Patient Physician sends “Superbill” to Front Desk with orders and instructions MA at Front Desk Prepares Orders reviews Orders with Patient Sets Follow Up Appointment

19. MA reviews Tracking List Daily Tracks Test-Consults Notes Appointment RN runs Appointment Reports Identifies Patients for Focused Visits Planned Care Process 48 Hours Prior to Appointment RN reviews EMR, Flow Sheet, Risk Status, Goals, Barriers, Preventive Care Needs Pre-Visit Huddle with Physician to discuss High Risk Patient Plan Interventions RN reviews Labs, Vital Signs, Medications, Report Card, SM Goals, Barriers, Preventive Care Needs, Patient Education, Counseling, Standing Orders Physician Sees Patient Reviews Reinforces Action Plan Sends Orders to Front Desk Interactive Action Plan Agreed Upon Follow Up Tracking for Follow Up Initiated MA at Front Desk Reviews Orders Sets Follow Up Appointment Reminds Patient of RN Follow Up RN communicates with Front Desk Regarding Patient Needs at End Of Visit

20. Self-Management Support • Changed Method of Communication • Provider Self Assessment • Patient Report Card • Clinical Measures • Self Management Goals • Process Measures • Identify Barriers to Goals & Readiness to Change • Action Plan

23. Impact of Self-Management Support • Improved Patient Outcomes • Patients Taking Control • Patients Increased Confidence • Spreading their Knowledge • Improved Patient Satisfaction • Improved Work Flow • Improved Provider/Staff Satisfaction • Development of Care Management Strategies • Developed Relationships with Insurance Carrier Care Managers and ABC Diabetes Education Program

24. Computer Information System The Tool • Goal • Population Management • Data Management • Access and Continuity • Monitor Performance

26. Advantage of Being a Small Practice • Small Practices can effect change faster than larger practices • Less Inertia • Change that occurs can result in improved patient outcomes that are consistent with improved patient outcomes in large practices

27. Questions?