Bree Collaborative Implementation Survey Results for Medical Groups - - PowerPoint PPT Presentation

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Dec 22, 2023 195 likes •371 views

Bree Collaborative Implementation Survey Results for Medical Groups & Hospitals Paul Gruen, Implementation Consultant Click to add date | Click to add location 13 Bree Collaborative Topics, 1 to 115 recommendations per topic Obstetrics

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Click to add date | Click to add location

Bree Collaborative Implementation Survey Results for Medical Groups & Hospitals

Paul Gruen, Implementation Consultant

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13 Bree Collaborative Topics, 1 to 115 recommendations per topic

 Obstetrics Care  Cardiology: Appropriate PCI  CABG Surgical Bundle  Spine/Low Back Pain  Spine SCOAP  Lumbar Fusion Surgical Bundle  Knee/Hip Replacement  Prostate Cancer Screening  Oncology Care  Addiction & Dependence Treatment  Opioid Prescriptions  End Of Life Care Planning  Avoidable Hospital Readmissions

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Implementation Survey

 Separate hospital and medical group surveys  Surveys are voluntary, self-reported (inter-rater reliability)  Bias towards larger urban & suburban systems  Implementation possibly independent of Bree Recommendation  Low implementation could mean “unknown”  Extensive length of survey reduced response rate

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Participating Hospitals &Medical Groups

 CHI Franciscan Health

 5 hospitals

 Confluence Health

 Hospital & medical group

 The Everett Clinic  Evergreen Health Partners  Group Health  Northwest Physicians Network  Polyclinic  Swedish/Providence

 5 hospitals, 3 medical groups

 UW

 4 hospitals

 Vancouver Clinic  Virginia Mason

 Hospital & medical group

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Implementation Scoring Scale

0 -No action taken 1 -Actively considering adoption 2 -Some/similar adoption 3 -Full adoption

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MG #1: Addiction & Dependence Treatment (Average Score: 1.46)

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20 40 60 80 100 1 2 3 Count Assessment Score (28 recommendations x 10 medical groups)

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MG #1: Addiction & Dependence Treatment (lowest scoring recommendations)

 Verbal communication takes place with the chemical dependency treatment facility to follow-up on any referrals and assess whether treatment was initiated and/or completed (0.75)  The patient’s perspective is included as work is done to increase the capability of the chemical dependency system (0.75)  Patients are contacted after they have been referred to chemical dependency treatment to address any barriers to accessing treatment (0.88)  Patient results from alcohol and other drug misuse screens are tracked

ver time (1.00)

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MG #8: Obstetrics (Average Score: 2.74)

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5 10 15 20 25 30 1 2 3 Count Assessment Score (5 recommendations x 7 medical groups)

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Knee and Hip Replacement Surgical Bundle

11 hospitals 87 recommendations 2.32 Average Score

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10 20 30 40 50 1 2 3

Count Assessment Score

Cycle 1: Disability Despite Conservative Therapy

(9 recommendations)

50 100 150 200 1 2 3

Count Assessment Score

Cycle 2: Fitness for Surgery

(31 recommendations)

20 40 60 80 100 120 140 1 2 3

Count Assessment Score

Cycle 3: Repair of Joint

(18 recommendations)

20 40 60 80 100 120 1 2 3

Count Assessment Score

Cycle 4: Return to Function

(19 recommendations)

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Knee and Hip Replacement Surgical Bundle (5 lowest scoring recommendations)

 Cycle 2: General health questionnaire completed: Patient Reported Outcomes Measurement Information System-10/PROMIS-10 (1.09)  Cycle 2: Patient participates in Shared Decision-making with WA State- approved Decision Aid (1.36)  Cycle 2: HOOS/KOOS survey completed (1.60)  Cycle 4: Patient-reported functional outcomes are measured with KOOS/HOOS instrument (1.55)  Cycle 4: If opioid use exceeds six weeks, a formal plan is developed for

pioid management (1.55)

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Hospitals: Appropriate PCI / COAP (Average Score: 3.00)

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5 10 15 20 25 1 2 3 Count Assessment Score (3 recommendations x 7 hospitals)

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Top BARRIERS to Adoption

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 Lack of availability & credibility of data, and burden to collect it  Business case- no economic reward, and lack of contract partners interested in value-based purchasing  Lack of consensus on what constitutes quality of care

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Top ENABLERS to Adoption

 Existing organizational improvement program for minimizing errors & waste  Business case- evidence of economic reward  Consensus on what constitutes quality of care  Individual provider-level performance feedback

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Implementation- Key Lessons: 1 - 4

1. Systematic collection of patient self-reported goals, function &
utcomes tracking are a challenge (STarT Back tool, Functional

Recovery Questionnaire, Oswestry, PROMIS-10, KOOS/HOOS, Opioid pain assessment, Cancer Care treatment goals)

2. Patient Decision Aids not yet available and shared decision making

not systematic (Prostate/PSA testing, knee/hip replacement)

3. Some recommendations may not be adopted as broadly as Bree

specifies (advance care plans >18 y.o., drug & alcohol screening in ED >13 y.o.)

4. Communication between entities not systematic (advanced

directives/POLST, PMP for Opioids)

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Key Lessons: 5-10

5. Long-term opioid use planning a challenge, also Prescription Monitoring

Program (PMP)

6. Addiction/dependency referrals, follow-up and tracking not systematic
7. Alignment with “Choosing Wisely” an opportunity (Oncology care,

Prostate/PSA screening)

8. Decisions by “Collaborative Team” not yet systematic (Lumbar Fusion)
9. Data issues, business case for implementation significant barriers
10. Organization improvement program, business case, provider level

performance feedback significant enablers

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Next Steps (work in process)

 Closer examination of providers successful in implementation  Work with health plans, particularly on business case

 WA state “Business Group on Health”?

 Healthier Washington/Hub, also Patient Decision Aids  Choosing Wisely  Bundled Payment specifications- revise/update

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