Developing Competence in System- and Practice-Based Learning and Improvement: The OK Primary Healthcare Cooperative F. Daniel Duffy, MD, MACP Daniel-duffy@ouhsc.edu 918-740-0433 AD Conference
Relevant Disclosure and Resolution Under Accreditation Council for Continuing Medical Education guidelines disclosure must be made regarding relevant financial relationships with commercial interests within the last 12 months. Daniel Duffy, MD, MACP Nature of Relevant Financial Relationship Commercial Interest What was received? For what role? Example: Name of Example: Speaker Fee Example: Promotional Speaker Commercial Interest None N/A N/A The conflict was resolved by
Relevant Disclosure and Resolution Under Accreditation Council for Continuing Medical Education guidelines disclosure must be made regarding relevant financial relationships with commercial interests within the last 12 months. Daniel Duffy, MD, MACP I have no relevant financial relationships or affiliations with commercial interests to disclose.
Experimental or Off-Label Drug/Therapy/Device Disclosure I will NOT be discussing experimental or off-label drugs, therapies and/or devices that have not been approved by the FDA.
Learning Objectives Upon completion of this session, participants will improve their competence and performance by being able to: • Describe the impact H2O ADs and PEAs have in helping practices develop competence in practice-based learning and improvement. • Describe how feedback on ABCS performance measures stimulates practice system change. • Explain how systems-based practice affects quality of care.
System-Based Practice • All healthcare is created and delivered by complex human-technical systems made up of policies, processes, hand-offs, interactions, and use of information, biochemical, pharmaceutic, physical, and other technology. • The site of all healthcare, quality, and safety is the clinical microsystem – a small number of professionals working together to provide care to a panel of patients. • To improve healthcare the change must occur at the clinical microsystem.
Practice-Based Learning & Improvement • Learning that transforms clinical quality, safety, and satisfaction occurs in a learning organization that acts on feedback from performance measurement to change it’s microsystem processes, people, and technology in order to achieve better performance. • Feedback, application of improvement science, skills training, in-practice coaching and change facilitation are the elements of PBLI. • PBLI occurs within a learning organization, the clinical microsystem.
System of OK Practice Transformation Initiatives CMS Community Comprehensive Integration Award Primary Care Plus ?2017 Integrate social services (CPC+) and primary care referral. 1/17 Multi-payer prospective payment to transform primary care AHRQ Evidence Now H2O Grant Comprehensive 5/15 Demonstrate Primary Care Initiative implementation of guidelines (CPCi) through feedback, detailing and practice facilitation.. 10/12 Multi-payer prospective payment shared savings AHRQ IMPaCT primary care transformation 9/11 Implement State-level primary care extension agents. Beacon Community Medicaid PCMH & 5/10 – Show how health IT leads to community HAN Waiver breakthroughs in 1/09 Bonus payment to PCMH healthcare quality certified Medicaid providers. & community care-coordination for high risk patients TIMELINE
OK Primary Healthcare Extension System 245 Primary Care Practices PA PEA AD
OPHIC Model of Practice Change Support (New CME: SB-PBLI) Define AD PEA Opportunity PA Sustain Measure PEA Improvement Performance MyHealth PEA Measure & Feedback & AD PA Analyze Effect Analyze PEA Change Work MyHealth PEA Processes
2 5 30 17 4 14 11 30 60 11 10 9 10 8 2 7 10 8 May 6, 2016 Map of Enrolled Practices
Number of H2O Practices By Owners 7 10 16 AMC Clinician FQHC 98 66 HIS-Tribe Hospital Private Corp 13 RHC 53
Number of Encounters per Support Type 1600 1449 1400 1200 1000 800 546 600 329 400 215 166 62 20 200 8 0 Academic Academic EHR Data Enrollment Practice Recruitment Technology Withdrawal Detailing (1) Detailing (2) Extraction Facilitation Support Note
Support Type Per Wave – 10/16-10/17 1200 Withdrawal Note 1000 Number of Encounters Technology Support 800 Survey/Research Data Recruitment 600 Practice Facilitation Enrollment 400 EHR Data Extraction 200 Academic Detailing (2) Academic Detailing (1) 0 1 2 3 4 Wave
System-Based Learning & Improvement Support Goal Strategy-1 Strategy-2 Strategy-3 Performance Get data from PA work with PEA chart Measurement EHR vendor/MyHealth abstraction Quality of Data EHR entry PA-PEA teach team Templates Blood Pressure Technique Medications Gap-Risk-list Smoking Document 5As - Referral Counsel code Aspirin Risk calculator Medication list Patient ed Cholesterol Risk calculator Medication list Chart Review Other Coding Teamwork Delegation
H2O Performance in MyHealth 9/2/2016
References • Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance: a systematic review of continuing medical education strategies. JAMA 1995; 274:700-705. • Moore DE, Pennington FC. Practice-Based Learning and Improvement. The Journal of Continuing Education in the Health Professions 2003; 23: S73-S80. • Weiss KB, Wagner R. Performance Measurement Through Audit, Feedback, and Profiling as Tools for Improving Clinical Care. Chest 2000; 118:53S–58S • Nagykaldi Z, Mold JE, Robinson A, Niebauer L, Ford A. Practice Facilitators and Practice-based Research Networks. J Am Board Fam Med 2005;19:506-510.
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