Developing Competence in System- and Practice-Based Learning and - - PowerPoint PPT Presentation

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

Commercial Interest Nature of Relevant Financial Relationship What was received? For what role?

Example: Name of Commercial Interest Example: Speaker Fee Example: Promotional Speaker

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
• ccurs 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

1/09 Bonus payment to PCMH certified Medicaid providers. & community care-coordination for high risk patients

Medicaid PCMH & HAN Waiver

10/12 Multi-payer prospective payment shared savings primary care transformation

Comprehensive Primary Care Initiative (CPCi)

5/10 – Show how health IT leads to community breakthroughs in healthcare quality

Beacon Community

5/15 Demonstrate implementation of guidelines through feedback, detailing and practice facilitation..

AHRQ Evidence Now H2O Grant

?2017 Integrate social services and primary care referral.

CMS Community Integration Award

1/17 Multi-payer prospective payment to transform primary care

Comprehensive Primary Care Plus (CPC+)

9/11 Implement State-level primary care extension agents.

AHRQ IMPaCT

TIMELINE

OK Primary Healthcare Extension System

PA AD PEA

245 Primary Care Practices

OPHIC Model of Practice Change Support

(New CME: SB-PBLI)

Define Opportunity Measure Performance Feedback & Analyze Change Work Processes Measure & Analyze Effect Sustain Improvement PA AD AD PEA MyHealth PEA PEA PA MyHealth PEA PEA

May 6, 2016 Map of Enrolled Practices

5 4 11 2 7 9 60 11 2 14 30 30 17 10 10 10 8 8

7 98 53 13 66 10 16

Number of H2O Practices By Owners

AMC Clinician FQHC HIS-Tribe Hospital Private Corp RHC

215 20 329 546 1449 62 166 8

200 400 600 800 1000 1200 1400 1600 Academic Detailing (1) Academic Detailing (2) EHR Data Extraction Enrollment Practice Facilitation Recruitment Technology Support Withdrawal Note

Number of Encounters per Support Type

200 400 600 800 1000 1200 1 2 3 4 Number of Encounters Wave

Support Type Per Wave – 10/16-10/17

Withdrawal Note Technology Support Survey/Research Data Recruitment Practice Facilitation Enrollment EHR Data Extraction Academic Detailing (2) Academic Detailing (1)

System-Based Learning & Improvement Support

Goal Strategy-1 Strategy-2 Strategy-3 Performance Measurement Get data from EHR PA work with vendor/MyHealth PEA chart 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.