-the evolving story of Quality Improvement *** Allan L. Bailey, MD, - - PowerPoint PPT Presentation

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-the evolving story of Quality Improvement *** Allan L. Bailey, MD, - - PowerPoint PPT Presentation

Aug 17, 2023 113 likes •318 views

Panel Management, Performance Measures and Reporting (PM 2 R) -the evolving story of Quality Improvement *** Allan L. Bailey, MD, CCFP Grace Moe, BPT, MSc, PCMH-CCE Branden Ayotte, MD Candidate 2017 Accelerating Primary Care Conference 2014

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SLIDE 1

WESTVIEW

Panel Management, Performance Measures and Reporting (PM2 R)

  • the evolving story of Quality Improvement

*** Allan L. Bailey, MD, CCFP Grace Moe, BPT, MSc, PCMH-CCE Branden Ayotte, MD Candidate 2017

Accelerating Primary Care Conference 2014 Edmonton, AB

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SLIDE 2

WESTVIEW

Context

WPC

  • Westview Physician

Collaborative

  • the Physician-operated Not-

for-Profit Corporation (NPC) WPCN

  • Westview Primary Care

Network

  • a Joint-Venture between the

WPC-NPC and Alberta Health Services

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SLIDE 3

WESTVIEW

Context

Provincial

  • PCN Evolution and Alberta’s

“Primary Health Care Strategy” emphasize evaluation as a priority for family physicians.

  • No system framework has

been proposed, nor is there an inventory of necessary resources to enable evaluation, performance measurement or reporting. Local

  • Westview PCN developed processes

to identify physician panels in 2008

  • Proactive care, screening and

prevention are identified as an important part of panel management.

  • Panel Management has been

facilitated by Proactive Office Encounter Technicians (POETs) – a role created by and introduced to the Westview PCN in 2010.

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SLIDE 4

WESTVIEW

The WPC Panel Management, Performance Measurement and Reporting (PM2R) Initiative

Objective 1

  • To identify some of the

essential elements required when using practice-based data for primary health care evaluation

Objective 2

  • To examine the

effectiveness of the POET role/intervention in screening and prevention, as a component of panel management

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WESTVIEW

Panel Management, Performance Measurement and Reporting (PM2R)

Results - Objective 1 - Essential Infrastructure:

  • 1. a technical (IT) solution
  • 2. adherence to data stewardship principles, and a
  • 3. quality improvement framework based on “meaningful

use” were ALL required in the development of the information management infrastructure and this PM2R system.

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WESTVIEW

Panel Management, Performance Measurement and Reporting (PM2R)

Results - Objective 1 - Essential Infrastructure:

  • 1. IT Data Sharing Platform:

– WPC server (separate from the WPCN server) – IT process to migrate “core” data elements from EMR to WPC server – Algorithms to extract specific data elements of panel (for ASaP manoeuvers) from WPC “core” data base Notes:

  • IT=Information Technology
  • WPC=Westview Physician

Collaborative

  • WPCN=Westview PCN
  • EMR=Electronic Medical

Record

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WESTVIEW

Panel Management, Performance Measurement and Reporting (PM2R)

Results - Objective 1 - Essential Infrastructure:

  • 2. Protection of Patient Health

Information (EMR Data):

  • Data Governance Structure

– ISA between sentinel physician & WPC-NPC; – Data Governance by WPC-NPC

  • Privacy Protection & Data

Stewardship – OIPC-approved PIA Notes:

  • EMR=Electronic Medical

Record

  • ISA=Information Sharing

Agreement

  • NPC=Not for Profit

Corporation

  • OIPC=Office of Information &

Privacy Commissioner

  • PIA=Privacy Impact

Assessment

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SLIDE 8

WESTVIEW

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WESTVIEW

Panel Management, Performance Measurement and Reporting (PM2R)

Results - Objective 1 - Essential Infrastructure:

  • 3. Quality Improvement Framework:
  • Identified EMR accessible data

elements from the “current state” but expanding universe of process and

  • utcome indicators and primary care

performance indicators

  • Data elements reflect principles of

“meaningful use” i.e. their use will improve population and public health Notes:

  • see current state WPC menu
  • f 27 primary health care

indicators

  • includes ASaP “data set”
  • indicators are periodically

reviewed and updated as new information—scientific, clinical or policy—emerges.

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WESTVIEW

Menu of EMR Primary Health Care Indicators*

(for Clinic Selection per EMR Capability)

# Type Description Measures Note 1 Process BP

Screening: HTN ASaP Maneuver

2 Process Height

ASaP Maneuver

3 Process Weight

Screening: Weight ASaP Maneuver

4 Process BMI

Screening: Obesity

5 Process Spirometry/Full Pulmonary

Screening: COPD

6 Process Tobacco Use

Screening: Lifestyle Risk ASaP Maneuver

7 Process Exercise Status

Screening: Lifestyle Risk ASaP Maneuver

8 Process Alcohol Use

Screening: Lifestyle Risk ASaP Maneuver

9 Process Illicit Drug Use

Screening: Lifestyle Risk

*Menu per “current state” as at October 2014; to be updated as new information—scientific, clinical or policy—emerges.

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WESTVIEW

Menu of EMR Primary Health Care Indicators*

(for Clinic Selection per EMR Capability) - cont’d

# Type Description Measures Note 10 Process Influenza Vaccination (18+)

Screening: Preventive Care ASaP Maneuver

11 Process Tetanus/Diphtheria Vaccination

Screening: Preventive Care

12 Process Pap Test (Females 21-69)

Screening: CA ASaP Maneuver

13 Process Plasma Lipid Profile – Fasting Males 40-74; Females 50-74

Screening: CV ASaP Maneuver

14 Process Diabetes Screen – one of

  • Fasting Glucose, Hgb A1c, Diabetes Risk

Calculator (40+)

Screening: Diabetes ASaP Maneuver

15 Process Colorectal Cancer Screen – one

  • f
  • FIT (FOBT prior to Dec 2013), Flex

Sigmoidoscopy, Colonoscopy (50-74)

Screening: CA ASaP Maneuver

*Menu per “current state” as at October 2014; to be updated as new information—scientific, clinical or policy—emerges.

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SLIDE 12

WESTVIEW

Menu of EMR Primary Health Care Indicators*

(for Clinic Selection per EMR Capability) - cont’d

# Type Description Measures Source 16 Process Mammography (Females: 50-60) (74)

Screening: CA ASaP Maneuver

17 Process Breast Exam (Females: 30+)

Screening: CA

18 Process Bone Density (ALL 65+)

Screening: OP

19 Process/ Outcome CV Risk Calculation

Screening: CV ASaP Maneuver

20 Outcome BP Reading

Health Outcome

21 Outcome BMI Reading

Health Outcome

22 Outcome HbA1c Reading

Health Outcome

23 Outcome Lipids Reading

Health Outcome

*Menu per “current state” as at October 2014; to be updated as new information—scientific, clinical or policy—emerges.

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WESTVIEW

Menu of EMR Primary Health Care Indicators*

(for Clinic Selection per EMR Capability) - cont’d

# Type Description Measures Note 24 PC Performance Time (# of Days) to Third Next Appointment

Access

25 PC Performance % of visits with same PC Provider

Internal continuity

26 Quality % of patients who have had a medication reconciliation in the past year

Comprehensiveness, Patient Centeredness

27 Quality % of patients with complex needs or chronic conditions with an integrated care plan updated in the past year

Comprehensiveness, Patient Centeredness

*Menu per “current state” as at October 2014; to be updated as new information—scientific, clinical or policy—emerges.

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WESTVIEW

Panel Management, Performance Measurement and Reporting (PM2R)

Methods - Objective 2 - POET Effectiveness:

  • A retrospective analysis using the developed information

management infrastructure to examine the success of screening manoeuvers in three phases:

1. baseline standard of care pre-POET; 2. in the early POET implementation phase; and 3. the “mature” phase of POET-facilitated panel management.

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WESTVIEW

Panel Management, Performance Measurement and Reporting (PM2R)

Methods – Objective 2 - POET Effectiveness:

Hypothesis: “The implementation of the POET role improves screening performance as defined by the Towards Optimized Practice (TOP) ASaP indicators”.

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WESTVIEW

Note: Results based on panel sampling (n=10-20 per panel) and manual review of patient EMR/chart data. Source: Towards Optimized Practice (TOP) September 2014.

ASaP – Provincial Baseline Chart Reviews

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WESTVIEW

10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 % of ASaP Manoeuvers “Completed*

ASaP Screening Performance of WPC Family Physician Panel

2007-2008 (Pre-POET Implementation Phase) 2009-2010 (Early-POET Implementation Phase) 2013-2014 (Mature-POET Implementation Phase)

Notes:

  • 1. Screening percentages are “completed”, not “offered”
  • 2. Results are for actual panel denominators – not based on ASaP

sampling methodology

  • 3. Family Physician Panel Size (n=1,599)
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WESTVIEW

Panel Management, Performance Measurement and Reporting (PM2R)

Results - Objective 2 - POET Effectiveness:

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WESTVIEW

For more information, please contact: Allan L. Bailey: baileymd@telus.net Grace Moe: gmoe.wpc@telus.net