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 Edmonton, AB WESTVIEW
Context WPC WPCN • Westview Physician • Westview Primary Care Collaborative Network • the Physician-operated Not- • a Joint-Venture between the for-Profit Corporation (NPC) WPC-NPC and Alberta Health Services WESTVIEW
Context Provincial Local • PCN Evolution and Alberta’s • Westview PCN developed processes “Primary Health Care to identify physician panels in 2008 Strategy” emphasize • Proactive care, screening and evaluation as a priority for prevention are identified as an family physicians. important part of panel • No system framework has management. been proposed, nor is there • Panel Management has been an inventory of necessary facilitated by Proactive Office resources to enable Encounter Technicians (POETs) – a evaluation, performance role created by and introduced to measurement or reporting . the Westview PCN in 2010 . WESTVIEW
The WPC Panel Management, Performance Measurement and Reporting (PM 2 R) Initiative Objective 1 Objective 2 • To identify some of the • To examine the essential elements effectiveness of the POET required when using role/intervention in practice-based data for screening and prevention, primary health care as a component of panel evaluation management WESTVIEW
Panel Management, Performance Measurement and Reporting (PM 2 R) 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 PM 2 R system . WESTVIEW
Panel Management, Performance Measurement and Reporting (PM 2 R) Results - Objective 1 - Essential Infrastructure: 1 . IT Data Sharing Platform: Notes : • IT=Information Technology – WPC server (separate from the • WPC=Westview Physician WPCN server) Collaborative – IT process to migrate “core” data • WPCN=Westview PCN elements from EMR to WPC server • EMR=Electronic Medical – Algorithms to extract specific data Record elements of panel (for ASaP manoeuvers) from WPC “core” data base WESTVIEW
Panel Management, Performance Measurement and Reporting (PM 2 R) Results - Objective 1 - Essential Infrastructure: 2. Protection of Patient Health Notes : Information • EMR=Electronic Medical Record (EMR Data): • ISA=Information Sharing • Data Governance Structure Agreement – ISA between sentinel physician & • NPC=Not for Profit WPC-NPC; Corporation – Data Governance by WPC-NPC • OIPC=Office of Information & • Privacy Protection & Data Privacy Commissioner Stewardship • PIA=Privacy Impact – OIPC-approved PIA Assessment WESTVIEW
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Panel Management, Performance Measurement and Reporting (PM 2 R) Results - Objective 1 - Essential Infrastructure: 3. Quality Improvement Framework: Notes: • see current state WPC menu • Identified EMR accessible data of 27 primary health care elements from the “current state” but indicators expanding universe of process and outcome indicators and primary care • includes ASaP “data set” performance indicators • indicators are periodically • Data elements reflect principles of reviewed and updated as new “meaningful use” i.e. their use will information — scientific, improve population and public health clinical or policy — emerges. WESTVIEW
Menu of EMR Primary Health Care Indicators* (for Clinic Selection per EMR Capability) # Type Description Measures Note Screening: HTN ASaP Maneuver 1 Process BP ASaP Maneuver 2 Process Height 3 Process Weight Screening: Weight ASaP Maneuver 4 Process BMI Screening: Obesity Screening: COPD 5 Process Spirometry/Full Pulmonary Screening: Lifestyle Risk ASaP Maneuver 6 Process Tobacco Use Screening: Lifestyle Risk ASaP Maneuver 7 Process Exercise Status 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. WESTVIEW
Menu of EMR Primary Health Care Indicators* (for Clinic Selection per EMR Capability) - cont’d # Type Description Measures Note Screening: ASaP Maneuver 10 Process Influenza Vaccination (18+) Preventive Care Screening: 11 Process Tetanus/Diphtheria Vaccination Preventive Care Screening: CA ASaP Maneuver 12 Process Pap Test (Females 21-69) Plasma Lipid Profile – Fasting 13 Process Screening: CV ASaP Maneuver Males 40-74; Females 50-74 Diabetes Screen – one of Screening: ASaP Maneuver 14 Process Diabetes - Fasting Glucose, Hgb A1c, Diabetes Risk Calculator (40+) Colorectal Cancer Screen – one Screening: ASaP Maneuver 15 Process CA of -FIT (FOBT prior to Dec 2013), Flex Sigmoidoscopy, Colonoscopy (50-74) * Menu per “current state” as at October 2014; to be updated as new information— scientific, clinical or policy — emerges. WESTVIEW
Menu of EMR Primary Health Care Indicators* (for Clinic Selection per EMR Capability) - cont’d # Type Description Measures Source 16 Process Mammography Screening: CA ASaP Maneuver (Females: 50-60) (74) Screening: CA 17 Process Breast Exam (Females: 30+) 18 Process Bone Density (ALL 65+) Screening: OP Screening: CV ASaP Maneuver 19 Process/ CV Risk Calculation Outcome Health Outcome 20 Outcome BP Reading 21 Outcome BMI Reading Health Outcome 22 Outcome HbA1c Reading Health Outcome Health Outcome 23 Outcome Lipids Reading * Menu per “current state” as at October 2014; to be updated as new information— scientific, clinical or policy — emerges. WESTVIEW
Menu of EMR Primary Health Care Indicators* (for Clinic Selection per EMR Capability) - cont’d # Type Description Measures Note Access 24 PC Time (# of Days) to Third Performance Next Appointment Internal continuity 25 PC % of visits with same PC Performance Provider Comprehensiveness, 26 Quality % of patients who have Patient Centeredness had a medication reconciliation in the past year Comprehensiveness, 27 Quality % of patients with complex Patient Centeredness needs or chronic conditions with an integrated care plan updated in the past year *Menu per “current state” as at October 2014; to be updated as new information— scientific, clinical or policy — emerges. WESTVIEW
Panel Management, Performance Measurement and Reporting (PM 2 R) 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. WESTVIEW
Panel Management, Performance Measurement and Reporting (PM 2 R) 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”. WESTVIEW
ASaP – Provincial Baseline Chart Reviews 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. WESTVIEW
ASaP Screening Performance of % of ASaP Manoeuvers “Completed * WPC Family Physician Panel 90.0 80.0 70.0 2007-2008 (Pre-POET 60.0 Implementation Phase) 50.0 2009-2010 (Early-POET Implementation Phase) 40.0 2013-2014 (Mature-POET 30.0 Implementation Phase) 20.0 10.0 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) WESTVIEW
Panel Management, Performance Measurement and Reporting (PM 2 R) Results - Objective 2 - POET Effectiveness: WESTVIEW
For more information, please contact: Allan L. Bailey: baileymd@telus.net Grace Moe: gmoe.wpc@telus.net WESTVIEW
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