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Quality Improvement SeriesSession 9

Windy Stevensonlammersw@ohsu.edu

Cindy Ferrell

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Today’s AgendaToday’s Agenda

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RecapRecap

Problem: The DCH ambulatory clinic problem lists are incomplete and inaccurate.

Problem: Patients with BMI>85%ile do not have obesity or overweight listed on their problem lists.

AIM: >95% of patients >2yo seen by a provider in the gen peds clinic or Westside clinic (including acute care; excluding healthy lifestyles) who have a BMI >85%ile will have “BMI; category” listed on their problem list.

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The Science of ReliabilityThe Science of Reliability

Reliability Level Reliability Expression

Reliability Rate Failure Rate

Level 1 10‾¹ 80-90% reliable 1-2 failures in 10 opportunities

Level 2 10‾² 95% reliable <5 failures in 100 opportunities

Level 3 10‾³ 99% reliable <5 failures in 1000 opportunities

Level 6(Six Sigma)

10‾6 <5 failures in 1,000,000 opportunities

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Let’s envision our ideal state(s)Let’s envision our ideal state(s)

Pt >2yo checked in and ht/wt

recorded

EPIC uses ht and wt to

generate BMI and flags if

>85%ile

Provider sees flag when…

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Clinical expectations shape the system Clinical expectations shape the system

What do we expect of acute care providers?– Is adding to the problem list sufficient? – Is a referral back to the PCP in order? – Should we order labs, etc?

What do we expect of WCC providers and PCP’s? – How can we use this to drive decision support? – What type of care do we envision for each of the 3 groups? – What resources support this?

What are our educational opportunities? – Maximizing the AVS– Starting the conversation

How do we want the alert to fire to make this happen?– Should it fire every time someone opens the chart? – Should it be a ribbon or a pop up? – Should it stop firing if the problem list is populated, independent of

whether any care has occurred?

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MeasurementMeasurement

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The baseline dataThe baseline data

Is pending. Let’s assume it is 10%.

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Next StepsNext Steps

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Obesity and Meaningful Use- more opportunityObesity and Meaningful Use- more opportunity

The percentage of patients 2‐17 years of age who had an outpatient visit with a PCP and who had evidence of BMI percentile documentation, counseling for nutrition and counseling for physical activity during the measurement year.

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Take Home Points (review)Take Home Points (review)

Real (sustainable) change comes from changing systems, not changing within systems

Be specific about what you want to accomplish, and why; be intentional

Focus on patients

Start before you think you are ready; don’t get paralyzed