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Transcript of 1 The Three Phases of Collaboration: Chronic Disease Management, Cancer Prevention, and Capacity Kim...
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The Three Phases of Collaboration: Chronic Disease Management, Cancer
Prevention, and Capacity
Kim Salamone, Ph.D.Vice President, Health Information Technology
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Health Services Advisory Group
Quality Improvement Organization for Arizona, California, and Florida
Subrecipient for Arizona Regional Extension Center (REC)
Dedicated to improving quality of care delivery and health outcomes through information, education, and assistance
Partners with physicians, health plans, nursing homes, hospitals
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Agenda Overview of 3 Phases
–Goals–Outcomes–Lessons Learned
Barriers to reporting Motivation to overcome barriers
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National Strategy for Quality Improvement in Healthcare
Better Care Reduce harm caused by poor-quality care.Increase patient engagement.Improve communication and care coordination.
Better Health for Populations Promote prevention and treatment of leading causes of mortality, starting with cardiovascular disease.Affordable Care Make quality care more affordable by developing and spreading new healthcare delivery models.
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Phase 1: Chronic Disease Management
Use Electronic Health Records (EHRs) to manage patients with chronic diseases => increased quality of healthcare
Baseline of Stage 1 core meaningful use (MU) and core clinical quality measures (CQMs)
Mammography screening, colorectal cancer screening, cervical cancer screening, and chlamydia screening
Administered the ASHLine Tobacco Cessation Assessment Tool to each site
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Phase 1 Outcomes
No CHCs had actually reached MU. Medicaid Adopt/Implement/Update (AIU) Out of the 8 community health centers (CHCs)
that purchased NextGen, only Chiricauhua and Adelante had received the necessary health quality measures (HQM) module.
The HQM was proven problematic– Some interfaces didn’t work– Calculations were wrong on CQMs
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Phase 1: Lessons Learned
Thresholds were difficult to meet for MU:– Clinical summaries– Providing patients with an electronic copy of
their health information (including diagnostic test results, problem lists, medication lists, medication allergies) upon request
– Reminders to patients, per patient preference, for preventive/follow up care
Diabetes measures were difficult to calculate for NextGen users.
Users struggled with documentation.
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Phase 2: Cancer Screening Measures
Limited budget and scope– Adelente Healthcare – Mountain Park – Maricopa County Health Care for the Homeless (MCHCH)– Wesley
Providers had met Stage 1, year 1 MU– Adelente could not produce the CQMs– MCHCH was the only one where baseline measures were
generated for diabetes measures
Every CHC improved– Breast cancer screening– Diabetes LDL management control– Diabetes A1C control
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Phase 2: Lessons Learned
Healthcare reform requires implementing change systemically – Using an EHR in a meaningful way – Improving quality measures – Implementing quality improvement projects – Emphasizing preventive medicine
Barriers that remain:– Data entry of labs, cancer screening reports, and
other scanned-in reports– Changes in EHRs
Users still struggle with documentation
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Phase 3: Capacity Building EHRs
– 2 Next Gens – 1 eCW
Aligned with Arizona Department of Health Services (ADHS) and Centers for Disease Control and Prevention (CDC) measure interests
Five distinct elements– Assessment– Baseline determinations– Workflow review– Capacity development– Identify best practices
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Phase 3: Assessment
Current utilization of the EHR to maintain current and complete information related to multiple measures– MU-focused
• Measure specifications different• 90 days
– EHRs restricted outside of MU requirements– Issue with 2014 versions
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Phase 3: Capacity Building
Currently generating measures:– Current baseline screening rates for breast, cervical and
colorectal cancers– Percent of the diabetes population within range for
HbA1C – Percent of population with smoking assessed, and a
referral to ASHline recorded for smokers– Percent of population with BMI assessed and recorded– Percent of population with complete HPV
immunizations– Percent of population with alcohol use assessed– Percent of population with physical activity assessed,
addressed
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Phase 3: Current Status and Next Steps
Current Status– Have baseline measures for Adelente– Feedback reports generated for each site– Started workflow analyses at each site
Next Steps– Obtain baseline from the other 2 CHCs– Produce feedback reports and conduct workflow analyses– Capacity development
• Train the trainer on generating care management reports• Implement preventive, patient-centered procedures
– Share best practices with ADHS, Arizona Alliance for Community Health Centers (AACHC), and others for dissemination
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Barriers to Reporting
Physician buy-in– Takes away from direct patient care– Adds work time– Less efficient than paper
EHRs– Some have multiple ways to input the same
measure, example: BP– Confusion regarding requirements– Standards– Interoperability
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Motivating providers
Must align with National Strategy Must demonstrate level of care Must demonstrate quality of care The U. S. Department of Health and Human
Services (HHS) beginning to align measures and payment mechanisms– MU– PCMH– ACA– PQRS
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Additional Questions?
Kim Harris-Salamone, PhD, MPAVice President, Health Information Technology
Health Services Advisory [email protected]