Using Clinical Information Technology to Support Better Practice Chronic Disease Care November 4,...
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Using Clinical Information Technology to Support Better Practice Chronic Disease Care November 4, 2005 Ralph Silber, MPH, CEO Community Health Center Network 1320 Harbor Bay Parkway, Suite 250 Alameda, CA 94502 www.chcn-eb.org
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Transcript of Using Clinical Information Technology to Support Better Practice Chronic Disease Care November 4,...
Using Clinical Information Technologyto Support Better Practice
Chronic Disease CareNovember 4, 2005
Ralph Silber, MPH, CEOCommunity Health Center Network1320 Harbor Bay Parkway, Suite 250
Alameda, CA 94502www.chcn-eb.org
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Asian Health Services
Axis Community Health
La Clinica de La Raza
LifeLong Medical Care
Native American Health Center
Tiburcio Vasquez Health Center
Tri-City Health Center
Our Community Health Centers
3
Sex %
Male 36
Female 64
Age %
<15 29
15-24 16
25-34 15
35-44 12
45-54 10
55-64 8
65+ 10
Race/Ethnicity %
Asian 25
African-American 10
Latino 47
Native American 2
White 11
Other 5
Payor %
Uninsured 41
Medi-Cal 34
Medicare 9
Healthy Families 3
Private Insurance 12
Patients with Chronic Diseases N
Cardiovascular Diseases 11,721
Diabetes 5,505
Demographics of CHCN Patients*, 2002 (N=79,281)
* Patients with 1 or more encounters
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The Evolution of Clinical IT
Community Health Center Network (CHCN)
Managed Care MSO-Quality Improvement
E-prescribing
Data integration products
Electronic health records
Chronic Disease Management
Registries
Clinical Measures
Data Warehouse
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• Clinics on different practice management systems
• We wanted to work with what we had and keep it simple and inexpensive
• We can look at the quality of care for all our patients
• We believe that measuring quality makes a difference
• We had already organized efforts to improve care for patients with diabetes and asthma; smoking as a vital sign
Why a Data Warehouse and Clinical Measures Approach?
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•Medical Directors select clinical measures and agree on methodology
•Extract data from data warehouse
•Chart reviews
•Analyze data by insurance status, ethnicity, and clinic
•Compare our data to state and national benchmarks
How We Do It
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Percentage of Diabetics with 1 or More HbA1c Tests, 7/1/03-6/30/04
50
80
90
0
10
20
30
40
50
60
70
80
90
100
Healthy People 2010Goal
HEDIS Average CHCN Average
Percent
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Frequency of 1 or More HbA1c Tests by Demographics and Insurance Coverage, CHCN, 2001
91
85
93
92
79
84
93
93
92
0 20 40 60 80 100
Medicare
Commercial
Medi-Cal
Uninsured
White
African Am.
Asian/PI
Native Am.
Latino
% of Patients with 1 or More HbA1c Tests, 10/1/00 to 9/30/01
Ethnicity/Race
Insurance Coverage
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Prevalence of Asthma Controller Medication Use by Clinic and Patient Demographics, CHCN, 7/1/02 to 6/30/03
77
85
91
93
64
64
87
0 20 40 60 80 100
White
Latino
Asian/PI
African Am.
HEDIS
CA Dept. of Managed Health Care
CHCN
% of Patients with Documented Controller Medication
Based on 338 patients with 3 or more ICDs of 493, 4 or more pharmacy claims for an asthma medication, or 1 or more asthma hospitalizations (7/01/01 to 6/30/02) and not classified as “mild intermittent” asthma in medical chart
Ethnicity/Race
Medication Use Averages
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Prevalence (%) of Asking Adults about Tobacco Use During 1 or More Encounters, CHCN, 2002 - 2003
59%
85%
0
20
40
60
80
100
CHCN 2002 Ave. (N=649) CHCN 2003 Ave. (N=900)
Percent
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Age-Adjusted* Prevalence (%) of Obesity (BMI > 30) in Adults, CHCN, 2003
15%
27%
20%
0 10 20 30 40 50
Helathy People 2010Goal
US Population (1990 -1999)
CHCN Ave. 2003(N=747)
Percent
* Adjusted to the 2000 US Population Standard
