Provider Tips and Toolsets Rural Quality Program Conference Office of Rural Health Policy Health Res

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Provider Tips and Toolsets Rural Quality Program
Conference Office of Rural Health Policy Health
Resources Services AdministrationSeptember 2,
2009
Eugene Maynard, MD Rural Quality Project
Participant Benson Area Medical Center Benson, NC

• Kathy Reims, MD
• Chief Medical Officer
• CSI Solutions, LLC
• Clinical Assistant Professor, UCHSC

I do not have any relevant financial
relationships to disclose
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Objectives

• Provide practical tools and tips to improve
  performance on OHRP CVD measures
• General approach
• Hypertension and Lipid control
• Integrated Smoking Cessation Toolkit

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Tools to Improve Performance

• Patient Factors
• Care Team Factors
• System Factors

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Patient Factors

• Awareness
• Education
• Commitment to Care Plan
• Patient confidence in managing condition
• Side effects
• Practical considerations
• Psychosocial impacts

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Assist Patients with Care Plans

• Self-Management supports
• Proactive follow up
• Care Team is accessible
• DAP programs
• Pay attention to medication regimens
• Medication reconciliation
• Screen for literacy, depression, substance
  abuse

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Care Team Factors

• Evidence-based care
• Planned Care
• POS prompts and reminders
• Protocols
• Trained Staff
• Delegated work
• Outreach and proactive follow up
• Expand the team pharmacist, promotora
• Optimize the team designated roles or FTE

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System Factors

• Access
• Group visits
• Email or Web-based
• Convenient, timely appointments
• Continuity of care
• Population management
• Coordination of care
• Effective use of technology

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Awareness BP Control Rates
Trends in awareness, treatment, and control of
high blood pressure in adults ages 1874
Sources Unpublished data for 19992000
computed by M. Wolz, National Heart, Lung, and
Blood Institute JNC 6.
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Awareness Guidelines
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Patient Education
http//www.nhlbi.nih.gov/health/public/heart/hbp/d
ash/dash_brief.pdf
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Education and Patient RemindersBP Wallet Card
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BP Wallet Card
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Education and Patient RemindersNational
Cholesterol Education Program
http//www.nhlbi.nih.gov/health/public/heart/chol/
wyntk.pdf
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HTN Lipid Patient Education

• http//www.nhlbi.nih.gov/health/index.htm
• http//www.americanheart.org/presenter.jhtml?ident
  ifier1516
• http//familydoctor.org/online/famdocen/home/commo
  n/heartdisease/risk/092.html
• http//www.webmd.com/heart-disease/guide/heart-dis
  ease-prevent

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Patient Self Management
http//www.ama-assn.org/ama1/pub/upload/mm/433/phy
s_resource_guide.pdf
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BUBBLE DIAGRAM If you have diabetes, here are
some things many individuals try to do for their
health. Would you like to set any goals
concerning any of them?
Blood glucose monitoring
Taking medications to help control blood sugar
Skin care
Taking insulin
Diet
Depression ?
Losing weight
Daily foot care
Smoking
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Goal Setting Tools
www.healthdisparities.net
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Plan the Visit Flowsheet

• Organize key information
• POS Reminders
• Share the work
• Huddles

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Plan the Visit Electronic Flow Sheet
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Delegated Work Standing Orders
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Standing Orders
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Evidence-based careJNC VII Reference Card
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JNC VII Reference Card, side 2
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Evidenced-based Care

• ATP III Palm Interactive Guideline Tool
  http//hp2010.nhlbihin.net/atpiii/atp3palm.htm
• CVD Risk Calculator http//hp2010.nhlbihin.net/atp
  iii/calculator.asp
• ATP III At-a-Glance Desk Reference
  http//www.nhlbi.nih.gov/guidelines/cholesterol/ds
  kref.htm

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Staff Training Lunch and Learns

• JNC VII Slide Set http//hp2010.nhlbihin.net/nhbpe
  p_slds/menu.htm
• AAFP Ask and Act Program http//www.aafp.org/onlin
  e/en/home/clinical/publichealth/tobacco/toolkit.ht
  ml
• ATP III Slide Set http//hp2010.nhlbihin.net/ncep_
  slds/menu.htm

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Staff Training Unified Health Communication
101 Addressing Health Literacy, Cultural
Competency, and Limited English Proficiency

• Improve your patient communication skills
• Increase your awareness and knowledge of the
  three main factors that affect your communication
  with patients
• Implement patient-centered communication
  practices

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Optimize your Team Case Manager Role

•  
• Plans and integrates care for people with
  diabetes and other chronic diseases 
• Liaison with other community resources  
• Provide good documentation in patient record, all
  patient contact attempts, and all telephone and
  written communication with patients 
• Log in binder the appointment date/time/location
  check off if the letter was sent, phone call
  made, films requested
• Reviews charts for what is needed (with help of
  other team members)
• Coordinate with other team members
• Help with referrals and links to community
  resources as needed
• Helps counsel around self-management goals

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Optimize your Team Outreach Log
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Manage your Population use your data
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Health Literacy Screen
Newest Vital Sign http//www.pfizerhealthliteracy
.com/pdf/FH_vitalsigns_040605.pdf
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Depression Screening

• http//www.commonwealthfund.org/usr_doc/PHQ2.pdf

PHQ -9 http//www.depression-primarycare.org/clin
icians/toolkits/materials/forms/phq9/
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Why Process Map?

• Creates a visual snapshot of the current flow of
  the process
• Allows you to see opportunities for improvement
• Facilitates identification of process variations,
  duplications and waste
• Adds a discipline to improvement
• Allows involvement of all key players

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Patient given order for fasting lipids
Results notification mailed
Yes
Lipids at target?
No
Lab gives results to PCP PCP orders follow up
visit
RN enters patient name and date into log (in lab)
But what about.?
Returned results are processed by lab staff and
results entered into log
RN schedules appointment
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Patient given order for fasting lipids
Results notification mailed
Yes
Lipids at target?
No
RN enters patient name and date into log (in lab)

• Gaps addressed
• Follow up for Lipid results that have not been
  returned
• Ability to track if patient received timely
  follow up on elevated lipids.

Lab gives results to PCP. PCP orders follow up
visit.
Log checked q 2 weeks for follow up phone calls
needed
RN schedules appointment and places reminder in
tickler file
Returned results are processed by lab staff and
results entered into log
Front desk checks tickler and reports no-show
appointment to RN
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Smoking Cessation Toolkit

• An Integrated Approach