Integration of Convenience care into a college health primary care model: GOPHER QUICK CLINIC - PowerPoint PPT Presentation

Loading...

PPT – Integration of Convenience care into a college health primary care model: GOPHER QUICK CLINIC PowerPoint presentation | free to download - id: 6a8be3-MzI1O



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Integration of Convenience care into a college health primary care model: GOPHER QUICK CLINIC

Description:

May 29, 2009 Jill Wooldridge P.A.-C. Boynton Health Service, University of Minnesota, Minneapolis, MN – PowerPoint PPT presentation

Number of Views:14
Avg rating:3.0/5.0
Slides: 60
Provided by: malderman
Learn more at: http://members.acha.org
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Integration of Convenience care into a college health primary care model: GOPHER QUICK CLINIC


1
Integration of Convenience care into a college
health primary care modelGOPHER QUICK CLINIC
  • May 29, 2009 Jill Wooldridge P.A.-C.
  • Boynton Health Service, University of Minnesota,
    Minneapolis, MN

2
Topics to be Covered
  • Define Convenience Care
  • How we came to develop/improve Gopher Quick
    Clinic
  • How Gopher Quick Clinic Functions
  • Display data about utilization of GQC
  • Impact on Providers, Primary Care, Urgent Care
  • Financial Impact
  • Future Considerations and Plans
  • Challenges to the Model

3
CONVENIENCE CAREWHAT IS IT?
  • Provides care for Minor Acute Illness (strep
    throat screens, bladder infections, sinus
    infections, warts, impetigo etc.), some basic
    vaccinations and basic testing.
  • A Walk-in patient centered model usually staffed
    by Advance Practice Clinicians.
  • Patients evaluate their own needs and pick care
    time that is convenient to their schedule.
  • One Stop Care. Total patient interaction is in
    one location and usually a single face-to-face
    interaction with a single Clinician.
  • Since the first Convenient Care clinics opened in
    2000, the industry has grown quickly today
    approximately 1,200 such clinics are in operation
    (many in retail locations)

4
HOW WAS THE BOYNTON PROJECT IDENTIFIED?
  • An effort to support the Universitys strategic
    mission to improve services to the student
    population.
  • Community trends and patient expectations for
    more choice and control over how they access care
    and Boyntons and University Human Resources
    desire to meet these.
  • An identified internal challenge in our current
    Urgent Care model to optimally serve acute care
    patients.

5
PURPOSE OF COMMITTEE
  • October 10, 2006 - Committee charged by COO to
    evaluate
  • The benefits of providing a Convenience Care
    model of service.
  • The appeal of Convenience Care to our patients
    and third-party payers.
  • The impact of this service on Urgent and Primary
    Care.
  • Over-all financial impact.

6
COMMITTEE MEMBERS
  • Chair Mary Alderman - Director Clinic Operations
  • Co-chair Dave Dorman Health Promotion
  • Beverly Carpenter Administrative Assistant
  • Joyce Fortier Executive Secretary
  • Jill Wooldridge, PA Provider
  • BJ Anderson, MD - Provider
  • Britt Bakke - Marketing and New Program
    Development
  • Paula Miller, RN Student Health Advisory
    Committee member
  • Barb Rangel, LPN Supervisor Patient Assistance
    and Information
  • Virginia Tranter, RN Lead Nurse Immunization
    Clinic

7
QUALITY IMPROVEMENT PROCESS
  • DMAIC
  • DMAIC is a basic component of the Six-Sigma
    methodology (Business Management Strategy) - a
    way to improve work processes by improving
    efficiency and eliminating defects.
  • In its methodology, it asserts that in order to
    achieve high quality business processes,
    continued efforts must be made to reduce
    variations.

8
DMAIC MODEL
  • DEFINE PHASE
  • What are the issues and desires for improvement
  • MEASURE PHASE
  • Data collection to direct improvement efforts
  • ANALYZE PHASE
  • Clarify and identify root cause of issue
  • IMPROVE PHASE
  • List of all potential solutions and their impact
    with implementation plan and milestones
  • CONTROL PHASE
  • Pilot plan, process control, implementation of
    solutions and transition control plan

9
Define Phase
  • COLLECTING THE VOICE OF THE CUSTOMER
  • Conducted informal focus groups with the Student
    Health Advisory Committee (SHAC).
  • Conducted informal focus groups with Boynton
    Health Service (BHS) staff Providers, RNs,
    Pharmacy, Lab, Front Desk and Support staff.
  • Created open message board for comments from BHS
    staff on shared network drive.

10
Measurement Phase
  • Measured interest in a Convenience Care model
  • An online survey sent to 4,000 students, with a
    return rate of 32, showed 68 were interested.
  • An online survey sent to 2,000 faculty and staff,
    with a return rate of 38, showed 53 were
    interested.

11
Measurement Phase (continued)
  • PROBLEM Urgent Care process of dealing with
    Minor acute illness is inefficient and lengthy
    for the patient.
  • Measured current process efficiency for treatment
    of minor acute illnesses in Urgent Care.
  • Urgent Care Cycle-time study
  • Urgent Care Provider Average Cycle Time 80.5
    minutes
  • RN Average Cycle Time 54.5 minutes
  • RUC Average Cycle Time 66.0 minutes

12
Measurement Phase (continued)
  • Reviewed 12-Month (9/05 - 8/06) Total
    MinuteClinic Utilization
  • U of M Student Benefit Plan (SBP) 61 visits
  • U of M Graduate Plan 75 visits
  • U of M Staff/Faculty Benefit Plans 1,885 visits
  • Of the total Staff/Faculty MinuteClinic visits,
    389 were seen at the Coffman site (just under
    50/month).

13
Analyze Phase
  • Analyzed results of student, staff and faculty
    online surveys.
  • Reviewed list of factors identified in the formal
    focus groups.
  • Performed a Root Cause analysis on current model
    of care.
  • Consulted with Boynton Health Service Chief
    Operating Officer (COO) to examine fiscal
    implications of implementing a Convenience Care
    model.
  • Toured the University of Minnesota Duluth
    QuickCare Clinic.

14
Improve Phase
  • In March 2007 the Committee recommended that BHS
    provide a Convenience Care model service as a
    pilot, effective fall 2007.
  • The service was named Gopher Quick Clinic.
  • The hours of service were to be Monday through
    Friday , 9 a.m. to 5 p.m. with no coverage over
    the lunch hour (1-2pm).
  • The service was not offered during
    holidays/breaks.
  • Unless year-round fees were approved and a need
    for summer services was established, the service
    would not be offered during the summer.

15
GQC IMPLEMENTATION TEAM
  • Chair Mary Alderman - Director Clinic Operations
  • Co-chair Jill Wooldridge, PA Provider
  • Britt Bakke - Marketing and New Program
    Development
  • Margaret Dahl, RN - Nurse Supervisor Primary Care
  • Davin Hedin - Principal Accounts Specialist
  • Sue Jackson - Director Student Health Benefit
    Plan
  • Amy Murphy Executive Accounts Specialist
  • Barb Rangel, LPN Supervisor Patient Assistance
    and Information
  • Deb Sandberg, MD Medical Director
  • Karen Strauman-Raymond, RN Nursing Director
  • Gina Tran Supervisor Patient Accounting

15
16
Improve Phase (continued)
  • BHS Marketing Department implemented the
    Marketing Plan during spring and summer 2007.
  • During March 2007 through August 2007 the
    Implementation Committee
  • defined flow and location of clinic,
  • equipped and stocked the clinic,
  • hired Advanced Practice Clinician providers (to
    split time between primary care and GQC)
  • trained staff on new processes.
  • On September 4, 2007 the new clinic service was
    opened.

17
(No Transcript)
18
Gopher Quick Clinic ServicesGopher Quick Clinic
is limited to addressing one of the following
concerns per patient visit.
Common IllnessesBladder InfectionBronchitisCol
d/CoughEar InfectionLaryngitisMononucleosisRes
piratory Flu(without vomiting or
diarrhea)Seasonal AllergiesSinus
InfectionStrep ThroatSwimmer¹s Ear
Skin ConditionsAthlete's FootCold
SoresImpetigoMinor SunburnPoison
IvyRingwormWarts (three or fewer, does not
include genital warts)VaccinesTetanus
Vaccines (Td and Tdap) Flu Vaccine (when flu shot
clinics not running)Additional
ServicesPregnancy Test
19
(No Transcript)
20
Boynton Gopher Quick Clinic
21
HOW DOES IT WORK?
  • FRONT DESK STAFF
  • Checks in patient, schedules them for next
    available slot (every 15 minutes), tells patient
    approximate wait time, gives them Short Health
    History form to fill out.
  • Handles any co-pay/insurance issues

22
(No Transcript)
23
(No Transcript)
24
(No Transcript)
25
HOW DOES IT WORK?
  • GQC PROVIDER (Team of 6 PAs, 2 NPs)
  • Calls patient from schedule on computer, brings
    back to room
  • Interviews patient (uses paper form)
  • Obtains vitals (Spot Vital Signs)
  • Examines patient
  • Performs any point-of-care labs Strep, Mono,
    Flu, Urine dip, urine pregnancy test Throat
    cultures, Urine cultures sent to lab
  • Writes any Rx, educates patient, uses pt.
    education materials
  • Patient leaves room, provider finishes any
    documentation

26
Boynton Gopher Quick Clinic Exam Room
27
(No Transcript)
28
HOW DOES IT WORK?
  • MEDICAL RECORDS
  • Collects paper encounter forms daily
  • Sorts for billing, clinical record
  • Scans the paper visit for our EMR (usually within
    1 day)
  • Abstracts pertinent data directly into our EMR
    Reason for Visit, Vitals, Labs done, Assessment,
    Medications prescribed (usually within 1-2 days)

29
Control Phase (Fall 2007)
  • The week of October 22-26, 2007 BHS sent a survey
    to all current Gopher Quick Clinic patients to
    assess satisfaction with the service.
  • Katie Lust, PhD, Director of Research and
    Surveillance, evaluated all surveys

30
October 2007 Survey Results
  • Compare Satisfied vs. Not so Satisfied
  • Satisfied Excellent, Very Good and Good
  • Not so Satisfied Fair and Poor
  • 81.2 of the patients surveyed rated the entire
    visit as satisfactory. Target is 90 satisfaction
    rate.
  • Patient concerns identified were
  • wait time in the lobby
  • time spent with the provider in the exam room
  • privacy

31
OCTOBER SURVEY PROCESS IMPROVEMENT PLAN
  • WAIT TIME
  • Added appointments over the 1-2 p.m. lunch time
  • Changed marketing material to indicate that GQC
    was
  • first-come-first serve and
  • capacity for the clinic may be reached prior to
    the 5 p.m. closing
  • TIME SPENT WITH PROVIDER
  • Changed marketing material to say Visits last
    approximately 10 minutes.
  • PRIVACY
  • Performed a second survey asking more specific
    privacy questions
  • Changed location of urine sample drop-off from
    Lobby to Front Desk

32
Control Phase (Winter 2008)
  • On January 22, 2008 BHS sent a 2nd survey to all
    current Gopher Quick Clinic patients to assess
    the following
  • Wait Time expectations
  • Satisfaction with amount of time spent with the
    provider in the exam room
  • Level of comfort with
  • check-in procedure
  • location of waiting room
  • location of exam room
  • Level of comfort with the process for giving a
    urine sample as it related to
  • location of restroom
  • privacy of restroom
  • walking from restroom to drop-off box
  • location of drop-of box and overall urine
    collection procedure

33
JANUARY 2008 SURVEY RESULTS
  • Compared Satisfied vs. Not so Satisfied
  • Satisfied Excellent, Very Good and Good
  • Not so Satisfied Fair and Poor
  • 89.0 of the patients surveyed rated the entire
    visit as satisfactory. Target is 90.
  • Patient concerns identified were
  • location of lobby in relation to exam room,
  • location of restroom in relation to drop-off box
    and
  • wait time

34
JANUARY SURVEY PROCESS IMPROVEMENT PLAN
  • Exam Room Location
  • Moved exam room from off of Lobby to interior
    exam room within Primary Care South (PCS)
  • Restroom and Drop-off Box Location
  • Changed restroom and drop-off box location to be
    within PCS clinic space
  • Wait Time
  • Added second GQC provider in the PM.

35
(No Transcript)
36
Fall of 2008 Opened Coffman Satellite
  • Opportunity arose to utilize the Minute Clinic
    site across the street in the Union
  • Hired 3 new staff to accommodate new full-time
    GQC clinic and have back-up, as well as rotate
    into primary care to make the position more
    appealing.
  • Front desk to be staffed from Patient Assistance
    Dept
  • Challenging new workflow to get supplies,
    equipment (LN2), labs, etc. back and forth
  • Set up remote access via computer as well
  • Marketing!

37
(No Transcript)
38
(No Transcript)
39
(No Transcript)
40
COFFMAN GOPHER QUICK CLINIC
  • Specific Challenges to the satellite site
  • Tried to make it as much like the original GQC as
    possible for provider staff and patients
  • Had to set up courier drop off in AM, pick up in
    PM for supplies/labs
  • Slightly more complicated transfer of patients to
    Urgent Care if needed more hassle for patients
  • Much less privacy, both in the lobby and the
    public restrooms
  • Had to determine which site to close if providers
    are absent?

41
Visit Statistics for 2007-08 vs. 2008-09
42
(No Transcript)
43
Cycle Time Statistics for 2007-08 vs. 2008-09
44
SUMMARY OF GQC STATISTICS(from previous slides)
  • From 2007-08 to 2008-09, GQC visits from a
    comparable period increased from 3787 to 6459.
  • Average total cycle time decreased from 37 to 29
    minutes.
  • Average wait time in the Lobby decreased from 25
    to 18 minutes.
  • Time with provider remained essentially constant.

45
NOVEMBER 2008 SURVEY RESULTS
  • Compared Satisfied vs. Not so Satisfied
  • Satisfied Excellent, Very Good and Good
  • Not so Satisfied Fair and Poor
  • Again, 89.0 of the patients surveyed rated the
    entire visit as satisfactory. Target is 90.
  • Issues identified were
  • wait time satisfaction improved from Spring 08
  • Significant concerns regarding Privacy/Comfort at
    Coffman GQC, especially with regard to waiting
    area and urine sample collection
  • Patients who rated overall visit as fair or poor
    were expecting or would have liked to have more
    time with the provider

46
NOVEMBER 08 SURVEY PROCESS IMPROVEMENT PLAN
  • Wait Time
  • Front Desk staff continue to offer Coffman as an
    option if the wait time is gt 30 minutes at BHS
  • Coffman Privacy/Comfort Concerns
  • In talks now with Coffman Building services about
    possible remodeling of the space to allow private
    waiting area. Unable to change restroom location.
  • Expectations regarding time with provider
  • Make sure marketing materials and those
    encouraging the service are clear as to its
    limitations

47
IMPACT ON PROVIDERS
  • Gopher Quick Clinic Providers
  • Simple, easy visits? Or mind-numbingly boring
    after 25/day?
  • Mix of GQC time with Family Practice is seen as a
    job satisfaction issue from a provider
    perspective, but results in possible Excess
    Access in clinic schedules
  • Primary Care Providers
  • Initial skepticism regarding continuity of care
  • Concern over loss of quick visits that allow for
    make-up time for more involved visits.
    Perception that the complexity of visits has
    increased in Primary Care, though RVUs via coding
    has not yet borne that out.
  • All agree Quick must not sacrifice Quality
    evidence-based guidelines and judicious use of
    Antibiotics important

48
Top 20 Diagnoses for 2008-09Gopher Quick Clinic
Code Descr CountOfCode
462 ACUTE PHARYNGITIS 2,149
465.9 ACUTE URI NOS 1,815
599.0 URIN TRACT INFECTION NOS 811
461.9 ACUTE SINUSITIS NOS 617
078.10 VIRAL WARTS NOS 404
466.0 ACUTE BRONCHITIS 365
788.1 DYSURIA 249
463 ACUTE TONSILLITIS 244
477.9 ALLERGIC RHINITIS CAUSE UNSPECIFIED 207
034.0 STREP SORE THROAT 179
786.2 COUGH 152
382.00 AC SUPP OTITIS MEDIA NOS 150
381.4 NONSUPP OTITIS MEDIA NOS 131
V72.40 PREGNANCY EXAM/TEST UNCONFIRMED 82
V06.1 VACCIN FOR DTP 80
054.9 HERPES SIMPLEX NOS 78
075 INFECTIOUS MONONUCLEOSIS 69
380.10 INFEC OTITIS EXTERNA NOS 68
919.4 INSECT BITE NEC 62
381.81 DYSFUNCT EUSTACHIAN TUBE 58
49
IMPACT ON PRIMARY CARE VISITS
  • Percent of minor acute illness was reduced from
    18 to 15

Top 10 DX for 0607 Top 10 DX for 0708
Screen for Venereal Disease 1838 Screen for Venereal Disease 2236
Routine Medical Exam 1805 Routine Medical Exam 1725
Routine GYN Exam 1548 Routine GYN Exam 1427
Acute Pharyngitis 1517 Acute Pharyngitis 1024
Nonspecific Skin Eruption 833 Pap and Pelvic 1005
Viral Warts 715 Nonspecific Skin Eruption 745
Pap and Pelvic 710 Acne 604
Acne 594 Dysuria 585
Joint Pain Ankle and Foot 538 Backache 513
Fatigue 538 Viral Warts 513
50
IMPACT ON URGENT CARE
  • Percentage of visits for minor acute illness was
    reduced from 51 to 20. Target was to reduce the
    percentage by 50.

51
GOPHER QUICK CLINIC AND URGENT CARE
VISITSACADEMIC YEAR 0708 VS. ACADEMIC YEAR
0809
52
SUMMARY OF CHANGE IN VISITS(from previous slides)
  • GQC visits have continually increased in the same
    ratio as Urgent Care visits have fallen.
  • Total GQC visits have increased.
  • Total UC visits have decreased.
  • Overall total visits to combined departments have
    increased.

53
Financial ImpactVisits and RVUs
54
FINANCIAL MODELING
55
FINANCIAL ASPECTS
  • The breakeven point for visits is three visits
    per hour.

56
CONCLUSIONS AND FUTURE CONSIDERATIONS
  1. We have met our goal of an average cycle time of
    30 minutes or less.
  2. We have met our goal of reducing the percentage
    of minor acute visits in Urgent Care by 50.
  3. We have not met our goal of reaching an over-all
    satisfaction rate of 90 (but so close at 89!).
  4. We need to balance access and/or services to
    remain financially sound. New Services? How to
    increase utilization of Coffman site?
  5. Anecdotally, there has been a slight shift in
    acuity in visits in Primary Care, requiring more
    people staying late.

57
Looking Forward Whats next?
  • Remodel of Coffman Gopher Quick Clinic to allow
    for private waiting area
  • Move another Gopher Quick Clinic into our St.
    Paul clinic for ½ day Monday-Friday. (Dropping
    2nd PM provider at BHS)
  • Looking at financial feasibility and/or
    profitability of adding some preventive services
    (Cholesterol screen, BP screen)

58
CHALLENGES to the CONVENIENCE CARE MODEL
  • Balancing schedule having back-up to remain
    open as advertised, but avoiding excess access
  • Appropriateness (or not) of self-triage
  • Repeat visits for same issue
  • Higher acuity or complexity than GQC can handle,
    and subsequent re-triage of patients
  • If desires of patient dont fit GQC model
    (wanting more time, more than one concern, etc.)
  • Getting all information into EMR in a timely way
  • EMR wasnt quick enough for pilot, but templates
    are in development that are more user-friendly,
    quick-templates will still likely have to
    abstract some historical medical information
  • H1N1 Swine Flu

59
QUESTIONS?? jwooldridge_at_bhs.umn.edu
Special Thanks to Mary Alderman, Director of
Clinic Operations, and Carl Anderson, Chief
Operations Officer!
About PowerShow.com