1 quality improvement series session 9 windy stevenson [email protected] cindy ferrell
Post on 19-Dec-2015
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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