clinicalstandards
TRANSCRIPT
CARENA VIRTUAL CLINIC
Clinical Standardsand Experience
YOUR PARTNER FOR QUALITY CARE
At Carena, we partner with health systems to create virtual clinics that deliver the highest quality patient care. Carena’s extensive experience as a pioneer in telemedicine ensures the practice of safe, evidence-based virtual medicine.
Your virtual clinic is a natural extension of your current operations and brand.
The clinicians who provide care can be your own staff members. Or, to get up
and running quickly, the board-certified, employed medical virtualists at Carena
are available to provide 24/7 quality care.
Whether you use your providers or ours, all clinicians and staff members
working in a Carena virtual clinic adhere to the highest quality clinical protocols,
training, and support. Our virtual care criteria and treatment guidelines for
urgent and primary care are built right into the system.
Health systems committed to the highest level of clinical quality choose Carena
to ensure great outcomes for their patients via computer, phone, or tablet.
DEDICATED MEDICAL GROUP When our health system partners choose to staff their virtual clinic with
Carena medical providers, they are confident that their patients are being
treated by an expert team of board certified family physicians and advanced
registered nurse practitioners. Our team is unified in their passion to deliver
the highest quality virtual healthcare. Our team of employed providers are
specialists in the field of telemedicine who have dedicated their clinical careers
to virtual care delivery.
Our providers are licensed to provide care in your state. They are salaried
with incentives tied to patient satisfaction and adherence to guidelines—
not volume of visits. We do not work with moonlighters who could be working
for another system. Quality of care is as important to us as it is to our health
system partners.
VIRTUAL PRACTICE GUIDELINES The Carena Virtual Practice Guidelines (VPGs) are the result of an analysis of
35,000 Carena house call encounters and national standards of practice with an
emphasis on patient safety, clinical quality and evidence-based medicine.
The VPGs are integrated into every virtual clinic we build. This point-of-care
clinical documentation software ensures that every health system that partners
with Carena efficiently and safely delivers Virtual Visits consistently. Our VPGs
also provide a basis for clinical and actuarial review and study.
Figure A. Your patients receive
appropriate care, whether
through our virtual clinic or, if
necessary, referred elsewhere
in your system. Our virtualists
complete visits for 64% of
all inquiries. The other 36%
are referred to Urgent Care,
Emergency Departments,
or primary care physicians.
64%completed virtually
36%other
REFERRALS
18% Urgent Care
12% PCP
6% ED
QUALITY ASSURANCE AND IMPROVEMENT PROGRAM Carena medical providers emphasize clinical quality and patient safety.
Our Quality Assurance And Improvement Program (QAIP) ensures that all
providers maintain the highest standard of clinical care. Our QAIP has been
approved and certified by the Washington State Department of Health.
Some of the measures of Carena’s robust QAIP program include:
• Clinical Appropriateness of Virtual Visit
• Adherence to Virtual Practice Guidelines
• Quality of Documentation
• Ongoing monitoring of prescribing practices and antibiotic stewardship
We are dedicated to improvement. A five-member clinician committee performs
blinded reviews of random and targeted diagnoses and produces quarterly
reports which are used to inform and improve clinical procedures going forward.
PROVIDER TRAINING AND COLLABORATION Expert training and support ensure the delivery of high quality, safe, and
evidence-based virtual medicine. Our comprehensive provider training program,
Carena University, helps to ensure high standards. Ongoing clinical collaboration
among the virtualist team is also essential for outstanding patient care. The
team’s interactions have fostered a culture dedicated to delivering exceptional
virtual care.
Responsible Prescription Practices We ensure the clinical appropriateness of every virtual visit and constantly
monitor our prescribing and antibiotic stewardship practices. Our providers
prescribe antibiotics wisely—up to 25% less often than the national average.
Your providers can learn the best practices of telemedicine by attending Carena University.
Figure B. Top 15 Virtual Diagnoses & Management Rates
Cystit
isSi
nusitis URI
Phary
ngiti
s
Cough/
Bronc
hitis
Conju
nctiv
itis
Ota
lgia
Rash
Gas
troe
nter
itis
Viral S
yndro
me
Skin
Infe
ctio
n
Feve
r
Back
& Nec
k Pai
n
Abdom
inal P
ain
Alle
rgy/
Urticar
ia
14%
Fre
qu
en
cy
of
Dia
gn
osi
s
Completed Virtual Visit
Referred for in-person Visit12%
10%
8%
6%
4%
2%
0%
ANTIBIOTIC PRESCRIBING PRACTICES Carena providers take particular care with the prescription of antibiotics.
Historically, our providers prescribe medication in approximately 40% of all
Virtual Visits. In an era of antibiotic over-prescription and bacterial resistance,
Carena’s overall antibiotic prescribing rate remains consistently lower than
national average. For the diagnosis of Upper Respiratory Infection (URI),
for example, Carena’s Virtual Antibiotic prescribing rate is only 1% for cough
and 4% for bronchitis.
COMMITMENT TO GREAT OUTCOMES Patient outcomes are as important to us as they are to you. Our team is
dedicated to helping customers get results. Our procedures include follow-up
patient calls, regular chart reviews, and bi-weekly meetings to assess cases.
We carefully consider our patient survey scores for continuous improvement.
It’s all part of our constant commitment to improving outcomes.
Figure C. Carena’s antibiotic prescribing rates are between 30% and 50% lower than
nationally reported clinic-based averages for Acute Respiratory Tract Infections (“ARTI”,
which includes diagnostic groups for cough, bronchitis, otitis, URI, sinusitis, and pharyngitis).
Figure D. Our virtual clinics deliver positive outcomes. 94% of patients who have
completed virtual visits report that their issue was either resolved (46%) or better (48%).
82% of visitors required no subsequent care.
Results compiled from completed virtual visits.
70%
80%
Carena Completed Virtual Visist
Grover 2012 Lee 2014 Grijalva 2009
38% 69% 73% 48%
Acute Respiratory Tract Infection (ARTI) Antibiotic Prescribing Rates
60%
50%
40%
30%
20%
10%
0%
46%Resolved
48%Better
4%No Change
2%Worse
Subsequent Care Required82%
None
12%PCP
3%UC
3%Other
0%ER
Clinical Status
Sources: Grover ML, Mookadam M,
Rutkowski RH, et al. Acute respiratory
tract infection: A practice examines its
antibiotic prescribing habits. Journal of
Fam Practice. 2012;61(6);330-35. Grijalva
CG, Nuorti JP, Griffin MR. Antibiotic
Prescription Rates in Acute Respiratory
Tract Infections in US Ambulatory Settings.
JAMA. 2009;302(7):758-766. Lee GC,
Reveles KR, Attridge RT, et al. Outpatient
antibiotic prescribing in the United States:
2000-2010. BMC Medicine. 2014.
FOR MORE INFORMATION, CONTACT US AT:
1 (800) 572–2103
www.carenamd.com© 2015 Carena, Inc. All rights reserved. 150224-01-01