disclosure i, michael kaiser, md, have no relationships with commercial interests to disclose. a...
TRANSCRIPT
LSU Improving Quality,
Improving Outcomes,Improving Efficiency
Michael Kaiser, MDChief Medical Officer
LSU Health Care Services Division
Disclosure
I, Michael Kaiser, MD, have no relationships with commercial interests to disclose.
A commercial interest is any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.
LSU SCHOOL OF MEDICINE-NEW ORLEANS
The best of times?
Or
The worst of times?
LSU Medical HomeD
IABE
TES
DIA
BETE
SD
IABE
TES
DIA
BETE
S
CHF
CHF
CHF
CHF
HIVHIV
HIVHIV
KID
NEY
DIS
EASE
KID
NEY
DIS
EASE
CAN
CER
CAN
CER
CAN
CER
CAN
CER
ASTH
MA
ASTH
MA
ASTH
MA
ASTH
MA
THROMBOGENIC STATE CONTROL
BLOOD PRESSURE CONTROL
GLYCEMIC CONTROL
LIPID CONTROL
SMOKING CESSATION
DIET EXERCISE WEIGHT CONTROL
SCREENING
DIABETES
1097 1914
1026
20251342
1694
695
9793
.45
.5
.55
.6
.65
.7
.75
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104AWARD criterion = 0.55, GOAL = 0.65, see lines on graph
diabetes: LDL <= 100 [R]denom: PC Sustained, 6/12
1358
2311
1325
2468
1509
1959
909
11839
.15
.2
.25
.3
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200801 through 201104
diabetes: A1c<7, LDL<100, BP<140/90denom: PC Sustained, 6/12
This is the diabetes “composite” control measure.
1043
1666
971
1739
1104
1431
645
8599
0
.1
.2
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104AWARD criterion = 0.55, see line on graph
diabetes: Eye exam in past 15 mos [R]denom: PC Sustained, 3/12
HEART FAILURE
76251
57
289
267302
1791421
.6
.65
.7
.75
.8
.85
.9
.95
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104AWARD criterion = 0.85, see line on graph
chf: on metop-s, carvedilol, or bisoprolol [R]denom: PC Sustained, 6/12
84
250
61
297
270
323
193
1478
.2
.25
.3
.35
.4
.45
.5
.55
.6
.65
.7
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104
chf: mod < 130/80, BP in last year [R]denom: PC Sustained, 6/12
186
318
124
419
370
368
237
2021
.1
.15
.2
.25
.3
.35
.4
.45
.5
.55
.6
.65
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200801 through 201101
admit: IP visits per person year - qrtdenom: CHF clinic population
Our heart failure admission rates have been steadily falling
12
15
11
14
17
1710
65
0
.1
.2
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104
chf: PC visit w/I 20 days of all-cause IPdenom: lowEF pop 3+ mos
Although we just starting tracking this measure, the fraction of inpatient discharges with PC visits within 30 days has been increasing for some time.
ASTHMA
326
307 159
396
260199
160
1807
0
.1
.2
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 201003 through 201104AWARD criterion = 0.80, GOAL = 0.80, see lines on graph
asthma: % with action plan ever [R]denom: Sust PC 3/12, DXconf
326
307159 396
260199
160 1807
.2
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104AWARD criterion = 0.80, see line on graph
asthma: % with PFT in past 3 yrs [R]denom: Sust PC 3/12, DXconf
326
307159
396260
199
160
1807
.4
.5
.6
.7
.8
.9
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104GOAL = 0.60, see line on graph
asthma: % with pneumovax imm ever [R]denom: Sust PC 3/12, DXconf
143
147
65218
13091
78 871
0
.5
1
1.5
2
2.5
3
3.5
4
4.5
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201103
asthma: #ER+IP visits/person-year, quarterdenom: Asthma pop 3+ mos, DXconf
HYPERTENSION
4323
6732
4036
5637
6256 7189
4303
38476
.2
.25
.3
.35
.4
.45
.5
.55
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201103
htn: Curr BP >= 140/90denom: PC Sustained, 3/12
4081
6425
3826
5318
59176867
4091 36525
.1
.15
.2
.25
.3
.35
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201103
htn: Sustained BP > 140/90denom: PC Sustained, 3/12
CHRONIC KIDNEY DISEASE
254 316260
493
363
443
211
2340
.4
.45
.5
.55
.6
.65
.7
.75
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104AWARD criterion = 0.65, see line on graph
renal: LIPIDS, LDL < 100, stage 34conf [R]denom: PC sustained 6/12
324
401
336582
421519
306
2889
.2
.25
.3
.35
.4
.45
.5
.55
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104AWARD criterion = 0.40, GOAL = 0.40, see lines on graph
renal: BP, last BP < 130/80, stage 34conf [R]denom: PC sustained 6/12
CANCER SCREENING
2725
5013 3216 4728
4814
5609
3586
29691
.5
.55
.6
.65
.7
.75
.8
.85
.9
.95
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200703 through 201104AWARD criterion = 0.80, GOAL = 0.80, see lines on graph
breastcancer: Mammogram in past 2 years, age 40-75 [R]denom: PC Sustained, 6/12
2198
5391
1667
3649
4538 4899
3141
25483
.45
.5
.55
.6
.65
.7
.75
.8
.85
.9
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104AWARD criterion = 0.80, GOAL = 0.80, see lines on graph
cervicalcancer: Pap in 2 yrs (21-29) or 3 yrs (30-69) [R]denom: PC Sustained, 6/12
3104
5000
3005
4191
5018
5440
352929287
.2
.25
.3
.35
.4
.45
.5
.55
.6
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104AWARD criterion = 0.50, see line on graph
coloncancer: Scope_10yr OR flexsig_5yr OR FOBT_1yr [R]denom: PC Sustained, 3/12
HIV
64
53493
132
607
270193 1893
.3
.4
.5
.6
.7
.8
.9
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104
hiv: current viral load undetectabledenom: HIV clinic 3/12 sustained
64
52795 136
613 274 201 1910
0
.1
.2
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104AWARD criterion = 0.80, GOAL = 0.80, see lines on graph
hiv: STDs, Chlamydia test in past 15 mos [R]denom: HIV clinic 3/12 sustained
18
235
13
36
168 86
54610
.1
.2
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104
hiv: Pap in 2 yrs (21-29) or 3 yrs (30-69)denom: HIV clinic 3/12 sustained
18 152
23
28
154
56
31
462
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200703 through 201104
hiv: mammogram in past 2 yearsdenom: HIV clinic 3/12 sustained
TOBACCO CONTROL
6427
9065
51387235 11723 9567
582654981
0
.1
.2
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLHPL
LAK
LJC
MCL
UMC
WOM
_TOT
SITES over QUARTERSGraph uses data from quarters 200801 through 201104AWARD criterion = 0.90, GOAL = 0.90, see lines on graph
tobacco: screening rate in past 90 days [R]denom: PC visit in past 3 month
358
235
86342
652
547
206
2426
.4
.5
.6
.7
.8
.9
1
SITES over QUARTERSGraph uses data from quarters 200901 through 201104AWARD criterion = 0.70, GOAL = 0.70, see lines on graph
tobacco: % selected assistance among smokers ready to quit [R]denom: PC visit in past 3 month
This is the fraction of “ready to quit” smokers who select some sort of assistance.
EMERGENCY DEPARTMENT
3617
4455
3885
40654543 4615
3292 28476
0
100
200
300
400
500
600
BMC
EKLHPL
LAK
LJC
MCL
UMC
WOM
_TOT
SITES over QUARTERSGraph uses data from quarters 200801 through 201104
ed: LOS, home, triage 4&5 (Median)denom: Non-BH in quarter
This is median LOS (in minutes) for non-behavior health patients, discharged to home, with triage levels 4 & 5
MEDICAL HOME
14947.00
21690.00
12100.00
20838.00
26071.00
24780.00
13755.00
10000
12000
14000
16000
18000
20000
22000
24000
26000
28000
BMC
EKLLA
KLJ
CM
CLUM
CW
OM
Graph combines data from quarters 201104 through 201104.Bottom row numbers on graph are sample sizes.
mh: # in denominatorDENOM: Total PC clinic population
These are our current medical home patient population estimates. The system-wide total is 134,181. These are likely rather conservative estimate.
Initial State – Analytic Assignment
Medical Home CorrectVerified at Each Visit
0
.1
.2
.3
.4
.5
.6
.7
.8
.9
1
Average Clinic TOPBOX Fractions and Rangesall respondents
First set of results from the new medical home patient perceptions instrument. Our most positive perceptions were on “friendly.” The least positive pertained to wait times in the clinic (i.e., time spent between arrival and seeing the doctor.)
CHALLENGES• Pelican Implementation• Medicaid Managed Care• Behavioral Health Managed Care• Obama Care• Value-Based Purchasing and hundreds of new
measures and reporting requirements• Budget Cuts
Do More with Less?
Or
Do Less with Less?
• Numbers we serve – throughput• Reduce delays in primary care• Decrease utilization of ED for primary care
and primary support
• From ED Medical Home
• From Inpatient Medical Home• From Medical Home Specialty• From Specialty Medical Home
• Patient self-management skills• Medication adherence• Disease Education• Goal setting and behavior change• System navigation
IMPROVE INTERACTIONS WITH OUR PATIENTS
PatientOur Vision
Value Leader
Our MissionTreat and Teach
Our Values Information Innovation ImprovementIntegrity
Tactics
ResourcesTeaching Research Revenue
Access Quality Safety SatisfactionService
Foundational ElementsMedicalHome
IntegratedInfo Systems
Disease Management Centers of Excellence
PerformanceImprovement
Low Cost Distributed ServicesHigh Quality
Excellence Equity Execution ExplainableEmpathetic
LSU Hospitals ---------------
Strategic Overview
BETTER UNDERSTANDING AND RESEARCH OF
QUALITY IMPROVEMENT PRACTICES
Transition Care InteractionsSelf Management Education Interaction
Coordinated Care Interactions
EVIDENCE BASED STRATEGIES
COORDINATED CARE INTERACTIONS
• Targeting• In-person contact• Access to timely information on hospital and ER
admissions• Close interaction between care coordinators and
primary care physicians• Patient assessment, planning, education, monitoring,
and coaching with social support
1358
2311
1325
2468
1509
1959
909
11839
.2
.3
.4
.5
.6
.7
.8
.9
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104
diabetes: IMM, flu immunization this seasondenom: PC Sustained, 6/12
64527 95
136613 274
2011910
.45
.5
.55
.6
.65
.7
.75
.8
.85
.9
.95
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104
hiv: STDs, syphilis test in past 15 mos [R]denom: HIV clinic 3/12 sustained
CLIQ Documentation
557
595
380
814
635
766
364 4111
0
.1
.2
.3
.4
.5
.6
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200801 through 201104
documentation: DX, asthma DX confirmeddenom: PC Sustained, 3/12
68182
38
207
193247
161 1096
.2
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104
documentation: DX, heart failure DX confirmeddenom: PC Sustained, 3/12
27095
37687
20785
31437
49304
4056922055 228932
0
.1
.2
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200804 through 201104
documentation: MEDREC, fraction with medrec donedenom: PC patients in qrt
1769525595 15208
20653
33383 2705516958
156547
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200703 through 201104
documentation: PP, fraction with blood pressure documenteddenom: PC patients in qrt
684710615 6537
8832
13470
9897
5729
68842
0
.1
.2
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLHPL
LAK
LJC
MCL
UMC
WOM
_TOT
SITES over QUARTERSGraph uses data from quarters 200801 through 201104
ed: ED summary & dictation rate [R]denom: All ED visits in quarter
Current Plan
Currently we are planning to develop measures in the following domains:
1. Patient engagement2. Access to primary care3. Access to specialty care4. Primary care efficiency5. Wellness6. Chronic disease management7. Reduction of adverse events 8. Patient perceptions of MH experiences9. Provider perceptions of MH experiences
Our current medical home measures plan calls for measures in these 9 domains. The next five slides show five initial measures now being added to the site visit reports.
3749
5514
3066
5294
6712
6283
3508
34127
0
.1
.2
.3
.4
.5
.6
.7
.8
.9
1
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200701 through 201104
mh: ER visits per person-year - qrt, x-IPdenom: Total PC clinic population
This is our ED visit rate per person-year for the total medical home patient population.
939
973
626
985
1331 1214
650
6718
0
10
20
30
40
50
60
70
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200801 through 201103
mh: Median time to appointment denom: new patients in quarter
This is the median days to wait for a new patient appointment
2609
3732
2514
2829
3225
5300
1538
21747
0
10
20
30
40
50
60
70
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200801 through 201103
mh: Median time to appointment denom: established patients in quarter
This is the median days to wait for a non-follow-up appointment for established patients.
940
973
626
985
1331
1214 650
6719
.55
.6
.65
.7
.75
.8
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200801 through 201103
mh: Show rate denom: new patients in quarter
2610 3733
2515
2829
3226
5300
1538
21751
.55
.6
.65
.7
.75
.8
.85
BMC
EKLLA
KLJ
CM
CLUM
CW
OM_T
OT
SITES over QUARTERSGraph uses data from quarters 200801 through 201103
mh: Show rate denom: established patients in quarter
Medical Home:Satisfaction & Patient Perceptions
• We continue to use our patient satisfaction survey which assessed post-visit impressions of the recent visit.
• We have begun using a “medical home patient perceptions” survey.– Conducted in clinics prior to visits– Assesses perceptions among existing (not new)
medical home patients– Summarized quarterly, based on surveys done one or
two days per month by each MH clinic.
Medical Home Designation and Documentation
CLIQ Summary Screen Update
CLIQ Powered by:LSU HCSD Medical Informatics Team
Initial State – No Medical Home
Medical Home Fields Blank
Medical Home Fields Populated
Two Initial States
Documenting A Medical Home
CommCare Medical Home
LSU Medical Home
Non-LSU Medical Home
LSU Medical Home
LSU Medical Home
LSU Medical Home
LSU Medical Home
LSU Medical Home
Updating/Viewing Medical Home Data
Questions
PatientOur Vision
Value Leader
Our MissionTreat and Teach
Our Values Information Innovation ImprovementIntegrity
Tactics
ResourcesTeaching Research Revenue
Access Quality Safety SatisfactionService
Foundational ElementsMedicalHome
IntegratedInfo Systems
Disease Management Centers of Excellence
PerformanceImprovement
Low Cost Distributed ServicesHigh Quality
Excellence Equity Execution ExplainableEmpathetic
LSU Hospitals ---------------
Strategic Overview