Chris Shea

Practicum Presentation

12-14-2012

The Problem

Patients with chronic conditions often must undergo substantial behavior change to perform self-care activities effectively

National efforts aim to improve care for patients by supporting their self-care activities

Patient Centered Medical Home (PCMH)

Scope and Goals of the Practicum Setting: Carolina Advanced Health (CAH)

Overall Goal: To achieve PCMH recognition

Requires use of EHR to document the following for 50% of patients in diabetes, hypertension, or depression registry:

Goal setting with patients

Patient education materials

Self-management tools

Counseling (i.e., nutritional and behavioral).

My goal was to engage staff who are involved with completion of the PCMH-related activities to participate in planning for the change and to adopt new workflows

Carolina Advanced Health

A partnership between UNC Health Care System (HCS) and Blue Cross Blue Shield of North Carolina

An innovative patient-centered primary care model

longer patient visits (i.e., 40 minutes)

onsite pharmacy, nutrition, and behavior specialists

Approach The PCMH change effort was embedded within the CAH’s

quality-improvement (QI) approach

The QI team dedicated to this effort consisted of representatives from each role directly involved with the care processes

The CAH QI specialist worked with developers to modify the EHR

The aims were to1. Modify the EHR to capture necessary data for PCMH

2. Optimize EHR usability and workflows related to the PCMH activities

3. Monitor the performance of the clinic in these areas.

Methods for Change Management Initial interviews and follow-up discussions with 6

CAH representatives to identify current and desired future processes for PCMH-required activities

Weekly QI meetings to

1. Make decisions about EHR design modifications

2. Formalize related workflows

3. Review data on the clinic’s performance on PCMH-related care processes

Education, Counseling, Self-Monitoring

Education, Counseling, Monitoring #2

Education, Counseling, Monitoring #3

Education, Counseling, Monitoring #4

Process Diagram: Educational Materials

Initial Results

Denominator Numerator % of Denominator

PCMH Requirement August November August November August November

Education Provided 154 168 49 106 31.82% 63.10%

Has Goal or Plan 154 168 54 85 35.06% 50.60%

Self-Mgt Tool Provided 154 168 21 76 13.64% 45.24%

Counseling Provided 154 168 14 112 9.09% 66.67%

Note:

Denominator = patients verified in diabetes, hypertension or depression registry

Numerator = patients who received education, set goal/plan, received self-monitoring tool or received counseling

Lessons Learned

Embedding this type of change within a QI framework helps ensure successful completion

As with most process-oriented requirements, there is a need to assess whether the “spirit” of the requirement is being achieved over time.

Are patients receiving educational materials that are appropriate?

Are patients being overloaded with information?

Do they use each source of information provided (e.g., educational materials and self-monitoring tools)? For what purposes?