improving your practice or hospital through healthy hearts ... your...(ami), coronary artery bypass...
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Improving Your Practice or Hospital through Healthy Hearts for Your
Patients
Ashley Rhude RHIA, CHTS-IM
Mission of OFMQOFMQ is a not-for-profit, consulting company
dedicated to advancing healthcare quality. Since 1972, we’ve been a trusted resource through
collaborative partnerships and hands-on support to healthcare communities.
OFMQ Areas of Expertise• Analytics
• Case Review
• Education
• HIPAA
• IT Consulting
• Health Information Technology
• National Quality Measures
• Quality Improvement
HIT Service Lines• HIPAA/Meaningful Use Security Risk Assessment -
Level 1, 2, and 3• Meaningful Use Assistance• Meaningful Use Audit Support• Risk Management Consulting and Development• Staff HIPAA Security Training• Website Development & Secure Email• IT Consulting
Ashley Rhude, RHIA, CHTS-IMAHIMA Approved ICD-10-CM/PCS Trainer
Ashley holds a bachelor’s degree in Health Information Management, as well as Health Care Administration. She is currently a Health Information Technology (HIT) practice advisor for the Oklahoma Foundation for Medical Quality. In this role, she assists providers, hospitals and nursing homes in the implementation and optimization of Electronic Health Records (EHR). Her specialties include: project coordination with EHR vendors, HIT security and privacy, workflow re-design and being an expert in meaningful use.
This session will cover:
Improving the health of your patients by:• Million Hearts• Healthy Hearts for Oklahoma
• Prevent 1 Million Heart Attacks and Strokes by 2017• By incorporating the ABCS of prevention
A- Aspirin B- Blood Pressure C- Cholesterol S- Smoking cessation
Source: http://millionhearts.hhs.gov/index.html
• High blood pressure, also called hypertension (HTN), is a leading cause of heart disease and stroke in the United States
• HTN is known as the “silent killer” because often times there are no symptoms
• 1 in 3 U.S. adults have diagnosed high blood pressure• High blood pressure caused or contributed to the deaths of more than
348,000 Americans in 2009—that's nearly 1,000 deaths per day• High blood pressure costs the nation an estimated $51 billion each
year• When your blood pressure is high: You are 4 times more likely to die from a stroke You are 3 times more likely to die from heart disease
Key Facts About High Blood Pressure
Source: http://www.millionhearts.hhs.gov/abouthds/blood_pressure.html
Source: National Health and Nutrition Examination Survey 2011-2012
About one third of the U.S. adult population have HTN
<140/90
SOURCE: National Health and Nutrition Examination Survey 2011-2012
Out of the 35 million U.S. adults with uncontrolled HTN, 13 million (5.5%) are unaware that they have HTN
U.S. HTN Statistics
http://www.cdc.gov/dhdsp/data_statistics/fact_sheets/docs/fs_bloodpressure.pdf
Oklahoma HTN Statistics
Source- CDC webpage at http://nccd.cdc.gov/DHDSPAtlas/viewer.aspx?state=OK
• HTN Deaths per 100,000
• Age 35+ • 2008-2010
Step 1: Identify HTN Population by Using HIT• To identify diagnosed HTN patients
– Query NQF 0018 (CMS 165 or PQRS 236)- Controlling High Blood Pressure
• Targets the percentage of patients 18-85 years with a diagnosis of HTN and whose BP was adequately controlled (<140/90 mmHg) during the measurement period
• In EHR report is located – Reports– Quality or Clinical Quality Measures– Meaningful use– Registry
– Results will have numerator, denominator and a percentage • 250/500 50%
Step 2: Identify Undiagnosed HTN Population by using HIT
• Query patients 18-85 years whose most recent BP was >140 systolic or >90 diastolic during the measurement period– In EHR report is located
• Reports• Registry
– Set criteria to generate the report– Results will be a list of patients that meet the criteria– Percentage of undiagnosed HTN population can be identified
• Total # of undiagnosed HTN pts/total adult population– 300/1500 or 20%
Step 3: Implement the C.H.I.L.L.I Protocol for Uncontrolled HTN
STEPS1. Triage patient as usual 2. If BP >140/90 begin C.H.I.L.L.I.
Protocol3. Check BP a second time after 15
minutes and document4. If improved end protocol-If still
Increased >140/90 then5. Let patient know6. Let provider know7. Institute a reminder or alert in EHR
for follow up 8. Refer to county health department
Heartland OK program for follow up
STEP 4: Collaboration• Provide onsite visits to assist providers and staff regarding the workflow
necessary to effectively document BP readings in reportable data fields in the EHR
• Implement the C.H.I.L.L.I. Protocol for detecting HTN in the undiagnosed patient
• Create awareness of measured HTN disparities to serve as a benchmark for improvement
• Provide educational materials for clinic staff and patients
Step 5: Re-Evaluate NQF 0018 Measure• Compile reports for NQF 0018
– Quarterly reports– Numerator, denominator and percentages
• Compare and present data– Individual level reports– Clinic level reports – Benchmark reports
ResultsExample of a Run Chart Shows the performance and improvement rates compared to other providers
Utilize Your EHR to Optimize the Management of HTN
• Document second BP reading in reportable field• Set BP alert parameters • Utilize the clinical decision support to embed clinical guidelines and best
practices for HTN at the point of care screening tools to identify high risk patients
• Implement treatment protocols or orders sets at the point of care• Utilize the patient portal to engage patients to self monitor and report
BP readings • Use CPOE to order and track referrals for HTN management• Use patient reminder system to track patients for follow up• Utilize the formulary function in EHR for Rx coverage• Measure NQF 0018 report at least quarterly for improvements
Use “unmet” patient report as a patient recall list for follow up
Healthy Hearts for Oklahoma (H2O)
8
Focus on the ABCs of a Healthy HeartName NQF
NumberCMS
Number Numerator Denominator
AAspirin Use in Ischemic
Vascular Disease
0068 164
Patients that have documentation of aspirin
usage or other antithrombotic during the measurement
period.
Patients 18 and older who have had at least one face to face visit during the reporting period and have a
diagnosis of IVD or were discharge alive for MI, CABG, or percutaneous coronary interventions in the 12
months prior to the reporting period.
BControlling
Blood Pressure
0018 165
Patients whose blood pressure at the most recent visit is controlled at <140/90
during the measurement period.
Patients 18-85 who have had at least one face to face visit during the reporting period and have an active
diagnosis of essential hypertension during the reporting period.
CCholesterol Control with
Statin Therapy
n/a n/a
Patients with a statin medication current on the
medication list or prescribed a statin medication during the
measurement period.
Patients 21 and older who have had at least one face to face visit during the reporting period and have an
active diagnosis of clinical atherosclerotic cardiovascular disease, LDL-C result of >=190 mg/dL
at any time during or prior to the measurement period, or aged 40-75 at the beginning of the
measurement period with an active diagnosis of diabetes with the highest LDL-C result of 70 – 189 mg/dL during the current measurement period or
two years prior to the beginning of the measurement period.
SSmoking
Cessation and
Intervention
0028 138
The number of patients who were screened for tobacco use at least once within 24 months and who received
tobacco cessation intervention if identified as a
tobacco user.
Patients 18 years and older and had at least two visits or at least one preventative visit during the
measurement period.
NQF 0068- Aspirin Use in Ischemic Vascular Disease
DENOMINATOR:• Patients aged 18 years of age and older with the
diagnosis of ischemic vascular disease (IVD) during the measurement period, OR who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period
NQF 0068- Aspirin Use in Ischemic Vascular Disease
Denominator Criteria (Eligible Cases):• Patients aged ≥ 18 years on date of encounter
AND• Diagnosis for Ischemic Vascular Disease (ICD-10-
CM)OR
• Diagnosis for acute myocardial infarction (ICD-10-CM)
NQF 0068- Aspirin Use in Ischemic Vascular Disease
NUMERATOR:• Patients who have documentation of use of
aspirin or another antithrombotic therapy
NQF 0018- Controlling Blood Pressure
DENOMINATOR: • Patients 18 through 85 years of age who had a
diagnosis of essential hypertension within the first six months of the measurement period or any time prior to the measurement period
NQF 0018- Controlling Blood Pressure
Denominator Criteria (Eligible Cases): • Patients 18 through 85 years of age on date of
encounter AND
• Diagnosis for hypertension (ICD-10-CM):
Proper Blood Pressure Measurement Video
http://www.nejm.org/doi/full/10.1056/NEJMvcm0800157
Cholesterol Control with Statin Therapy
THERE ARE THREE REPORTING CRITERIA FOR THIS MEASURE: 1) Patients aged ≥ 21 years at the beginning of the measurement period with clinical ASCVD diagnosis
OR 2) Patients aged ≥ 21 years at the beginning of the measurement period who have ever had a fasting or direct laboratory result of LDL-C ≥ 190 mg/dL
OR 3) Patients aged 40 to 75 years at the beginning of the measurement period with Type 1 or Type 2 diabetes and with an LDL-C result of 70–189 mg/dL recorded as the highest fasting or direct laboratory test result in the measurement year or during the two years prior to the beginning of the measurement period
Cholesterol Control with Statin Therapy
DENOMINATOR:• Patients 21 and older who have had at least one face to
face visit during the reporting period and have an active diagnosis of clinical atherosclerotic cardiovascular disease, LDL-C result of >=190 mg/dL at any time during or prior to the measurement period, oraged 40-75 at the beginning of the measurement period with an active diagnosis of diabetes with the highest LDL-C result of 70 – 189 mg/dL during the current measurement period or two years prior to the beginning of the measurement period.
Cholesterol Control with Statin Therapy
NUMERATOR:• Patients with a statin medication current on
the medication list or prescribed a statin medication during the measurement period
NQF 0028- Smoking Cessation and Intervention
DENOMINATOR: • All patients aged 18 years and older
NQF 0028- Smoking Cessation and Intervention
NUMERATOR: • Patients who were screened for tobacco use at least
once within 24 months AND who received tobacco cessation intervention if identified as a tobacco user
DEFINITIONS: • Tobacco Use – Includes use of any type of tobacco • Tobacco Cessation Intervention – Includes brief
counseling (3 minutes or less), and/or pharmacotherapy
Thank you!