objectives clinical dashboards for prevention: process ......microsoft powerpoint - 263-l05_5 slides...

Clinical Dashboards for Prevention: Process Improvement

Carrie Nolan, PharmD

QA Program Manager Pharmacist

Southwest VA CMOP (762)

Tucson, AZ

Objectives

Determine potential limitations of available data

Identify necessary process improvements (e.g., accurate documentation)

Develop tools to utilize data to improve patient care

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Outline

Review of Immunization Dashboard

Review of MOVE! Report

Key steps to process improvement Key steps to process improvement

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Audience Poll

Which preventative health issue is most important at your facility?

A. Vaccination

B. Obesity and chronic disease

C. Smoking Cessation

D. Other

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Prevention Dashboard

Started out as a way to monitor patient’s access to preventative health

Smoking cessation

I i ti Immunizations

Obesity screening/weight management offered

Behavioral health screening

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Platforms for Performance: Clinical Dashboards to Improve Quality and Safety

© 2011 American Society of Health-System Pharmacists

2011 Midyear Clinical Meeting

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Immunization Dashboard

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Why focus on immunizations?

Top seven vaccines have prevented ~ 14 million cases of disease

Annual cost savings of $9.9 billion in direct medical costs and $33.4 billion in indirect costs

Pneumonia and influenza is 8th leading cause of death in U.S.

Influenza causes ~ 20,000 deaths per year

Immunization and Infectious Disease Progress Review. U.S. Dept. of Health & Human Services. July 20, 2007http://www.healthypeople.gov/2010/Data/2010prog/focus14/

Why are patients not receiving vaccines?

Most common reason - not knowing that the vaccine was needed

40% of non-vaccinated patients cited concerns about the vaccine

13% cited lack of a doctor’s recommendation

Reasons reported by Medicare beneficiaries for not receiving influenza and pneumococcal vaccinations – United States, 1996. CDC MMWR Weekly, October 8, 1999 48(39); 556‐890

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4839a4.htm

Selection of Metrics

Selected vaccines included:

Tetanus, diphtheria, pertussis (Td/Tdap)

Human papillomavirus (HPV)

Zoster

Influenza

Pneumococcal

Patient Eligibility

Based on CDC criteria for each vaccine

Takes into account: Age

G d Gender

Date of vaccination (e.g., annual influenza)

Series (e.g., 3 injections for HPV)

Design Document Example

Type of Criteria Criteria Definition Programmed/Includedin Code

Inclusion All previously unvaccinated women

through age 26

Yes (ages 9-26)

HPV

through age 26

Exclusion Moderate or severeacute illness

No

Met Received vaccination (full 3 dose series)

Yes

Not Met Did not receive vaccination

Yes




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Limitations of Data

Design document findings

VA-specific immunization issues

Diff i diff di l Different practices among different medical centers

• Clinical reminders

Accurate documentation

Dashboard

Provider Name

Dashboard

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Tetanus Report

Next Steps

Process Improvement

Correct documentation errors• Work with medical centers to incorporate system-wide

changes

• Standardization of clinical reminder system

• Standardization of immunization file in database

Expansion of tool• Target specific populations

MOVE! Report

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MOVE! Weight Management Program

Helps veterans lose weight, keep it off and improve their health

Mandated at all VA facilities

No co-pays

For veterans of all ability levels, both male and female

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Potential Barriers

Services vary between medical centers

Requires coordination between different levels of care and different providers

No universal means to identify patients

Loss to follow up

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MOVE! Report

Created to identify eligible patients

Also tracks those underutilizing the service

Inclusion/Exclusion Criteria Inclusion/Exclusion Criteria

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Parameter Selection

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MOVE! Data BMI & waist circumference

Number of MOVE! encounters within last year

Date of last MOVE! attendance

Diabetes diagnosis with most recent HbA1c

Dyslipidemia diagnosis with most recent LDL

Hypertension diagnosis with most recent BP

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Baseline Data# of pts within VISN 21

Overweight patients eligible for MOVE!

69,872

BMI > 40 6,460

BMI 35-40 with all co-biditi

135morbidities

BMI 35-40 with diabetes 4,386

BMI 35-40 with HTN 7,097

BMI 35-40 with dyslipidemia

6,316

BMI 35-40 with sleep apnea

448

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Next Steps

Report entered as part of a larger project in the VHA Employee Innovation Competition

Training staff and providers on report features

Process improvement Identification of patients

Enroll patients in MOVE!

Comprehensive care to veterans

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Conclusion

Available data might be limited and can lead to potential for process improvement activities

Access to accurate data is key to successfully identify specific patient populations

Dashboard tools are helpful in providing excellent preventative care

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Discussion

How can you utilize data at your institution to provide quality preventative care?

How can you create process improvement tools to promote change within your organization?

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Clinical Dashboards for Prevention: Process Improvement

Carrie Nolan, PharmD

QA Program Manager Pharmacist

Southwest VA CMOP (762)

Tucson, AZ




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objectives clinical dashboards for prevention: process ......microsoft powerpoint - 263-l05_5 slides...

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