team based care combining team based care and technology to improve quality and transform healthcare...
TRANSCRIPT
Team Based CareTeam Based Care
Combining Team Based Care and Technology to Combining Team Based Care and Technology to Improve Quality and Transform Healthcare to Improve Quality and Transform Healthcare to Improve Blood Pressure ControlImprove Blood Pressure Control
Wednesday February 12th, 12 NoonWednesday February 12th, 12 NoonImproving Health for Populations & CommunitiesImproving Health for Populations & CommunitiesSouth Dakota Foundation for Medical CareSouth Dakota Foundation for Medical Care
Christopher H. Tashjian, MD, FAAFP HIT fellow using the EHR and practice innovations to increase participation in the Million Hearts Initiative and improve performance on the Million Hearts goal Chief Medical Advisor WHITEC
Active Decision to Improve Active Decision to Improve CareCareWe changed our overall thinking
from:
◦It’s a physician problem
To
◦It’s a team challenge
What does that mean?What does that mean?Physicians had to give up TOTAL
ownership
Staff had to be trained to understand the problem◦Nurses◦Lab ◦Care Co-ordinators◦Front Office
What does that mean? What does that mean? (Part II)(Part II)My patients are my partner’s
patientsMy partner’s patients are my
patients
Every visit is a hypertension visit!
MU and MH built into the patient visitMU and MH built into the patient visit
Using basic EHR functionality and performing common tasks can meet MU and Million Hearts goals
Privacy & Security
Patient & Family Engagement
Stages of Meaningful Use
Million Hearts®
• National initiative co-led by CDC and CMS
• Partners across federal and state agencies and private organizations
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Goal: Prevent 1 million heart attacks and strokes in 5 years
Heart Disease and Stroke Leading Killers in the United States
• Cause 1 of every 3 deaths• More than 2 million heart attacks and strokes each year
– 800,000 deaths– Leading cause of preventable death in people <65 – $444B in health care costs and lost productivity– Treatment costs are ~$1 for every $6 spent
• Greatest contributor to racial disparities in life expectancy
Roger VL, et al. Circulation. 2012;125:e2-e220.Heidenriech PA, et al. Circulation. 2011;123:933–4.
Key Components of Million Hearts™COMMUNITYPREVENTION
Changing the context
CLINICALPREVENTIONOptimizing care
Focus on ABCS
Health information technology
Clinical innovations
TRANSFAT
Million Hearts – Provider Goals
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Clinical PreventionOptimizing Quality, Access, and Outcomes
Focus on the ABCS
• Simple, uniform set of measures
• Data collected or extracted in the workflow of care
• Link performance to incentives
NQF#0064 Comprehensive Diabetes Care: LDL-C Control <100 mg/dL
NQF#0018 Controlling High Blood Pressure
NQF#0075 Ischemic Vascular Disease (IVD): Complete Lipid Profile and LDL-C Control <100 mg/dL
NQF#0068 Ischemic Vascular Disease (IVD): Use of Aspirin or Another Antithrombotic
NQF#0028 Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention
Getting to Goal
Intervention Baseline TargetClinical target
Aspirin for those at high risk 47% 65% 70%
Blood pressure control 46% 65% 70%
Cholesterol management 33% 65% 70%
Smoking cessation 23% 65% 70%
Sodium reduction ~ 3.5 g/day 20% reduction
Trans fat reduction ~ 1% of calories 50% reduction
Unpublished estimates from Prevention Impacts Simulation Model (PRISM).
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Low TechLow Tech
HIGH TECHHIGH TECHFirst Take Data from EHR and First Take Data from EHR and
Export to ExcelExport to Excel
Excel to Access DatabaseExcel to Access Database
Generate Patient ListsGenerate Patient Lists
Use of FiltersUse of Filters
Patient ScorecardsPatient Scorecards
Provider ScorecardsProvider Scorecards
Results!Results!In just four years, Ellsworth Medical
Clinic reported the following improvements in blood pressure control:◦Among patients with diabetes, hypertension
control increased from 73% to 97% (2007–2011)
◦Among patients with cardiovascular disease, BP control increased from 68% to 97% (2007–2011)
◦Currently as of December 2012ALL patients with hypertension controlled at 90%
Percentage (%) of Patients in Control by CategoryNovember 2013 Review
Category In ControlTotal Patients Percent
BP 95 100 95.0%Hgb A1c 74 100 74.0%LDL 85 100 85.0%ASA 100 100 100.0%Tobacco 82 100 82.0%
Total Patients in Control 52 100 52.0%
August 2013 Review
Category In ControlTotal Patients Percent
BP 99 104 95.20%Hgb A1c 82 104 78.80%LDL 86 104 82.70%ASA 104 104 100.00%Tobacco 87 104 83.70%
Total Patients in Control 57 104 55.00%
Current progressCurrent progress
SavesSaves 417 Hearts, 72 Legs 417 Hearts, 72 Legs & & 745 Pairs of 745 Pairs of EyesEyesEach Year!Each Year!
• 32,747 members with diabetes, in one health plan, in 2012 suffered 417 fewer heart attacks, 72 fewer leg amputations and 745 people did not experience eye complications compared to what would have happened to the same 32,747 plus members in 2000. 24
For our Patients – We have a Million For our Patients – We have a Million HeartsHearts
This YearThis Year
River Fallsis a
Million HeartsFinalist!
The Difference it Makes – Ask our The Difference it Makes – Ask our Patients!Patients!
It Takes Teamwork!It Takes Teamwork!
Join Us: Take the Pledge
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http://millionhearts.hhs.gov
Resources
• Vital Signs: Where’s the Sodium?www.cdc.gov/VitalSigns/Sodium/index.h®l
• Vital Signs: Getting Blood Pressure Under Controlwww.cdc.gov/vitalsigns/Hypertension/index.h®l
• Team Up. Pressure Down.http://millionhearts.hhs.gov/resources/teamuppressuredown.h®l
• Community Guide: Team-Based Carewww.thecommunityguide.org/cvd/teambasedcare.h®l
• SDOH Workbook: Promoting Health Equity, a Resource to Help Communities Address Social Determinants of Healthwww.cdc.gov/nccdphp/dach/chhep/pdf/SDOHworkbook.pdf
• Program Guide for Public Health: Partnering with Pharmacists in the Prevention and Control of Chronic Diseaseswww.cdc.gov/dhdsp/programs/nhdsp_program/docs/Pharmacist_Guide.pdf
• Data Trends & Mapshttp://apps.nccd.cdc.gov/NCVDSS_D®
A Different Way to Look at A Different Way to Look at Quality?Quality?
Previous simvastatin label New simvastatin label
Avoid simvastatin with: Itraconazole Ketoconazole Erythromycin Clarithromycin Telithromycin HIV protease inhibitors Nefazodone
Contraindicated with simvastatin: Itraconazole Ketoconazole Posaconazole (New) Erythromycin Gemfibrozil Clarithromycin Cyclosporine Telithromycin Danazol HIV protease inhibitors Nefazodone
Do not exceed 10 mg simvastatin daily with: Gemfibrozil Cyclosporine Danazol
Do not exceed 10 mg simvastatin daily with: Amiodarone Verapamil Diltiazem(Note: These drugs are contraindicated with Simcor as Simcor is only available with 20 mg or 40 mg of simvastatin.)
Do not exceed 20 mg simvastatin daily with: Amiodarone Verapamil
Do not exceed 20 mg simvastatin daily with:Amlodipine (New)Ranolazine (New)
Do not exceed 40 mg simvastatin daily with: Diltiazem
Avoid large quantities of grapefruit juice (>1 quart daily)
Avoid large quantities of grapefruit juice (>1 quart daily
What We FoundWhat We Found
Simvastatin Dose
Total Number
20 95
40 976
80 365
Amiodarone
Amlodipine
Verapamil Diltiazem
8 241 13 49
70,000 Total Patients in all 3 clinics
Other
Itraconazole
Ketoconazole
Posaconazole
Erythromycin
Clarithromycin
Telithromycin
Nefazadone
Gemfibrozil
Danazol
0 2 0 1 1 0 0 23 0
Be BOLD!Be BOLD!
