Panel Management, Performance Measures and Reporting (PM 2 R)

Transcription

1 Panel Management, Performance Measures and Reporting (PM 2 R) -the evolving story of Quality Improvement *** Allan L. Bailey, MD, CCFP Grace Moe, BPT, MSc, PCMH-CCE Branden Ayotte, MD Candidate 2017 Accelerating Primary Care Conference 2014 Edmonton, AB

2 Context WPC Westview Physician Collaborative the Physician-operated Notfor-Profit Corporation (NPC) WPCN Westview Primary Care Network a Joint-Venture between the WPC-NPC and Alberta Health Services

3 Context Provincial PCN Evolution and Alberta s Primary Health Care Strategy emphasize evaluation as a priority for family physicians. No system framework has been proposed, nor is there an inventory of necessary resources to enable evaluation, performance measurement or reporting. Local Westview PCN developed processes to identify physician panels in 2008 Proactive care, screening and prevention are identified as an important part of panel management. Panel Management has been facilitated by Proactive Office Encounter Technicians (POETs) a role created by and introduced to the Westview PCN in 2010.

4 The WPC Panel Management, Performance Measurement and Reporting (PM 2 R) Initiative Objective 1 To identify some of the essential elements required when using practice-based data for primary health care evaluation Objective 2 To examine the effectiveness of the POET role/intervention in screening and prevention, as a component of panel management

5 Panel Management, Performance Measurement and Reporting (PM 2 R) Results - Objective 1 - Essential Infrastructure: 1. a technical (IT) solution 2. adherence to data stewardship principles, and a 3. quality improvement framework based on meaningful use were ALL required in the development of the information management infrastructure and this PM 2 R system.

6 Panel Management, Performance Measurement and Reporting (PM 2 R) Results - Objective 1 - Essential Infrastructure: 1. IT Data Sharing Platform: WPC server (separate from the WPCN server) IT process to migrate core data elements from EMR to WPC server Algorithms to extract specific data elements of panel (for ASaP manoeuvers) from WPC core data base Notes: IT=Information Technology WPC=Westview Physician Collaborative WPCN=Westview PCN EMR=Electronic Medical Record

7 Panel Management, Performance Measurement and Reporting (PM 2 R) Results - Objective 1 - Essential Infrastructure: 2. Protection of Patient Health Information (EMR Data): Data Governance Structure ISA between sentinel physician & WPC-NPC; Data Governance by WPC-NPC Privacy Protection & Data Stewardship OIPC-approved PIA Notes: EMR=Electronic Medical Record ISA=Information Sharing Agreement NPC=Not for Profit Corporation OIPC=Office of Information & Privacy Commissioner PIA=Privacy Impact Assessment

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9 Panel Management, Performance Measurement and Reporting (PM 2 R) Results - Objective 1 - Essential Infrastructure: 3. Quality Improvement Framework: Identified EMR accessible data elements from the current state but expanding universe of process and outcome indicators and primary care performance indicators Data elements reflect principles of meaningful use i.e. their use will improve population and public health Notes: see current state WPC menu of 27 primary health care indicators includes ASaP data set indicators are periodically reviewed and updated as new information scientific, clinical or policy emerges.

10 Menu of EMR Primary Health Care Indicators* (for Clinic Selection per EMR Capability) # Type Description Measures Note 1 Process BP Screening: HTN ASaP Maneuver 2 Process Height ASaP Maneuver 3 Process Weight Screening: Weight ASaP Maneuver 4 Process BMI Screening: Obesity 5 Process Spirometry/Full Pulmonary Screening: COPD 6 Process Tobacco Use Screening: Lifestyle Risk ASaP Maneuver 7 Process Exercise Status Screening: Lifestyle Risk ASaP Maneuver 8 Process Alcohol Use Screening: Lifestyle Risk ASaP Maneuver 9 Process Illicit Drug Use Screening: Lifestyle Risk *Menu per current state as at October 2014; to be updated as new information scientific, clinical or policy emerges.

11 Menu of EMR Primary Health Care Indicators* (for Clinic Selection per EMR Capability) - cont d # Type Description Measures Note 10 Process Influenza Vaccination (18+) Screening: Preventive Care 11 Process Tetanus/Diphtheria Vaccination Screening: Preventive Care ASaP Maneuver 12 Process Pap Test (Females 21-69) Screening: CA ASaP Maneuver 13 Process Plasma Lipid Profile Fasting Males 40-74; Females Process Diabetes Screen one of -Fasting Glucose, Hgb A1c, Diabetes Risk Calculator (40+) 15 Process Colorectal Cancer Screen one of -FIT (FOBT prior to Dec 2013), Flex Sigmoidoscopy, Colonoscopy (50-74) Screening: CV Screening: Diabetes Screening: CA ASaP Maneuver ASaP Maneuver ASaP Maneuver *Menu per current state as at October 2014; to be updated as new information scientific, clinical or policy emerges.

12 Menu of EMR Primary Health Care Indicators* (for Clinic Selection per EMR Capability) - cont d # Type Description Measures Source 16 Process Mammography (Females: 50-60) (74) 17 Process Breast Exam (Females: 30+) Screening: CA Screening: CA 18 Process Bone Density (ALL 65+) Screening: OP 19 Process/ Outcome ASaP Maneuver CV Risk Calculation Screening: CV ASaP Maneuver 20 Outcome BP Reading Health Outcome 21 Outcome BMI Reading Health Outcome 22 Outcome HbA1c Reading Health Outcome 23 Outcome Lipids Reading Health Outcome *Menu per current state as at October 2014; to be updated as new information scientific, clinical or policy emerges.

13 Menu of EMR Primary Health Care Indicators* (for Clinic Selection per EMR Capability) - cont d # Type Description Measures Note 24 PC Performance 25 PC Performance Time (# of Days) to Third Next Appointment % of visits with same PC Provider 26 Quality % of patients who have had a medication reconciliation in the past year 27 Quality % of patients with complex needs or chronic conditions with an integrated care plan updated in the past year Access Internal continuity Comprehensiveness, Patient Centeredness Comprehensiveness, Patient Centeredness *Menu per current state as at October 2014; to be updated as new information scientific, clinical or policy emerges.

14 Panel Management, Performance Measurement and Reporting (PM 2 R) Methods - Objective 2 - POET Effectiveness: A retrospective analysis using the developed information management infrastructure to examine the success of screening manoeuvers in three phases: 1. baseline standard of care pre-poet; 2. in the early POET implementation phase; and 3. the mature phase of POET-facilitated panel management.

15 Panel Management, Performance Measurement and Reporting (PM 2 R) Methods Objective 2 - POET Effectiveness: Hypothesis: The implementation of the POET role improves screening performance as defined by the Towards Optimized Practice (TOP) ASaP indicators.

16 ASaP Provincial Baseline Chart Reviews Note: Results based on panel sampling (n=10-20 per panel) and manual review of patient EMR/chart data. Source: Towards Optimized Practice (TOP) September 2014.

17 % of ASaP Manoeuvers Completed * ASaP Screening Performance of WPC Family Physician Panel (Pre-POET Implementation Phase) (Early-POET Implementation Phase) (Mature-POET Implementation Phase) Notes: 1. Screening percentages are completed, not offered 2. Results are for actual panel denominators not based on ASaP sampling methodology 3. Family Physician Panel Size (n=1,599)

18 Panel Management, Performance Measurement and Reporting (PM 2 R) Results - Objective 2 - POET Effectiveness:

19 For more information, please contact: Allan L. Bailey: Grace Moe: