Population Health: Using Patient Reported Measures. Carmen Parrotta, Performance Improvement Consultant, Fairview Medical Group

Transcription

1 Population Health: Using Patient Reported Measures Carmen Parrotta, Performance Improvement Consultant, Fairview Medical Group

2 Fairview Medical Group 44 primary care clinics 1 million+ office visits in primary care providers Epic users since 2003

3 Journey to Population Health Paradigm shift Goal is to create health, rather than focus on treating illness Emphasis on providing quality care, in addition to RVUs Creating comprehensive health solutions vs individualized care

4 Timeline of Key Activities Epic EHR live 2003 Minnesota Community Measurement (MNCM) 2004 MyChart (patient portal) 2004 Care Model Innovation (Partnership with commercial payers to move toward population health) 2010 Quality-based provider compensation model Care Coordination established 2010 Health Care Home Certification 2011 ACO Pioneer Population Management Tool Ver Qlikview

5 What is the impact of our Population Health Initiates? Literature is mixed Medical Home Model (Rand, MDH) ACO Shared risk contracts Increased need to self-evaluate population health initiatives for effectiveness Fairview s formal research project Health coaching for diabetic patients Insignia Health & Sanofi US. Inc Feasibility of PRM data collection The Dartmouth Institute Provider Compensation Model University of Oregon Fairview s program evaluation requests Mindfulness care Integrated Primary Care Clinic (complex care services) On-line self management, wellness tools ACO Pioneer

6 Transforming Data into Intelligence

7 Key Patient Reported Measures (PRM) intermediate and outcome measures Patient Activation Measure (PAM) Assess patient knowledge, skill and confidence CDC Core Healthy Days Survey Health-related quality of life (physical and mental health) PROMIS-10 Physical, mental and social well-being PHQ-9 Screening, diagnosis and monitoring severity of depression

8 Engaging Patient: Need help from our IT systems Recruiting specific populations into research or pilot programs 1) Best Practice Advisory (BPA) w/ smartphrase summary 2) MyChart messaging

9 Best Practice Advisory: During office visit BPA will trigger for patients with eligible Health Maintenance modifier Can display as a pop-up or passive BPA Potential use for enrollment, reminders or survey administration Please encourage this Fairview patient to enroll in the diabetes health coaching study. Click here to have the patient register online (~5 minutes) Patient should enter access code fairview2013 when prompted To turn this BPA off, click the add HM Modifier check box and accept the alert Add HM Modifier: Research Enrolled/Declined Diabetes Coaching Study Open Smartset: Insert Health Coaching Study Recruitment Information into AVS (preview)

10 Best Practice Advisory: Reminders for Patient when they leave Clicking on open smartset inserts a summary of program into Epic patient instructions section for print off in an After Visit Summary (AVS)

11 MyChart Secure Messaging: Asynchronous messaging to large populations Create an Epic report which selects target population based on eligibility criteria (Reporting Workbench) Use report to send hundreds (thousands) of secure messages summarizing at once. Not robust tool Message can include hyperlink to website, provide contact information or include a survey

12 A Few More Tools: Documenting and Collecting Data Clarity reporting Review flowsheets Doc flowsheets Custom research query Qlikview application

13 Evaluation Results: What is the ideal workflow for collection and use of PRM given key barriers and facilitators? Optimal administration design of PRM should incudes: Ideally driven by patient s pursuit of health care services MyChart day before visit or during office visit Increase validity of scores Include translation tables for providers When possible automate follow-up administration Embed provider review process Ensure front line staff see benefit of surveys How do patients view importance of PRM and burden of 47 question survey?

14 How important do you think it is for your clinician to have the information you just provided Trending in Initial Survey (n=209) Dissatisfied Not important at all Minimally important Somewhat important Neutral - neither satisfied nor dissatisfied Satisfied Very satisfied Very important Extremely important 88% of patients found some to Extreme importance in these questions

15 How satisfied were you with the NUMBER OF QUESTIONS on this questionnaire? Trending in Initial Survey (n=209) Dissatisfied Neutral - neither satisfied nor dissatisfied Satisfied Very satisfied Only 4% of patients were dissatisfied with in the number of questions asked

16 How satisfied were you with the TYPES OF QUESTIONS asked on this questionnaire? Trending in Initial Survey (n=209) Dissatisfied Neutral - neither satisfied nor dissatisfied Satisfied Very satisfied Only 2% of patients were dissatisfied with in the number of questions asked

17 Evaluation Results (preliminary): from EMR-Facilitated tools How do patients view importance of PRM and burden of 47 question survey? Patient s have favorable view content and need for PRM Can PRM surveys meaningfully stratify our patient population? Benchmarks against local and national PRM results to provide normative insights into the health status of your patients (determine if you need to apply focused resources on condition X) Health Coaches have dramatically improve diabetes control specifically for lowly activated patients (PAM) Lower activated patients use on-line wellness tool more than highly activated patients

18 Diabetes Patients Self Reported Health Status 50% 45% 40% 35% 36.1% Eagan Clinic n= Minnesota n= U.S. n=57, % 46.2% 30% 25% 20% 15% 10% 5% 23.3% 18.2% 18.8% 0% % Excellent/Very Good % Fair/Poor

19 Self Reported Health Status by PAM Level % Poor/Fair 60% 50% 51.8% 40% 30% 20% 18.6% P-value.000 (chi square) 10% 0% Low PAM (1's,2's) High PAM (3's,4's)

20 Health Coaching: Diabetes Control by PAM Level

21 Evaluation Results (preliminary): from EMR-Facilitated tools Can PRM surveys meaningfully stratify our patient population? Benchmarks against local and national PRM results to provide normative insights into the health status of your patients (determine if you need to apply focused resources on condition X) Health Coaches have dramatically improve diabetes control specifically for lowly activated patients (PAM) Lower activated patients use on-line wellness tool more than highly activated patients

22 Summary IT support for PRM is critical get familiar with your tools Don t stop after creating knowledge, strive for intelligence Patient s value being asked their perspective PRM are intermediate and outcome measures Take advantage of the times when patient seeks care Provide benchmarks to identify area of need Stratify population based on activation level to efficiently allocated limited resources Carmen Parrotta cparrot1@fairview.org