Platforms for Performance: Clinical Dashboards to Improve Quality and Safety 2011 Midyear Clinical Meeting
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1 Clinical Dashboards for Chronic Disease Management: Participation of the Clinical Pharmacist in the Medical Home Model Joy L. Meier, Pharm.D. VISN 21 Clinical Pharmacist and Data Analyst What I will cover today VA electronic medical record VA National data extraction process to SQL Server databases Structure and use of the clinical dashboard Use of clinical data reports by health care teams Clinical improvements associated with dashboard use 2 Audience Question What type of medical record storage do you have available in your health care system? A. Completely computerized no paper records B. Combination of computerized and paper record C. Paper records only no clinical data computerized VA Medical Record Completely computerized since 1999 Stored in MUMPS format: cumbersome reporting Over past several years, IT developed data copy in SQL databases Page 1 of 8
2 7 8 O&IT Business Intelligence Service Line Analytic Ecosystem REGION 1 REGION 2 REGION 3 REGION 4 Data Extraction Process Regional Data Processing Center (x4) Regional Data Warehousing Journal Austin Automation Center Corporate Other VHA Systems Nightly V21 V20 V22 V19 V18 V23 V12 V17 VISTA Data SAS Grid V15 V16 VINCI V1 V2 V5 V3 V4 V6 V7 V11 V8 Co-located Vista Systems reader Shadowed Vista Feeder DB VISN DWs Nightly DB CDW DB NPCD, DSS VHA/VBA clients Governance Board Enterprise GIS CDW epm Web Apps V10 V9 Data changes captured within seconds of operational VistA Data Flow Data Domains Available VHA continues to exceed HEDIS in the vast majority of common measures CLINICAL PERFORMANCE INDICATOR Breast cancer screening Cervical cancer screening Colorectal cancer screening LDL Cholesterol < 100 after AMI, PTCA, CABG LDL Cholesterol < 130 after AMI, PTCA, CABG Beta blocker on discharge after AMI Diabetes: HgbA1c done past year Diabetes: Poor control HbA1c > 9.0% (lower is better) Diabetes: Cholesterol (LDL-C) Screening Diabetes: Cholesterol (LDL-C) controlled (<100) Diabetes: Cholesterol (LDL-C) controlled (<130) Diabetes: Eye Exam Diabetes: Renal Exam Hypertension: BP <= 140/90 most recent visit Smoking Cessation Counseling (5) CLINICAL PERFORMANCE INDICATOR (6) (7) Immunizations: influenza, (note patients age groups) Immunizations: pneumococcal, (note patients age groups) (6) 12 Page 2 of 8
3 Audience Question VISN 21 PBM Dashboard and Reports In your practice area, do you have access to information on how well all patients are doing on specific clinical measures? A. Receive periodic performance reports B. Periodic reports limited to patient sampling C. No access to this type of information D. I have no idea if this information is available 13 VISN 21 PBM Dashboard and Reports Northern California Dashboard Access Clinical Performance Dashboard Clinical Performance Dashboard Page 3 of 8
4 Entire Panel Report Entire Panel Report 20 Entire Panel Report Upcoming Appointments Report Report: Patients With Upcoming Appointments Dashboard Implementation Team Members Data Mart Managers Develop and maintain dashboard Team/Site Leader Selects, develops and coordinates team Pi Primary Care Physician i or Provider Clinical resource for select cases Clinical Champion (RN/Clinical Pharmacist) Evaluate therapy and adherence Algorithmic, protocol based adjustments in therapy or management under approved scope of practice Administrative or Clinical Associate Champion Contact patients by phone/letter Obtain outside records for Co Managed patients Shared Excel Spreadsheet Team member assigned color Clinical champion to flag appropriate team member for action 23 Team member to document action taken 24 Page 4 of 8
5 Shared Excel Spreadsheet Write-Back Reports Click on + symbol to expand patient medication details Includes Medication Possession Ratio (MPR) Lists names of current active prescriptions for diabetes, lipid, hypertension Patients with MPR <85% are highlighted yellow 25 Write-Back Reports Write-Back Reports Click Top Box for drop down of clinic address choices. Click desired boxes Click OK Choose progress note title: Patient Appointment Reminder Letter or Patient Lab Reminder Letter or Letter for NonVA Records Click OK Page 5 of 8
6 Electronically sign the note 31 Note can then be printed and will be automatically formatted to have address fit in window envelope. Don t worry about the spacing/text 32 format, it will print correctly. Performance Improvement Workload Distribution ts, % Patient Baseline 6 months HTN DM, LDL<100 AMI, LDL<100 DM, A1c 9 Lipid Initiative Clerical, 67% Glycemic Control Not ready for change, 10% MD Evaluation, 10% Clerical, 10% Clinical Evaluation, 70% CPM Peer Comparison CPM Peer Comparison Page 6 of 8
7 Dashboard Hits Report Report Hits Report Hits Report Hits Measure Diabetes Outpt-A1C Measured Annually Diabetes Outpt and A1C < 9 Diabetes Outpt and LDL<100 Diabetes and BP < 140/90 Diabetes Outpt - LDL Measured Annually IHD - Outpt LDL Measured Annually IHD - Patients with LDL < 100 Hypertension Outpt and BP < 140/90 Mono-Therapy on Thiazide Multi-drug Therapy on Thiazide Spinal Cord Injury- DM and BP < 140/90 Spinal Cord Injury- DM & A1C < 9 Diabetes Outpt and A1C < 7 Diabetes - Outpt-BP < 130/80 Total Patients Total Patients Patients Meeting Measure Patients Meeting Measure % Improved Pts Affected 31,414 31, % 96.50% 6% 1,818 p< ,414 31, % 83.90% 6% 1,807 p< ,414 31, % 68.20% 9% 2,797 p< ,414 31, % 78.60% 7% 2,213 p< ,414 31, % 94.60% 7% 2,113 p< ,595 3, % 90.40% 6% 214 p< ,595 3, % 67.20% 8% 276 p< ,649 66, % 76.30% 6% 4,046 p< ,747 11, % 23.40% 0% (41) p= ,119 22, % 66.00% 3% 571 p< % 80.40% 26% 46 p< % 90.50% 3% 6 p= ,414 31, % 49.70% 2% 480 p= ,414 31, % 47.50% 7% 2,247 p< Total 18, Conclusions Effective integration of clinical dashboard tools into health care teams requires timely and accurate data dashboards that quickly identify areas for improvement actionable reports to find patients with sub-optimal health-related markers Clinical dashboards and reports improve health outcomes in large patient populations 42 Page 7 of 8
8 43 Page 8 of 8
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