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2 3/21/06
Northwest Region Quality Vision
Our vision is to provide the highest quality care in the world
We will measure success by achieving 90th percentile on HEDIS effectiveness of care (EOC) quality measures
3 3/21/06
Quality Populations/Measures for 2006 (2005 HEDIS Rank)
Adult Women Breast Cancer Screening (50th) Cervical Cancer Screening (10th) Diabetic Members
Lipid screening (25th) Lipid control < 130 (90th) Lipid control < 100 (75th) HgbA1c screening (50th) Poor Hgba1c control (75th)
4 3/21/06
Quality Population/Measures for 2006 (continued)
Patients with CV conditions (new measure—no rankings) Lipid screening Lipid control <130 Lipid control <100
5 3/21/06
JCAHO AMI Measures
ACE Inhibitor for LVSD (89%)* Smoking cessation advice/counseling (74)* Aspirin at arrival (100)* Aspirin at discharge (98)* Beta blocker at arrival (99)* Beta blocker at discharge (99)* (Thrombolytics) * KSMC 2004 results
6 3/21/06
Quality Populations/Measures for 2006 (continued)
Children/ Adolescents Immunizations children (90th) Immunizations adolescent (75th)
Appropriate asthma meds Age 5-9 (50th) Age 10-17 (10th)
7 3/21/06
Quality Populations/Measures for 2006 (continued)
Patients with depression Practitioner contact (25th) Acute phase treatment (90th) Chronic phase treatment (75th)
8 3/21/06
ICP Service Quality Targets
Measure2006
Threshold2006
Target2006
Stretch
Recommend KP to friend 46.5% 47% 48%
Saw own PCP 71% 73% 75%
Time to Appt – Primary Care 71% 72% 74%
Time to Appt – Specialty Care 65.7% 66.7% 68.7%
MD Listened – Primary Care 82% 83% 84.5%
MD Listened – Specialty Care 84% 85% 86.5%
MD in work unit support me in providing quality service 76% 78% 80%
10 3/21/06
Beta Blockers Post-MI
For 2006 one of our quality goals regionally is improvement in all the JCAHO AMI measures, including beta blocker use post-MI
At KSMC this is a primary quality initiative for 2006 All plan hospitals—St. Vincent’s, SWWMC, St. Johns,
Salem are participating in IHI 100,000 lives campaign with AMI bundle as a core strategy
Six month adherence to beta blocker use is a new HEDIS measure, we are currently considering strategies to ensure compliance
11 3/21/06
Diabetic Nephropathy Monitoring
Those patients at risk for diabetic nephropathy can be identified with newer urinalysis tests— microalbuminuria testing
HEDIS adopted microalbuminuria testing as a standard annual test for all diabetics
Kaiser had microalbuminuria as a standard test on our “panel diabetes” lab ordering process
12 3/21/06
Diabetes Nephropathy Monitoring (continued)
Context: Diabetics develop macrovascular (large vessel) and microvascular (small vessel) atherosclerosis
Macrovascular disease causes heart attacks and strokes and is the leading cause of death in diabetes
Microvascular disease causes diabetic retinopathy leading to blindness; and diabetic nephropathy leading to end stage renal disease (ESRD) resulting in dialysis or kidney transplant
13 3/21/06
Historical Perspective
Research on microvascular disease, specifically diabetic nephropathy, has shown that early detection of those diabetics at risk of renal disease and specific treatments can slow the progression and prevent ESRD/dialysis
The main treatments are: Improved blood pressure control—goal bp < 130/80, and use of specific medications—ACE-I and/or ARB
14 3/21/06
Macrovascular Disease Research
Research on macrovascular disease has demonstrated that all diabetics given ACE-I (or ARB’s) had lower rates of macrovascular disease (heart attacks/strokes)
Based on this information Kaiser Northwest and nationally felt microalbuminuria screening was unnecessary and removed it from the “panel diabetes” order
As a result our HEDIS nephropathy scores have fallen
15 3/21/06
Current Consensus
HEDIS has proposed changing the nephropathy screening measure for 2007 such that any patient on ACE-I or ARB will count as having had nephropathy monitoring
Kaiser Northwest region has decided to add microalbumin testing back to our “panel diabetes” order
By the end of 2007 our nephropathy screening rate will be significantly higher
16 3/21/06
Tools to Achieve Improved Diabetes Quality Goals
Health maintenance alerts for any diabetic who has not had diabetic labs in past 9 months
Health maintenance alerts when last recorded blood pressure is not at goal
Promotion of ALL= Aspirin, Lovastatin, Lisinopril use in all members
Monthly rosters for health care teams listing diabetics with LDL > 100, or no LDL in past 9 months, hgba1c > 9 or no hgba1c in past 9 months, no microalbuminuria testing in past 9 months, bp not at goal