Quality Improvement Overview April 14, 2011 1

Quality ImprovementOverview

April 14, 2011www.oquin.musc.edu

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MISSIONPromoting Health andPreventing DiseaseAcross the Lifespan

Promoting Health and Preventing Disease Across

the Lifespan

Mission

To facilitate the transition of South Carolina and the Southeast from a leader in CV disease to a model of heart and vascular health

MissionSoutheast > > > INTERNATIONALCardiovascular > > > ALL CONDITIONSPBRN > > > PLATFORM FOR CER LEADERSHIP

Began in 1999 •20 physicians and other providers•3000 patients

Today in 2011•9000 physicians and other providers•1.94 million patients

The Outpatient Quality Improvement Network continues to IMPROVE…

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1,646,706 Active Discrete Patient Records4,874,408 Prescription Records

Background: The Outpatient Quality Improvement Network (OQUIN) evolved from the Hypertension Initiative, which was formed in 2000 at the Medical University of South Carolina (MUSC). It is an active Practice Based Research Network and Quality Improvement Network..

Purpose: The purpose of the OQUIN is primordial, primary and secondary prevention of chronic diseases, which began with a focus on heart and vascular health. OQUIN uses a complementary two-component strategy to pursue its purpose; namely, healthy lifestyles and access to effective care and medications. The principal means for pursuing its purpose is a network of community-based practices that share a common commitment to improving health promotion and excellence in chronic disease prevention and management through application and sharing of evidence-based best practices. A centralized database reflecting medical summary data from adult patients at all participating practice sites provides a dynamic information management infrastructure to assist primary care physicians to monitor and optimize their cardiovascular risk factors and treatment patterns in their patients. Physicians are able to meaningfully use health data for decision support and improve outcomes for patients. Scope: In 2000, the project began with 20 participating providers and 3,000 patient records. Today, the database contains 1.94 million patients seen by ~3,000 physicians and actively monitors cardiovascular treatment and outcomes in more than 350,008 hypertensive patients. It is available to practices and physicians across the United States.

Quality Improvement andPractice Based Research Network

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Collaborative: OQUIN is a Practice-Based Research Network (PBRN) and is a collaboration of healthcare professionals and researchers focused on improving the care and health of patients and using quality data to drive decisions as well as to research and improve the care provided. Membership in OQUIN is active upon execution Business Associates Agreement between the Clinic and the Hypertension Initiative at the Medical University of South Carolina or the Outpatient Quality Improvement Network (OQUIN). The Business Associates Agreement governs the rights and usage of OQUIN data. Benefits to Collaborative Members: An external information management infrastructure is needed to provide concise quality-of-care feedback to providers. There are significant barriers to accessing data reports in many practices. Advanced computing skills and/or additional fees are required in order to produce reports for quality-of-care monitoring. Moreover, comparison to a broad range of providers outside the practice is often very difficult to impossible. Healthcare professionals participating in OQUIN receive reports containing data on their individual treatment patterns and risk factor control levels. OQUIN has adopted an ongoing quality-improvement paradigm to provide update reports. While a great deal of data is gathered, the reports attempt to represent the most clinically relevant information in the most concise, comprehensible manner possible. OQUIN equips healthcare professionals to meaningfully use data to improve outcomes for patients.

Quality Improvement andPractice Based Research Network

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Trust Growth

Built on Trust: OQUIN is built on trust over many years. OQUIN always keeps the patient needs at the forefront and is very careful to create winning opportunities for providers to participate in quality improvement and in research. The meaningful metrics presented in an actionable format coupled with academic engagement foster a win/win relationship.

Capacity to Grow: OQUIN is built in a way that is very scalable with reasonable incremental cost. Because it is centrally hosted and maintained, it has flexibility to work with virtually all Electronic Health Records , multiple geographies and multiple medical disciplines. It includes private and hospital owned practices, FQHCs, and the Veterans Administration clinics.

OQUIN Sites

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OQUIN maintains a central, searchable, database containing:•Records since 1999•Demographic data•~2 million patient records•~9000 physicians and other providers•~5 million prescription records•~500,000 current hypertensive patients •~150,000 current diabetic patients

Network Stats

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ResultsDuring the past decade, Cardiovascular Mortality in South Carolina has declined. OQUIN may have contributed to that improvement.

Centers for Disease Control and Prevention, National Center for Health Statistics. Compressed Mortality File 1999-2007. CDC WONDER On-line Database, compiled from Compressed Mortality File 1999-2007 Series 20 No. 2M, 2010. Accessed at http://wonder.cdc.gov/cmf-icd10.html on Jan 6, 2011 6:01:19 PM

1999 2007

Florida 318.7 212.3 106.4 33.4% above

South Carolina 383.2 265.0 118.2 30.8% above

Georgia 383.6 274.2 109.4 28.5% equal

National Total 350.8 250.9 99.9 28.5% equal

North Carolina 363.3 260.4 102.9 28.3% below

Tennessee 399.5 294.0 105.5 26.4% below

Louisiana 395.2 295.1 100.1 25.3% below

Mississippi 440.1 341.7 98.4 22.4% below

Alabama 396.6 311.2 85.4 21.5% below

CV =cardiovascular; D=change.

CV Mortality / 100,000 D CV Death 1999–2007

D% CV Death 1999–2007

D% CV Death Relative to US

1999 2007

Florida 20 7 13 yes

South Carolina 41 36 5 yes

Tennessee 47 44 3 yes

Georgia 42 40 2 yes

North Carolina 34 34 0 no

Louisiana 45 45 0 no

Mississippi 51 51 0 no

Alabama 46 49 -3 no

CV =cardiovascular; National Rank lowest death rate is lowest rank.

CV Mortality National Rank D National Rank 1999–2007

Improvement

Collaborative: Outpatient Quality Improvement Network (OQUIN) is a collaborative of healthcare providers, most of whom are primary care physicians. It is built on a shared passion for serving patients in the best way possible. Active OQUIN physicians are interested in using data to improve quality and many have an interest in pay for performance. Membership in OQUIN is active upon execution of a Business Associates Agreement.

Leadership of Collaborative: The Executive Board of the OQUIN functions as its governing body. OQUIN currently has collaborative agreements with the American Society of Hypertension (ASH) Carolinas Chapter and the Veterans Administration. Letters of Intent are in place to expand the ASH collaboration nationally and to expand OQUIN to India.

Improved Outcomes Result in Reduced Healthcare Costs


Win/Win

OQUIN maintains a central, searchable, database containing:

•Records since 1999•Demographic data•~2 million patient records•~9000 physicians and other providers•~5 million prescription records•~500,000 current hypertensive patients •~150,000 current diabetic patients

Win/Win: OQUIN selects initiatives that are useful and of interest to its members. OQUIN leadership is careful to ensure that endeavors are win/win for the patients, practices, researchers, payers, and public health. OQUIN always keeps the patient needs at the forefront and is very careful to create winning opportunities for practices.

Capacity for Improvement: OQUIN is built in a way that is very scalable with reasonable incremental cost. Because it is centrally hosted and maintained, it has flexibility to work with virtually all Electronic Health Records , multiple geographies and multiple medical disciplines. It includes private and hospital owned practices, FQHCs, and the Veterans Administration clinics. This makes the network a good partner for business and researchers.

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OQUIN Sites

OQUIN DatabaseReliable and Accurate

Patient Data

Early Queries

Link to State

Database

Pilot Data

Clinical Specialty

Care

Research•CER, TCT, PCT•Industry—RCT, Analysis of Patient Data•Multi-site Clinical Trials—External PI•QI & HIE

Publications

Quality Improvement

Physicians and Other Providers

ImprovedPatient

Outcomes

OQUIN Improvement Process: The QQUIN process has been refined over a decade and continues to grow in capabilities, capacity, patients and providers. It is more relevant today with the prevalence of electronic records, and the tools to improve patient outcomes.


OQUIN produces quarterly reports to help healthcare physicians and providers with their improvement efforts. An example of the quarterly report follows.As data is received, reports are updated and physicians and providers have 24/7 secure online access to their data.

Example Quality Reports

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Documents

Quality Improvement Overview April 14, 2011 1