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Initial'Work'Flow
New'Work'Flow
Pa#ent'informs'the'health'center'about'an'
overdue'test'or'procedure'that'they'
received'outside'of'the'UMass'system.'
Staff'member'makes'wri>en'note'or'mental'note'to'obtain'the'medical'record'from'the'outside'facility.'
Medical'record'is'never'tracked'down'and'test'
remains'listed'as'overdue.'Health'center'performance'suffers.'
Pa#ent'informs'the'health'center'about'an'
overdue'test'or'procedure'that'they'
received'outside'of'the'UMass'system.'
Medical'staff'generates'a'Task'in'the'EMR'to'track'down'the'
record.'Task'is'assigned'to'Medical'
Records.'
Medical'Records'tracks'down'the'record;'test'is'no'longer'listed'as'
overdue;'Health'center'performance'improves.'
Quality Improvement at a Rural Family Health Center Michael C Murphy
University of Massachusehs Medical School, Barre Family Health Center
Michael C Murphy University of Massachusehs Medical School, Class of 2016 Email: [email protected] Phone: (508) 963-‐7758
Contact 1. Eckelbecker, L 2013, ‘Barre clinic joins medical home movement’, Worcester Telegram & Gaze1e, 7 July. Photo by T&G Staff/Rick Cinclair. 2. Safran, D.G.. (2012, October). AlternaAve Quality Contract White Paper from Blue Cross Blue Shield. Retrieved from hhp://www.bluecrossma.com/visitor/about-‐us/affordability-‐quality/aqc.html
References
SeIng • The Barre Family Health Center (BFHC) • Located in Barre MA, 22 miles northwest of Worcester. • Primary care provider for 10 rural communiAes. • 7,800 paAents and more than 35,000 visits a year. • CerAfied Level-‐3 PaAent-‐Centered Medical Home.
Payment Reform is Forcing Health Centers To Improve Performance
• Healthcare payment models are switching from fee-‐for-‐service to pay-‐for-‐performance.
• Insurers use various measurements to assess how well a health center is caring for their paAents.
• Reimbursement rates ($) increase as performance improves. • BFHC aims to improve their performance so that they can hire more staff and
improve paAent outcomes. Project ObjecNves
• Improve paAent health outcomes and improve BFHC’s performance measures by implemenAng creaAve and innovaAve approaches.
SeIng, Context & Project ObjecNves
PaNent Outreach Project
Inefficient work flows were idenNfied and improved upon. Example – DocumentaNon and Follow Up on Out-‐of-‐System Care: • Problem
Ø Staff were not appropriately following up on care that paAents were receiving outside of the UMass Memorial system.
Ø Result was that most records were never tracked down; test remains overdue; performance measures on tesAng rates such as cancer screenings remained inaccurately low.
• SoluNon Ø Staff generate tasks in the EMR to track down medical records for out-‐
of-‐system care. Ø Task assigned to the Medical Records division. Ø Result is increased likelihood that the medical records are tracked
down; test no longer listed as over due & performance improves.
Improving Performance By Improving Work Flows
An incenNve was needed to improve provider performance. A soluNon is a “Provider Report Card” (see figure 5)
• Key Features: Ø Accurate comparisons of all physicians in the pracAce Ø Simple color code for quick idenAficaAon of the “best” and “worst”
providers in each category. Ø Target Goals were set according to the AlternaAve Quality Contract (AQC)
Gate Scores, which are the goals set forth by Blue Cross Blue Shield.
IncenNvizing Change with a Provider Report Card
1. To score well on performance measures a health center needs an accurate and up-‐to-‐date electronic medical record (EMR).
• Medical staff must work as a team to maintain an accurate EMR. 2. A major source of Quality Improvement (QI) is to fully implement the resources provided through your EMR.
• QI teams must maintain good working relaAonships with IT & EMR staff. 3. Quality Improvement teams must conNnually reassess work flows and improve work flow inefficiencies.
4. Quality Improvement requires group solidarity…and group solidarity requires all staff to be part of the conversaNon.
• The QI “fever” must manifest itself in as much of your staff as possible.
Conclusions
Figure 1. Photo of BFHC staff in a T&G arAcle about the BFHC’s status as a “PaAent-‐centered medical home”.
Figure 2. Barre’s locaAon with respect to Worcester and Boston. Figure 3. PaAents in our Outreach Group fell into 1 of 5 categories.
Chart 1. Label in 16pt Calibri.
Who were the paNents we reached out to? • 509 paAents, divided into 6 categories (see figure 3). • Every paAent was overdue for some combinaAon of the following:
Ø Colorectal cancer screening Ø Breast cancer screening Ø Cervical cancer screening Ø LDL cholesterol test, and/or Ø Hemoglobin A1c test.
What was the outreach?
• Concise and navigable leher signed by their physician. • Leher informs the paAent what he/she is due for. • Leher also contains educaAonal materials about the tests that are overdue. • EducaAonal materials presented in a simple Q & A format.
Figure 4. Example of a poor work flow and how it was improved.
Figure 5. Example of a Provider Report Card.
