Transcript Document

Blue Meadow Family Clinic
Case Study
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short time ago, in land not far away…
BLUE MEADOW
FAMILY CARE
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The Blue Meadow Team…
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Next Step….
• Provider Enrollment
• Sandee is your CPA
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Let’s get our First Visits With Provider
Checklist and Visit Blue Meadow!
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BMFC Meeting #1…with Provider(s)
Your Name Here
(IF)
Dr. Doe
(physician)
Dr. Green
(physician)
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Enrolling Providers
• First we ensure the Letter of Consent is complete
Registering Drs. Doe & Green –
The SuperForm
For provider registration and chart review
Complete one for each provider
Latest version available on TOP website
You can take a printed hard copy or softcopy on
laptop to your meeting to complete the form
• Let’s take a closer look at the form!
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Provider SuperForm Highlights
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Must use Windows based PC
Must be using MS Excel 2003 or later
Macros must be enabled
You can only work in yellow fields
Saving: Macro-enabled format
Refer to video links on first tab of SuperForm
More information in SuperForm User Guide on
TOP website
Blue Meadow Improvement Team
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BMFC Meeting #2…with Improvement Team
Your Name Here
(IF)
Dr. Doe
(physician)
• Panel Discussion
• Maneuvers Selections
Dr. Green
(physician)
Doreen
(receptionist)
Maureen
(office manager)
Chris
(MOA)
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Panel Discussion
Dr. Doe
(physician)
Doreen
(receptionist)
We’ve been validating patient
attachment at check-in since AIM
and PDI, right?
I thought those were
over??
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Panel Process Development Checklist
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Panel Process Assessment Tool
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Maneuvers Selection
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Screening Offers Documentation
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BMFC Meeting #3
Your Name Here
(IF)
Dr. Doe
(physician)
• Current Screening Processes
Dr. Green
(physician)
Doreen
(receptionist)
Maureen
(office manager)
Chris
(MOA)
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Screening Offers Documentation
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Screening Discussion – Guided Interview
Your Name Here
(IF)
Dr. Doe
(physician)
Dr. Green
(physician)
Doreen
(receptionist)
Maureen
(office manager)
Chris
(MOA)
Sometimes I discuss screening
with patients, but I don’t always
chart what I’ve offered –
especially if they decline.
In reality, I only screen patients
when they book a PHE.
Otherwise, I generally don’t
think of it unless prompted…
We have room for improvement
- even some patients who are
here frequently aren’t getting
screened.
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Map Current Screening Process
No
Patient
greeted by
reception
Address
confirmed
Physician
completes
CPX
maneuvers
Screening if
patient
requests
(physician)
MOA
measures
Ht/Wt
MOA
brings up
CPX
template
PHE?
Yes
Completes
exam,
closes
chart
MOA
rooms
patient
Physician
enters
MOA
leaves
MOA
enters
Ht/Wt
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Reception
MOA
Blue Meadow Family Care – Current Screening Process
Physician
No
Greets
patient
Confirms
address
Rooms
patient
PHE?
Yes
Measures
Ht/Wt
Opens CPX
template
Completes
maneuvers
as per CPX
Finishes
exam,
closes chart
Enters room
Leaves
room
Records
Ht/Wt
Screening
if patient
requests
Meeting #3 Discussion
Your Name Here
(IF)
Dr. Doe
(physician)
Dr. Green
(physician)
Doreen
(receptionist)
Maureen
(office manager)
Chris
(MOA)
I think I only see a height and
weight on about ½ of my
patients - I end up doing it
myself!
I tried running a report on
height & weight and got low
numbers of screens.
I’m not really sure where to
chart height and weight.
There’s more than one place
where they can go.
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EMR “Intervention”
• BMFC sought out help from an experienced
Wolf EMR user to observe how they were using
Wolf for panel and screening processes to
make recommendations for moving ahead with
ASaP
• Experienced user observed Dr. Doe, Dr. Green
and the care team working with them:
– Receptionists
– MOAs
BMFC Meeting #4 - Panel and Status
• Validate panel processes
• Revisit patient status processes
– Managing active and inactive patients
• Use Practice Search to identify active patients
with no visits in 36 months – change these
patients to inactive
– Managing deceased patients
• Use Patient Client Registry
– Managing demographics consistently
– Use validate box in patient demographics
Meeting #4 Continued - Screening Offers
• Decide:
– How important are Run Charts on all offers?
• Stop: Documenting offers in Notes
• Start: To use Templates or Manual Lab Result
to document offers that do not involve a lab
requisition
• Agree on documentation outside of the
Complete Physical eXam (CPX)
EMR Tips
• EMR and reliable processes need to work
together
– Ask: What work do we want to make the EMR
do?
• Create processes for active, panelled patients
in the EMR
– Manage demographics to contact the patients
– Processes to maintain patient status so that
Practice Search is accurate and reliable
• Document screening offers in Templates or
Manual Lab Results
BMFC Meeting #5
Your Name Here
(IF)
• Applying QI Tools
Dr. Doe
(physician)
Dr. Green
(physician)
Doreen
(receptionist)
Maureen
(office manager)
Chris
(MOA)
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Cause/Effect Diagram (“Fishbone”)
Why are screening offers not documented in a standard way?
Providers/Team
Policies
Patients
No
standardized
documentation
of screening
Places/Equipment
Procedures
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MFI/PDSA
• Read both sides of the BMFC plan
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Future State Process Maps
• BMFC decided to adapt the sample processes you
showed them for Opportunistic and Outreach Screening
• They understand that this is only a proposed process,
and revisions will likely be made
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BMFC Future State Process (Opportunistic)
BP Due?
• check BP
• enters in EMR
Greets
patient
Validates in EMR:
• Address/phone
• Primary provider
• Status (active)
Escorts Patient to
Exam Area
Checks Height &
Weight
Rooms Patient
• opens EMR chart
• enters Ht & Wt
Patient
>18?
Exercise Due?
• # minutes/week
• enters in EMR
Addresses
primary reason
for visit
Checks
Reminders in
Patient Chart
Tobacco Use Due?
• check status
• enters in EMR
Alcohol Use Due?
• drinks/week
• enters in EMR
PAP Due?
• offers
• enters in EMR
Patient
>40?
CV Risk Due?
• enters values into
Framingham Risk
Calculator
• enters in EMR
DM & Plasma
Lipid Profile Due
• prints lab req and
instructions
•enters in EMR
Reception
MOA
Physician
D6
Patient
>50?
Completes
encounter
Mammogram
Due?
• prints req for pt
• enters in EMR
Colorectal Due?
• provides FOBT kit
&/OR makes
colonoscopy
referral, as needed
• updates EMR
D5
BMFC Future State Process (Outreach)
Consults
‘Monthly
Maneuver
List’*
Selects
appropriate
maneuver for
current month
Using EMR,
generates list of
patients overdue
for that maneuver
Opens each
patient chart on
the list and checks
status of all 12
maneuvers
Phones Patient
Using script,
informs of all
overdue
maneuvers and
offers screening
As appropriate,
offers appointment
or to fax req(s) to
lab of choice.
Documents
offer(s) of
screening in
patient chart
MOA
• Process performed once/month for each
physician's panel
• Each MOA responsible for 2 physicians’
panels
• Over a 1 year period, each maneuver
provides the basis for the search once
• A patient chart may come up during
consecutive months, serving as a further
reminder to complete screening
• For patients who decline particular
maneuvers, exemptions can be made in
the EMR
Monthly Maneuver List*
January - BP
February – Height/Weight
March - Exercise Assessment
April – Pap test
May – Tobacco Use Assessment
June –Alcohol Use Assessment
July – Plasma Lipid Profile
August – Diabetes Screen
September – Colorectal Screen
October - Mammography
November – CV Risk Calculator
December – Influenza Vaccine
ABC Clinic Improvement Board for “Topic”
Names of People Working on this Improvement
What have we learned about the
way we currently do things?

Insert ‘cause & effect diagram’ OR
‘process map’ OR ‘pareto diagram’ OR ‘5
whys’
Provider/Staff
Policies
Person/Patients
Effect
Place/Equipment
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What changes are we making
that will lead to an
improvement?
Patient Awareness :Placing posters in
rooms promoting pharmacist reviews for
patients on 5 or more medications.
Provider Reminders: Each day, attaching
a pharmacist brochure to charts of
patients on 5 or more medications who
are scheduled.
Procedures
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20
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Series 1
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Target
5
0
1
2
3
4
5
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7
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EXTENDICARE FALCONBRIDGE- PUAP COLLABORATIVE WOUND WARRIORS TEAM
CASE FOR ACTION
RESULTS
WHAT WE DID
TEAM
Kim Lapierre, Kinesiologist
Sylvie Clark RN ADOC
Angela Perreault PSW
Nicole Viel, Dietitian
Stefanie Lavallee RN
Discussion & Questions
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