Transcript New York State Department of Health Hospital

New York State
Department of Health
Hospital-Medical Home
Demonstration
Reflections, Celebrations and
Transformations
April 4, 2016
2
Goals of the HMH Pilot
Transform healthcare and medical training in primary
care residency clinics through:
• Better care of chronic disease
• Increased focus on prevention
• Increased access to care
• Improved performance on population health
• Involving residents in quality improvement and
increasing continuity with their patients
April 4, 2016
3
Achievements
• Improved care for diabetes, high blood pressure,
depression, and preventive health
• Decreased readmissions
• Assignment of patient panels to residents and use
of population health dashboards
• Making significant progress toward revitalization of
the spirit of primary care to again take its place as
the center of a high functioning healthcare system
4
PCMH Recognition
• 100% of HMH sites are now recognized at
Level 2 or Level 3 with the 2011 standards
N=15
6
N=15
6
5
PCMH Recognition by Level
N=15
6
N=15
6
6
Growth in NYS PCMH Recognized Providers by Quarter
4,868
4,631
4,684
4,813
5,277
Increase of
593 new
PCMHrecognized
providers
between
January 2014
and July 2014.
7
EHR achievements
• 97% of sites made changes to their EHR as part of HMH
• 82% have EHRs interoperable between their hospital and
outpatient sites
• 96% connect to the RHIO from the outpatient site (85% regularly
upload data to the RHIO)
• 98% connect to the RHIO from the hospital (95% regularly upload
data to the RHIO)
• 68% have office processes that include accessing the RHIO for
information
• 70% have processes for hospital admissions that include
accessing the RHIO for information
8
Clinical Performance
Statistically significant changes in overall rates from
Q3 2013 to final reporting were seen for the following
measures (one changed in undesirable direction):
•
•
•
•
•
Breast Cancer Screening (47% to 60%)
Cervical Cancer Screening (51% to 64%)
Child Immunization Status (57% to 71%)
Colorectal Cancer Screening (48% to 59%)
Dilated Eye Exam for Diabetics (31% to 42%)
•
Follow Up After Hospitalization for Mental Illness within 30 days (85% to 66%)
•
•
•
Nephropathy Testing for Diabetics (68% to 82%)
Tobacco Use Assessment (70% to 86%)
Weight and Physical Activity Assessment for Children/Adolescents (58% to 86%)
9
Resident Continuity
As of final reporting:
• Percentage of resident visits with patients on their panel:
55%
• Percentage of patient visits with assigned resident PCP: 54%
• High rates in these measures of continuity are:
– Correlated with better performance on lipid control
measures
– Associated with higher rates of breast cancer screening
10
Resident Continuity, continued
• 89% of sites report that patients are assigned to a team
• 91% report having assigned patient panels and/or
resident/attending teams
• 93% report residents have been assigned a panel of patients for
whom they are responsible over an extended time period
• 40% report having increased the number of continuity training sites
or expanding the current hospital-based sites beyond the hospital
environment
• 82% have restructured the resident training schedule to redistribute
the time spent in an ambulatory setting
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Care Integration and Coordination Projects:
Improved Access and Coordination Between Primary and Specialty Care (54 sites)
100%
95%
96%
99%
97%
87%
Average Measure Rate/Average Composite
Score
90%
81%
83%
74%
73%
73%
74%
70%
65%
65%
65%
61%
60%
89%
86%
80%
70%
99%
99%
Average site-level composite
score for care coordination
report card projects
85%
78%
76%
75%
75%
72%
69%
67%
64%
60%
50%
Average rate of all patients
referred from the outpatient site
seen that are seen for post
specialty visit care within the
timeframe recommended
Average rate of all referrals
from the outpatient site without
adequate documentation
*
*
40%
*
Average rate of all referrals
from the outpatient site that are
made and not completed
30%
20%
*
10%
72%
75%
79%
81%
83%
79%
Q3 2013
Q4 2013
Q1 2014
Q2 2014
Q3 2014
Q4 2014
0%
Average rate of all referrals
from the outpatient site rejected
by Specialists
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Care Integration and Coordination Projects:
Integration of Physical and Behavioral Health Care (34 sites)
P = <.0001
100%
95%
Average Measure Rate/Average Composite Score
93%
90%
87%
80%
78%
70%
70%
77%
80%
76%
74%
86%
83%
85%
83%
78%
82%
63%
58%
61%
57%
60%
85%
97%
Average site-level composite score for
behavioral health report card projects
Average rate of clinicians at the
outpatient site who completed
depression and pain management
training
Average rate of depression screening of
adult patients at the outpatient site
57%
51%
50%
49%
47%
43%
41%
38%
40%
43%
41%
41%
32%
Average rate of patients screened
positive for depression at the outpatient
site who enrolled in physical-behavioral
healthcare coordination program
Average rate of patients enrolled in the
collaborative care initiative whose PHQ9 decreased below 10 in 16 Weeks
35%
30%
24%
20%
Average rate of patients referred for
psychiatric consultation that are enrolled
in the collaborative care unit
16%
10%
40%
0%
Q3 2013
0%
57%
64%
70%
73%
73%
Q4 2013
Q1 2014
Q2 2014
Q3 2014
Q4 2014
Average rate of behavioral health
services provided within timeframe
requested by PCP
13
Care Integration and Coordination Projects:
Enhanced Interpretation Services for Culturally Competent Care (28 sites)
100%
100%
100%
99%
98%
100%
99%
97%
98%
100%
97%
95%
100%
97%
95%
92%
Average Measure Rate/Average Composite Score
90%
86%
81%
80%
79%
70%
67%
68%
67%
60%
46%
30%
43%
36%
35%
Average rate of all interpretor
encounters at the outpatient site where
the wait time for an interpreter is 15
minutes or less
20%
10%
13%
10%
63%
0%
Q3 2013
0%
Average rate of staff from the outpatient
site who completed a cultural
competency training in the past 12
months
Average rate of all non-Englishspeaking patients discharged with
discharge instructions in the language
preferred by the patient
39%
40%
Average site-level composite score for
culturally competent care report card
projects
Average rate of visits in the outpatient
site in which the patient's gender, race,
ethnicity, date of birth, and preferred
language are recorded
60%
50%
P = .004
62%
69%
84%
88%
90%
Q4 2013
Q1 2014
Q2 2014
Q3 2014
Q4 2014
Average rate of prescription labels
written in a language other than English
for all prescriptions written for nonEnglish-speaking patients
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Care Integration and Coordination Projects:
Care Transitions and Medication Reconciliation (80 sites)
100%
Average Measure Rate/Average Composite Score
90%
80%
85%
70%
80%
75%
82%
82%
81%
97%
89%
87%
85%
88%
87%
83%
85%
82%
80%
78%
78%
71%
95%
87%
83%
83%
93%
72%
69%
70%
90%
87%
83%
73%
Average rate of all high risk Medicaid
patients from the outpatient site
discharged that had a follow up phone call
within 48 hours of discharge
60%
56%
50%
47%
40%
32%
26%
19%
Average rate of all patients from the
outpatient site with documentation of
medications reconciled on admission
73%
68%
68%
30%
Average site-level composite score for
care transitions and medication
reconciliation report card projects
32%
32%
23%
20%
10%
62%
69%
72%
77%
76%
78%
Q3 2013
Q4 2013
Q1 2014
Q2 2014
Q3 2014
Q4 2014
0%
Average rate of all high risk Medicaid
patients from the outpatient site
discharged that completed a follow up visit
with their PCP within 48 hours of
discharge
Average rate of all high risk Medicaid
patients from the outpatient site that were
readmitted within thirty (30) days
Average rate of all patients from the
outpatient site discharged from an
inpatient facility who received a reconciled
medication list at the time of discharge
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Medication Reconciliation
(within Care Transitions/Medication Reconciliation Project)
• Patients who did not have a post-discharge
medication reconciliation at the ambulatory site had
1.51 times the odds of having an all-cause 30 day
readmission compared to patients who did have a
medication reconciliation at the ambulatory site.
• There was no relationship between medication
reconciliation at the ambulatory site and odds of
having a potentially preventable readmission (PPR).
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Care Integration and Coordination Project
Composite Scores Q3 2013 – Q4 2014
100%
90%
Average Composite Score
80%
70%
60%
84%
79%
72%
63%
62%
75%
69%
72%
69%
62%
64%
81%
77%
70%
88%
83%
76%
73%
90%
79%
Behavioral
Health
78%
73%
Care Transitions
and Medication
Reconsiliation
57%
50%
Care
Coordination
40%
40%
30%
Culturally
Competent Care
20%
10%
0%
Q3 2013
Q4 2013
Q1 2014
Q2 2014
Q3 2014
Q4 2014
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Rates with large ranges
A large range was seen in Q4 2014 reporting for the following
measures:
• Adult BMI assessment (range: 7% to 100%)
• Breast cancer screening (range: 3% to 94%)
• Patients Enrolled in A Physical-Behavioral Health Program
(range: 14% to 94%)
• Post visit specialty care (range: 0% to 100%)
• Specialty care wait times (range: 22% to 100%)
• Follow up visit (range: 0% to 100%)
• Very little variation in culturally competent care measures
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New York State
Department of Health
Hospital-Medical Home
Demonstration
Resident PCMH
Survey
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ABOUT THE SURVEY
• Developed by Greater New York Hospital
Association and administered jointly with
DOH in July 2013 and January 2015 to
assess knowledge of PCMH concepts
• Sent by e-mail to primary care Program
Directors to share with residents
• 1000 responses per survey
*Due to the data collection methodology, results should not be generalized to the entire New York
State resident population. Additionally, the data should not be scientifically compared from 2013
and 2015 due to potential differences in population of the respondents.
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RESIDENT SURVEY
2013 vs. 2015
Familiarity with PCMH
• Respondents are more likely to say they are familiar with
PCMH (89% vs. 81%).
• They are also more likely to say they are very familiar or
familiar with the core concepts of
PCMH (56% vs. 44%).
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RESIDENT SURVEY
2013 vs. 2015
PCMH Experience
Respondents are more likely to strongly or somewhat agree with the
following:
• Their residency program has involved them in activities within the
clinic site associated with being a PCMH (70% vs. 60%).
• PCMH concepts have been incorporated into educational activities
within their residency program. (71% vs. 61%).
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RESIDENT SURVEY
2013 vs. 2015
Practice Value
• A large majority of respondents continue to agree or strongly agree
that being cared for in a PCMH is beneficial to patients (83% vs.
81%).
• Respondents agree or strongly agree that they are providing teambased, coordinated, patient-centered primary care at their clinic site
(84% vs. 82%).
• Respondents agree or strongly agree that the residency program
clinic schedule allows residents to develop a continuous
relationship with their patients (79% vs. 81%).
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RESIDENT SURVEY
2013 vs. 2015
Practice & PCMH Decisions
• The same number of respondents answered affirmatively that the
prevalence of the PCMH model of care will affect their decision to
practice in a given state (35% vs. 35%) and the number of
respondents who answered no increased slightly (18% vs. 14%).
• The number of respondents who reported that they would like to work
in a PCMH model of care for both years remained the same (41% vs.
42%).
– Approximately, half the respondents answered that they are not sure whether they
would like to work in a PCMH model of care (48% vs. 53%) and those that
answered ‘No’ increased (11% vs. 5%)
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Panel Discussion
• The Patient-Centered Medical Home
• Integration of Care
• Residency Training