Transcript Peer Review for MWCN (Tom)

Peer Review
Thomas C. Platt, M.D.
Chief Medical Officer
Cherry Health
100 Cherry St SE
Grand Rapids, MI
Presentation Outline
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What is Cherry Health
Reactive Peer Review
Ongoing Peer Review
Specific Examples
Cherry Health
• FQHC established 1988 as Cherry
Street Health Services
• Name change to Cherry Health in
2014
• Approximately 800 employees
serving 60,000 patients in 23 sites
Cherry Health
• Services include:
– Family Practice
– Pediatrics
– Internal Medicine
– Obstetrics/Gynecology
– Dental
– Counseling
Cherry Health
• Other Services Provided:
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Optometry, Optical
Traveling School Programs (Dental, Vision)
Psychiatry
Case Management
Medication Assisted Treatment Program
Correctional Residential/Re-entry
Employee Assistance Center
Clubhouse
Health Promotion
Reactive Peer Review
• An event occurs that raises question about
quality of care given by specific provider
• Group of peers convened to review
– May include appearance by provider
• Recommendations made to CMO
– Education
– Limitation
– Dismissal
Reactive Peer Review
• CMO has ultimate decision
• Process is protected from discovery
• Example:
– Physician sees pt for first time
– Pt given Rx for tramadol
– Pt OD’s
Ongoing Peer Review
• A process in which practitioners
regularly review and give feedback
on each other’s work
• No universal standard
• Can be simple or complex review
• Frequency of review varies
Peer Review at Cherry Health
• When I first arrived 2006…
– Medical Director doing chart reviews:
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Problem list
Medication list
Allergies
Physical done in past year
SOAP note
– Each provider had 10 charts reviewed
quarterly
Phase 2 Peer Review at Cherry Health
• When I assumed role as Medical Director
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EHR use starts
Need to find other measures
Need to involve all providers in process
Need to keep it simple to start
Phase 2 cont’d
• Adult providers look at mammography in
women 50-75 yr
• Pediatric providers look at adolescent well
child exams
• School based providers look at RAAPS
(Rapid Assessment for Adolescent
Preventive Services)
• (Most sites still using paper charts, so
providers review others at same site)
Phase 3
• Look for universal measure across all
services
– Smoking
• Was pt asked
• If smoker, were they counseled
• Measure in children was asking about
second hand smoke
Current Process
• The previous reviews were really “chart
audits” rather than “peer review”
• Let the computer keep track of data
(mammograms, A1c’s, etc) and generate
reports
• Use Peer Review to look at quality of
encounter note: can you follow the thought
process?
Process
• Each provider given specific visit to review
of like provider each month
• Provider fills out form and forwards to
CMO
• CMO reviews for trends, etc
• Copy then sent to provider being reviewed
• Findings reviewed at provider meeting
Examples
• Different specialties may require
different tools
CONFIDENTIAL
Quality Peer Review Chart Audit
Provider being audited:
_____________________________
Provider doing audit:
_____________________________
Patient name, DOB:
_____________________________
Date of visit for audit:
_____________________________
Is there a chief complaint/reason for visit with HPI adequately documented?
YES NO
Comments:
Does the physical include appropriate findings pertinent to HPI?
YES NO
Comments:
Does the assessment/plan appropriately address HPI
YES NO
Comments:
Is patient on controlled substance prescribed by CSHS (pain med, ADHD med, etc)?
YES NO
If so, was use of controlled substance addressed (e.g. contract, UDS, MAPS)?
Comments:
Health Maintenance issues addressed?
YES NO
YES NO
Psychiatry Tool
Medication Utilization Evaluation
Reviewer: _________________________________________
Date of review: ______________
Physician Reviewed: _________________________________
Client Reviewed: _____________________________________
1. Was the medication prescribed to the client appropriate based on the needs and preferences of the person served?
(a) The documentation does not show that the clients needs and preferences were taken into account when prescribing the
medication.
(b) The documentation does not show that the clients needs and preferences were taken into account when prescribing the
medication; however the rational was documented
(c) The documentation does show the client’s needs and preferences were taken into account when prescribing the
medication.
2. The documentation shows the efficacy of the medication
(a)The documentation does not show the efficacy of the medication
(b)The documentation does show the efficacy of the medication
Psychiatry Tool cont’d
3. The documentation of the medication review shows that side effects, unusual effects, and contraindications were
identified and addressed in the note
(a) The documentation does not show that side effects, unusual effects, and contraindications were identified and addressed
in the note
(b) The documentation shows that no side effects, unusual effects, and contraindications were identified
(c) The documentation does show that side effects, unusual effect, and contraindications were identified and addressed in the
note
4. If tests are necessary, the documentation shows those tests were conducted
(a)The documentation does not show that necessary tests were conducted
(b) The documentation does show that necessary tests were conducted
5. The documentation of the medication review identifies the use of multiple simultaneous medications if prescribed.
(a) The documentation does not identify the use of multiple simultaneous medications if prescribed.
(b)The documentation does identify the use of multiple simultaneous medications if prescribed.
6. The documentation of the medication review identifies medication interactions
(a) The documentation does not identify medication interactions
(b)The documentation does identify medication interactions
7. The documentation indicates the clients satisfaction in regards to there medication
(a) The documentation does not identify the clients satisfaction in regards to there medication
(b) The documentation does identify the clients satisfaction in regards to there
medication
Peer Review: Vision
Reviewer:________________________________
Encounter/DOB:___________________________
Date of Service Evaluated:____________
Is there a chief complaint/reason for visit with HPI adequately documented?
(e.g. for a ‘well child’ vs. ‘medical complaint’)
Did the Provider complete the HPI and indicate in the record?
Does the exam include appropriate findings pertinent to CC/HPI?
Does the assessment/plan appropriately address CC/HPI? (e.g. #1 CC matches #1 Assessment)
If a student exam, was there clear documentation from attending?
If diagnostic tests were ordered is a separate report completed and the document generated?
Additional Comments or Suggestions:
What do we find?
• Commonest concern is that the chief
complaint doesn’t match the
diagnosis
– MA typically enters the CC, but pt and
provider end up discussing something
else – provider doesn’t redo the CC
• Occasionally the provider does not
provide enough detail in the
assessment to support action
– e.g. pt with hematuria put on abx, but
differential diagnoses not mentioned, or
follow up plan if abx fails not given (e.g.
CT urogram)
Goals of Peer Review
• Monitor performance
• Feedback to provider
• Be a learning process
– Individual
– Group
• Improve quality
Questions?