Transcript Importance of a Registry

Chapter Quality Network (CQN)
Asthma Pilot Project
Importance of a Registry
Amy Belisle, MD
Laura Brann, Program Manager, CIR
Eric Anderson, Dir. Quality Data Management
Disclosure Slide
Amy Belisle’s Disclosure
I have no relevant financial relationships with the manufacturers(s) of any
commercial products(s) and/or provider of commercial services discussed in
this CME activity.
Laura Brann’s Disclosure
I have no relevant financial relationships with the manufacturers(s) of any
commercial products(s) and/or provider of commercial services discussed in
this CME activity.
Eric Anderson’s Disclosure
I have no relevant financial relationships with the manufacturers(s) of any
commercial products(s) and/or provider of commercial services discussed in
this CME activity.
We need a registry to…
Identify patient populations
Help manage patients
Prepare for patient visits using evidence based protocols
Provide “opportunistic care”
Track quality indicators
Identify gaps in performance
Help sustain long-term quality care
MaineHealth Clinical Improvement Registry
Health System
Community
Resources
& Policies
Informed,
Activated
Patient
Health Care Organization
SelfManagement
Support
Delivery
System
Design
Decision
Support
Productive
Interactions
Clinical
Information
Systems
Prepared,
Proactive
Practice Team
Improved Outcomes
Chronic Care Model
CIR Development & Deployment Process
MaineHealth Clinical Integration
Clinical Integration develops evidence based programs of care and develops educational
material for patients and providers. Specialty expertise is brought together with primary
care for determination of best practice delivery of care. Works closely with collaborative
practices to build process improvement tools. With input from Clinical Integration
Workgroups, proposes program quality metrics and reporting for CIR
Clinical Integration programs currently supported by the CIR
Asthma, Diabetes, Cardiovascular Disease, Depression, Preventive Health
MaineHealth
Value Data
Measurement &
Reporting
Committee
The Committee
provides oversight for
the direction,
resources, long term
planning and sets
priorities for CIR
development and
deployment in line with
the strategic plans of
MH and affiliates.
Primary Care Physicians Measures Group
Responsible for determining specific values for clinical
improvement measures
CIR Development Team
Quality Data Management
Information Services
Practice Deployment
A collaborative process between the staff of the PHO and the
Quality Data Management Division
MaineHealth CIR Statistics
1152 Active Users
124 MaineHealth Practices
508 MaineHealth Providers
Other users:
• Mercy Primary Care Center
sites
• SOCHS PHO (Maine Covenant)
• Maine Health Alliance
(Northern Maine Medical
Center
January 2010
•
•
•
•
Pines Health Care Service
Maine Coast Memorial Hospital
Mayo Regional Hospital
Kennebec Regional Health
Alliance, etc…
Current patients in the CIR
~21,000 Diabetes
~12,000 Asthma (7k adult/5k pediatric)
~15,000 CVD
~8,000 Depression
~1,000 HF (all clinical counts)
Preventive Health:
~66,000 Pediatric (0-18 years)
~168,000 Adult (18 or older) with no
other chronic illness
MMC PHO Patients Managed in the Clinical
Improvement Registry
14,000
12,000
10,000
Pediatric Asthma (ages 2-18)
8,000
Adult Diabetes (ages 18 +)
6,000
4,000
Adult CVD (ages 18 +)
2,000
0
2004
2005
2006
2007
2008
2009
Data………..
Collection
Entry
Validation
Reporting
Use for Quality Improvement
Data………..
Collection
Entry
Validation
Reporting
Use for Quality Improvement
Sample
Asthma PCP Visit Report Process
Provider:
Patient Service Representative:
Reminder call before appointment
Nurse/Medical Asst:
Verify CIR/Visit Summary is up to date
Print VS if needed, place with chart. (May want
to highlight where information/updates are
needed)
Include with chart any paperwork needed
In process of visit, review Visit Summary report where information is
needed, add/update on the visit summary all necessary information
Document referral (if applicable) to Asthma Educator or Specialist for
persistent uncontrolled asthma and/or considers MMC PHO Care
Manager for additional support.
Provider gives completed VISIT REPORT to Clinical Staff.
Nurse/Medical Asst:
Obtain parent/guardian signature on School Plan;
Nurse/Medical Asst/Patient Services
Representative:
Roomer/Nurse/Medical Asst:
Record all applicable data on the CIR Visit Summary and in the
Medical Record
Ask/document any information needed:
(ex Immunizations, tobacco exposure, ht, wt, BP,
Data Entry in CIR from Visit Summary Report
New visit summary report printed. Indicate missing
information for provider review at next visit.
If labs/tests ordered, the test information is entered into the
CIR upon receipt and a new Visit Summary Report
printed.
Process is complete!
Data………..
Collection
Entry
Validation
Reporting
Use for Quality Improvement
Data………..
Collection
Entry
Validation
Reporting
Use for Quality Improvement
Internal Reporting
Progress report
Patient Clinical Reminder report
Visit Summary
For the patient
Self Care report
Patient mailings/reminder letters
External Reporting
PQRI
PTE
NCQA
Include drill down progress report
Include drill down progress report
Important things to know
Where to get more information…
There are some costs
$120 every 3 years for secure ID
$240/year per provider
To get your practice set up on the CIR
Paperwork
Business Associate Agreements
Service Level Agreements
Practice Start Up Packet
Identify a practice CIR lead
disclosure statement
I have no relevant financial relationships with the manufacturer(s) of any
commercial products(s) and/or provider of commercial services discussed in
this CME activity.
Questions?
For more information:
Contact your PHO, Practice Manager or CIR Program Manager
[email protected]
Patient Service Representative:
Reminder call before appointment to bring
diary/log, meds, peak flow meter, spacer, etc.
Nurse/Medical Asst:
Review chart for VS (Visit Summary) or print
from the CIR;
Check CIR database to see if latest visit and
tests have been entered; If missing, document
lab/test values on VS Report
Indicate on VS where information is needed
Attach Visit Summary and any additional forms
to be completed (Action/School Plan) and
lab/Test reports to front of chart.
Patient escorted to exam room by Roomer.
VERIFY PATIENT ID. RECORD DATA ON BOTH THE VISIT REPORT &
IN THE APPROPRIATE AREA OF THE MEDICAL RECORD:
Roomer/Nurse/Medical Asst:
Ask about any missing information:
Flu and Pneumonia Immunizations/updates
Any ED Visit or Hospital Admission (date & reason)
Triggers, smoke exposure
Obtain HEIGHT, WEIGHT, BLOOD PRESSURE and PEAK
FLOW for kids > 5 years old;
Document Peak Flow, technique and effort on encounter
form and visit summary where applicable; and
Calculate peak flow zones, update plan.
Give patient blank diary to record home Peak Flow and
assesses patient technique on inhalers and spacers and
instructs as needed.
RECORD ALL APPLICABLE DATA ON BOTH THE VISIT REPORT & IN THE
APPROPRIATE AREA OF THE MR:
Provider:
Review areas of (VS) Visit Summary report where information is
needed, add or update on the visit summary including but not limited to
Condition, Medications, Allergies/Adverse drug reactions, patient
asthma status (if symptom free less than 14 days);
Evaluate patient level of understanding of asthma, meds, management
plan, etc.;
Complete and explain zones, meds asthma management plan for home
and school;
Prescribe spacers for inhalers, peak flow meters for kids > 5;
Emphasize importance of follow-up visits for reassessment/ education;
and
Refer to Asthma Educator or Specialist for persistent uncontrolled
asthma and/or considers MMC PHO Care Manager for additional
support.
Provider gives completed VISIT REPORT to Clinical Staff.
Nurse/Medical Asst:
Provide asthma education (i.e., use of peak flow meter,
inhalers, etc.);
Obtain parent/guardian signature on School Plan;
Nurse/Medical Asst/Patient Services
Representative:
Data Entry in CIR from Visit Summary Report
New visit summary report printed. Indicate missing
information for provider review at next visit.
If PFT’s ordered, the test information is entered into the CIR
upon receipt and a new Visit Summary Report
printed.
Process is complete.
Newly Diagnosed Patient with Asthma requires:
Initial Data Entry into CIR; Severity Classification; Action
Management Plan and/or School Plan; Peak Flow Baselines;
Patient Education