Transcript Healthcare Quality - Feinberg School of Medicine

HEALTHCARE QUALITY
ECMH Grand Rounds, December 14th, 2012
Moderators: Donna Woods, Kris Gleason, Dan Evans
INSTITUTE OF MEDICINE
SIX AIMS FOR IMPROVEMENT
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Safe
Timely
Effective
Efficient
Equitable
Patient-centered
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Safe
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Healthcare should not cause unnecessary harm
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Make planned actions occur as intended
Avoid incorrect or more dangerous plans
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Timely
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Avoid long delays
Improve flow of care with patients’ interest in mind
Effective
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Care based on best scientific knowledge
Maximize use of services likely to produce benefits
Avoid services unlikely to result in benefits
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Efficient
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Equitable
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Avoid waste
Reduce administrative and production costs of care
Use lower-cost choices if efficacy is comparable
Secure the benefits of healthcare for all people
Improve access and care delivery based on need
Reduce disparities between groups
Treat all individuals fairly
Patient-Centered

Deliver care responsive to patients’ values, preferences and
expressed needs
IS HEALTHCARE IN THE U.S. SAFE?
An Epidemic of Medical Error
Heart Disease
Cancer
Stroke
Lung Disease
Medical Errors
Accidental Injury
Pneumonia
Diabetes
AIDS
0
100
200
300
400
500
600
700
800
Deaths in Thousands
Source: US Mortality Data 1997 / CDC / IOM
IS HEALTHCARE IN THE U.S. EFFECTIVE?
COMPARATIVE RELIABILITY BETWEEN
INDUSTRIES
PPM
Difficulty with
Referral
Mammography
Screening
IRS - Tax Advice
(phone-in) (140,000 PPM)
1,000,000
100,000
10,000
1,000
Low
Back TX
Airline Baggage
Handling
Post Heart Attack
Medications
U.S. Anesthesia
Deaths
Inpatient
Medication
Safety
100
10
1
Domestic Airline Flight Fatality Rate
(0.43 PPM)
0
Defects
Sigma
50%
1
31%
2
7%
3
1%
4
Sigma Scale of Measure
0.02%
5
0.0003%
6
CASE #1:
49 yo with sarcoidosis, congenital colonic
malrotation with chronic abd pain, major
depression, and uncontrolled diabetes…
 Had been hospitalized in Oct for glc of 1,100 !
 Presents (after multiple team outreach calls) to
discuss her severe depression, passive suicidal
thoughts, her glucose of 450 last week, and her
continuing abd & back pain…
 ROS: + cough (sarcoid?) + burning hands/feet
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WHICH QUALITY INDICATORS DID WE SATISFY?
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BP control for DM
LDL control for DM
Cervical Ca screening
Breast Ca screening
DM foot exam
DM eye exam
DM – attn to nephropathy
DM a1c measurement
BMI documentation, counseling
Influenza vaccination
PNA vaccination
WHICH QUALITY INDICATORS DID WE SATISFY?
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BP control for DM
LDL control for DM
Cervical Ca screening
Breast Ca screening
DM foot exam
DM eye exam
DM – attn nephropathy
DM a1c measurement
BMI & counseling
Influenza vaccination
PNA vaccination
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No (140/89)
No (149 in Oct ‘12)
No (last pap ’06)
Yes (Oct ‘12)
No
No
No
Yes (11, down from 16)
No
Yes
Yes
CASE #2:
84 yo had not seen MD for 20+ yrs until slurred
speech while at Treasure Island in ‘11
 Next 12 mths: CVA (HTN, HL), colon cancer (found
when she bled on heparin), pneumonia, DVT/PE,
c.diff, deconditioning, SNF, more c.diff, hemicolectomy with ostomy, more SNF, another CVA,
depression, recovers – goes home! 3 mths later
dx with B breast cancer (on femara)
 Comes to see us for a planned visit, check-up
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WHICH QUALITY INDICATORS DID WE SATISFY?
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BP control
LDL control for IVD
Statin for CVA
Depression med mgmt
BMI & counseling
Influenza vaccination
PNA vaccination
ASA for hx of CVA
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Yes (120/74)
No (108 in ‘11)
Yes
Yes
Yes
Yes
Yes
No !!!!!!!!!!!!!!!
QUESTIONS FOR THE AUDIENCE…
Are your patients receiving QUALITY CARE?
 How would you MEASURE their quality of care?
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DECEMBER ‘12 STUDENT CHART AUDITS:
FIRST 100 ECMH PATIENTS LOGGED
ANALYSIS OF THE FIRST 100 CHARTS LOGGED:
66% female, 33% male
 60% minorities, 40% white
 66% of ECMH patients have HTN
 20% have CAD
 8% with afib, 6% with prior MI, 6% with CHF
 8% with asthma
 60% on meds that require monitoring
 33% diabetes
 63% have a BMI > 30
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CONTROLLED BLOOD PRESSURE
BP <140/90 on last visit
100%
90%
80%
70%
67%
60%
62%
62%
50%
40%
30%
20%
10%
0%
2010
2011
2012
ANTI-PLATELET DRUG & STATINS FOR ISCHEMIC
VASCULAR DISEASE
Documentation of active Rx
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
84%
79%
66%
63%
53%
2010
Anti-plt
Statin
2011
2012
VACCINATION: PNEUMOCOCCAL
Received PNA-vax
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
62%
44%
2010
48%
2011
2012
WOMEN’S HEALTH:
CERVICAL CA, BREAST CA, & CHLAMYDIA SCREENING
Documentation of active Rx
80%
70%
65%
60%
60%
57%
50%
50%
40%
43%
42%
58%
57%
30%
20%
2010
2011
2012
Cervical Ca
Breast Ca
Chlamydia
DIABETES A1C CONTROL
100%
90%
80%
70%
60%
50%
40%
52%
44%
50%
30%
20%
10%
0%
2010
2011
2012
DIABETIC FOOT & EYE EXAMS
100%
90%
80%
70%
60%
52%
50%
40%
30%
20%
10%
0%
15%
6%
2010
18%
9%
2011
9%
2012
BMI & COUNSELING
100%
92%
90%
80%
70%
60%
50%
57%
55%
68%
60%
62%
BMI measured
Documented counseling
(if obese)
40%
30%
20%
10%
0%
2010
2011
2012
COLON CA SCREENING
Chart Title
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
71%
71%
71%
47%
47%
47%
2010
2011
2012
Blacks
Whites
QUALITY METRIC Q & A
GOING FORWARD…
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Over the next month…
We need to establish our baseline performance
We need your help to track the quality of care
We need a team captain for each ECMH clinic
Compile your “official panel” list
Make sure 1 person “owns” each patient
Fill out the QI survey for each patient that you OWN
Due date = mid January (before next GR)
NEXT GRAND ROUNDS:
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We will focus on best practices across each ECMH clinic,
use the hour for students to present ideas for
improvement
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Remember – you can’t improve things unless you have
baseline data!
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Please keep logging your patients!
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https://www.surveymonkey.com/s/ECMH_QI_chart_aud
it_scorecard