Care Management & Quality Improvement

[JParry]

Stage 1 - Assessement

Care Management & Quality Improvement
In addition to the practice assessments, practices will take this time to conduct a simulation of the patient experience in their practice to determine bottlenecks and other opportunities for improvement. The practice will also review literature and tools on alternative design options for delivery systems, including such options as group visits and motivational interviewing techniques. The DOQIT team will also provide tools to help the practice determine its demands in terms of major demographics and chronic conditions relative to its staffing resources.

DOQ-IT Quality Measures:
CMS Physician Focus Quality Initiative: Overview (http://jeny.ipro.org/attachment.php?attachmentid=2299&stc=1&d=1174913358)
CMS Physician Focus Quality Initiative: Detailed Definitions (http://jeny.ipro.org/attachment.php?attachmentid=2300&stc=1&d=1174913755)
CMS Physician Focus Quality Initiative: Analytic Narratives & Data Elements (http://jeny.ipro.org/attachment.php?attachmentid=2301&stc=1&d=1174914358)



Assess the delivery system design of practice:·

Conduct practice readiness assessment (http://jeny.ipro.org/attachment.php?attachmentid=1418&stc=1&d=1146751364)
Conduct staff skills assessment (http://jeny.ipro.org/attachment.php?attachmentid=1308&stc=1&d=1146670721)
CMS Baseline Assessment (TBD)

Conduct a simulation of patient experience in the practice (http://jeny.ipro.org/attachment.php?attachmentid=1309&stc=1&d=1146670849)
Review resources for designing expanded services

Using Clinical Information Technology in Chronic Disease Care (http://jeny.ipro.org/attachment.php?attachmentid=1310&stc=1&d=1146670929)
Group Visit Starter Kit (http://jeny.ipro.org/attachment.php?attachmentid=1311&stc=1&d=1146670929)
Clinical Microsystems Overview (http://jeny.ipro.org/attachment.php?attachmentid=1312&stc=1&d=1146670929)
Beyond Traditional Office Visits (http://jeny.ipro.org/attachment.php?attachmentid=1367&stc=1&d=1146671792)
Chronic Care Model Change Package (http://jeny.ipro.org/attachment.php?attachmentid=1368&stc=1&d=1146671792)
Motivational Interviewing Guide (http://jeny.ipro.org/attachment.php?attachmentid=1369&stc=1&d=1146671792)
Sequence of Access Improvement (http://jeny.ipro.org/attachment.php?attachmentid=1370&stc=1&d=1146671792)
Steps to Implement Transitional Open Access (http://jeny.ipro.org/attachment.php?attachmentid=1371&stc=1&d=1146671792)

Identify practice demands including patient:

Primary Care Practice Profile (http://jeny.ipro.org/attachment.php?attachmentid=1313&stc=1&d=1146670929)
Getting to Know your Practice (http://jeny.ipro.org/attachment.php?attachmentid=1314&stc=1&d=1146670929)
Demand Measurement Tool (http://jeny.ipro.org/attachment.php?attachmentid=1315&stc=1&d=1146670929)

Determine staff capacity to address demands (http://jeny.ipro.org/attachment.php?attachmentid=1316&stc=1&d=1146670929)
Conduct regular staff meetings

Effective Meetings (http://jeny.ipro.org/attachment.php?attachmentid=1364&stc=1&d=1146671456)
Group Huddles (http://jeny.ipro.org/attachment.php?attachmentid=1365&stc=1&d=1146671456)
Staff Meeting Plan and Agenda (http://jeny.ipro.org/attachment.php?attachmentid=1366&stc=1&d=1146671456)

[JParry]

Stage 2 - Planning

Care Management & Quality Improvement

Planning for a major change like an EGR is crucial to the success of the change. Without planning for changes to key practice processes prior to implementation, a practice runs the risk of automating bad processes. During the planning stage, practices should list and map the workflow for major activities and determine unnecessary steps. In addition, now is the time to identify the delivery design changes that will be made and plan for them. Lastly, the practice should determine its clinical decision support needs, based on the results of assessment of practice demands and the worksheets that the DOQ-IT team will provide.


List & Map All High Volume Activities:

Common Office Visit Service Issues (http://jeny.ipro.org/attachment.php?attachmentid=1372)
High Volume Activity Survey (http://jeny.ipro.org/attachment.php?attachmentid=1373&stc=1&d=1146672682)
Workflow Modeling Diagrams (http://jeny.ipro.org/attachment.php?attachmentid=1374&stc=1&d=1146672682)

Review Workflow Redesign: Eliminate Waste
Identify & Plan For Expanded Services - see Stage 1 #3

Additional Resources (http://jeny.ipro.org/attachment.php?attachmentid=1375&stc=1&d=1146672864)

Integrating an EHR into Care Management (http://jeny.ipro.org/attachment.php?attachmentid=1376&stc=1&d=1146672864)
Determine Clinical Decision Support Needs (http://jeny.ipro.org/attachment.php?attachmentid=1377&stc=1&d=1146672864)
Conduct Staff Meetings - see Stage 1 #6

[JParry]

Stage 3 - Selection

Care Management & Quality Improvement

When reviewing system functionalities and vendor demonstrations, take into consideration important capabilities, such as population management and clinical decision support functionalities, based on the top diagnoses for the practice. Be sure to ask the vendor to take you through these features


Create Workflow Solutions:

Define Practice Redesign Requirements (http://jeny.ipro.org/attachment.php?attachmentid=1378&stc=1&d=1146673312)
Develop Protocols for Selected Interventions (http://doqit.healthinsight.org/workflow.html)(Web Link)

Evaluate EHR for Population Management

Guideline for Evaluating EHR Systems (http://jeny.ipro.org/attachment.php?attachmentid=1379&stc=1&d=1146673580)
Vendor Evaluation Matrix (http://jeny.ipro.org/attachment.php?attachmentid=1380&stc=1&d=1146673580)

Conduct Regular Staff Meetings - see Stage 1 #6

[JParry]

Stage 4 - Implementation

Care Management & Quality Improvement

The implementation stage will likely be a hectic time for the practice. Its important to continue to have regular staff meetings during this time and to set aside a portion of the meeting to discuss issues and concerns that staff members may have. Any gaps in training should be addressed, as well at this time. The practice will also begin to implement the expanded services it has been planning for, such as group visits.

The practice should consider and plan for data collection and analysis.


Modify EHR to Capture Data for Reports:

Simple Data Collection Planning (http://jeny.ipro.org/attachment.php?attachmentid=1381&stc=1&d=1146673837)
Local Clinical Information Systems and their Knowledge-Delivery Features (http://jeny.ipro.org/attachment.php?attachmentid=1382&stc=1&d=1146673837)

Implement Expanded Services - see Stage 1 #3
Use Tools to Measures Outcomes (http://jeny.ipro.org/attachment.php?attachmentid=1383&stc=1&d=1146673837)
Conduct Regular Staff Meetings - see Stage 1 #6

[JParry]

Stage 5 - Evaluation

Care Management & Quality Improvement

See the Information Technology Module Summary above.

The DOQ-IT Team will provide guidance and examples of data analysis reports for the practice, as well as training and support on submitting quality improvement data to the QIO Clinical Data Warehouse, should the practice choose to submit this data.


Conduct Post Implementation Review (http://jeny.ipro.org/attachment.php?attachmentid=1384&stc=1&d=1146674021)
Utilize EHR Data for Analysis (http://jeny.ipro.org/attachment.php?attachmentid=1385&stc=1&d=1146674021)
Capture & Submit Selected DOQ-IT Measures (http://jeny.ipro.org/attachment.php?attachmentid=1386&stc=1&d=1146674021)
Continue Staff Meetings - see Stage 1 #6

[JParry]

Stage 6 - Improvement

Care Management & Quality Improvement

The DOQ-IT team will provide a breakdown of the data being submitted to the QIO Clinical Data Warehouse. In addition, IPRO’s DOQ-IT team will assist the practice in identifying and planning for further quality improvement projects that can be implemented and tracked with the help of the EHR. The practice should continue to monitor and adjust its processes as it settles into using the EHR system.


Review Impact of EHR on Practice (http://jeny.ipro.org/attachment.php?attachmentid=1387&stc=1&d=1146674215)
Utilize DOQ-IT Quality Reporting (http://jeny.ipro.org/attachment.php?attachmentid=1388&stc=1&d=1146674215)
Plan Additional Expanded Services - see Stage 1 #3
Identify & Plan a Quality Improvement Project (http://jeny.ipro.org/attachment.php?attachmentid=1389&stc=1&d=1146674215)
Conduct a Patient Survey (http://jeny.ipro.org/attachment.php?attachmentid=1390&stc=1&d=1146674215)
Conduct Staff Meetings - see Stage 1 #6
Additional Reading:

Internet Based Self Care (Web Link) (http://www.jmir.org/2003/2/e8/)
Assessment of a patient portal (Web Link) (http://www.jmir.org/2005/4/e47/)
EHR in the Exam Room (http://jeny.ipro.org/attachment.php?attachmentid=1391&stc=1&d=1146674469)
EHR, Registries, and Care Management Core Functions (http://jeny.ipro.org/attachment.php?attachmentid=1392&stc=1&d=1146674469)
Quality Improvement: An introduction with worksheets (http://jeny.ipro.org/attachment.php?attachmentid=1393&stc=1&d=1146674469)