1. Improving IPC Clinical Measures Model for Identifying Areas for Improvement Colleen A. Hayes MHS, RN IPC Learning Session #2 Denver, CO

2. Objectives 1)Participants will assess one clinical indicator or clinical bundle measure based on the model 2)Participants will identify a workplan for improving at least one clinical indicator based on this model

3. IPC Clinical Measures accessprocessroles information system documentationknowledgeresources

4. IPC Measures accessprocessroles information system documentationknowledgeresources

5. Access Are patients able to access services to improve this measure? How much is lack of access effecting the results? Examples: - Diabetes Comprehensive: access to retinopathy screening - Cancer Screening – PAP, Mammogram appt availability

6. IPC Measures accessprocessroles information system documentationknowledgeresources

7. Process Do we have any systems or processes that are preventing or inhibiting us from meeting this measure? What have we learned from cycle times, patient experience and staff satisfaction about our processes – that may relate to measures?

8. CDC Community Guide Recommendations

9. IPC Measures accessprocessroles information system documentationknowledgeresources

10. Roles Who is completing the screenings? Is every person functioning at their “highest level” in the organization? Who is able to refer for/or schedule a PAP, Mammogram, etc. Who is providing tobacco cessation counseling? Is someone tracking data (iCare) and sending reminders to patients?

11. IPC Measures accessprocessroles information system documentationknowledgeresources

12. Information Systems Are we using iCare panels to identify patients not meeting targets? Are we using iCare and other tools to “drill down” and identify what is effecting bundle or comprehensive measures? Are we using reminders to staff in E.H.R. – or in a paper system?

18. Diabetes Comprehensive: Individual Indicators A1C measured72.7% Blood Pressure (2)81.8% LDL Assessed69.7% Nephrology Assessed63.6% Retinopathy Assessed45.5% Foot Exam39.4%

19. What does this tell you about the DM Measures

20. Information Systems What other searches in RPMS/other system are useful in identifying pts not meeting measures? Are we using the system to generate reminders to patients? Use of pharmacy systems – prescribing patterns/need for updates to formulary

21. IPC Measures accessprocessroles information system documentationknowledgeresources

22. Documentation Are screenings and interventions being documented and captured in RPMS? Are taxonomies for lab results up to date? Are outside tests/procedures being entered into RPMS – so they can be “counted” for the measures (ie, mammograms, colonoscopies) Is data entry up to date? How long between visit and data entry? How does this effect your measures?

23. IPC Measures accessprocessroles information system documentationknowledgeresources

24. Knowledge Do staff need additional training/information on the measures? Does the community need information on screenings/care? Documentation training for providers? Feedback on measures trends (per team/provider)? Depression screening (or other) training needed?

25. IPC Measures accessprocessroles information system documentationknowledgeresources

26. Resources Equipment – ?need for retinal camera Supplies – availability of hemocult cards for CR screening, etc. Formulary – ?any changes/updates needed - antihypertensives, DM meds Telemedicine resources Contract health resources – contracts for services - is funding effecting referrals for screening services, etc.? Adequate personnel for tracking/reporting data?

27. Exercise In your group (or team), discuss one clinical indicator that is in need of improvement at your clinic or site. Using the worksheet, start to identify how access, roles, the information system, etc. might be effecting this clinical indicator. Be ready to describe 1-2 issues with the large group.

28. IPC Clinical Measures accessprocessroles information system documentationknowledgeresources