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Promoting Primary Care for South Florida A Community Dialogue HRSA/BPHC Quality and the National Landscape Presentation to : Presentation to : Health Foundation.

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Presentation on theme: "Promoting Primary Care for South Florida A Community Dialogue HRSA/BPHC Quality and the National Landscape Presentation to : Presentation to : Health Foundation."— Presentation transcript:

1 Promoting Primary Care for South Florida A Community Dialogue HRSA/BPHC Quality and the National Landscape Presentation to : Presentation to : Health Foundation of South Florida November 15, 2007, 9:00 a.m. – 3:00 p.m. Jungle Island Miami, Florida Vanessa Watters, MHA Chief, Quality Branch U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care Office of Quality and Data

2 Presentation Purposes Illustrate how quality is defined by HRSA/BPHC Provide national examples of organizations that demonstrate the HRSA/BPHC Quality Strategy Offer dialogue which supports organizational assessment and planning next steps

3 Some Key Questions What is the HRSA/BPHC Quality model? Based on this model, what is working for HRSA grantees and partners in other parts of the country? How can South Florida health care organizations link with and benefit from the HRSA/BPHC quality strategies?

4 OFFICE OF QUALITY AND DATA OFFICE OF THE DIRECTOR Kay Felix, MD OFFICE OF THE DIRECTOR Kay Felix, MD Data Branch Angela Damiano-Holder Performance Measures UDS Data System Consolidation Patient Survey Data Branch Angela Damiano-Holder Performance Measures UDS Data System Consolidation Patient Survey Quality Branch Vanessa Watters, MHA FTCA Risk Management Care Model Implementation Accreditation Oral Health Mental/Physical Health HIV Quality Branch Vanessa Watters, MHA FTCA Risk Management Care Model Implementation Accreditation Oral Health Mental/Physical Health HIV

5 HRSA/BPHC/OQD Quality Strategy PATIENT ACCESS CLINICAL CARE CONTROLS & MONITORS ACCESS REDESIGN PT SAFETY RISK MGMT PI MEASURES

6 HRSA/BPHC/OQD Quality Strategy PATIENT ACCESS CLINICAL CARE CONTROLS & MONITORS PI MEASURES

7 HRSA/BPHC Quality Strategy Performance Improvement Measures BPHC Clinical Measures National Clinical Performance Reporting Efforts –NQF, AQA and HEDIS alignment Build upon clinical performance reporting efforts –HRSAs Healthcare Disparities Collaborative – quality improvement approach that uses evidence based models to transform clinical, leadership, operational and community systems –The United Health Foundation/George Washington University Study – multi-site demonstration project which examines health centers against standard indicators of high quality performance –HRSAs Office of Performance Review Measures – a menu of national performance measures for use during performance reviews of HRSA funded programs.

8 New Proposed Clinical Measures New clinical measures –Cervical cancer screening –Childhood immunization –Childhood lead blood levels –Hypertension (blood pressure levels)* –Diabetes (HbA1c levels)* *The measures indicated with an asterisk would be reported by total, race/ethnicity and special population Existing clinical measures –Prenatal Care –Low birth weight

9 Test Specifications: Childhood Clinical Process Measures MEASUREALIGNMENTNUMERATORDENOMINATOR Percentage of children by 2 years of age with appropriate immunizations. AQA, NQF, HEDIS (adds 4x pneumococcal conjugate) Number of children who have received 4XDTP/DTaP, 3xIPV, 1xMMR, 3xHib, 3xHepB = & Varicella. Number of children who turn two years of age during the measurement year Percentage of patients months of age with a blood test for elevated blood lead levels Congressional Mandate Section 330(b)(1)(A)(i)(III)(ee) of the Public Health Service Act, HEDIS (measure under development) Number of children ages 9-36 months tested for elevated blood lead levels Number of children ages 9-36 months

10 Test Specifications: Adult Clinical Process Measures MEASUREALIGNMENTNUMERATORDENOMINATOR Percentage of women years of age who received one or more Pap tests. AQA, NQF, HEDISOne or more Pap tests during the measurement year or the two years prior to the measurement year. All female patients ages years of age during the measurement year - with look back" period to include 18 year olds

11 Test Specifications: Adult Clinical Outcome Measures MEASUREALIGNMENTNUMERATORDENOMINATOR Percentage of adult patients, 18 years and older, with diagnosed hypertension (HTN) whose blood pressure (BP) was less than or equal to 140/90 (adequate control) NQFPatients with last systolic blood pressure measurement 140 mm Hg and diastolic blood pressure 90 mm Hg during the measurement year. All patients 18 years of age as of December 31 of the measurement year with diagnosis of hypertension (HTN). Percentage of adult patients with type 1 or 2 diabetes with most recent hemoglobin A1c (HbA1c) 7% or or = 9% (poor control) AQA, NQF, HEDIS (all measure levels > 9) Number of adult patients whose most recent hemoglobin A1c level during the measurement year is 7% or or = 9%, respectively. Number of adult patients years of age as of December 31 of the measurement year with a diagnosis of type 1 or 2 diabetes.

12 National Examples NETWORKSTANDALONE EHR/RegistryEHRRegistryPaper Special Population URBANCA NY UT TN MD (Homeless) RURAL WV MS AK

13 HRSA/BPHC/OQD Quality Strategy PATIENT ACCESS CLINICAL CARE CONTROLS & MONITORS ACCESS REDESIGN

14 HRSA/BPHC Quality Strategy Access/Redesign Access/Redesign Curriculum Builds off of HDC successes Patient-centered care through effectiveness and efficiency Increases patient access to care Increases the efficiency of the patient visit Improves provider, staff, and patient satisfaction Gets the waiting time out of the system Decrease cost/visit Improves the bottom line

15 HRSA/BPHC Quality Strategy Access/Redesign Key Principles of the Model Continuity of care - the patient routinely sees his own provider. Provider Panel - each provider has an identified panel of patients for which he is accountable. Demand and Supply of Appointments are in balance - patient demand for appointments from the provider and the number of provider appointments available are in balance.

16 National Examples Community Health Center, Inc. Large, multi-sight HC in Connecticut; Medical, Dental, Mental Health, Ryan-White Services Uses an open-access model where patients are encouraged to schedule same day appointments to reduce no-show rates, improve patient access and care continuity Goal to minimize system waste by doing todays work today Increased patient and staff satisfaction while sustaining/slight improvements in productivity

17 National Examples White River Rural Health Center Multi-site Health Center located in Rural Arkansas; Medical, Dental, and Pharmacy Uses fiscal health and business operations to improve access and sustain the care model. High emphasis on data to link financial outcomes with patient care outcomes - the big picture Patient-focused visit with less waiting time and increased revenue

18 What about you….. What are your insights and reactions to these quality examples? What actions or next steps would you take? What might you do to connect with these components of the HRSA/BPHC Quality Strategy?

19 HRSA/BPHC/OQD Quality Strategy PATIENT ACCESS CLINICAL CARE CONTROLS & MONITORS PT SAFETY RISK MGMT

20 HRSA/BPHC Quality Strategy FTCA Program Goals GOAL 1: Improve access to health care by eliminating the need to purchase professional liability insurance - savings to be used to increase the number of patients served. GOAL 2: Minimize risk to the Judgment Fund through deeming process and health center oversight and monitoring.

21 FTCA Malpractice Incident Summary Nature of Allegation, Source: KePRO, Harrisburg, PA, FTCA HC Med Mal Cases, September 30, 2006

22 HRSA/BPHC Quality Strategy Patient Safety and Pharmacy Initiative Goals Improve Patient Safety –Increased Compliance w/ NQF Guidelines –Fewer Errors, Fewer Injuries, Less Harm –Possible Reductions in Size & Number of Tort Claims Increase High Quality, Cost-Effective Pharmacy Services Improve Health Outcomes

23 Phase 1: Study & Capability Development October, 2007 to April, 2008 Phase 2: Implementation, Action & Results May, 2008 to October, 2009 Patient Safety and Pharmacy Initiative 2 Phases of Work

24 Identify and learn from HRSA grantees and partners with results and successes – especially 2-fers and 3-fers –Patient Safety –Pharmacy Services –Outcomes in Core Measure Areas Document best practices of high performers Conduct HRSA Patient Safety Inventory to identify already existing tools and resources Enroll high performers as faculty and leaders in national improvement initiative Patient Safety & Pharmacy Initiative Study Phase

25 Establish quantitative aims to guide improvement Enroll HRSA grantees and their partners in national peer-to-peer technical assistance & collaboration initiative Help these teams generate rapid improvements Patient Safety & Pharmacy Initiative Implementation Phase

26 National Examples University Maryland Medical Center DSH hospital and AMC located in Baltimore MD Focus on pharmacy safety to reduce errors, adverse events and improve quality Strong emphasis on the use of technology –Strike the balance between access and controls –Support the shift to the right where pharmacist has a heightened role in clinical care and greater time to focus on patient education

27 National Examples El Rio Health Center HC located in Tucson, AZ with a pharmacist managed DM clinic Focus on the appropriate use of medications and the tracking diabetes measures to generate positive health outcomes and demonstrate improvements Increased patient access and improved patient outcomes in diabetes through pharmacy-based disease management

28 What about you….. What are your insights and reactions to the Patient Safety & Pharmacy initiative? What improvements or additions would you make to this plan? What are your insights and reactions to the national examples? What actions or next steps would you take? What might you do to connect with this component of the HRSA/BPHC Quality Strategy?

29 Contact Information Vanessa Watters, MHA Chief, Quality Branch U.S. Department of Health and Human Services Health Resources and Services Administration Bureau of Primary Health Care Office of Quality and Data 5600 Fishers Lane 15 C 26 Rockville, MD


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