Presentation on theme: "PPRNet August 23, 2014 Kristen Dutter Ripon Family Physicians."— Presentation transcript:
PPRNet August 23, 2014 Kristen Dutter Ripon Family Physicians
Why we needed a change: Patient Satisfaction/ConvenienceInconsistent schedules-up to 5 providers at a time Waiting room full or empty Staff over-worked or under-worked Only 2 exam rooms per providerLittle time for PPRNet reports
Our Providers Full-Time, but plenty of travel Dr. Dutter Full-Time, plus SNF 2 Half-Days/week Dr. Hufford Full-Time Dr. Daley 3 days/week (2 days/wk for Ortho) Travis Wolf, PA 3 days/week (2 days/wk for Cardiology) Ken Bowman, PA 3 days/week (2 days/wk RN at Hospital) Sarah Lilly, PA
Provider Adjustments Created some 6 hour shifts, instead of 8. To keep the same # of patients per provider, per day (22), we created some 10 minute slots for acute, same-day appointments, and fewer breaks. Never more than 3 providers in the office at a time. 3 exam rooms available for each provider
Provider Schedule – average week Gray boxes mean that provider is out of the office. 7 JDSL 20 TWKB 21 DDKH 22 KHJD 23 JDDD 24 8 DD KHJD TWKB KHKB JDKBTWSLDDSL DD JD
Reception Staff Adjustments 2 Staff for check-in/out from 7-8AM Lab opens at 7AM 1 Staff for check-in/out from 5-7PM Cross-Trained for check in/out Perk: All Staff get ½ day off each week (or 1 day every other week) Phone hours remain 8-5, with special Voic box for Cancellations and Appointment requests.
Shift Planning for Staff
Medical Assistant Adjustments 5 Medical Assistants – Max of 3 Providers at a time Extra MA’s not working with a provider are assigned to Refills, Walk-Ins, lunch coverage and working PPRNet reports. No MA has more than one late shift/week. After 5pm, 1 MA rooms for 2 Providers. Acutes;No procedures
Shift Planning – Monday
Shift Planning - Friday
Impact on Patient Outcomes (via PPRNet) Prior to our extended hours, working the PPRNet reports was sporadic at best. Now there’s scheduled time for that. Started Extended Hours April 2013
Tracking our Work 3/28/20149 DM patients with Microalbumin in 1 yearBWATNEY 4/11/ Quarter 1 Received 4/11/ Made sure that ETOH counseling was in their HM.KDUTTER DONE 5/14/2014CKD 3B eGFR in past 3 months for pts with CKD stage 4KDUTTER DONE 5/14/2014CKD 6B Most recent BP >130/80 for pts with CKD and high Alb/Creat ratioKDUTTER DONE 5/14/2014CKD 7 ACE/ARB for pt with CKD and Alb/Creat ratio >300KDUTTER STARTED 5/16/2014CKD 7 ACE/ARB for pt with CKD and Alb/Creat ratio >300KDUTTER DONE 5/23/2014 IVD/CHD/Atherosclerosis patients with anticoagulant/anti-plateletBWATNEY 6/2/2014CKD 9 Hemoglobin in past year in patients with CKD stage 3B-5KDUTTER DONE 6/2/2014CKD 10 CKD patients with rx for NSAID or Cox-2 InhibitorKDUTTER DONE 6/30 - 7/1 DM/CKD Registry Got labs reports from Endo and NephrologyKDUTTER DONE 7/1/2014 Submitted Data to PPRNETKDUTTER 7/18/2014H2 blocker Appropriate dosages of H2 blockers in patients with CrCl < 50 ml/min KELLER DONE 7/21/201457Avoid Rx for thiazolidinedione in patients with Dx of heart failure KELLER DONE 7/21/201458Avoid Rx for metformin in pts with most recent serum creat in past year KELLER DONE 7/21/201461Patients with active Rx for any thiazide and Potassium measure KELLER DONE 7/21/201455Avoid Rx for NSAID or cox 2 inhibitor in patients with Dx of heart failure KELLER DONE 7/21/201452Appropriate dosages of Benzodiazepines in patients ≥ 65 years KELLER DONE 7/21/ Quarter 2 Received 7/21/ Avoid Rx of anticholinergic in patients with Dx of dementia KELLER DONE 7/21/201452Appropriate dosages of Benzodiazepines in patients ≥ 65 years KELLER DONE 7/21/201463Glucose measured in past year in patients with Rx for any antipsychotic KELLER DONE 7/21/201464Patients with active Rx for Warfarin with INR measured in past 45 days KELLER STARTED 7/21/201415HTN pts with Glucose in past 3 years KDUTTER STARTED 7/22/201415HTN pts with Glucose in past 3 years KDUTTER Still working the list
DM Patients with BP in 6 months DM pt with BP in 6 months Due for Appt? Lab? BP? Reminder (WV, Letter, Call) Note on spreadsheet Up to date Note on spreadsheet
ACE/ARB for CKD patients No ACE/ARB for CKD pt with alb/creat ratio > 300 On ACE/ARB, but Not active RX Refill needed? Filled by Specialist? Renew? No ACE/ARB Message provider to Review/Consider
AHA/ACC Cholesterol Guidelines AHA/ACC Guidelines Filter by Concordance = N Filter by Age < 75 Filter by Risk > 7.5% Re-Identify patients Print the list for each provider, with their patients names high-lighted for review.
PPRNet Message Template ||PAT_FNAME|| ||PAT_LNAME|| appears on PPRNet report for: «*» Measure Description/Criterion: «*» Eligible patients: «*» Comments: «DEL» «*» Please review. If changes need to be made or you have questions - please forward them to your nurse. Thank you.
Positive Outcomes Waiting room is less crowded Patients love the convenience Providers like having more time with their family Staff has adjusted and now likes their new hours PPRNet reports are worked on more regularly Added appointment slots and percent of unfilled slots went down slightly. More available same-day appointments