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Welcome to the Mount Auburn Practice Improvement Program Community Learning Session
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2. May 4, 2016 Community Learning Session
Mount Auburn Practice Improvement Program (MA-PIP)
Update
Yvonne Cheung, MD, MPH, CPPS Chair, Department of Quality and Patient Safety Mount Auburn Hospital Paula Griswold Executive Director Massachusetts Coalition for the Prevention of Medical Errors
May 4, 2016
Community Learning Session

3. Introductions Guest Speaker: Karen Boudreau, MD
Former Senior Vice President, Medical Director for the Continuum Portfolio, Institute for Healthcare Improvement
Medical Director, Valley Medical Group
Board certified, Family Medicine
Tell us where you are from and if there is anything in particular you would like to learn from this session.
Karen Boudreau, MD, FAAFP, is an experienced improvement advisor at the health plan, medical group and hospital level, including primary care practice redesign, population management, guideline development and implementation, patient safety and medication error prevention.
Board Certified in Family Medicine,
most recently the Chief Medical Officer (CMO) at Boston Medical Center HealthNet Plan (BMCHP) and Well Sense Health Plan, a not-for-profit, provider-sponsored managed care organization in Massachusetts and New Hampshire.  As CMO, she led an experienced team in the Office of Clinical Affairs, setting clinical strategy and policy, overseeing all aspects of medical and pharmacy management (including clinical vendors) as well as expanding clinical quality improvement programs.
Previously,
Karen was the Senior Vice President, Medical Director for the Continuum Portfolio at the Institute for Healthcare Improvement (IHI),
the Medical Director for Healthcare Quality Improvement at BCBS of Massachusetts, and
the Medical Director at Valley Medical Group, P.C. in Western Massachusetts, where she practiced for 15 years.
Karen is moving to Seattle next month to become the Vice President of Care Management at Providence Health & Services.

4. Learning Objectives
As a result of participating in this activity, learners will be able to:
Identify key drivers of diagnostic failure and explain how they contribute to late or incorrect diagnoses
 Test practical strategies to prevent diagnostic error in the ambulatory setting
 Describe how quality improvement strategies can be used to make changes in office practice processes

5. Disclosure statement
All Presenters and Content Developers have no significant financial interest/arrangement with any organization(s) that could be perceived as a real or apparent conflict of interest with the subject matter of the presentation.

6. Mount Auburn Practice Improvement Program (MA-PIP): Purpose
To improve patient safety in office practices/ ambulatory care
Local Learning - Teaching and supporting practice teams, with coaches, to solve patient safety problems within their own office environment
“See problems – Solve problems”
Improving without disrupting patient care
Community Learning - building an improvement infrastructure to support and share local learning (not just for the grant – also for sustainability)
Enabling your practice to improve without disrupting patient care
- Skills to be a learning organization
- Engaging all practice staff to “ see problems and solve problems”
- Same approach can improve patient safety, quality, patient experience, efficiency
- Makes work more manageable
Accelerating Improvement in Healthcare &
“ Leader-led Learning: the great differentiator”
Steve Spear

7. Key Concepts Safety Science Improvement Focus on systems, not people
Most problems do not result from individual workers but from the design of work processes/system
Build a culture of safety
Leadership & values
Teamwork &communication
Trust, psychological safety
Improvement
Care processes
Work environments
Communication with patients
Define a clear aim
Use measurement and data for decision making
Test changes
Implement improvements

8. Model for Improvement PDSA = Aim Measures Changes Test of Change
Developed by: Associates in Process Improvement
Yvonne doesn’t have to teach this slide – Just display it as the picture of the work we are doing.
(Karen is teaching this.)
The Improvement Guide: A Practical Approach to Enhancing
Organizational Performance, 2nd Ed. Gerald J. Langley et al. Jossey-Bass April 2009
Test of Change

9. Projects Underway: Mount Auburn Medical Associates:
Aim statement: Dr. Cutler to have a documented conversation regarding Colon Cancer Screening with 100% of his patients ages by June 30, 2016
Baseline data – Practice manager led an effort to clean up patient panel data & record colonoscopies completed
Testing – new letters, new roles for MAs, other staff, listening to patient concerns/testing responses to persuade
Measuring
Run Charts
Lessons Learned so far
Team Work!
The values that patient stories can add: data alone not always enough
5 Practices working with 3 coaches
Mount Auburn Medical Associates
Lots of work to “clean up” their data –
assure that they know all their patients in this population
Assure they know who has/has not had this conversation with Dr. Cutler
Tremendous Patient safety implications

10. Making progress!
From 6/2015 to 3/2016 increased from 73% to 92% of patients in this category
Next they will be measuring how many follow through to complete a colorectal cancer screening test.

11. Making progress!
Patient Safety Implications – improved systems to ensure patients continue to get care following guidelines
Next Steps: Measure and increase the number of patients who actually complete the test after the conversation
From 6/2015 to 3/2016 increased from 73% to 92% of patients in this category
Next they will be measuring how many follow through to complete a colorectal cancer screening test.

12. And it has been contagious
Across the practice - Other physicians in the practice, and their MAs have joined project
Across other clinical processes - Using the same improvement process to reach patients who should have a mammogram
Their success (and their obvious joy!) has been contagious
All of the other physicians in this practice have started this project.
Plan to use this improvement process to reach patients who haven’t had a mammagram

13. Projects Underway: Cambridge Medical Associates
Aim Statement – to improve rate of diabetic eye exam from 50% to 75% of diabetic patients by June 30, 2016
Baseline data collection – revealed that even when patients did have the exam, the practice was not always getting the results
Patient safety implication: prevent diabetic retinopathy
Patient engagement - input on effective reminder letters
Next steps: tracking orders in EMR

14. Projects Underway: Primary Care Center
Aim Statement (start-up project): By 7/31/2015, increase the return rate of Hemosure IFOB tests for Dr. Powers’ patients to 75%.
Baseline data collection (1 month of data): 33% return rate
Test Ideas:
Dispense kit to patient, make notation in EMR for huddle alert.
Follow-up calls (2 wks.) to patients who have not returned the kit
Letters to patients encouraging completion of test and return of kit
Jan 2016 rate of return: Increased to 90%
Next: Dr. Beckett’s team and Residents have begun working on same project to increasing the rate of returned IFOB test kits

15. Projects Underway Waverly Primary Care
Goal: To increase the rate of colorectal screening by 18% by July 1, 2016.
Baseline data: 67% percent of patients with current colorectal screening on file
Testing Ideas:
Letters to overdue patients and include educational document
Schedule overdue patients for GI consult while in office
Improve ordering/tracking process for colonoscopies and FIT tests
August 2015
Number of patients assigned to our practice aged = 913
Number of patients with up to date colorectal screening = 356
Percentage of patients with up to date colorectal screening on file = 39%
September-February
Outreach by phone
Empanelment
Data pull from Meditech
February 2016
Number of patients assigned to our practice aged = 1096
Number of patients with up to date colorectal screening = 733
Percentage of patients with up to date colorectal screening on file = 67%
AIM STATEMENT:
To increase our rate of colorectal screening by 18% by July 1, 2016.
Brainstorming ideas for improvement:
Send letters to overdue patients and include educational document
If an overdue patient is in the office for a visit, schedule GI consult while in office
Improve ordering/tracking process for colonoscopies and FIT tests
The team is still gathering some possible ideas and will select our first small test of change when we meet during the first week of March.

16. Project Getting Started Marino Center for Integrative Health
Goal:
to improve specialty lab test results management and “closing the loop” with patients

17. Business Impact Measures
Our funder (Health Care Workforce Transformation Fund) is interested in learning how our work impacts cost savings.
looking for efficiencies in care processes that have saved time or improved care.
asking coaches, practice managers and other team members, keep a list of changes that save time, and/or reduce other costs

18. Business Impact Measures
Examples of Efficiencies
Time saved for practice staff and clinicians
Reduced use of materials, supplies, other costs
Reduction in costs for others outside the practice
Time saved for patients/families

19. Business Impact Measures
Some we’ve already heard:
Doing pre-visit planning and huddles
Saves time because they aren’t searching for needed items
Getting accurate tracking reports
Reduces the volume of letters
Get more test kits back
Fewer duplicate kits dispensed
Scheduling GI appt in consultation with patients
Reduction in “no shows” for initial visits and tests
Increased access for other patients to use those slots
Doing pre-visit planning and huddles with clear list of what patient needs (upcoming lists, test results expected)
Getting “clean” reports from their system so they can track tests and informing patients that they will be tracking FIT Kits dispensed, follow up by phone, if needed
Scheduling GI appt in consultation with patients (rather than scheduling and sending letter to patient)
For now we are in the “Green Light” process – just write it down!
Later we will move to the “Red Light” process – when we decide which changes to quantify

20. Mount Auburn Practice Improvement Program (MA-PIP)
Seeking to integrate the value of
local learning – “see problems, solve problems”
with
community learning – “this is what we’ve learned”
Designing the approach for spread and sustainability after the grant period

21. Questions? Suggestions? “Take home” messages?
Quick (2 Min) discussion with people around you.
Do you have any questions?
Do you have any suggestions about how we can spread and sustain the value of this work?
Group discussion (5 minutes)