1. Team Presentations Part 2
March 20, 2019
Katie

2. Muting Your Line Click the mute button on your phone OR
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Katie
Before we begin, I’m going to ask everyone please take a minute to mute your lines
You can click the mute button on your phone OR
Click on the webex screen, hover over the top or bottom until this menu appears
If a microphone pops up in the menu, you can click that to mute yourself. If the menu appears at the top, click the person icon in the menu. This will make the attendee list show up, then, hover over your name in the attendee list and click the microphone icon. When muted, microphone will appear red. To unmute, click microphone icon again

3. Tell us in the chat…. Your name
Names of the people in the room with you
Your team affiliation
Finger Lakes Migrant Health Center
Planned Parenthood of Mohawk Hudson
Chautauqua County
Tioga Opportunities
Katie
We want to know who is here with us today. Because we want to make sure we have time for team presentations, tell us in the chat….
HRHCare
Jacobi Hospital
Public Health Solutions/MIC
Gotham South Queens
Coney Island Hospital

4. Average Percent Tested
% Avg Tested Current Month
Katie
650 tests completed September through January

5. Chlamydia Screening Performance Update March 20, 2019
Public Health Solutions/ MIC Women’s Health Services Fort Greene Center
Chlamydia Screening Performance Update
March 20, 2019

6. Screening Rate: % Tested in Current Month, Over Time
Qualitatively describe the data. What trends do you see?
To what extent can the trend be explained? What do you think drove the observed ups and downs throughout the learning collaborative?

7. Screening Rate: Baseline Average vs. Learning Collaborative Average
-12%
Baseline average = average monthly screening rate from May to August
Learning collaborative average = average monthly screening rate from September to December

8. Most Impactful Change
While we have not seen the impact on our screening rate yet, we are pleased to report that we have a new protocol for walk-in pregnancy tests that now includes chlamydia and gonorrhea screening. Staff are also more aware of the need to proactively assess for STI screening/testing opportunities at all visits.
Tell us, why did you decide to make this change in the first place?
Describe a brief overview of the process of implementing this change.

9. Most Impactful Change
As part of our on-going QI, we monitor our initial and annual visit STI screening rate, which is approximately 85% for all female patients 24 and younger. However, our walk-in pregnancy test patients have traditionally never been screened for chlamydia/gonorrhea and are often in the priority age range. We determined that we had missed screening opportunities for patients who were coming to us solely for pregnancy testing.
Tell us, why did you decide to make this change in the first place?
Describe a brief overview of the process of implementing this change.

10. Measurement of Change
As we implemented our “PT with Chlamydia/Gonorrhea Screening” visit type in late January, we have not seen an impact on our overall screening rate to date. However, we have noted impact in the following ways:
The kick-off of an interdisciplinary QI group focused on improving screening rates (staff feedback/buy-in)
The development and implementation of a new protocol (process measure)
Walk-in pregnancy test patients are now routinely screened for chlamydia and gonorrhea at our Fort Greene center

11. Challenges LPN staffing model made us reconsider our original PDSA
Staff perception of high screening rate for new and annual visits made it a challenge to identify new opportunities for QI

12. Challenges
Additional input and buy-in from the advanced practitioner staff allowed us to use their RN license to execute the standing orders
Fine-tuning of this process is still underway
Workflows for insured walk-in PT patients are still needed

13. Next Steps and Opportunities
Continued implementation and monitoring of PT STI inclusive visit
Development of workflow for insured patients
Development and roll-out of simple workflow steps to increase testing/screening at visits besides new and annual

14. Next Steps and Opportunities
Interdisciplinary STI QI group with dashboard measures that are monitored monthly and reported back to larger QI quarterly meeting
NYCDOH Program to Improve Chlamydia and Gonorrhea Screening (new contract)

15. Finger Lakes Migrant Health Care Project Inc. Geneva Community Health
Chlamydia Screening Performance Update
March 20, 2019

16. Screening Rate: % Tested in Current Month, Over Time
Qualitatively describe the data. What trends do you see?
At event our data shocked us, (0% May, 10% June, 15% July-why? Once we fixed this data, they ended up being some of our best months May 75%, June 78.6%, July 45.5%) We had problems with our CVR data-this was a major undertaking to fix for our organization but well worth it.
To what extent can the trend be explained?
College students get tested on campus health center, but still come to us for contraception refills. Thus we can’t capture the STD screening, but we know they have had it done so the numbers look lower there. Students who use contraception only for period regulation and state they are not sexually active, decline STD testing.
What do you think drove the observed ups and downs throughout the learning collaborative?
When youth come for services we were not always able to do a CVR, due to data being missed

17. Screening Rate: Baseline Average vs. Learning Collaborative Average
-11%
Baseline average = average monthly screening rate from May to August
Learning collaborative average = average monthly screening rate from September to December
Two tough months (September, December) acute visits in December (less patients seen during these months, we have students who get testing done on campus so they decline testing with us (and we can’t track it since we didn’t do the service, just get the results) but they still come to us for contraception needs (Oct 64.3%, November 71.4%)

18. Most Impactful Change
Describe the change that had the most impact on your chlamydia screening rate, or the change of which you are proudest.
Better CVR Reporting
Opt-Out Language
Training providers on proper CVR notes
Team monitoring CVR data
Tell us, why did you decide to make this change in the first place?
Give credit where credit is do
Describe a brief overview of the process of implementing this change.
Train medical team
Re-did “entire” CVR reporting process
Chart Audit
Reminders of importance of screening (even with no symptoms/not sexually active at least counseling)
Keep funding

19. Measurement of Change
What makes you say this was the most impactful change?
Great increase in numbers being accurately reported
Staff buy in
Pre-visit Planning (CPCI, Azara)
What data do you have that shows the impact of this change?
Improved numbers by month

20. Challenges
What challenges did you encounter while working on increasing chlamydia screening rates at your site?
Missing data to do CVR and track visits
Patients declining screening, unable to track this
Screening being done at another location
Patients mindset in on primary care-integration
How did you overcome those challenges?
Opt-out language reminders
Educate community with HE team
Team work between FLCH Staff
How are you continuing to work on addressing challenges?
Ongoing training with medical team
CVR Audit ongoing
Sore throat-patient will not want to be tested due to parents being there (regardless)

21. Next Steps and Opportunities
What next steps have you identified for continuing the progress made during the course of the collaborative?
Working to get self-swabs
Reminders for annual testing to all medical staff
If you have more than one site, how will you bring lessons learned from this collaborative to those other sites?
Data is shared monthly with entire medical team and medical director
2018 numbers are baseline for 2019 goals
What are your plans for ensuring changes and improvements are sustained?
Continue to monitor CVR
Continue to send reminders to medical team about importance of annual testing
Curious to see if self-swab actually increases #?

22. HRHCare Riverhead and Peekskill
Chlamydia Screening Performance Update
March 20, 2019

23. Screening Rate: % Tested in Current Month, Over Time [Riverhead]
Qualitatively describe the data. What trends do you see?
To what extent can the trend be explained? What do you think drove the observed ups and downs throughout the learning collaborative?

24. Screening Rate: Baseline Average vs
Screening Rate: Baseline Average vs. Learning Collaborative Average [Riverhead]
119%
Increase
Baseline average = average monthly screening rate from May to August
Learning collaborative average = average monthly screening rate from September to December

25. Screening Rate: % Tested in Current Month, Over Time [Peekskill]
Qualitatively describe the data. What trends do you see?
To what extent can the trend be explained? What do you think drove the observed ups and downs throughout the learning collaborative?

26. Screening Rate: Baseline Average vs
Screening Rate: Baseline Average vs. Learning Collaborative Average [Peekskill]
-8%
Baseline average = average monthly screening rate from May to August
Learning collaborative average = average monthly screening rate from September to December

27. Most Impactful Change The change that had the most impact on the chlamydia screening rate
Constant conversations during team meetings about Chlamydia screening
Partnering with the Site Medical Director to share the Chlamydia Screening and documentation efforts with Providers.
Chart audits and re-education
Peekskill: will use best practice
Riverhead: Reinforcing the importance in team meetings and chart audits, randomly look at WH schedule, check the Chlamydia. Use the error reports and check to see if screening was done. Checking multiple pieces and just looks at the CVR.

28. Most Impactful Change The decision to make this change: Our Internal Audit vs Ahlers Data
77% of the Female Patients ages were being tested in Riverhead
48% of the Female Patients ages 15 – 24 were being tested in Peekskill
The internal audit validated that testing was inadequately reported in the CVR’s which determined that communication about proper documentation needed to take place to close this gap.
Peekskill: will use best practice
Riverhead: Reinforcing the importance in team meetings and chart audits, randomly look at WH schedule, check the Chlamydia. Use the error reports and check to see if screening was done. Checking multiple pieces and just looks at the CVR.

29. Most Impactful Change A brief overview of the process of implementing this change
Internal Audit on Testing vs. CVR Documentation
Identified the gap is proper CVR documentation
Communicated gap and strategies to improve documentation with Clinical Support teams
Conduct random CVR chart audits
Provide real-time re-education on documenting Chlamydia screening in CVR for any missed opportunity
Peekskill: will use best practice
Riverhead: Reinforcing the importance in team meetings and chart audits, randomly look at WH schedule, check the Chlamydia. Use the error reports and check to see if screening was done. Checking multiple pieces and just looks at the CVR.

30. Measurement of Change Process Measures: Internal Audit and Ahlers Data
The first month of the collaborative, October, the Ahlers data demonstrated that testing increased at both sites;
Peekskill increased by 2%
Riverhead increased by 35%.
Our December goal was to reach 30% Ahlers documented testing for both sites
By December, Riverhead had surpassed this goal by attaining 62% testing.
Peekskill held a steady gradual increase by 6% attaining 28% testing; 2% shy from the December goal. P;
R: audits – communication, talking about the number and improvement. CVR exceptions. Quarterly FP meetings, Staff receiving feedback and improving documentation behaviors. Standing orders in chart – chart audits to find out if this is working.

31. Challenges
Communication between the clinical support staff and providers.
Uncertainty of whether or not a Provider performed a PAP with GC/Chlamydia.
CVR is completed solely by the clinical support team
Confusion on when to complete a CVR for visits
The CA’s remembering to go back to document testing after preparing the lab requests. P:
R: theres competing concerns of the patient….pts focused on other issues….coming in for visit doesn’t require urine.

32. Overcoming Challenges
Team meeting reminders about the necessary communication required between Clinical Support Staff and Providers
Partnering with Site Medical Director to address the communication gap during their team discussions
Providing a general CVR training to clear up any confusion as it relates to the CVR and documentation
Emphasizing Chlamydia and other STI screening documentation during the training.
There is still a great amount of fluctuation in testing. We realize the need to try another method to close the documentation to testing gap. We will continue;
Providing CVR training with an emphasis on STI testing documentation.
Implementing a new signage strategy that will feature bright posted reminders for clinical staff at workstations and labs. P:
R: theres competing concerns of the patient….pts focused on other issues….coming in for visit doesn’t require urine.

33. Next Steps and Opportunities
Team Meeting Discussions
CVR Training
3 - 4 chart audits a day with real-time coaching and re-education
Implementation of signage as reminders of CVR workflow
P: use reporting to identify where the documentation gap. Bin btwn FM and Wh
R: CA indicates its due…isit CA’s responsibility – it’s the PROVIDER problem. Continued reinforcement of standing orders. And clinical staff putting in the orders.

34. Chautauqua County Mayville
Chlamydia Screening Performance Update
February 20, 2019

35. Screening Rate: % Tested in Current Month, Over Time
Qualitatively describe the data. What trends do you see?
To what extent can the trend be explained? What do you think drove the observed ups and downs throughout the learning collaborative?

36. Screening Rate: Baseline Average vs. Learning Collaborative Average
-21%
Decrease
Baseline average = average monthly screening rate from May to August
Learning collaborative average = average monthly screening rate from September to December

37. Percentage Tested We trended down  …… Explanation:
We are working closely with our FQHC to help with services and to take over the Family Planning grant in 2019
The number of patients that we see is down so the percentage of testing is very sensitive
For example: December was based on 3 clients and none of those were tested

38. Most Impactful Change EDUCATION of STAFF
National and local rates were reviewed
Disease pathophysiology was presented at a staff meeting
Describe the change that had the most impact on your chlamydia screening rate, or the change of which you are proudest.
Tell us, why did you decide to make this change in the first place?
Describe a brief overview of the process of implementing this change.

39. Measurement of Change
Staff feedback was positive about the education/review
Even though our % is falling there is more conversation & awareness about testing

40. Challenges Biggest Challenge is the small number of clients we see
We work closely with the FQHC to promote STD testing
We are working with community partners to increase testing, ie. Colleges, schools
What challenges did you encounter while working on increasing chlamydia screening rates at your site?
How did you overcome those challenges?
How are you continuing to work on addressing challenges?

41. Other Challenges EMR is a challenge to pull statistics from
New EMR coming in mid year
Should help with Ahlers reporting

42. Next Steps and Opportunities
Working closely with our FQHC
Identify ways to report more accurately through our new EMR
Educational services about STD testing to FQHC & public
What next steps have you identified for continuing the progress made during the course of the collaborative?
If you have more than one site, how will you bring lessons learned from this collaborative to those other sites?
What are your plans for ensuring changes and improvements are sustained?

43. Chlamydia Screening Performance Update March 20, 2019
Jacobi Medical Center
Chlamydia Screening Performance Update
March 20, 2019

44. Screening Rate: % Tested in Current Month, Over Time
Qualitatively describe the data. What trends do you see?
To what extent can the trend be explained? What do you think drove the observed ups and downs throughout the learning collaborative?

45. Screening Rate: Baseline Average vs. Learning Collaborative Average
24%
Increase
Baseline average = average monthly screening rate from May to August
Learning collaborative average = average monthly screening rate from September to December

46. Most Impactful Change
Changing the way providers were documenting their encounters with their patients thus impacting the accuracy of data collection.
Realizing a large percentage of our Chlamydia screening was not being documented appropriately.
Reviewing the discrepancy between the actual testing numbers vs. what was being reported. Provider education was implemented for the entire department, along with ongoing review and feedback of the appropriate documentation.

47. Measurement of Change
This change had an impact based upon timely CVR data entry, which was directly related to the increase in support staff. Initially, we identified our deficiencies to be directly related to documentation and data entry.
Based on the Ahlers monthly reports it is apparent that our Chlamydia screening has improved from 49% to 64% over a 5 month period.

48. Challenges
The greatest challenge we encountered was provider buy-in in relation to documentation. The variety of documentation options creates challenges as some providers may be resistant to change.
Work in progress to overcome the challenges.
We addressed the challenges by periodic feedback and audits of documentation.

49. Next Steps and Opportunities
The vast majority of 15 – 24 year old patients are seen in the Adolescent Clinic. Our emphasis is to engage the providers in this department to join our collaborative to capture the chlamydia screening in this service.
Going forward we will continue to monitor the screening rates and documentation of such. Within the next 6 months we will be transitioning to an improved EMR which will facilitate accurate documentation.

50. nysfptraining.org > Training and Events
Katie
As a reminder, all of the materials from today’s session will be posted on our PIC webpage, which you can access by going to nysfptraining.org > clicking on “training and events” in the top menu, and clicking on the Performance Improvement Collaborative webpage.

51. Conclusions Today is our final session!
April webinar – review of best practices, lessons learned
Overall learning collaborative evaluation coming soon
THANK YOU for your time and commitment in this performance improvement collaborative!!
Katie

52. Contact: nysfptraining@jsi.com
Thank you!
Contact:
Katie
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