MiPCT Webinar 2/5/2014

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MiPCT Demonstration Webinar 2/5/2014

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MiPCT Webinar 2/5/2014

  1. 1. MiPCT Demonstration Project Medical Network One February 5, 2014
  2. 2. Agenda   Describe the team-based practice changes that lead to improved efficiency and quality of care  Explain how to plan a team huddle  2 Illustrate the key attributes of a care team and how to develop a team in practice Outline 2014 Metrics
  3. 3. Care Model  Prepared, proactive interdisciplinary care team  Planned, coordinated, protocol-driven care  Informed, activated patients  Trained team  Community collaboration . 3
  4. 4. Challenges to Developing Effective Teams   Not trained together  Hierarchy  Asynchronous care  Lack of continuity  4 Different disciplines Culture slow to change
  5. 5. What is a Team? Multidisciplinary Interdisciplinary Interprofessional 5
  6. 6. What is a Team?   Membership defined by healthcare professional rather than patient, family, or caregiver  6 Task-oriented vs relationship-oriented Teams develop around the core principle of “trust”
  7. 7. Teamwork Model (Baker et al, 2005) Organization Team Individual 7
  8. 8. Team Structure   Coordinating Team  8 Core Team Contingency Team
  9. 9. The Team “Bundle” Intervention  Leadership Commitment • Practice level • Organization  The Team Development Measure • Feedback to team with discussion • Target improvements   9 Intra-staff communication skills training Patient/case-focused care conferences or “huddles”
  10. 10. What have we learned about teams?  Teams don’t just happen, formalized training is necessary  Requires ongoing maintenance  Huddle helps the team “practice” • Teams are a prerequisite for sustainable quality improvement   10 Clinical outcomes are better Organizational health improves
  11. 11. Team Practice Interventions That Make a Difference   Protocol-Driven Standardized Processes  Care Management Services  Managing “Transitions”  11 Practice re-design Engagement of Patients and Families
  12. 12. Practice Re-Design: PCMH   Inter-professional care teams  12 One-stop shop Multi-disciplinary care teams
  13. 13. Protocol-Driven Standardized Processes   Immunizations  Medication Management  13 Very Important Process (VIP) Disease-specific management
  14. 14. Immunization Pearls   Educate team  Provide standing orders  Assign the role of immunization management to a nurse and provide appropriate training and resources  14 Agree on immunization protocol Measure and have a process for follow-up
  15. 15. Patient and Family Engagement   Group visits: new patient and family orientation  Quality improvement Project participation  15 Self-management : Disease Self-Management Program Patient Advisory Council
  16. 16. Huddle Board Components Metric 1: Metric 2 Metric 3 Daily Critical Communications Information Ideas in Motion When and Who Beginning or mid shift 5 minutes Lead by member of unit leadership team 16
  17. 17. Structured Huddles Action Plan Task Obtain team buy-in Order Huddle Board Select huddle metrics: Define huddle process: • Define time of day and frequency • Who will lead huddle • Expectations of staff—who will attend • Create agenda (in first huddles include overview of purpose of huddles and huddle process) Hang huddle board and fill in metrics Identify when huddles will begin Define process for changing huddle metrics Create evaluation process: how will I know if huddles are successful? 17 Responsibility Due Date
  18. 18. Selecting Metrics   Must be specific and measureable – and feasible to monitor frequently  Identify who will be collecting data and updating board  18 Should reflect improvement opportunities that have been identified by MiPCT, aligned MiPCT goals and objectives Define goal for metric – this will help you decide how long to keep metric going
  19. 19. A Healthcare Imperative “In medicine, as in any profession, we must grapple with systems, resources, circumstances, people-and our own shortcomings, as well. We face obstacles of seemingly endless variety. Yet somehow we must advance, we must refine, we must improve.” - Atul Gawande, Better: A Surgeon’s Notes on Performance 19
  20. 20. What Are We Measuring? Utilization (assessed at PO level) Exceed benchmark or % improvement over previous year  Primary care sensitive ED visits (NYU algorithm)  Asthma ED Visits for Previously Diagnosed Asthma*  Ambulatory Care Sensitive Hospitalizations  Hospital Readmissions Claims 20
  21. 21. What Are We Measuring? Clinical Quality Metrics (assessed at PO level) Exceed benchmark or % improvement over previous year       Diabetes: Annual retinal eye exams Breast Cancer Screening Cervical Cancer Screening Well Child Visits - 15 months Well Child Visits - 3-6 years Adolescent immunizations Claims 21
  22. 22. What Are We Measuring? Clinical Quality Metrics (assessed at PO level) Exceed benchmark or % improvement over baseline  Diabetes Control A1C < 8  Diabetes: Blood Pressure < 140/90  CVD: Blood Pressure < 140/90  Hypertension: Blood Pressure < 140/90  Tobacco Use Assessment  Weight Assessment for Children and Adolescents Registry and Claims 22
  23. 23. What Are We Measuring? Process Measures (assessed at practice level)     Depression Screening for Patients with Chronic Health Conditions Notification of hospital admissions and discharges Follow-Up Referrals to a Community-Based Program or Agency Self-Management Support Offered for Chronic Condition of Focus Registry, Claims and Quarterly MiPCT Report 23
  24. 24. What have we learned?   Implement a “bundle” of improvement changes  Interdisciplinary, interdependent team approach  Planned, coordinated care  Protocol-driven processes (standardization)  Continually involve patients and caregivers  24 This model of care has features that produce better outcomes Patients and families need to be “partners”, not just “consumers”

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