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Tips for generating and utilizing quality data reports using health it full slide deck

This document summarizes a webinar presented by the U.S. Department of Health and Human Services Health Resources and Services Administration (HRSA) on generating and utilizing quality data reports using health IT. The webinar discussed how Community Health Center, Inc. uses data from their electronic health record system to drive quality improvement initiatives. They provide actionable data and performance feedback to clinical teams to help enhance care delivery and sustain gains. The webinar emphasized making data easily accessible, using a structured quality improvement approach, and embedding measurement into small tests of change.

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U.S. Department of Health and Human Services Health Resources and Services Administration HRSA Health Information Technology and Quality Webinar “Tips for Generating and Utilizing Quality Data Reports Using Health IT” Date: 7/22/2011 US Department of Health and Human Services Health Resources and Services Administration
Office of Health Information Technology and Quality Additional HRSA Health IT and Quality Toolboxes and Resources including past webinars can be found at: http://www.hrsa.gov/healthit http://www.hrsa.gov/quality Additional questions can sent to the following e-mail address: HealthIT@hrsa.gov • US Department of Health and Human Services • Health Resources and Services Administration
Upcoming HRSA Health IT and Quality Announcements • New Items to the HRSA Health IT Site: • CMS Frequently Asked Questions Document on Meaningful Use for CAHs • HRSA Health IT Adoption Toolbox for HIV/AIDS Providers • Next HRSA HIT and Quality webinar, "Privacy and Security – What Questions Should You Ask Your Vendor“ Friday August 19th 2pm EST • Last month’s webinar “Tips for the Safety Net Community on Using Health IT within a Patient Centered Medical Home” Now available online • HRSA “Call for Papers: Evidence for Informing the Next Generation of Quality Improvement Initiatives: Models, Methods, Measures and Outcomes” for Journal of Health Care for the Poor and Underserved. Due September 1st. Questions? Please contact OHITQPapers@hrsa.gov
Introduction Presenters: • Margaret Flinter-Community Health Center Inc. • Dr. Kwame Kitson-Institute for Family Health • Bob Demarco-Springfield Medical Care Systems Inc.
Using Data to Drive Quality Daren Anderson, MD - VP/Chief Quality Officer Nwando Olayiwola, MD, MPH - Chief Medical Officer Margaret Flinter, APRN, PhD - Senior VP/Clinical Director Community Health Center, Inc. July 22, 2011 1
Community Health Center, Inc. Our Vision: Since 1972, Community Health Center, Inc. has been building a world-class primary health care system committed to caring for underserved and uninsured populations and focused on improving health outcomes, as well as building healthy communities. CHC Inc. Profile: • Founding Year - 1972 • No. of health centers – 12 • No. of Service Locations - 173 • SBHC locations – 23 • Organization Size - 450 Innovations • Integrated primary care disciplines • eConsults with specialists Three Foundational Pillars • Fully integrated EHR • Patient portal and HIE Clinical Excellence • Automated clinical dashboards Research & Development • Nation’s first Nurse Practitioner Training the Next Generation residency training program
CHC Inc. Patient Profile • Patients who consider CHC their health care home: 130,000 • Health care visits: 350,000 per year CHC Patient Demographics 90.80% 100% 75% 64.8% 65% Patient Care Model 42% 50% 22% • PCMH (NCQA Level 3) 25% 6% 0% • Advanced access scheduling • Clinical dashboard & drive improvement • Expanded hours Care Delivery • Clinical integration of all services Medical Care & Ancillary Services • Formal research program Dental Care • Electronic health records Mental Health Care • Residency training for nurse practitioners Prenatal • W.Y.A. (Wherever You Are) Health Care for the Top Chronic Diseases homeless Cardiovascular Disease • Mobile dentistry services to 150 schools Diabetes • Outreach and eligibility screening/enrollment Asthma
Performance Feedback – Competing Interests Organizations Providers Productivity & Efficiency Quality and Performance Population Health Individual patient outcomes Systems improvement Professional Growth 10/05/10 4
Middle Ground? • Providers are inherently interested in and concerned about the quality of care they deliver • Self-reflection is a powerful driver • Framing of QI feedback – non-competing interests • Utilize multiple vehicles to communicate performance 10/05/10 5
Provider-Centered QI Cycle • Encourage provider participation in measure Defining selection and definition • Provide frequent, individual and systems Enhancing Monitoring reporting • Provide actionable data to front line teams • Link performance and Reporting quality 10/05/10 6
Multilevel Performance Assessment Performance Appraisals Peer Reviews Data Driven Provider Feedback Dashboard and Professional Education Sharepoint 10/05/10 7
Using Data to drive QI • Key Points for discussion: – Make data easily accessible to teams – Use a structured QI approach – QI projects need a strong focus on measurement – Collect data to evaluate each PDSA – Provide actionable data to front line teams – Use data to drive performance and sustain gains 10/05/10 8
Key Points • Key Points for discussion: – Make data easily accessible to teams – Use a structured QI approach – QI projects need a strong focus on measurement – Collect data to evaluate each PDSA – Provide actionable data to front line teams – Use data to drive performance and sustain gains 10/05/10 9
CHC Quality Improvement on SharePoint 10/05/10 10
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Key Points • Key Points for discussion: – Make data easily accessible to teams – Use a structured QI approach – QI projects need a strong focus on measurement – Collect data to evaluate each PDSA – Provide actionable data to front line teams – Use data to drive performance and sustain gains 10/05/10 15
Based on “Clinical Microsystems”, Nelson et al 10/05/10 16
Key Points • Key Points for discussion: – Make data easily accessible to teams – Use a structured QI approach – QI projects need a strong focus on measurement – Collect data to evaluate each PDSA – Provide actionable data to front line teams – Use data to drive performance and sustain gains 10/05/10 17
Embed Measurement into each PDSA • How will we know that a change is an improvement? • Use Survey Monkey, EHR data, chart reviews, hand counts, to measure PDSA outcomes • Data collection does not need to be complicated. Simplicity is key 10/05/10 18
Based on “Clinical Microsystems”, Nelson et al 8/19/10 19
10/05/10 20
• Key Points for discussion: – Make data easily accessible to teams – Use a structured QI approach – QI projects need a strong focus on measurement – Collect data to evaluate each PDSA – Provide actionable data to front line teams – Use data to drive performance and sustain gains 10/05/10 21
Example: Planned Care Huddles • Purpose: – ensure all patients are offered routine prevention/screening – improve efficiency – share routine tasks amongst the team – promote team cohesion – improve the health of our patients and our community
Basic Process • Pre-huddle – MA reviews CDSS for scheduled visits next day – MA notes things that are due on a paper copy of the schedule – RN reviews patient schedule for vaccine needs/SM needs/other disease management needs • Huddle – booked into schedule each day – MA convenes huddle 5 minutes before start of patient schedule – Brief review by team of what is due, discussion of plan for complex cases.
Missed Opportunities: Agency-wide 595 595 600 500 424 400 A1C testing in patients with diabetes (6months) 303 Breast cancer screening 290 300 Colorectal cancer screening by colonoscopy 219 200 Depression Screening 148 146 115 100 39 32 24 0 Week of April 25th Week of May 2nd Week of May 9th
Missed Opportunities: Site that started huddling 40 36 35 Sum of A1C 30 testing in patients with diabetes (6 months) 25 Sum of Breast 24 cancer screening 22 21 20 17 17 Sum of Colorectal 15 cancer screening by colonoscopy 10 10 Sum of 9 Depression 7 Screening 6 5 4 4 3 3 2 0 0 4/25 5/2 5/9 5/16 Middletown
Missed Opportunities: Site that didn’t start huddling 200 180 179 160 Sum of A1C testing in patients with 140 142 diabetes (6 138 136 months) Sum of Breast 120 cancer screening 100 Sum of Colorectal 80 80 cancer screening by colonoscopy 65 65 65 60 Sum of Depression 40 Screening 35 32 32 20 24 11 11 6 4 0 4/25 5/2 5/9 5/16 Meriden
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• Key Points for discussion: – Make data easily accessible to teams – Use a structured QI approach – QI projects need a strong focus on measurement – Collect data to evaluate each PDSA – Provide actionable data to front line teams – Use data to drive performance and sustain gains 10/05/10 30
Improving HTN Care Using Technology Developing an HTN Dashboard – Combine registry reporting from EHR with real-time pt data from the practice management system – Present timely, actionable data to each care team – Not just a performance “report card” 8/19/10 31
Hypertension Performance Indicators 32
Locate your panel on Share point
Click to sort by Average BP or Next Appt
Summary of Key Points • Performance feedback critical for provider professional growth and clinical objectives • Framing of QI feedback for providers must reflect balance between quality and efficiency, not competition • SharePoint is an effective tool for providing easily accessible data to front line teams • Use multiple sources of data to evaluate QI projects • Present actionable data • Data drives performance 10/05/10 36
Comments or Questions? Please Contact: Daren Anderson VP/ Chief Quality Officer Daren@chc1.com 860.347.6971 ext.3740 _________________________ Margaret Flinter Senior VP and Clinical Director Margaret@chc1.com 860.347.6971 ext. 3622 _________________________ Nwando Olayiwola Chief Medical Officer Nwando@chc1.com 860-347-6971 ext. 3728 37
Medical Home Coordinated Care Management Start date: 05 05 11 Springfield Medical Care Systems Springfield, Vermont
Springfield Medical Care System Brief Chronological Organizational History Springfield Hospital was formed in 1914 • Moved to our current location in1923; expansions 1955,1964 • Critical Access Hospital designation received in 2005 – 9 primary care practices, 1 OB/GYN practice, 5 specialty practices – FQHC approval received in 2009 • Unique model, perhaps the only one in the United States where a community health center and critical access hospital work together under one umbrella governing Board of Directors.
Our Service Area • We serve 12 communities in Vermont and New Hampshire • Service area population is approximately 35,000
Long standing relationship Primary Care – Springfield Hospital Long history of close working relationship between primary care practices and hospital presenting unique opportunities to assess our environment, identify realizable goals, collaborate and implement change towards establishing a Medical Home for the community we serve.
An opportunity recognized Establish a care coordination system between our Community Health Center and Hospital. Initial Focus: Emergency Department Utilization
Emergency Department Emergency Department Volume 18,000 1 7 ,3 3 5 1 6 ,8 2 6 1 6 ,8 7 6 1 7 ,0 2 5 1 6 ,1 3 5 16,000 1 5 ,6 2 4 1 4 ,3 9 8 14,000 1 3 ,0 1 6 1 2 ,7 4 2 1 2 ,5 6 8 1 2 ,6 4 1 1 2 ,1 9 9 12,000 1 0 ,6 4 3 10,000 8,000 6,000 4,000 2,000 0 FY 1998 FY 1999 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010
Key Daily Indicator Report 05 01 11 - 06 11 11 05 01 11 - 07 09 11 Definitions Summary Average / Total Average / Total Definitions define "Indicator" and identifies number as average or total Community Health Center - Monday through Friday Indicator No./% No./% Indicator Definition New patients 143 218 Total new patients added daily Indicator of system growth CHC Utilization 88% 90% Average percentage of clinician's blocked hours filled Indicator of clinical activity and capacity Walk ins/same day 1833 3133 Total number of walk in patients accepted Indicator of clinical activity and capacity No shows 444 781 Total number of patients did not show for appointment Indicator of clinical activity Springfield Hospital Indicator No./% No./% Indicator Definition Emergency Department, Inpatient Activity - Sunday through Saturday; OR Utilization - Monday through Thursday; Endo - Monday through Friday Emergency Department visits 46 47 Average number of ED patients daily Indicator of ED activity level Admissions 193 338 Total number of inpatient admissions daily Indicator of clinical activity level Discharges 208 354 Total number of inpatient discharges daily Indicator of clinical activity level * (Actual) OR Utilization (Room 1) 85.6% 72.6% Percentage of OR capacity utilized Indicator of clinical activity level * (Actual) OR Utilization (Room 2) 78.3% 60.6% Percentage of OR capacity utilized Indicator of clinical activity level * (Actual) Endoscopy Utilization 66.6% 65.7% Percentage of Endoscopy capacity utilized Indicator of clinical activity level Transfers 27 40 Total number of ED transfers for no capacity Indicator of restricted capacity Midnight Hospital census 18.5 19.0 Average number of inpatients at midnight, end of prior day Indicator of final daily census Observation patients 1.0 0.9 Average number of observation patients at midnight Indicator of clinical activity level 9a.m. Activity Report - Daily planning meeting "snapshot" - Monday through Friday Core Measures (met/not met) Met 100% Met 100% Clinical hospital quality measures (met or unmet) Quality of care indicator 9 a.m. Hospital census 18.7 19.3 Average number of inpatient and observations patients Indicator of daily census 9 a.m. Windham Center census 9.1 9.0 Average number of patients Indicator of daily census Labor 0.4 0.3 Average number of labor patients (not in census) Indicator of clinical activity level One to one patient care 0.4 0.5 Average number of patients with special needs Indicator of clinical activity level Same Day Surgery admissions 0.9 0.8 Average confirmed ED and Same day surgery admits Indicator of ED activity level Confirmed ED admissions 0.3 0.4 Average number of available total staffed beds Prime capacity indicator Total inpatient capacity 21.7 20.4 Average number of available total staffed beds Prime capacity indicator * Note: (Actual) OR/Endo Utilization collection data start date June 6
Emergency Department General categories of visits • Emergent care • Acute care chronic disease management: – heart failure, diabetes, asthma, pain management, pneumonia, mental health • Unable to get an appointment with PCP • Practice closed to new patients • Patient has no designated PCP • Patients with financial needs,10% of ED patients are insured • Frequent Flier • Drug Seekers • Transient
An Opportunity for a Medical Home Capture and redirect from ED to CHC • Emergent • Acute care chronic disease management: – heart failure, diabetes, asthma, pain management, pneumonia, mental health • Unable to get a timely appointment with primary care physician • Practice closed to new patients • Patient has no designated PCP • Patients with financial needs,10% of ED patients are insured • Frequent flier • Drug seekers • Transients
Capture audience • We have assessed that 2000 to 3500 Emergency Department ED patients annually through a coordinated systems based effort might be redirected to our Community Health Center and provided a Medical Home – This respresents12 to 20% of our current ED volume
Impact of ED volume reduction Assumptions Emergency Department Community Health Center – Improved access to – Increased utilization Emergency Services for – Increased Medical Home those that need it population base – Shorter ED wait times – Increased opportunities for – Increase in clinical value preventive care time – Appropriate management – Reduction of potential of chronic disease medical errors – Less costly delivery of care – Lower staff burn out
Medical Home Coordinated Care Management Hospital Care Managers CHC Care Managers Building a system to coordinate communications and follow up between our established hospital Case Management system and our newly formed CHC Care Management Team
Indicators for CHC care coordination & CHC referral • ED patients without identified CHC primary care provider • ED patients requiring post ED procedure follow up care • ED “frequent fliers” • Patients with a chronic diseases: CHF, Diabetes, Obesity, Pediatric Asthma • Patients seen in the ED within 3 days of a CHC visit • Patients requiring financial assistance, 10% of ED patients are uninsured.
Key measurable improvement indicators • Volume of new CHC patients • Volume of walk in/same day CHC patients • CHC Utilization • Volume of ED visits, i.e. volume reduction – Volume of ED patients assigned a PCP – Volume of frequent fliers – Volume of chronic disease referrals – Volume of patients provided financial assistance • In addition this team will be coordinating inpatient hospital discharges and hospital readmissions
Initial Goals • Increase CHC Utilization by 7% – Improve access – Increase walk-in/same day – Increase Community education • Decrease ED volume by 15% – Assign PCP – Chronic Disease referral, increase management – Financial Assistance – Decrease frequent fliers
Very early progress indicators At this point, a bit of the Hawthorne effect, perhaps • CHC Walk in Same Day Access - 17% increase over 2010 • ED patients assigned a CHC PCP – 14 patients per week are being identified as needing a PCP • ED Volume is demonstrating downward trend towards 2007-8 levels – Economy, other factors vs early care coordination efforts
Summary • Our overall goal is provide excellent preventative primary care • Data will guide us to determine the sources of patients who will benefit and measure progress • A Care Management system that joins our CHC and hospital has been implemented and is in the beginning stages of evolution • Early data results points towards potential wins • Next steps will move to include our local community care centers as part of our care management network
THE IMPACT OF HEALTH INFORMATION TECHNOLOGY ON QUALITY IMPROVEMENT THE INSTITUTE FOR FAMILY HEALTH Kwame A. Kitson, MD VP of Quality Improvement Institute for Family Health 19 West 21st street New York, NY 10003 kkitson@ institute2000.org 212-633-0815 www. institute2000.org HRSA Webinar July 22, 2011
LEARNING OBJECTIVES  NOW THAT YOUR ORGANIZATION HAS ACCESS TO DATA, HOW DO YOU TRANSLATE THAT INTO MEANINGFUL USE ?  HOW CAN THE USE OF DATA AND REPORTING IMPACT PATIENT SAFETY ?  HOW CAN THE USE OF DATA AND REPORTING IMPROVE QUALITY MEASURES PERFORMANCE ?
MEANINGFUL USE OF HIT DATA  “MORE DATA = MORE PROBLEMS”
MEANINGFUL USE OF HIT DATA  A mountainful of data yet a finite amount of resources to handle it.
MEANINGFUL USE OF HIT DATA  “Beware lest you lose the substance by grasping at the shadow .” Aesop  Solution- Target measures and target resources in the most efficient ways possible.
MEANINGFUL USE OF HIT DATA  Electronic Patient Outreach Team Created
PATIENT SAFETY  DRUG RECALLS
THE IFH RESPONSE TO THE VIOXX RECALL FDA SENDS AN ALERT BY EMAIL INTERNAL VIOXX REPORT GENERATED 664 PATIENTS IDENTIFIED VIA REPORTING WITHIN 35 MINUTES OF RECEIVING FDA EMAIL ALL BUT SIX PATIENTS CONTACTED BY TELEPHONE OR MAIL WITHIN 10 DAYS
PATIENT SAFETY DRUG INTERACTIONS AND CONTRAINDICATIONS  INTERNAL EHR VENDOR LINKED DRUG- DRUG INTERACTION WARNINGS  CUSTOM REPORTING ASTHMA PATIENTS ON BETA BLOCKERS PREGNANT PATIENTS ON CLASS D OR X MEDICATIONS BEERS CLASSIFIED MEDICATIONS IN THE ELDERLY
PATIENT SAFETY IDENTIFYING AND PREVENTING INAPPROPRIATE MEDICATION PRESCRIBING  CUSTOM REPORTING NARCOTIC ANALGESICS METFORMIN IN PATIENTS WITH RENAL DISEASE
PATIENT SAFETY IDENTIFYING AND PREVENTING INAPPROPRIATE CODING  CUSTOM REPORTING PROBLEM LIST AUDIT REPORTS IDENTIFIED MISCODING OF PATIENTS (HIV, DIABETES). THIS LED TO ENHANCEMENTS IN DECISION SUPPORT WHICH PREVENTED FURTHER REOCCURENCES.
PERFORMANCE IMPROVEMENT IN QUALITY MEASURES MACROSOLUTIONS (i.e. DECISION SUPPORT, GLOBAL WORKFLOW CHANGES) ACCESS TO DATA ALLOWS FOR GREATER ABILITY TO PINPOINT PROBLEMS MICROSOLUTIONS (i.e. INDIVIDUAL PROVIDER ATTENTION)
PERFORMANCE IMPROVEMENT IN QUALITY MEASURES CQI INTERVENTIONS ARE APPLIED WITH CONTINUED REASSESSMENT  DECISION SUPPORT ALERTS ACCOMPANIED BY WORKFLOW CHANGES.  IFH – AGGRESSIVE IMPLEMENTATION OF BEST PRACTICE ALERTS 9 MONTHS AFTER GO-LIVE
IFH BEST PRACTICE ALERTS PRIMARILY BASED ON HEDIS CRITERIA • PneumoVax • Seasonal FluVax • Breast Cancer Screening • Cervical Cancer Screening • Lead Screening • HGBA1C Testing & Control
IFH BEST PRACTICE ALERTS • Ophthalmology consults for diabetics. • Peak Flow measurements for all asthmatics • Nephrology consults for patients with greater than 1.8 serum creatinine. • LDL Screening • Annual RPR Screening in HIV
Number of Vaccinations Given Ja n 10 20 30 40 50 60 0 M -02 ar M -02 ay - Ju 02 Se l-02 p N -02 ov Ja -0 2 n M -03 ar M -03 ay - Ju 03 Se l-03 p N -03 ov Ja -0 3 n M -04 ar M -04 ay - Ju 04 Se l-04 p N -04 ov Ja -0 4 n Electronic Reminders Begin M -05 ar M -05 ay - Ju 05 Se 5l-0 p N -05 ov Ja -0 5 n M -06 ar M -06 ay - Ju 06 Se l-06 p N -06 ov Ja -0 6 n M -07 ar M -07 ay - Monthly Pneumonia Vaccinations Among 65+ Ju 07 PNEUMOVAX Se l-07 p N -07 ov Increase Preventive Services Ja -0 7 n M -08 ar M -08 ay Electronic Health Record Reminders - Ju 08 Se l-08 p N -08 ov Ja -0 8 n M -09 ar -0 9 5% -5% 15% 25% 35% 45% 55% 65% 75% 85% 95% Percent Vaccinated (Since Jan 2002)
COLORECTAL CANCER SCREENING Colorectal Screening IFH Sites 2005 to 2008 100% BPA FOR COLORECTAL SCREENING INITIATED 90% JAN 2008 80% 70% EAST 13TH ST. FAMILY HLTH CTR 60% MT. HOPE FAMILY HEALTH CENTER PARKCHESTER FAMILY HLTH CTR 50% PHILLIPS FAMILY PRACTICE SIDNEY HILLMAN FAMILY HLTH CTR 40% URBAN HORIZONS FAMILY HLTH CTR WALTON FAMILY HEALTH CTR 30% 20% All sites listed 10% were fully on 0% the EHR as of Jan 2003 05 05 05 06 06 06 06 06 06 07 07 07 07 07 07 08 08 08 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 1/ 1/ 1/ 8/ 0/ 0/ 1/ 1/ 1/ 8/ 0/ 0/ 1/ 1/ 1/ 9/ 0/ 0/ /3 /3 /3 /2 /3 /3 /3 /3 /3 /2 /3 /3 /3 /3 /3 /2 /3 /3 08 10 12 02 04 06 08 10 12 02 04 06 08 10 12 02 04 06
05 /3 1/2 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 00 100% 07 5 /3 1/ 20 09 05 /3 0/ 20 11 05 /3 0/ 20 01 05 /3 1/ 20 03 06 /3 1/ 20 05 06 /3 1/ 20 07 06 /3 1/ NURSING SHORTAGE 20 PERSONNEL 09 06 /3 0/ 20 11 06 /3 0/ 20 01 06 /3 1/ 20 03 07 /3 1/ 20 05 07 /3 1/ 20 07 07 /3 1/ 20 09 07 /3 NURSING RESOLVED SHORTAGE 0/ 20 11 07 /3 0/ 20 01 07 /3 PARKCHESTER DEPRESSION SCREENING RATE 1/ 20 03 08 /3 1/ 20 08 TO BPA ADHERENCE STEPPED UP VIGILANCE PARKCHESTER
THE INSTITUTE FOR URBAN FAMILY HEALTH ROUTINE HIV SCREENING AT IFH NYC SITES 100% NYSDOH POLICY DECISION 90% CHANGE SUPPORT 80% FEBRUARY 2010 INITIATED 70% 60% 50% 40% 30% 20% 10% 0% 09/30/2007 12/31/2007 03/31/2008 06/30/2008 09/30/2008 12/31/2008 03/31/2009 06/30/2009 09/30/2009 12/31/2009 03/31/2010 06/30/2010 09/30/2010 12/31/2010
THE INSTITUTE FOR URBAN FAMILY HEALTH TCNY REPORT: KNOW YOUR HIV STATUS 100% DECISION SUPPORT INITIATED NYSDOH POLICY 90% CHANGE 2/2010 80% 70% AMSTERDAM AVENUE EAST 13TH ST. FAMILY HLTH CTR 60% HOMELESS CENTERS MT. HOPE FAMILY HEALTH CENTER 50% PARKCHESTER FAMILY HLTH CTR 40% PHILLIPS FAMILY PRACTICE SIDNEY HILLMAN FAMILY HLTH CTR 30% URBAN HORIZONS FAMILY HLTH CTR 20% WALTON FAMILY HEALTH CENTER 10% 0%
THE INSTITUTE NYCDOH EQUITS SMOKING FOR URBAN FAMILY HEALTH CESSATION REPORT 100% 90% 80% 70% 60% 58% 52% 50% 48% ALL NYC SITES IFH CLINICAL SITES 40% 33% 28% 30% 30% 20% 10% 0% BASELINE QUARTER 1, 2011 QUARTER 2, 2011
 The greatest danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it. Michelangelo
Office of Health Information Technology and Quality Additional HRSA Health IT and Quality Toolboxes and Resources including past webinars can be found at: http://www.hrsa.gov/healthit http://www.hrsa.gov/quality Additional questions can sent to the following e-mail address: HealthIT@hrsa.gov • US Department of Health and Human Services • Health Resources and Services Administration

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Tips for generating and utilizing quality data reports using health it full slide deck

  • 1.
    U.S. Department ofHealth and Human Services Health Resources and Services Administration HRSA Health Information Technology and Quality Webinar “Tips for Generating and Utilizing Quality Data Reports Using Health IT” Date: 7/22/2011 US Department of Health and Human Services Health Resources and Services Administration
  • 2.
    Office of HealthInformation Technology and Quality Additional HRSA Health IT and Quality Toolboxes and Resources including past webinars can be found at: http://www.hrsa.gov/healthit http://www.hrsa.gov/quality Additional questions can sent to the following e-mail address: HealthIT@hrsa.gov • US Department of Health and Human Services • Health Resources and Services Administration
  • 3.
    Upcoming HRSA HealthIT and Quality Announcements • New Items to the HRSA Health IT Site: • CMS Frequently Asked Questions Document on Meaningful Use for CAHs • HRSA Health IT Adoption Toolbox for HIV/AIDS Providers • Next HRSA HIT and Quality webinar, "Privacy and Security – What Questions Should You Ask Your Vendor“ Friday August 19th 2pm EST • Last month’s webinar “Tips for the Safety Net Community on Using Health IT within a Patient Centered Medical Home” Now available online • HRSA “Call for Papers: Evidence for Informing the Next Generation of Quality Improvement Initiatives: Models, Methods, Measures and Outcomes” for Journal of Health Care for the Poor and Underserved. Due September 1st. Questions? Please contact OHITQPapers@hrsa.gov
  • 4.
    Introduction Presenters: • Margaret Flinter-CommunityHealth Center Inc. • Dr. Kwame Kitson-Institute for Family Health • Bob Demarco-Springfield Medical Care Systems Inc.
  • 5.
    Using Data toDrive Quality Daren Anderson, MD - VP/Chief Quality Officer Nwando Olayiwola, MD, MPH - Chief Medical Officer Margaret Flinter, APRN, PhD - Senior VP/Clinical Director Community Health Center, Inc. July 22, 2011 1
  • 6.
    Community Health Center,Inc. Our Vision: Since 1972, Community Health Center, Inc. has been building a world-class primary health care system committed to caring for underserved and uninsured populations and focused on improving health outcomes, as well as building healthy communities. CHC Inc. Profile: • Founding Year - 1972 • No. of health centers – 12 • No. of Service Locations - 173 • SBHC locations – 23 • Organization Size - 450 Innovations • Integrated primary care disciplines • eConsults with specialists Three Foundational Pillars • Fully integrated EHR • Patient portal and HIE Clinical Excellence • Automated clinical dashboards Research & Development • Nation’s first Nurse Practitioner Training the Next Generation residency training program
  • 7.
    CHC Inc. PatientProfile • Patients who consider CHC their health care home: 130,000 • Health care visits: 350,000 per year CHC Patient Demographics 90.80% 100% 75% 64.8% 65% Patient Care Model 42% 50% 22% • PCMH (NCQA Level 3) 25% 6% 0% • Advanced access scheduling • Clinical dashboard & drive improvement • Expanded hours Care Delivery • Clinical integration of all services Medical Care & Ancillary Services • Formal research program Dental Care • Electronic health records Mental Health Care • Residency training for nurse practitioners Prenatal • W.Y.A. (Wherever You Are) Health Care for the Top Chronic Diseases homeless Cardiovascular Disease • Mobile dentistry services to 150 schools Diabetes • Outreach and eligibility screening/enrollment Asthma
  • 8.
    Performance Feedback – Competing Interests Organizations Providers Productivity & Efficiency Quality and Performance Population Health Individual patient outcomes Systems improvement Professional Growth 10/05/10 4
  • 9.
    Middle Ground? • Providers are inherently interested in and concerned about the quality of care they deliver • Self-reflection is a powerful driver • Framing of QI feedback – non-competing interests • Utilize multiple vehicles to communicate performance 10/05/10 5
  • 10.
    Provider-Centered QI Cycle • Encourage provider participation in measure Defining selection and definition • Provide frequent, individual and systems Enhancing Monitoring reporting • Provide actionable data to front line teams • Link performance and Reporting quality 10/05/10 6
  • 11.
    Multilevel Performance Assessment Performance Appraisals Peer Reviews Data Driven Provider Feedback Dashboard and Professional Education Sharepoint 10/05/10 7
  • 12.
    Using Data todrive QI • Key Points for discussion: – Make data easily accessible to teams – Use a structured QI approach – QI projects need a strong focus on measurement – Collect data to evaluate each PDSA – Provide actionable data to front line teams – Use data to drive performance and sustain gains 10/05/10 8
  • 13.
    Key Points • Key Points for discussion: – Make data easily accessible to teams – Use a structured QI approach – QI projects need a strong focus on measurement – Collect data to evaluate each PDSA – Provide actionable data to front line teams – Use data to drive performance and sustain gains 10/05/10 9
  • 14.
    CHC Quality Improvement on SharePoint 10/05/10 10
  • 15.
  • 16.
  • 17.
  • 18.
  • 19.
    Key Points • Key Points for discussion: – Make data easily accessible to teams – Use a structured QI approach – QI projects need a strong focus on measurement – Collect data to evaluate each PDSA – Provide actionable data to front line teams – Use data to drive performance and sustain gains 10/05/10 15
  • 20.
    Based on “ClinicalMicrosystems”, Nelson et al 10/05/10 16
  • 21.
    Key Points • Key Points for discussion: – Make data easily accessible to teams – Use a structured QI approach – QI projects need a strong focus on measurement – Collect data to evaluate each PDSA – Provide actionable data to front line teams – Use data to drive performance and sustain gains 10/05/10 17
  • 22.
    Embed Measurement into each PDSA • How will we know that a change is an improvement? • Use Survey Monkey, EHR data, chart reviews, hand counts, to measure PDSA outcomes • Data collection does not need to be complicated. Simplicity is key 10/05/10 18
  • 23.
    Based on “ClinicalMicrosystems”, Nelson et al 8/19/10 19
  • 24.
  • 25.
    • Key Points for discussion: – Make data easily accessible to teams – Use a structured QI approach – QI projects need a strong focus on measurement – Collect data to evaluate each PDSA – Provide actionable data to front line teams – Use data to drive performance and sustain gains 10/05/10 21
  • 26.
    Example: Planned Care Huddles • Purpose: – ensure all patients are offered routine prevention/screening – improve efficiency – share routine tasks amongst the team – promote team cohesion – improve the health of our patients and our community
  • 27.
    Basic Process • Pre-huddle – MA reviews CDSS for scheduled visits next day – MA notes things that are due on a paper copy of the schedule – RN reviews patient schedule for vaccine needs/SM needs/other disease management needs • Huddle – booked into schedule each day – MA convenes huddle 5 minutes before start of patient schedule – Brief review by team of what is due, discussion of plan for complex cases.
  • 28.
    Missed Opportunities: Agency-wide 595 595 600 500 424 400 A1C testing in patients with diabetes (6months) 303 Breast cancer screening 290 300 Colorectal cancer screening by colonoscopy 219 200 Depression Screening 148 146 115 100 39 32 24 0 Week of April 25th Week of May 2nd Week of May 9th
  • 29.
    Missed Opportunities: Sitethat started huddling 40 36 35 Sum of A1C 30 testing in patients with diabetes (6 months) 25 Sum of Breast 24 cancer screening 22 21 20 17 17 Sum of Colorectal 15 cancer screening by colonoscopy 10 10 Sum of 9 Depression 7 Screening 6 5 4 4 3 3 2 0 0 4/25 5/2 5/9 5/16 Middletown
  • 30.
    Missed Opportunities: Sitethat didn’t start huddling 200 180 179 160 Sum of A1C testing in patients with 140 142 diabetes (6 138 136 months) Sum of Breast 120 cancer screening 100 Sum of Colorectal 80 80 cancer screening by colonoscopy 65 65 65 60 Sum of Depression 40 Screening 35 32 32 20 24 11 11 6 4 0 4/25 5/2 5/9 5/16 Meriden
  • 32.
  • 33.
  • 34.
    • Key Points for discussion: – Make data easily accessible to teams – Use a structured QI approach – QI projects need a strong focus on measurement – Collect data to evaluate each PDSA – Provide actionable data to front line teams – Use data to drive performance and sustain gains 10/05/10 30
  • 35.
    Improving HTN CareUsing Technology Developing an HTN Dashboard – Combine registry reporting from EHR with real-time pt data from the practice management system – Present timely, actionable data to each care team – Not just a performance “report card” 8/19/10 31
  • 36.
  • 37.
    Locate your panelon Share point
  • 38.
    Click to sortby Average BP or Next Appt
  • 40.
    Summary of KeyPoints • Performance feedback critical for provider professional growth and clinical objectives • Framing of QI feedback for providers must reflect balance between quality and efficiency, not competition • SharePoint is an effective tool for providing easily accessible data to front line teams • Use multiple sources of data to evaluate QI projects • Present actionable data • Data drives performance 10/05/10 36
  • 41.
    Comments or Questions? Please Contact: Daren Anderson VP/ Chief Quality Officer Daren@chc1.com 860.347.6971 ext.3740 _________________________ Margaret Flinter Senior VP and Clinical Director Margaret@chc1.com 860.347.6971 ext. 3622 _________________________ Nwando Olayiwola Chief Medical Officer Nwando@chc1.com 860-347-6971 ext. 3728 37
  • 42.
    Medical Home CoordinatedCare Management Start date: 05 05 11 Springfield Medical Care Systems Springfield, Vermont
  • 43.
    Springfield Medical CareSystem Brief Chronological Organizational History Springfield Hospital was formed in 1914 • Moved to our current location in1923; expansions 1955,1964 • Critical Access Hospital designation received in 2005 – 9 primary care practices, 1 OB/GYN practice, 5 specialty practices – FQHC approval received in 2009 • Unique model, perhaps the only one in the United States where a community health center and critical access hospital work together under one umbrella governing Board of Directors.
  • 44.
    Our Service Area •We serve 12 communities in Vermont and New Hampshire • Service area population is approximately 35,000
  • 45.
    Long standing relationship Primary Care – Springfield Hospital Long history of close working relationship between primary care practices and hospital presenting unique opportunities to assess our environment, identify realizable goals, collaborate and implement change towards establishing a Medical Home for the community we serve.
  • 46.
    An opportunity recognized Establisha care coordination system between our Community Health Center and Hospital. Initial Focus: Emergency Department Utilization
  • 47.
    Emergency Department Emergency Department Volume 18,000 1 7 ,3 3 5 1 6 ,8 2 6 1 6 ,8 7 6 1 7 ,0 2 5 1 6 ,1 3 5 16,000 1 5 ,6 2 4 1 4 ,3 9 8 14,000 1 3 ,0 1 6 1 2 ,7 4 2 1 2 ,5 6 8 1 2 ,6 4 1 1 2 ,1 9 9 12,000 1 0 ,6 4 3 10,000 8,000 6,000 4,000 2,000 0 FY 1998 FY 1999 FY 2000 FY 2001 FY 2002 FY 2003 FY 2004 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010
  • 48.
    Key Daily IndicatorReport 05 01 11 - 06 11 11 05 01 11 - 07 09 11 Definitions Summary Average / Total Average / Total Definitions define "Indicator" and identifies number as average or total Community Health Center - Monday through Friday Indicator No./% No./% Indicator Definition New patients 143 218 Total new patients added daily Indicator of system growth CHC Utilization 88% 90% Average percentage of clinician's blocked hours filled Indicator of clinical activity and capacity Walk ins/same day 1833 3133 Total number of walk in patients accepted Indicator of clinical activity and capacity No shows 444 781 Total number of patients did not show for appointment Indicator of clinical activity Springfield Hospital Indicator No./% No./% Indicator Definition Emergency Department, Inpatient Activity - Sunday through Saturday; OR Utilization - Monday through Thursday; Endo - Monday through Friday Emergency Department visits 46 47 Average number of ED patients daily Indicator of ED activity level Admissions 193 338 Total number of inpatient admissions daily Indicator of clinical activity level Discharges 208 354 Total number of inpatient discharges daily Indicator of clinical activity level * (Actual) OR Utilization (Room 1) 85.6% 72.6% Percentage of OR capacity utilized Indicator of clinical activity level * (Actual) OR Utilization (Room 2) 78.3% 60.6% Percentage of OR capacity utilized Indicator of clinical activity level * (Actual) Endoscopy Utilization 66.6% 65.7% Percentage of Endoscopy capacity utilized Indicator of clinical activity level Transfers 27 40 Total number of ED transfers for no capacity Indicator of restricted capacity Midnight Hospital census 18.5 19.0 Average number of inpatients at midnight, end of prior day Indicator of final daily census Observation patients 1.0 0.9 Average number of observation patients at midnight Indicator of clinical activity level 9a.m. Activity Report - Daily planning meeting "snapshot" - Monday through Friday Core Measures (met/not met) Met 100% Met 100% Clinical hospital quality measures (met or unmet) Quality of care indicator 9 a.m. Hospital census 18.7 19.3 Average number of inpatient and observations patients Indicator of daily census 9 a.m. Windham Center census 9.1 9.0 Average number of patients Indicator of daily census Labor 0.4 0.3 Average number of labor patients (not in census) Indicator of clinical activity level One to one patient care 0.4 0.5 Average number of patients with special needs Indicator of clinical activity level Same Day Surgery admissions 0.9 0.8 Average confirmed ED and Same day surgery admits Indicator of ED activity level Confirmed ED admissions 0.3 0.4 Average number of available total staffed beds Prime capacity indicator Total inpatient capacity 21.7 20.4 Average number of available total staffed beds Prime capacity indicator * Note: (Actual) OR/Endo Utilization collection data start date June 6
  • 49.
    Emergency Department General categories of visits • Emergent care • Acute care chronic disease management: – heart failure, diabetes, asthma, pain management, pneumonia, mental health • Unable to get an appointment with PCP • Practice closed to new patients • Patient has no designated PCP • Patients with financial needs,10% of ED patients are insured • Frequent Flier • Drug Seekers • Transient
  • 50.
    An Opportunity fora Medical Home Capture and redirect from ED to CHC • Emergent • Acute care chronic disease management: – heart failure, diabetes, asthma, pain management, pneumonia, mental health • Unable to get a timely appointment with primary care physician • Practice closed to new patients • Patient has no designated PCP • Patients with financial needs,10% of ED patients are insured • Frequent flier • Drug seekers • Transients
  • 51.
    Capture audience • Wehave assessed that 2000 to 3500 Emergency Department ED patients annually through a coordinated systems based effort might be redirected to our Community Health Center and provided a Medical Home – This respresents12 to 20% of our current ED volume
  • 52.
    Impact of EDvolume reduction Assumptions Emergency Department Community Health Center – Improved access to – Increased utilization Emergency Services for – Increased Medical Home those that need it population base – Shorter ED wait times – Increased opportunities for – Increase in clinical value preventive care time – Appropriate management – Reduction of potential of chronic disease medical errors – Less costly delivery of care – Lower staff burn out
  • 53.
    Medical Home Coordinated Care Management Hospital Care Managers CHC Care Managers Building a system to coordinate communications and follow up between our established hospital Case Management system and our newly formed CHC Care Management Team
  • 54.
    Indicators for CHCcare coordination & CHC referral • ED patients without identified CHC primary care provider • ED patients requiring post ED procedure follow up care • ED “frequent fliers” • Patients with a chronic diseases: CHF, Diabetes, Obesity, Pediatric Asthma • Patients seen in the ED within 3 days of a CHC visit • Patients requiring financial assistance, 10% of ED patients are uninsured.
  • 55.
    Key measurable improvementindicators • Volume of new CHC patients • Volume of walk in/same day CHC patients • CHC Utilization • Volume of ED visits, i.e. volume reduction – Volume of ED patients assigned a PCP – Volume of frequent fliers – Volume of chronic disease referrals – Volume of patients provided financial assistance • In addition this team will be coordinating inpatient hospital discharges and hospital readmissions
  • 56.
    Initial Goals • IncreaseCHC Utilization by 7% – Improve access – Increase walk-in/same day – Increase Community education • Decrease ED volume by 15% – Assign PCP – Chronic Disease referral, increase management – Financial Assistance – Decrease frequent fliers
  • 57.
    Very early progressindicators At this point, a bit of the Hawthorne effect, perhaps • CHC Walk in Same Day Access - 17% increase over 2010 • ED patients assigned a CHC PCP – 14 patients per week are being identified as needing a PCP • ED Volume is demonstrating downward trend towards 2007-8 levels – Economy, other factors vs early care coordination efforts
  • 58.
    Summary • Our overallgoal is provide excellent preventative primary care • Data will guide us to determine the sources of patients who will benefit and measure progress • A Care Management system that joins our CHC and hospital has been implemented and is in the beginning stages of evolution • Early data results points towards potential wins • Next steps will move to include our local community care centers as part of our care management network
  • 59.
    THE IMPACT OFHEALTH INFORMATION TECHNOLOGY ON QUALITY IMPROVEMENT THE INSTITUTE FOR FAMILY HEALTH Kwame A. Kitson, MD VP of Quality Improvement Institute for Family Health 19 West 21st street New York, NY 10003 kkitson@ institute2000.org 212-633-0815 www. institute2000.org HRSA Webinar July 22, 2011
  • 60.
    LEARNING OBJECTIVES  NOW THAT YOUR ORGANIZATION HAS ACCESS TO DATA, HOW DO YOU TRANSLATE THAT INTO MEANINGFUL USE ?  HOW CAN THE USE OF DATA AND REPORTING IMPACT PATIENT SAFETY ?  HOW CAN THE USE OF DATA AND REPORTING IMPROVE QUALITY MEASURES PERFORMANCE ?
  • 61.
    MEANINGFUL USE OFHIT DATA  “MORE DATA = MORE PROBLEMS”
  • 62.
    MEANINGFUL USE OFHIT DATA  A mountainful of data yet a finite amount of resources to handle it.
  • 63.
    MEANINGFUL USE OFHIT DATA  “Beware lest you lose the substance by grasping at the shadow .” Aesop  Solution- Target measures and target resources in the most efficient ways possible.
  • 64.
    MEANINGFUL USE OFHIT DATA  Electronic Patient Outreach Team Created
  • 65.
  • 66.
    THE IFH RESPONSE TO THE VIOXX RECALL FDA SENDS AN ALERT BY EMAIL INTERNAL VIOXX REPORT GENERATED 664 PATIENTS IDENTIFIED VIA REPORTING WITHIN 35 MINUTES OF RECEIVING FDA EMAIL ALL BUT SIX PATIENTS CONTACTED BY TELEPHONE OR MAIL WITHIN 10 DAYS
  • 67.
    PATIENT SAFETY DRUG INTERACTIONS AND CONTRAINDICATIONS  INTERNAL EHR VENDOR LINKED DRUG- DRUG INTERACTION WARNINGS  CUSTOM REPORTING ASTHMA PATIENTS ON BETA BLOCKERS PREGNANT PATIENTS ON CLASS D OR X MEDICATIONS BEERS CLASSIFIED MEDICATIONS IN THE ELDERLY
  • 68.
    PATIENT SAFETY IDENTIFYING AND PREVENTING INAPPROPRIATE MEDICATION PRESCRIBING  CUSTOM REPORTING NARCOTIC ANALGESICS METFORMIN IN PATIENTS WITH RENAL DISEASE
  • 69.
    PATIENT SAFETY IDENTIFYING ANDPREVENTING INAPPROPRIATE CODING  CUSTOM REPORTING PROBLEM LIST AUDIT REPORTS IDENTIFIED MISCODING OF PATIENTS (HIV, DIABETES). THIS LED TO ENHANCEMENTS IN DECISION SUPPORT WHICH PREVENTED FURTHER REOCCURENCES.
  • 70.
    PERFORMANCE IMPROVEMENT INQUALITY MEASURES MACROSOLUTIONS (i.e. DECISION SUPPORT, GLOBAL WORKFLOW CHANGES) ACCESS TO DATA ALLOWS FOR GREATER ABILITY TO PINPOINT PROBLEMS MICROSOLUTIONS (i.e. INDIVIDUAL PROVIDER ATTENTION)
  • 71.
    PERFORMANCE IMPROVEMENT IN QUALITY MEASURES CQI INTERVENTIONS ARE APPLIED WITH CONTINUED REASSESSMENT  DECISION SUPPORT ALERTS ACCOMPANIED BY WORKFLOW CHANGES.  IFH – AGGRESSIVE IMPLEMENTATION OF BEST PRACTICE ALERTS 9 MONTHS AFTER GO-LIVE
  • 72.
    IFH BEST PRACTICEALERTS PRIMARILY BASED ON HEDIS CRITERIA • PneumoVax • Seasonal FluVax • Breast Cancer Screening • Cervical Cancer Screening • Lead Screening • HGBA1C Testing & Control
  • 73.
    IFH BEST PRACTICEALERTS • Ophthalmology consults for diabetics. • Peak Flow measurements for all asthmatics • Nephrology consults for patients with greater than 1.8 serum creatinine. • LDL Screening • Annual RPR Screening in HIV
  • 74.
    Number of VaccinationsGiven Ja n 10 20 30 40 50 60 0 M -02 ar M -02 ay - Ju 02 Se l-02 p N -02 ov Ja -0 2 n M -03 ar M -03 ay - Ju 03 Se l-03 p N -03 ov Ja -0 3 n M -04 ar M -04 ay - Ju 04 Se l-04 p N -04 ov Ja -0 4 n Electronic Reminders Begin M -05 ar M -05 ay - Ju 05 Se 5l-0 p N -05 ov Ja -0 5 n M -06 ar M -06 ay - Ju 06 Se l-06 p N -06 ov Ja -0 6 n M -07 ar M -07 ay - Monthly Pneumonia Vaccinations Among 65+ Ju 07 PNEUMOVAX Se l-07 p N -07 ov Increase Preventive Services Ja -0 7 n M -08 ar M -08 ay Electronic Health Record Reminders - Ju 08 Se l-08 p N -08 ov Ja -0 8 n M -09 ar -0 9 5% -5% 15% 25% 35% 45% 55% 65% 75% 85% 95% Percent Vaccinated (Since Jan 2002)
  • 75.
    COLORECTAL CANCER SCREENING Colorectal Screening IFH Sites 2005 to 2008 100% BPA FOR COLORECTAL SCREENING INITIATED 90% JAN 2008 80% 70% EAST 13TH ST. FAMILY HLTH CTR 60% MT. HOPE FAMILY HEALTH CENTER PARKCHESTER FAMILY HLTH CTR 50% PHILLIPS FAMILY PRACTICE SIDNEY HILLMAN FAMILY HLTH CTR 40% URBAN HORIZONS FAMILY HLTH CTR WALTON FAMILY HEALTH CTR 30% 20% All sites listed 10% were fully on 0% the EHR as of Jan 2003 05 05 05 06 06 06 06 06 06 07 07 07 07 07 07 08 08 08 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 20 1/ 1/ 1/ 8/ 0/ 0/ 1/ 1/ 1/ 8/ 0/ 0/ 1/ 1/ 1/ 9/ 0/ 0/ /3 /3 /3 /2 /3 /3 /3 /3 /3 /2 /3 /3 /3 /3 /3 /2 /3 /3 08 10 12 02 04 06 08 10 12 02 04 06 08 10 12 02 04 06
  • 76.
    05 /3 1/2 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 00 100% 07 5 /3 1/ 20 09 05 /3 0/ 20 11 05 /3 0/ 20 01 05 /3 1/ 20 03 06 /3 1/ 20 05 06 /3 1/ 20 07 06 /3 1/ NURSING SHORTAGE 20 PERSONNEL 09 06 /3 0/ 20 11 06 /3 0/ 20 01 06 /3 1/ 20 03 07 /3 1/ 20 05 07 /3 1/ 20 07 07 /3 1/ 20 09 07 /3 NURSING RESOLVED SHORTAGE 0/ 20 11 07 /3 0/ 20 01 07 /3 PARKCHESTER DEPRESSION SCREENING RATE 1/ 20 03 08 /3 1/ 20 08 TO BPA ADHERENCE STEPPED UP VIGILANCE PARKCHESTER
  • 77.
    THE INSTITUTE FOR URBAN FAMILY HEALTH ROUTINE HIV SCREENING AT IFH NYC SITES 100% NYSDOH POLICY DECISION 90% CHANGE SUPPORT 80% FEBRUARY 2010 INITIATED 70% 60% 50% 40% 30% 20% 10% 0% 09/30/2007 12/31/2007 03/31/2008 06/30/2008 09/30/2008 12/31/2008 03/31/2009 06/30/2009 09/30/2009 12/31/2009 03/31/2010 06/30/2010 09/30/2010 12/31/2010
  • 78.
    THE INSTITUTE FOR URBAN FAMILY HEALTH TCNY REPORT: KNOW YOUR HIV STATUS 100% DECISION SUPPORT INITIATED NYSDOH POLICY 90% CHANGE 2/2010 80% 70% AMSTERDAM AVENUE EAST 13TH ST. FAMILY HLTH CTR 60% HOMELESS CENTERS MT. HOPE FAMILY HEALTH CENTER 50% PARKCHESTER FAMILY HLTH CTR 40% PHILLIPS FAMILY PRACTICE SIDNEY HILLMAN FAMILY HLTH CTR 30% URBAN HORIZONS FAMILY HLTH CTR 20% WALTON FAMILY HEALTH CENTER 10% 0%
  • 79.
    THE INSTITUTE NYCDOH EQUITS SMOKING FOR URBAN FAMILY HEALTH CESSATION REPORT 100% 90% 80% 70% 60% 58% 52% 50% 48% ALL NYC SITES IFH CLINICAL SITES 40% 33% 28% 30% 30% 20% 10% 0% BASELINE QUARTER 1, 2011 QUARTER 2, 2011
  • 80.
    The greatest danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it. Michelangelo
  • 81.
    Office of HealthInformation Technology and Quality Additional HRSA Health IT and Quality Toolboxes and Resources including past webinars can be found at: http://www.hrsa.gov/healthit http://www.hrsa.gov/quality Additional questions can sent to the following e-mail address: HealthIT@hrsa.gov • US Department of Health and Human Services • Health Resources and Services Administration