American Medical Association Johns Hopkins Medicine Telligen Improving Health Outcomes: Blood Pressure (IHO: BP) Devin Detwiler, MBA, MSHA, CHTS Program Specialist Telligen January 13, 2016 11 SOW QIN-QIO Map 2 The QIO Program: What is our end goal. Support a continuously evolving network of dedicated and committed experts in quality improvement, working together in partnership with multiple entities, patients and families to improve health care, support the creation of healthy people in healthy communities and lowering costs through improvement. To change a nation.. 3 Improving Cardiac Health and Reducing Cardiac Healthcare Disparities Heart attack and stroke prevention Million Hearts Support Improve the ABCS Aspirin therapy as appropriate Blood pressure control HHS Priority Focus Cholesterol management Smoking screening and cessation 4 Telligen QIN-QIO cardiac task overview Technical Assistance Boost EHR reporting specifically on cardiac measures Facilitate the use of new and/or existing best practices, resources, and protocols LANs, webinars, tele-conferences, face-to-face meetings, site visits Active engagement of patients, partners, and stakeholders Consultation and education Translate quality data into strategies for improvement Partnership and collaboration on community-based activities to promote beneficiary engagement Knowledge management and sustainment 5 Polling question 6 Why partner with the American Medical Association (AMA) Johns Hopkins Medicine (JHM)? The AMA is in a unique position to reach physicians in all practice settings and specialties. The AMA is working with the Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality and the Johns Hopkins Center to Eliminate Cardiovascular Health Disparities to improve cardiac health for patients by spreading a model for better detection and management of high blood pressure. This aligns closely with task B.1. The AMA-JHM is collaborating with the Million Hearts initiative. 7 Meet the Telligen Task B.1 state leads 8 Colorado Devin Detwiler Program Specialist Illinois Anna Astalas Program Specialist Iowa Frann Otte Senior QI Facilitator AMA-JHM faculty introductions 9 Vikas Bhala, MPH, MBA Improvement Advisor, IHO Strategies American Medical Association Lisa H. Lubomski, PhD Assistant Professor Johns Hopkins Armstrong Institute for Patient Safety and Quality Michael Rakotz, MD Director, Chronic Disease Prevention American Medical Association Polling question Who is on our webinar today? 10 Working together to improve blood pressure control Vikas Bhala, MPH, MBA Improvement Advisor American Medical Association 11 What we hope to accomplish today Understand the expectations of participating in the IHO: BP Program. Describe the impact of uncontrolled blood pressure (BP) from a public health perspective and from a patients perspective. Identify evidence-based best practices your team can use to improve BP control: the M.A.P. checklists. Describe how achieving BP control in patients with hypertension is dependent on effective systems of care. Provide tools and resources your team can use to implement the M.A.P. checklists. 12 Todays agenda 13 TopicLength Welcome, introductions and objectives10 minutes Working together to improve blood pressure control5 minutes Apply evidence to improve blood pressure control 60 minutes Q&A The science of improving care 25 minutes Q&A Wrap-up10 minutes Q&A10 minutes The American Medical Association designates this live activity for a maximum of 2.0 AMA PRA Category 1 Credit. Physicians can claim CME credit and non- physician participants can obtain a certificate of participation. 14 The M.A.P. framework Actionable dataEvidence-based tools Adaptive change Curriculum overview 15 KickoffPrepare for Your Journey Module 1Apply the science of improving care to Measuring BP Accurately Module 2Automated Office BP Measurement: An Opportunity to Engage the Entire Practice or Health Center Module 3Understanding How Clinical Inertia and Limited Patient Engagement Contribute to Uncontrolled Hypertension Module 4Protocols to Guide Evidence-based Prescribing Module 5Engaging Patients through Evidence-based Communication Strategies Module 6Self-measured Blood Pressure Monitoring to Improve BP Control Module 7Dietary and Lifestyle Interventions to Improve BP Control Module 8Sustainability and Wrap-up Celebration Applying evidence to improve blood pressure control Michael Rakotz, MD Director, Chronic Disease Prevention American Medical Association 16 Causes of death in the U.S Cause of Death in US 2012Modifiable Behaviors 1. Heart Disease (600,000)H D P W S C DM 2. Cancer (583,000)D P W S 3. Lung Disease (143,000)S 4. Stroke (129,000)H D P W S C DM 5. Accidental (128,000) 6. Alzheimers (84,000)P 7. Diabetes (74,000)H D P W 8. Influenza /Pneumonia (51,000) S 9. Kidney Disease (46,000)H DM 10.Suicide (41,000) 7 Modifiable Hypertension Diet Physical Inactivity Weight Cholesterol DM Diabetes Smoking 3 Non-Modifiable Age Gender Family HistoryData Source: National Vital Statistics System, National Center for Health Statistics, CDC. Produced by: National Center for Injury Prevention and Control, CDC using WISQARS Relationship between elevated BP and cardiovascular mortality 18 Lewington S. et al. Age-specific relevance of usual blood pressure to vascular mortality The Lancet ;Vol.360;December 14, 2002 Ischemic heart disease and stroke mortality due to elevated blood pressure 1 Million Adults, 61 Prospective Studies Ischemic Heart Disease Ischemic Stroke Morbidity and mortality due to cardiovascular diseases are directly related to BP. In people with hypertension (HTN) and elevated BP, when BP is lowered there, is less vascular damage to organs (i.e. heart, brain, eyes and kidneys). We have known since the 60s and the landmark VA-1 and VA-2 trials that treating high blood pressure with medication reduces risk for heart attacks, strokes and death. 19 Why controlling BP is important Kaplan and Victor Kaplan's Clinical Hypertension 11 th Edition 2015 20 46% are uncontrolled Most adults with uncontrolled HTN have health insurance and a usual source of care 2015 Prevalence rate 33% 2030 Prevalence rate 41% (projected) Source: CDC, AHA Barriers to success Patient factors Non-adherence Financial Literacy Physician factors Time Financial Knowledge of evidence System factors Quality reporting Work flow Leadership (buy-in) 21 22 23 Why measuring blood pressure accurately is important Uncertainty of patients true blood pressure is the leading cause for failure of a clinician to act on a high blood pressure in the office Significant BP variability exists in all patients Poor measurement technique decreases reliability of a patients BP, which can lead to poor clinical decisions, adversely affecting the health of a patient How does this impact clinicians in practice? Braunwald Hypertension 2014 Kerr E et al. The Role of Clinical Uncertainty in the Treatment Decisions for Diabetic Patients with Uncontrolled Blood Pressure. Annals of Internal Medicine (148) Number More to come in Module 1! 24-hour ambulatory blood pressure monitoring (ABPM) Pros Most evidence for accurate diagnosis of HTN Best predictor of future events Helps rule out white coat HTN Helps identify patients with masked HTN Gives BP information during sleep Cons Expensive to purchase and requires training Inconvenient if patients have to be referred out Lack of availability often long wait if referred to a specialist Payment varies for the service (0-$150) and only for the diagnosis of white coat HTN 25 Self-measured blood pressure (SMBP) Pros Complements 24-hour ABPM, but does not replace. Superior to office BP for accuracy Better predictor of future events than routine office BP Helps to rule out white coat HTN Helps identify patients with masked HTN Relatively inexpensive and cost effective (NHS) Convenient Cons Requires the patient to have a home monitor Does not give asleep BP Requires clinical support for maximum benefit 26 *The threshold for diagnosing HTN at home is >135/85 mm Hg Office blood pressure measurement Pros Convenient Can predict future events, if done correctly. Best if used as part of a protocol. Inexpensive Cons Impacted by observer (person taking the BP), patient and environmental factors Many offices are not set up for proper positioning Requires time (>5 minutes) to be done effectively Terminal digit preference Cannot rule out white coat HTN Cannot identify patients with masked HTN Does not give information about asleep BP Routine auscultatory office blood pressures are 9/6 mm Hg higher than research protocol BPs (mean of multiple oscillometric BPs)* 27 Polling questions Errors in BP measurement 28 How many errors in BP measurement do you see? 1.Back is not supported 2.Arm is not supported near heart level 3.Cuff is over sweatshirt 4.Legs are crossed 5.Legs are not both flat on the stool 6.She is talking 7.She is listening (lack of quiet environment) 29 Common errors made during office BP measurement Observer factors Patient factors System factors Wrong cuff size Full bladder Location of monitor/device Cuff placed over clothing Stimulants Noise Improper positioning Recent exercise Work flows No rest periodRecent meal Terminal digit preference Talking, texting, reading Talking to patient Rapid cuff deflation 30 31 Correct patient position for BP measurement For screening BP measurement Automated, validated device Sitting in a chair with back and arm supported (1) Legs uncrossed, feet on the ground or a stool (2) Cuff over a bare arm (3) Correct cuff size No talking or texting If the screening BP is > 140/90 mm Hg, obtain confirmatory BP measurements For confirmatory BP measurements, same as above, plus Ensure patient has an empty bladder Rest for at least five minutes Obtain the average of at least three measurements 32 Why use office BP measurement? Opportunity to obtain BPs Technology has improved measurement reliability (validated, automated machines less human error) Protocols improve reliability, reduce variability and errors and can improve workflow efficiency Obtaining confirmatory measurements increases diagnostic accuracy and reduces misclassification of hypertension By reducing errors and increasing reliability of BP measurement, clinicians are less likely to hesitate when initiating or escalating treatment (clinical inertia) 33 More to come in Module 2! 34 Measure accurately checklist When screening patients for high blood pressure: Use a validated, automated device to measure BP Use the correct cuff size on a bare arm Ensure patient is positioned correctly If BP is 140/90 mm Hg, obtain a confirmatory measurement: Repeat screening steps above Ensure patient has an empty bladder Ensure patient has rested quietly for at least five minutes Obtain the average of at least three BP measurements Most common factors contributing to uncontrolled hypertension 1.Clinicians miss opportunities to treat a patient with a BP > 140/90 Fail to initiate or escalate therapy during an office visit Fail to stress frequent follow up until BP is controlled 35 CLINICAL INERTIA 2. Patient non-adherence to treatment plan Usually due to not taking medications as instructed 36 Factors leading to clinical inertia CLINICIAN Failure to initiate treatment Failure to titrate to goal Failure to recommend follow-up Failure to set clear goals Underestimating patient needs Adapted from Milani RC et al J Am Coll Cardiol. 2013; 62: More to come in Module 3! Failure to identify and manage comorbid conditions Not enough time Insufficient focus or emphasis on goal attainment Reactive rather than proactive Factors leading to clinical inertia PATIENT Medication side effects Failure to take meds Too many medications Cost of medications Denial of disease Forgetfulness Perception of low susceptibility Absence of symptoms Poor communication Mistrust of clinician Mental illness Low health literacy Adapted from Milani RC et al J Am Coll Cardiol. 2013; 62: Factors leading to clinical inertia HEALTH SYSTEM Lack of clinical guidelines Lack of care coordination No visit planning Lack of decision support Poor communication among office staff No disease registry No active outreach Adapted from Milani RC et al J Am Coll Cardiol. 2013; 62: HIGHLAND RIDGE PRIMARY CARE 39 Why standardized treatment protocols are important In patients with HTN with systolic BPs >150 mm Hg, increased risk of acute cardiovascular events or death can occur with Delays in medication intensification >6 weeks Delays in follow-up appointments >10 weeks after medication intensification 40 Xu et al. BMJ 2015;350:h158 doi: /bmj.h158 More to come in Module 4! Polling question Standardized treatment 41 How single-pill combination therapy can help Single-pill combination therapy gets patients to goal more quickly by Expediting escalation of therapy Using fewer prescriptions Non-adherence to medications, another barrier to achieving blood pressure control, is reduced with single-pill combinations Using single-pill combination therapy improves adherence rates 26% compared to non-combination medications Bangalore et al The American Journal of Medicine (2007) 120, 43 If patient has BP 140/90 mm Hg confirmed: Use an evidence-based protocol to guide treatment Re-assess patient every two to four weeks until BP is controlled When possible, prescribe single-pill combination therapy Act Rapidly checklist What does clinical inertia look like in our practices? How can we act rapidly? 44 Case 1: A 32-year-old man with diabetes, HTN and high cholesterol comes into your office for medication refills, cold symptoms and left knee pain. 15-minute appointment He wants antibiotics, medications refills and wants to talk about why you are recommending an influenza vaccine His blood pressure is 144/94 (last two BPs are 145/93 were 146/94) What would you do? What does clinical inertia look like in our practices? How can we act rapidly? 45 Why clinical inertia may occur: Competing factors Lack of time Unsure of true BP What you can do: Use an evidence-based treatment protocol Distribute work across your care team Use SMBP to determine true blood pressure Frequent follow-up until BP is controlled Case 1: A 32-year-old man with diabetes, HTN and high cholesterol comes into your office for medication refills, cold symptoms and left knee pain. What does clinical inertia look like in our practices? How can we act rapidly? 46 Case 2: A 55-year-old woman with HTN and migraines comes into your office for a migraine headache. You dont open the EMR in the room. Later that evening when completing the progress note you notice her BP was 154/94 BP was 152/92 at a visit two months ago You had not addressed blood pressure during this visit What would you do? What does clinical inertia look like in our practices? How can we act rapidly? 47 Why clinical inertia may occur: Competing factor Lack of time Unsure of true BP What you can do: Use an evidence-based treatment protocol Distribute work across your care team Use SMBP to determine true blood pressure Frequent follow up can reduce uncertainty Case 2: A 55-year-old woman with HTN and migraines comes into your office for a migraine headache. You dont open the EMR in the room. What does clinical inertia look like in our practices? How can we act rapidly? 48 Case 3: A 45 year-old man with a positive family history of heart disease (father MI age 49) presents to the office for his third BP follow-up visit in six months. For the past 12 months, he has been implementing lifestyle changes (exercise, low sodium diet, decreasing excessive alcohol intake) in an attempt to lower his BP. No weight has been lost in spite of his effort. BP today 152/85 (155/90 and 150/88 on previous two visits) Patient not self-measuring BP as instructed Patient continues to refuse medication Wants to continue to pursue lowering BP with lifestyle modifications He wants six more months of trying lifestyle change What do you do? What does clinical inertia look like in our practices? How can we act rapidly? 49 Why clinical inertia may occur: Absence of symptoms in patient Patient denial of disease Patient may lack understanding of disease Provider failure to initiate pharmacotherapy What you can do: Use an evidence-based treatment protocol Use evidence-based communication strategies Use SMBP to determine true blood pressure Frequent follow-up until BP is controlled Case 3: A 45 year-old man with a positive family history of heart disease (father MI age 49) presents to the office for his third BP follow-up visit in six months. For the past 12 months, he has been implementing lifestyle changes (exercise, low sodium diet, decreasing excessive alcohol intake) in an attempt to lower his BP. No weight has been lost in spite of his effort. What does clinical inertia look like in our practices? How can we act rapidly? 50 Case 4: A 75 year-old woman comes in for a BP check. She has known HTN and is on hydralazine (vasodilator) 10 mg four times daily and atenolol (beta- blocker) 25 mg once daily. She has no other medical problems. She reports fatigue. BPs have been running 160/95 in the office and at home What do you do? What does clinical inertia look like in our practices? How can we act rapidly? 51 Why clinical inertia may occur: Unsure of medication adherence Unsure of true BP Possible uncontrolled hypertension What you can do: Use an evidence-based communication strategy Early follow up can reduce uncertainty Case 4: A 75 year-old woman comes in for a BP check. She has known HTN and is on hydralazine (vasodilator) 10 mg four times daily and atenolol (beta-blocker) 25 mg once daily. She has no other medical problems. She reports fatigue. 52 If patient has BP 140/90 mm Hg confirmed: Use an evidence-based protocol to guide treatment Re-assess patient every two to four weeks until BP is controlled When possible, prescribe single-pill combination therapy Act Rapidly checklist 53 Use evidence-based communication strategies 54 Patient engagement is important if we expect patients to adhere to therapy When clinicians use this style of communicating which is essentially talking less and listening more we often learn important details that help us determine a preferred treatment approach When patients use this kind of communication, they are more engaged/committed, and as a result, are more likely to adhere Using these communication techniques does not lengthen visits (it actually shortens them), especially if all practice staff are using them More to come in Module 5! STRATEGY Begin with open-ended questions about adherence, including recent medication use Explore reasons for possible non-adherence Elicit patient views on options and priorities to customize a care plan for each patient Remain non-judgmental at all times Use teach-back to ensure understanding of the care plan Use evidence-based communication strategies 55 Five communication skills 1.Open-ended questions 2.Reflective listening 3.Positive reinforcement 4.Ask-provide-ask 5.Teach-back 56 Partner with patients case I have to be honest with you. I havent been taking the medicines. I know you mean well, but I dont think pills are natural. Lets practice. 57 Non-preferred and preferred responses Instead ofTry At the molecular level, everything is made of molecules. In fact many medicines are derived from plants found in nature Tell me more about why medicines are not natural You know, medicines are really important to control blood pressure. You could die or have stroke if you dont take them. It sounds like you want to control your blood pressure, but you dont feel comfortable taking medicines. What do you see as a solution? Diet and exercise are non-medical alternatives. Why dont we give them a try? It sounds like you might prefer a way to control blood pressure without medicines. What ideas do you have in mind? 58 Partner with patients case Using reflection, you say to Mr. Wayne, It sounds like you want to control your blood pressure but dont want to take your medicines. Then using an open-ended question, you ask him, What do you think would work for you? He tells you, I am going to relax more, maybe try exercising too. Lets practice a combination of positive reinforcement and ask- provide-ask. 59 Preferred and non-preferred responses Instead ofTry Relaxing probably wont do much for your blood pressure, but exercise could be useful. Evidence shows that walking for 40 minutes a day 3-4 times a week can lower blood pressure by 5 mmHg Its great that you are coming up with ways to manage your blood pressure. I particularly like your idea of exercising more. What do you know about exercising to control blood pressure? Exercise is a good idea. Perhaps you could combine it with something called the DASH diet? Its great that you are thinking about exercise. What are you thinking about doing? [After patient responds] It sounds like you already know a lot about walking. May I share some information about diet with you too? Exercise is a good idea, but with your blood pressure in the 160s, I dont think it will be enough to get your blood pressure under control. Are there other things you also could do to lower your blood pressure? Its great that you are thinking about exercise. What are you thinking about doing? [After patient responds] It sounds like you already know that walking can help lower your blood pressure, would it be okay if I shared some more information with you? 60 Partner with patients case As you recognize that there is no evidence that relaxing would help Mr. Wayne control his blood pressure, you reinforce the idea of exercising more. Using ask-provide-ask, you learn what he knows about exercise and share with him some ideas about walking around his lovely neighborhood each day. Mr. Wayne appears open to do these things, and you begin to close out this office visit. Lets practice teach-back. 61 Key takeaways Goals for collaboration: To understand patients, not interrogate them To encourage patients, not persuade them To support patients, not fix them 62 Why SMBP is clinically useful Slide from the American Society of HTN 2014 Review Course SMBP better predicts CV morbidity and mortality than office BPs Reduces variability and provides more reliable BP measurement Provides better assessment of hypertension control Empowers patients to self manage their HTN May improves medication adherence 63 More to come in Module 6! Empower patients to self-manage 64 SMBP empowers patients to: Check their BP Communicate results Make adjustments between visits Self-manage HTN Richard J McManus, Jonathan Mant, Emma P Bray, Roger Holder et al. Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial. Lancet 2010; 376: 16372 How to use SMBP in clinical practice 65 Educating staff to train patients on proper use of SMBP is critical and includes: Proper measurement technique Proper frequency to measure SMBPs How to record SMBPs A plan for patients to act if BPs are out of the desired range How to communicate SMBP readings to the clinical team Polling question Diagnosing HTN at home 66 Lifestyle changes for hypertensive patients Healthy diet, such as DASH diet Reduced sodium intake Weight loss Aerobic exercise Moderate alcohol consumption No smoking Taking a pill to lower BP 67 More to come in Module 7! Impact of lifestyle changes for improving blood pressure in patients with HTN Lifestyle changeCan lower SBP/DBP up to: DASH diet, compared with typical American diet11.6/5.3 mm Hg Reduce sodium intake by average of 1150 mg/d4/2 mm Hg Average weight loss of 11 lbs4.4/3.6 mm Hg 40 minutes of moderate intensity aerobic physical activity, 34 times a week 5/4 mm Hg 68 Key messages when advising patients about healthy lifestyle choices to lower blood pressure 69 Reduce the amount of salt in food and processed foods Eat at least five servings of fruits and vegetables per day Choose whole-grain products and high-fiber foods over refined grains (avoid white bread, rice and pastas) Gradually build up to 40 minutes of physical activity, like brisk walking, most days of the week Limit calories to meet and not exceed daily needs. Use personalized and cultural food preferences (eat the foods you like just dont over eat) 70 To empower patients to control their blood pressure: Help patients accurately self-measure BP Direct patients and families to resources that support medication adherence and healthy lifestyles Engage patients using evidence-based communication strategies Partner with patients, families and communities checklist Questions? 71 The science of improving care 72 Lisa H. Lubomski, PhD Assistant Professor Johns Hopkins Armstrong Institute for Patient Safety and Quality Learning objectives 73 Distinguish between technical work (what youll do) and adaptive work (how youll do it) Describe the Adaptive change in ambulatory practice (ACAP) program Summarize methods to assess the culture for change within your organization What is Improvement Science? Every system is perfectly designed to achieve its results Recognize principles of safe design Safe design principles must be applied to technical work and adaptive work Use tools to improve teamwork and communication 74 Adaptive change in ambulatory practice (ACAP) Based on the Comprehensive Unit-based Safety Program (CUSP) Created by Johns Hopkins Medicine and the American Medical Association as part of the Improving Health Outcomes: Blood Pressure (IHO: BP) program" Provides ambulatory teams with a framework for leveraging the experience and knowledge of all practice or health center team members to improve care 75 Adaptive change in ambulatory practice (ACAP) Improves patient care through: Engaging all clinical and non-clinical staff members whose work can affect patient care Using the care teams collective wisdom to identify the best solutions to complex problems Improving teamwork and communication in a practice or health center Can be implemented alongside other change models such as LEAN, Six Sigma or the Institute for Healthcare Improvements Model for Improvement 76 Getting started Assemble the quality improvement (QI) team Secure the support of a health system leader Consider conducting the Medical Office Survey on Patient Safety (MSOPS) to assess practice context http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/medical-office/ 77 Polling question QI leader 78 Five steps of ACAP 1 Conduct Improvement Science Training 2 Identify Defects 3 Engage Practice or Health Center Leadership 4 Learn from Defects 5 Use Tools to Improve 79 Step 1: Conduct improvement science training Suboptimal care is usually due to a flaw in the practice system not because of an individual clinician or staff member Suboptimal care is a result of: Defects anything either clinical or operational you dont want to happen again Hazards have the potential to become defects but have not yet happened 80 System failure cascade 81 Patient suffers Reason J. Human error: models and management. BMJ. 2000;320: Technical work Can be undertaken/solved with existing science or technology Issues or challenges for which there is an answer Work that lends itself to checklists and protocols e.g. Using an evidence-based checklist to guide blood pressure measurement Requires a change of values, attitudes or beliefs. Need to get providers to use the technical tools, in this case, evidence-based interventions to Measure accurately Act rapidly and Partner with patients, families and communities to promote self-management 82 Adaptive work Step 2: Identify defects Identifying defects increases the reliability of patient care Obtain insights from everyone in an organization To identify issues (hazards) before they become problems (defects) To gather multiple perspectives that lead to more effective interventions and solutions Include all stakeholders, even patients 83 84 Staff hazard assessment 1. What is the most likely way your medical office might fail to adequately respond to the next patient with high blood pressure? 2. What can be done to prevent or minimize that failure? Step 3: Engage practice or health center leadership Your team should include a practice or health center leader Let your senior executive know the expectations for your partnership Leadership can connect team members to available resources, materials and people 85 Step 4: Learning from defects What happened? From view of person involved What happened? From view of person involved Why did it happen? How will you reduce the risk of it happening again? How will you know the risk is reduced? 86 Prioritize defects Link the results of the Staff hazard assessment with Learning from defects Discuss where there are current defects Identify the effort needed for the solution Identify the impact of the solution for the patient 87 Prioritize Defects 1)Low effort/High impact: low-hanging fruit with an easy solution and high potential to harm patients 2)High effort/High impact: difficult to fix defect with high potential to harm patients 3)Low effort/Low impact: easy to fix defect with little potential to harm patients. 4)High effort/ Low impact: difficult to fix defect with little potential to harm patients. 88 Step 5: Use tools to improve Teamwork and communication in a practice or health center creates a culture of quality, leading to real and lasting improvements in patient care Examples: Learning from defects; Staff hazard assessment; Daily huddle form 89 Improvement science to-do list Identify a QI leader Introduce the IHO: BP program and the Improvement Science webinar to your entire staff Consider implementing the Medical Office Survey on Patient Safety (MSOPS) in your practice or health center. Use the results to help drive change 90 In summary System factors impact patient care Technical and adaptive Teams make wise decisions when there is diverse and independent input The ACAP program helps sustain improvement efforts 91 Questions? 92 Wrap-up Vikas Bhala 93 Curriculum overview 94 KickoffPrepare for Your Journey Module 1Apply the Science of Improving Care to Measuring BP Accurately Module 2Automated Office BP Measurement: An Opportunity to Engage the Entire Practice or Health Center Module 3Understanding How Clinical Inertia and Limited Patient Engagement Contribute to Uncontrolled Hypertension Module 4Protocols to Guide Evidence-based Prescribing Module 5Engaging Patients through Evidence-based Communication Strategies Module 6Self-measured Blood Pressure Monitoring to Improve BP Control Module 7Dietary and Lifestyle Interventions to Improve BP Control Module 8Sustainability and Wrap-up Celebration Communication is critical What it is: Ongoing throughout the change initiative A two-way process An opportunity for feedback and transparency Audience-specific What it is not: A one-and-done event Just for the roll-out Telling Limited to mode Communicating your change plan to your stakeholdersindividuals positively or negatively impacted by your changeis a critical step in getting buy-in for a change 95 Communication for change management Why change? Why this improvement project? Why now? Whats in it for my stakeholder? How will the change impact this stakeholder? How and when will the change happen? What are the details? 96 Communication management plan 97 Action plan If we fail to plan, we plan to fail. The purpose of an action plan is to assist teams in creating a step-by-step guide for developing and implementing improvement efforts. Teamwork is key. 98 Action plan Goal Where do we want to be? Metrics How do we know when we get there? 99 Action plan template Use the template to develop an action plan for an identified goal 1.Identify a goal 2.Brainstorm the tasks you need to complete to achieve the goal 3.Prioritize the tasks 4.Assign tasks to team leads and follow-up dates 5.Review the form regularly to assess progress 6.Ask your team: How will we determine that our goal has been reached? What are our measures? 100 Additional tools IHO: BP QI team membership form Identify and organize contact information for members of your QI team. Categories include: Health system leader; site administrative leader; physician or clinical champion; lead MA; etc. Post w/ photo of each champion to build enthusiasm and team cohesion 101 Additional tools QI team: Roles, responsibilities and tasks form QI team should have three to six members Considerations for completing: Amount of work involved Type of work involved Balancing workload 102 Additional tools Improvement Science training attendance sheet 103 Action items following todays kickoff Enlist team members for your IHO: BP QI team, including a health system leader Create a schedule for your internal IHO: BP QI team meetings Finalize and implement your communication plan Tell your entire practice about the IHO: BP program and ask them to view the Improvement Science webinar Set up process for reporting BP control rates (by clinician or team) every month and provide team members with lists of patients who have uncontrolled hypertension Carve out time for monthly QI activities and ensure that share your experiences webinars are on IHO: BP QI team members calendars 104 STEPS Forward: Improving blood pressure control 105 Whats next? Tools/Resources accessible via https://ama assn.box.com/s/5wa519z2fhqbyz8fz8wi6w5uivdoetu0 https://ama assn.box.com/s/5wa519z2fhqbyz8fz8wi6w5uivdoetu0 Kickoff SYE Webinar February 10, 2016 Register here: https://qualitynet.webex.com/qualitynet/onstage/g.php?MTID=e a669ef906796b3f8076eacb https://qualitynet.webex.com/qualitynet/onstage/g.php?MTID=e a669ef906796b3f8076eacb Module 1 Accurate BP measurement Impact of small increase in BP on outcomes Strategies to overcome inaccurate BP readings Measure Accurately assessment tools SYE webinar in March 106 Program schedule 107 AMA Blood Pressure Champion How it works: Participants will attend a virtual Kickoff event that introduces them to the IHO: BP program. After the kickoff event, practice and health center staff will listen to two, 10 12 minute podcasts each month. After participants have had an opportunity to listen to the podcasts and work on each module, they will convene virtually on a monthly Share your experience webinar with other participants to discuss lessons learned and opportunities for improvement. To become an AMA Blood Pressure Champion, representatives from the practice or health center must attend the Kickoff event and participate in at least six Share your experience webinars. 108 Program materials 109 Program materials can be accessed via the following link: https://ama-assn.box.com/s/5wa519z2fhqbyz8fz8wi6w5uivdoetu0 How to claim CME credit The American Medical Association designates this live activity for a maximum of 2.0 AMA PRA Category 1 Credit. Physicians can claim CME credit and non- physician participants can obtain a certificate of participation. https://cme.ama-assn.org/Activity/ /Detail.aspx Access code: 6000 Participants can claim credit until February 28, Questions? 111 Thank you! If you have any questions please contact the Telligen program lead from your state. 112 Please complete the webinar evaluation via the link in the chat box. Colorado Devin Detwiler Program Specialist Illinois Anna Astalas Program Specialist Iowa Frann Otte Senior QI Facilitator