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Managing Chronic Obstructive
Pulmonary Disease (COPD)
Learning Collaborative Sponsored by AMGA and Boehringer Ingelheim Pharmaceuticals, Inc.
November 2-4, 2011
San Antonio, TX
DuPage Medical Group
COPD Collaborative – Final Report
Kamila Zlotnicki, MHA; Project Manager – Value Driven Health Care
Susan Becker, RN, MBA; Quality Manager – Value Driven Health Care
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Presentation Agenda
• DuPage Medical Group (DMG) ▫ Vital Statistics and QEA
• DMG and COPD ▫ What we have done thus far: Tools and processes in
place for the care of our COPD patients
• COPD Collaborative Results
• Challenges and Solutions
• Future Steps
• Lessons Learned
• Questions for the Group
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DuPage Medical Group
Vital Statistics and QEA
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DuPage Medical Group
• Independent multi-specialty group in the western suburbs of Chicago
• Established in 1999 (from groups practicing since the ’60s)
• 333 Physicians; 2500 employees
• ~$375 million Revenue
• 40 Specialties; 45+ Sites
• 350,000 active patients; Serve 1/3 of DuPage County (Locations in 4 counties –DuPage, Will, Kane and Cook)
• Dedicated to a full range of Ancillary services including Imaging, Infusion Therapy and the Cancer Center (currently under construction)
• Dominant physician group at 3 area hospitals; committed to growing our footprint in the Hinsdale and LaGrange area
• Partnership with Edward Hospital to improve quality, efficiency and access in the region
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Quality · Efficiency · Access
DMG’s transformation to adapt and lead the changing health care environment by delivering physician-directed, market-competitive health care services focused on excellence in:
▫ Patient outcomes
▫ Patient experience
▫ Business processes
▫ Patient access
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DMG and COPD What we have done thus far: Tools
and processes in place for the care of our COPD patients
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DMG and COPD
Vision:
To improve the outcomes of COPD in our patient population
Goal:
Improve the care provided to our COPD patients, to decrease hospitalizations and improve patient outcomes
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Collaborative Team Composition
• Pulmonary ▫ R. Nemivant, MD ▫ M. McCormick,
BA.RRT, MBA ▫ S. Stakenas, APN ▫ K. Warren, APN
• Internal Medicine ▫ R. King, MD
• Family Practice
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• Value Driven Health Care ▫ K. Ramachandran ▫ K. Zlotnicki, MHA ▫ S. Becker, RN, MBA
• Information Technology ▫ D. Pickering ▫ K. LeClair
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COPD Pathway
• Released January 2010
• Site by site roll out of the pathway
• On-site education of functionality
• COPD Pathway is triggered by the use of the Problem List
• Includes COPD-specific SmartSets, flowsheet, dyspnea scale, patient education and guidelines
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Epic - COPD Tools
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• COPD on Problem List
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Epic - COPD Tools
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• COPD Pathway
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Epic - COPD Tools • COPD SmartSet
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Epic - COPD Tools • COPD Flowsheet
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Epic - COPD Tools
•COPD Flowsheet report over time
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Epic - COPD Tools
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Epic - COPD Tools • Patient Instructions
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Spirometry
• Spirometry results are not integrated with Epic
• Worked with respiratory team to develop a process to routinely enter results into Epic following procedure
• Manually enter results for procedures previously done
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Post Hospital Patient Outreach
• Developed process for post-hospitalization follow-up of COPD patients
▫ Most hospitalized COPD patients are contacted upon discharge by a DMG Case Manager
▫ Assure understanding of follow-up instructions
▫ Arrange any follow-up appointments
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Phytel Outreach Calls
• Utilizing automated outreach calls to our COPD patients
• Following 5 month pilot, rolled out to all Primary Care sites in June 2011
• COPD protocol for outreach:
▫ Identify patients 18 – 99 years old with a COPD diagnosis who have not had a chronic condition visit-related charge in the previous 6 months
and do not have a visit scheduled in the
next 2 months
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Outreach Call Data
0
5
10
15
20
25
30
35
40
5 10 - 15 20 - 25 30 +
To
tal
Nu
mb
er
of
Pa
tie
nts
Days from Outreach to Appointment Scheduled
Time in Days to Appointment Scheduled
44%
14% 13%
29%
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COPD Collaborative Results
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COPD Initiative Data
DuPage Medical Group
COPD on Problem List
Total Number of Active Patients w/COPD on
Problem List
Oct 2009 - Oct 2011
Number of Active Patients w/COPD added
to Problem List betw.
Jan 2011 – Oct 2011
All Patients with COPD Count % Count %
Patient Total - All patients with diagnosis of COPD 4,297 610
Patients with spirometry evaluation results documented 1,910 44% 320 52% ↑
Patients who have an FEV1/FVC less than 70% and have symptoms who were prescribed an inhaled bronchodilator during the past 12 months
Count % Count %
Patient Total - All patients with FEV1/FVC < 70% 1,076 56% 200 63% ↑
Patients with documented symptoms 733 68% 166 83% ↑
Patients prescribed an inhaled bronchodilator (short-acting or long-acting) 774 72% 149 75% ↑
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COPD Collaborative Results
n=890
n=320
n=1,910
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Challenges and Solutions
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Challenges and Solutions
• DMG is not part of an integrated health system so we were unable to utilize hospital-ready data
• Utilizing our claims data was difficult as the information was incomplete
▫ Developed partnership with our hospitals to get data on ER visits and hospital admissions
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Challenges and Solutions
• Past data on spirometries was not easily accessible within Epic, nor was it on the COPD flowsheet
▫ Manually went back and input the historical spirometry results onto the flowsheet
▫ Redesigned the workflow so spirometry results are captured on the flowsheet
• Keeping the momentum we have gained
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Future Steps
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Future Steps
• Initiation of the Pulmonary Dashboard
• Continue work on Medical Home for COPD patient population
• Continue to improve and enhance COPD Pathway
• Develop patient screening / survey for use in MyChart to capture QoL information
• Develop COPD Action Plan for patients
• Continue physician and staff education regarding COPD management
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Dashboards – Pulmonary Dashboard
• PFT performed
• AAP completed
• ACT completed
• Bronchodilator prescribed
• Smoking status recorded and smoking cessation given
• Pneumovax administered
• COPD hospitalizations
• COPD re-hospitalizations within 30 days of discharge
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Dashboards – Adult PCP
Bailey, Miranda
Grey, Meredith
Burke, Preston
O’Malley, George
Shepherd, Derek
Yang, Cristina
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Dashboards – Pediatric
Bailey, Miranda
Burke, Preston
Grey, Meredith
O’Malley, George
Shepherd, Derek
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Lessons Learned
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Lessons Learned
• Continuing education
▫ Redesigning workflows and putting tools into place does not guarantee they will be used
• Important to keep the pathways top of mind
▫ Ongoing education on usage and pathway updates
• Education on spirometry and diagnostic symptoms of COPD
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Questions for the Group
What strategies are your organizations using to keep COPD patients out of the hospital? How successful have these interventions been?
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Thank You