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