implementation - agnihotri
TRANSCRIPT
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Implementation
Parag Agnihotri ,MD
Medical Director, Continuum of Care
Sharp Rees-Stealy Medical Group
San Diego, California
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What are we trying to achieve?
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Appropriate imaging for low
back pain
Appropriate antibiotic usage
Achieve reduction in cardiac stress testing
Implementing Choosing Wisely
Reduce Inappropriate care
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How do we achieve this as part of the
ABIM/RWJF Challenge ?
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Goal Setting
Baseline rateCommercial HMO
Improvement by 2018
Avoidance of antibiotics for Acute Bronchitis
75% 25%
20% fewer antibiotics
Reduce inappropriate imaging for low back pain
83% 17%
20% Fewer images
Reduce pre-operative cardiac stress testing
/? 8.75/1000 rate Need to improve
20% fewer cardiac stress tests
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Our Steps
Resources
Practice Variation
Education
Technology
Measure Effectiveness
Patient Engagement
Align Stakeholders
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How do you address this in a large multispecialty medical group with …
250,000 assigned patients
1.4 million visits
500 Physicians
60 NP/PA
2000 Clinic staff
21 Clinic locations
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Aligning Stakeholders
Antibiotic Use
Urgent CarePrimary
Care
Back Imaging MSK/PM&R NeurologyPrimary
Care
Stress TestPrimary
CareCardiology
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Clinical GuidelinesCardiac Stress Testing Guidelines
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Clinical GuidelinesLow Back pain Management Guidelines
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Appropriate Coding Education
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Appropriate Coding Education Example
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Provider and Staff Educational
Resources
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Practice Variation Reports by Site
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sharp Rees-Stealy Medical CentersMonthly Antibiotics for Acute Bronchitis Commercial Members 18 - 64 yrs
August 2015
Current LBP Rate Baseline 2014 SRS Goal: 95% SRS Overall: 75.21%
Site 1 Site 2 Site 3 Site 4 Site 5 Site 6 Site 7 Site 8 Site 9 Site 10 Site 11 Site 12 Site 13 Site 14 Site 15
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Peer to Peer Consult Process Established
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Web Portal Links Education to Appointments
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Shared Decision Making: Engage the Patient
Form personal connection
Face to face interaction
Step by step wellness plan
Coordination of care
Patient specific education material
Shared care plans
Medication adherence reporting
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Shared Decision Making: Consumer Reports
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Shared Decision Making: Consumer Reports
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Change
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Implementation at Sharp Rees-Stealy
Parag Agnihotri MD [email protected]
Sharp Rees-Stealy Medical Group
San Diego, California