importance of a registry amy belisle, md laura brann, program manager, cir eric anderson, dir....
TRANSCRIPT
Importance of a RegistryAmy Belisle, MD
Laura Brann, Program Manager, CIREric Anderson, Dir. Quality Data Management
Chapter Quality Network (CQN)
Asthma Pilot Project
Amy Belisle’s Disclosure
I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in
this CME activity.
Disclosure Slide
Laura Brann’s Disclosure
I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in
this CME activity.
Eric Anderson’s Disclosure
I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in
this CME activity.
Identify patient populationsHelp manage patients
Prepare for patient visits using evidence based protocolsProvide “opportunistic care”
Track quality indicatorsIdentify gaps in performance
Help sustain long-term quality care
We need a registry to…
Informed,Activated
Patient
ProductiveProductiveInteractionsInteractions
Prepared,Proactive
Practice Team
Improved Outcomes
DeliveryDeliverySystemSystemDesignDesign
DecisionDecisionSupportSupport
ClinicalClinicalInformationInformation
SystemsSystems
Self-Self-Management Management
SupportSupport
Health SystemHealth System
Resources Resources & Policies & Policies
CommunityCommunity Health Care OrganizationHealth Care Organization
Chronic Care Model
MaineHealth Clinical Improvement Registry
MaineHealth Clinical IntegrationClinical Integration develops evidence based programs of care and develops educational material for patients and providers. Specialty expertise is brought together with primary care for determination of best practice delivery of care. Works closely with collaborative practices to build process improvement tools. With input from Clinical Integration Workgroups, proposes program quality metrics and reporting for CIR
Clinical Integration programs currently supported by the CIRAsthma, Diabetes, Cardiovascular Disease, Depression, Preventive Health
Primary Care Physicians Measures GroupResponsible for determining specific values for clinical
improvement measures
CIR Development & Deployment Process
CIR Development Team Quality Data Management
Information Services
Practice DeploymentA collaborative process between the staff of the PHO and the
Quality Data Management Division
MaineHealth Value Data
Measurement & Reporting Committee
The Committee provides oversight for
the direction, resources, long term
planning and sets priorities for CIR development and
deployment in line with the strategic plans of
MH and affiliates.
1152 Active Users
124 MaineHealth Practices
508 MaineHealth Providers
January 2010
Other users: • Mercy Primary Care Center
sites• SOCHS PHO (Maine
Covenant)• Maine Health Alliance
(Northern Maine Medical Center
• Pines Health Care Service • Maine Coast Memorial
Hospital• Mayo Regional Hospital • Kennebec Regional Health
Alliance, etc…
MaineHealth CIR Statistics
Current patients in the CIR~21,000 Diabetes~12,000 Asthma (7k adult/5k pediatric)~15,000 CVD~8,000 Depression~1,000 HF (all clinical counts)
Preventive Health: ~66,000 Pediatric (0-18 years)~168,000 Adult (18 or older) with no other chronic illness
MMC PHO Patients Managed in the Clinical Improvement Registry
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
2004 2005 2006 2007 2008 2009
Pediatric Asthma (ages 2-18)
Adult Diabetes (ages 18 +)
Adult CVD (ages 18 +)
Data………..
Collection Entry
ValidationReporting
Use for Quality Improvement
Data………..
Collection Entry
ValidationReporting
Use for Quality Improvement
Nurse/Medical Asst:Verify CIR/Visit Summary is up to datePrint VS if needed, place with chart. (May want to highlight where information/updates are needed)Include with chart any paperwork needed
Patient Service Representative:Reminder call before appointment
Provider:In process of visit, review Visit Summary report where information is needed, add/update on the visit summary all necessary information
Document referral (if applicable) to Asthma Educator or Specialist for persistent uncontrolled asthma and/or considers MMC PHO Care Manager for additional support.
Provider gives completed VISIT REPORT to Clinical Staff.
Nurse/Medical Asst:Obtain parent/guardian signature on School Plan;Nurse/Medical Asst/Patient Services
Representative:Data Entry in CIR from Visit Summary ReportNew visit summary report printed. Indicate missing
information for provider review at next visit.If labs/tests ordered, the test information is entered into the
CIR upon receipt and a new Visit Summary Report printed.
Sample Asthma PCP Visit Report Process
Roomer/Nurse/Medical Asst:Record all applicable data on the CIR Visit Summary and in the Medical RecordAsk/document any information needed:(ex Immunizations, tobacco exposure, ht, wt, BP,
Process is complete!
Data………..
Collection Entry
ValidationReporting
Use for Quality Improvement
Data………..
Collection Entry
ValidationReporting
Use for Quality Improvement
For the patientSelf Care report
Patient mailings/reminder letters
Internal ReportingProgress report
Patient Clinical Reminder reportVisit Summary
External ReportingPQRIPTE
NCQA
Include drill down progress report
Include drill down progress report
Important things to know
Where to get more information…There are some costs
$120 every 3 years for secure ID$240/year per provider
To get your practice set up on the CIRPaperwork
Business Associate AgreementsService Level AgreementsPractice Start Up PacketIdentify a practice CIR lead
I have no relevant financial relationships with the manufacturer(s) of any commercial products(s) and/or provider of commercial services discussed in
this CME activity.
disclosure statement
For more information: Contact your PHO, Practice Manager or CIR Program Manager
Questions?
Nurse/Medical Asst:Review chart for VS (Visit Summary) or print from the CIR; Check CIR database to see if latest visit and tests have been entered; If missing, document lab/test values on VS ReportIndicate on VS where information is neededAttach Visit Summary and any additional forms to be completed (Action/School Plan) and lab/Test reports to front of chart.
Patient escorted to exam room by Roomer.
Patient Service Representative:Reminder call before appointment to bring diary/log, meds, peak flow meter, spacer, etc.
RECORD ALL APPLICABLE DATA ON BOTH THE VISIT REPORT & IN THE APPROPRIATE AREA OF THE MR:Provider:Review areas of (VS) Visit Summary report where information is needed, add or update on the visit summary including but not limited toCondition, Medications, Allergies/Adverse drug reactions, patient asthma status (if symptom free less than 14 days);Evaluate patient level of understanding of asthma, meds, management plan, etc.;Complete and explain zones, meds asthma management plan for home and school;Prescribe spacers for inhalers, peak flow meters for kids > 5;Emphasize importance of follow-up visits for reassessment/ education; andRefer to Asthma Educator or Specialist for persistent uncontrolled asthma and/or considers MMC PHO Care Manager for additional support.
Provider gives completed VISIT REPORT to Clinical Staff.
Nurse/Medical Asst:Provide asthma education (i.e., use of peak flow meter,
inhalers, etc.);Obtain parent/guardian signature on School Plan;Nurse/Medical Asst/Patient Services
Representative:Data Entry in CIR from Visit Summary ReportNew visit summary report printed. Indicate missing
information for provider review at next visit.If PFT’s ordered, the test information is entered into the CIR
upon receipt and a new Visit Summary Report printed.
Process is complete.
VERIFY PATIENT ID. RECORD DATA ON BOTH THE VISIT REPORT & IN THE APPROPRIATE AREA OF THE MEDICAL RECORD:Roomer/Nurse/Medical Asst:Ask about any missing information:Flu and Pneumonia Immunizations/updatesAny ED Visit or Hospital Admission (date & reason)Triggers, smoke exposureObtain HEIGHT, WEIGHT, BLOOD PRESSURE and PEAK FLOW for kids > 5 years old;Document Peak Flow, technique and effort on encounter form and visit summary where applicable; andCalculate peak flow zones, update plan.Give patient blank diary to record home Peak Flow and assesses patient technique on inhalers and spacers and instructs as needed. Newly Diagnosed Patient with Asthma requires:
Initial Data Entry into CIR; Severity Classification; Action Management Plan and/or School Plan; Peak Flow Baselines;Patient Education