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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