Platforms for Performance: Clinical Dashboards to Improve Quality and Safety 2011 Midyear Clinical Meeting

Objectives

Clinical Dashboards for Prevention: Process Improvement

 Determine potential limitations of available data  Identify necessary process improvements (e.g., accurate documentation)  Develop tools to utilize data to improve patient care

Carrie Nolan, PharmD QA Program Manager Pharmacist Southwest VA CMOP (762) Tucson, AZ

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Outline

Audience Poll

 Review of Immunization Dashboard

 Which preventative health issue is most important at your facility?

 Review of MOVE! Report A. Vaccination

 Key steps to process improvement

B. Obesity and chronic disease C. Smoking Cessation D. Other

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Prevention Dashboard  Started out as a way to monitor patient’s access to preventative health  Smoking cessation  Immunizations I i ti  Obesity screening/weight management offered  Behavioral health screening

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© 2011 American Society of Health-System Pharmacists Page 1 of 5

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Platforms for Performance: Clinical Dashboards to Improve Quality and Safety 2011 Midyear Clinical Meeting

Why focus on immunizations?  Top seven vaccines have prevented ~ 14 million cases of disease  Annual cost savings of $9.9 billion in direct medical costs and $33.4 billion in indirect costs

Immunization Dashboard

 Pneumonia and influenza is 8th leading cause of death in U.S.  Influenza causes ~ 20,000 deaths per year

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Immunization and Infectious Disease Progress Review.  U.S. Dept. of Health & Human Services. July 20, 2007 http://www.healthypeople.gov/2010/Data/2010prog/focus14/

Why are patients not receiving vaccines?  Most common reason - not knowing that the vaccine was needed

Selection of Metrics  Selected vaccines included:  Tetanus, diphtheria, pertussis (Td/Tdap)

 40% of non-vaccinated patients cited concerns about the vaccine  13% cited lack of a doctor’s recommendation

 Human papillomavirus (HPV)  Zoster  Influenza  Pneumococcal

Reasons reported by Medicare beneficiaries for not receiving influenza and pneumococcal vaccinations  – United States, 1996.  CDC MMWR Weekly, October 8, 1999 48(39); 556‐890 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4839a4.htm

Patient Eligibility  Based on CDC criteria for each vaccine  Takes into account:    

Age G d Gender Date of vaccination (e.g., annual influenza) Series (e.g., 3 injections for HPV)

Design Document Example

HPV Type of Criteria

Criteria Definition

Programmed/Included in Code

Inclusion

All previously unvaccinated women through age 26

Yes (ages 9-26)

Exclusion

Moderate or severe acute illness

No

Met

Received vaccination (full 3 dose series)

Yes

Not Met

Did not receive vaccination

Yes

© 2011 American Society of Health-System Pharmacists Page 2 of 5

Platforms for Performance: Clinical Dashboards to Improve Quality and Safety 2011 Midyear Clinical Meeting

Dashboard

Limitations of Data  Design document findings  VA-specific immunization issues  Diff Different practices i among diff different medical di l centers • Clinical reminders

Provider Name

 Accurate documentation

Tetanus Report

Dashboard

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Next Steps  Process Improvement  Correct documentation errors • Work with medical centers to incorporate system-wide changes • Standardization of clinical reminder system • Standardization of immunization file in database

MOVE! Report

 Expansion of tool • Target specific populations

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Platforms for Performance: Clinical Dashboards to Improve Quality and Safety 2011 Midyear Clinical Meeting

MOVE! Weight Management Program  Helps veterans lose weight, keep it off and improve their health

Potential Barriers  Services vary between medical centers

 Mandated at all VA facilities

 Requires coordination between different levels of care and different providers

 No co-pays

 No universal means to identify patients

 For veterans of all ability levels, both male and female

 Loss to follow up

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Parameter Selection

MOVE! Report  Created to identify eligible patients  Also tracks those underutilizing the service  Inclusion/Exclusion Criteria

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MOVE! Data

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Baseline Data

 BMI & waist circumference

# of pts within VISN 21 Overweight patients eligible for MOVE!

69,872

BMI > 40 BMI 35-40 with all comorbidities biditi

6,460 135

BMI 35-40 with diabetes

4,386

BMI 35-40 with HTN

7,097

 Dyslipidemia diagnosis with most recent LDL

BMI 35-40 with dyslipidemia

6,316

 Hypertension diagnosis with most recent BP

BMI 35-40 with sleep apnea

448

 Number of MOVE! encounters within last year  Date of last MOVE! attendance  Diabetes diagnosis with most recent HbA1c

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Platforms for Performance: Clinical Dashboards to Improve Quality and Safety 2011 Midyear Clinical Meeting

Next Steps

Conclusion

 Report entered as part of a larger project in the VHA Employee Innovation Competition

 Available data might be limited and can lead to potential for process improvement activities

 Training staff and providers on report features

 Access to accurate data is key to successfully identify specific patient populations

 Process improvement  Dashboard tools are helpful in providing excellent preventative care

 Identification of patients  Enroll patients in MOVE!  Comprehensive care to veterans

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Discussion

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Clinical Dashboards for Prevention: Process Improvement

 How can you utilize data at your institution to provide quality preventative care?  How can you create process improvement tools to promote change within your organization?

Carrie Nolan, PharmD QA Program Manager Pharmacist Southwest VA CMOP (762) Tucson, AZ 27

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