OVERVIEW
In alignment with VCH PHCTF deliverables, there is general agreement that our teams use the following core evaluation indicators and evaluation processes to move closer to the proposed targets or “stretch goals”.
We will be working in partnership with your team and the UBC Family Practice Informatics, Clinical Decision Support System development team, (BC-CDSS). The BC-CDSS together with our VCH evaluation, IT and CDM experts will provide support for your professional practice to integrate and utilize these tools in your daily practice. Our objective is to ensure that over time, they are built into practice to support improvements that ultimately benefit all of your patients.
The overall aim and purpose of the evaluation effort is to use this information for positive change and effective office practice redesign. The “Model for Improvement” developed by the IHI* is the framework being adopted as current “best practice” for change management. Key questions your project teams are asked to address include:
1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
3. What changes can we make that will result in improvement?
* Refer to the Institute for Health Improvement at www.ihi.org for more information on the “Model for Improvement”. Chronic Disease Management indicators, processes and targets parallel those used in B.C. CDM Collaboratives
Type of Data Indicators & Definitions Data Collection Process
Data Collection
Tool(s)
Data Storage & Reporting
Proposed Targets PATIENT DEMOGRAPHICS
o Patient
Information Date of Birth Sex
First 3 digits of postal code
Entered from chart
into EMR Chart / new patient questionnaire
EMR All patients
registered in EMR
PATIENT ACCESS o Third available
appointment.
The third occurrence in a schedule when a certain type of appointment is available.
Weekly, MOA counts & records the days until the next routine appointment for each physician / nurse in the practice.
EMR for schedule Excel spreadsheet to record weekly counts Spreadsheet (template to be provided by VCH) Appointment for a routine physical within 6 days
All others same day access
CHRONIC DISEASE MANAGEMENT Type of Data Indicators & Definitions Data Collection
Process
Data Collection
Tool(s)
Data Storage & Reporting Proposed Targets CHRONIC DISEASE MANAGEMENT
For Diabetes and CHF For CDM, the data is recorded on the flow sheet on the EMR
The EMR Data stored on and transferred from the EMR
Taken from CHF and DM Collaboratives based upon Best Practice Guidelines DIABETES o Patient Population Patient Registered
Patients with diabetes will be retrospectively and prospectively identified
Establish registry from billing code info, MOH secure website info, chart audit and clinical reassessment Billing system, MOH secure website, registry Registry developed on the EMR and data sent to CDM Toolkit (optional)
95%
o Glycemic Control
HbA1C Results and
% of patients with lab test done every 3 months Record result on EMR EMR EMR to CDM Toolkit (optional) <7.0 % in >90% o Hypertension BP % of patients with BP <=130/80 determined by clinical asst. every 3-6 months
Record on EMR EMR EMR to CDM
Toolkit (optional)
<=130/80 in >40%
o Lipids LDL
% of patients with lab test done at least annually (or as indicated)
Record result on EMR
EMR EMR to CDM
Toolkit (optional)
<2.5 in >70%
o Eyes Dilated eye exam
% of patients with referral made to Ophthalmologist/Optometrist at least annually (or as indicated)
Record on EMR when referral made
EMR EMR to CDM
Toolkit (optional)
Referral made at least annually in >70%
Type of Data Indicators & Definitions Data Collection
Process Collection Data Tool(s)
Data Storage &
Reporting Proposed Targets DIABETES continued
o Neuropathy Lower extremity exam
% of patients, at least annually (or as indicated) Record on EMR when done EMR EMR to CDM Toolkit (optional) Tested at least annually in >90% o Self-management
Set and/or review self-management goals with patient annually
Record on EMR when done
EMR EMR to CDM
Toolkit (optional)
>70%
CONGESTIVE HEART FAILURE o Patient
Population
Patient Registered:
Patients with CHF will be
retrospectively and prospectively identified; % of patients
Establish registry from billing code info, MOH secure website info, chart audit and clinical reassessment Billing system, MOH secure website, registry
Data stored on and transferred from the EMR
95%
LV Ejection Fraction
LV Ejection Fraction as determined by ECHO or RNV will be done; % of patients
Record method used, % Ejection Fraction and whether systolic or diastolic HF on EMR EMR EMR to CDM Toolkit (optional) Data recorded in >85%
Drug Use in Patients with Systolic HF
ACE Inhibitors (or ARB if ACE-I Intolerant); % of patients with documented systolic HF who are on ACE-I (or ARB)
Record drug use on EMR EMR EMR to CDM Toolkit (optional) >85% with systolic CHF will be on ACE-I or ARB Drug Use in Patients
with Systolic HF B-Blockers; % of patients with documented systolic HF who are on B-Blockers
Record drug use on
EMR EMR EMR to CDM Toolkit (optional) >85% with systolic CHF will be on B-Blockers o
Self-management
Set and/or review self-management goals with patient annually
Record on EMR when done
EMR EMR to CDM
Toolkit (optional)
Type of Data Indicators & Definitions Data Collection Process Data Collection Tool(s)
Data Storage & Reporting
Proposed Targets
PRACTICE SIZE PRACTICE SIZE
Fee for service sites Quarterly count of current patients listed in EMR
Query of EMR patient records for totals over the last 18 months
EMR EMR >1500 active
patients/physician
>7100 services/physician Rostered sites - Roster size
- Outflows
Report from MOH >1500 active
patients/physician >4000 service/nurse? PREVENTION Dated records of occurrence of tests &/or results Record notes in
EMR EMR EMR – review & post run charts
>80% of these patients will meet patient goals in each category
INFLUENZA Occurrence of vaccination
Record notes in EMR
EMR EMR >90% of patients over 65
years of age
>90% of diabetics and CHF patients any age
SMOKING
o Baseline Status Smoking Status Record All patients over 8 years
o Self-management This indicator to be reviewed for use next year, not used in Fall 04 report
Assess & discuss self-management challenges Offer smoking/risk management reduction education Record if ready to quit and when Record date(s) of smoking cessation
See
www.bcdssp.com for smoking status data collection tool
>90% smoking status recorded & documented
self-management goals each visit. > X% patients quit 2 weeks to 1 year. X% > 1 year. MAMMOGRAPHY Occurrence of mammogram and result Record notes in EMR of discussion held for those 50+
EMR EMR >90% of women 50-69 are
screened in the last year PAP TESTS Occurrence of Pap Record notes in EMR EMR 1st 3 normal Pap smears at
SATISFACTION SURVEYS Type of Data Indicators &
Definitions
Data Collection Process
Data Collection Tool(s)
Data Storage & Reporting
Proposed Targets PATIENT SATISFACTION SCORES
o Internal Survey Document
(under review – to shorten, review otheralternative tools and send for plain language review)
Means, counts and percentages for responses to questions about different aspects of satisfaction On one randomly selected day each month, MOAs distribute a
questionnaire to all patients as they check in and collect them in a drop box as patients leave. Patient satisfaction questionnaire MS Access or EXCEL database (to be provided by VCH)
Run Charts posted in clinic and reviewed by team for action
STAFF SATISFACTION SCORES o Internal Survey
Document
(Process to be discussed at site visits)
Means, counts and percentages for responses to questions about different aspects of satisfaction
All staff in the practice will be given an anonymous questionnaire every 6 months or more frequently at the discretion of the practice Staff satisfaction questionnaire(s) MS Access or EXCEL database (to be provided by VCH)
Run Charts posted in clinic and reviewed by team for action. o PHCTF Project Group Survey Document (Suggest to be used with physicians only)
Means, counts and percentages for responses to questions about different aspects of satisfaction
All physicians in the practice will be given an anonymous questionnaire in March 2004, 2005, and March 2006 and a stamped envelope return to VCH evaluation staff. Satisfaction questionnaire VCH staff will send a summary report back to each practice
