Panel Management, Performance Measures and Reporting (PM 2 R)

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WESTVIEW

Panel Management,

Performance Measures and Reporting

(PM

2

R)

-the evolving story of Quality Improvement

***

Allan L. Bailey, MD, CCFP

Grace Moe, BPT, MSc, PCMH-CCE

Branden Ayotte, MD Candidate 2017

Accelerating Primary Care Conference 2014

Edmonton, AB

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Context

WPC

• Westview Physician Collaborative

• the Physician-operated Not-for-Profit Corporation (NPC)

WPCN

• Westview Primary Care Network

• a Joint-Venture between the WPC-NPC and Alberta Health Services

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WESTVIEW

Context

Provincial

• PCN Evolution and Alberta’s “Primary Health Care

Strategy” emphasize

evaluation as a priority for family physicians.

• No system framework has been proposed, nor is there an inventory of necessary resources to enable

evaluation, performance measurement or reporting.

Local

• Westview PCN developed processes to identify physician panels in 2008 • Proactive care, screening and

prevention are identified as an important part of panel

management.

• Panel Management has been facilitated by Proactive Office

Encounter Technicians (POETs) – a role created by and introduced to the Westview PCN in 2010.

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The WPC

Panel Management, Performance Measurement

and Reporting (PM

2

R) Initiative

Objective 1

• To identify some of the

essential elements

required when using

practice-based data for

primary health care

evaluation

Objective 2

• To examine the

effectiveness of the POET

role/intervention in

screening and prevention,

as a component of panel

management

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WESTVIEW

Panel Management, Performance Measurement and

Reporting (PM

2

R)

Results - Objective 1 - Essential Infrastructure:

1. a technical (IT) solution

2. adherence to data stewardship principles, and a

3. quality improvement framework based on “meaningful

use”

were ALL required in the development of the information

management infrastructure and this PM

2

R system

.

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Panel Management, Performance Measurement and

Reporting (PM

2

R)

Results - Objective 1 - Essential Infrastructure:

1. IT Data Sharing Platform:

– WPC server (separate from the WPCN server)

– IT process to migrate “core” data elements from EMR to WPC server – Algorithms to extract specific data

elements of panel (for ASaP manoeuvers) from WPC “core” data base Notes: • IT=Information Technology • WPC=Westview Physician Collaborative • WPCN=Westview PCN • EMR=Electronic Medical Record

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WESTVIEW

Panel Management, Performance Measurement and

Reporting (PM

2

R)

Results - Objective 1 - Essential Infrastructure:

2. Protection of Patient Health

Information (EMR Data):

• Data Governance Structure

– ISA between sentinel physician & WPC-NPC;

– Data Governance by WPC-NPC • Privacy Protection & Data

Stewardship – OIPC-approved PIA Notes: • EMR=Electronic Medical Record • ISA=Information Sharing Agreement

• NPC=Not for Profit Corporation

• OIPC=Office of Information & Privacy Commissioner

• PIA=Privacy Impact Assessment

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WESTVIEW

Panel Management, Performance Measurement and

Reporting (PM

2

R)

Results - Objective 1 - Essential Infrastructure:

3. Quality Improvement Framework:

• Identified EMR accessible data

elements from the “current state” but expanding universe of process and outcome indicators and primary care performance indicators

• Data elements reflect principles of “meaningful use” i.e. their use will improve population and public health

Notes:

• see current state WPC menu of 27 primary health care indicators

• includes ASaP “data set” • indicators are periodically

reviewed and updated as new information—scientific,

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Menu of EMR Primary Health Care Indicators*

(for Clinic Selection per EMR Capability)

# Type Description Measures Note

1 Process BP Screening: HTN ASaP Maneuver

2 Process Height ASaP Maneuver

3 Process Weight Screening: Weight ASaP Maneuver

4 Process BMI Screening: Obesity

5 Process Spirometry/Full Pulmonary Screening: COPD

6 Process Tobacco Use Screening: Lifestyle Risk ASaP Maneuver

7 Process Exercise Status Screening: Lifestyle Risk ASaP Maneuver

8 Process Alcohol Use Screening: Lifestyle Risk ASaP Maneuver

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WESTVIEW

Menu of EMR Primary Health Care Indicators*

(for Clinic Selection per EMR Capability) - cont’d

# Type Description Measures Note

10 Process Influenza Vaccination (18+) Screening:

Preventive Care

ASaP Maneuver

11 Process Tetanus/Diphtheria Vaccination Screening:

Preventive Care

12 Process Pap Test (Females 21-69) Screening: CA ASaP Maneuver

13 Process Plasma Lipid Profile – Fasting Males 40-74; Females 50-74

Screening: CV ASaP Maneuver

14 Process Diabetes Screen – one of

-Fasting Glucose, Hgb A1c, Diabetes Risk Calculator (40+)

Screening: Diabetes

ASaP Maneuver

15 Process Colorectal Cancer Screen – one of

-FIT (FOBT prior to Dec 2013), Flex Sigmoidoscopy, Colonoscopy (50-74)

Screening: CA

ASaP Maneuver

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Menu of EMR Primary Health Care Indicators*

# Type Description Measures Source

16 Process Mammography

(Females: 50-60) (74)

Screening: CA ASaP Maneuver

17 Process Breast Exam (Females: 30+)

Screening: CA

18 Process Bone Density (ALL 65+) Screening: OP

19 Process/ Outcome

CV Risk Calculation Screening: CV ASaP Maneuver

20 Outcome BP Reading Health Outcome

21 Outcome BMI Reading Health Outcome

22 Outcome HbA1c Reading Health Outcome

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WESTVIEW

Menu of EMR Primary Health Care Indicators*

# Type Description Measures Note

24 PC

Performance

Time (# of Days) to Third Next Appointment

Access

25 PC

Performance

% of visits with same PC Provider

Internal continuity

26 Quality % of patients who have had a medication

reconciliation in the past year

Comprehensiveness, Patient Centeredness

27 Quality % of patients with complex needs or chronic

conditions with an integrated care plan

updated in the past year

Comprehensiveness, Patient Centeredness

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Panel Management, Performance Measurement and

Reporting (PM

2

R)

Methods - Objective 2 - POET Effectiveness:

• A retrospective analysis using the developed information

management infrastructure to examine the success of

screening manoeuvers in three phases:

1. baseline standard of care pre-POET;

2. in the early POET implementation phase; and

3. the “mature” phase of POET-facilitated panel

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WESTVIEW

Panel Management, Performance Measurement and

Reporting (PM

2

R)

Methods – Objective 2 - POET Effectiveness:

Hypothesis:

“The implementation of the POET role improves screening

performance as defined by the Towards Optimized

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ASaP –

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WESTVIEW 10.0 20.0 30.0 40.0 50.0 60.0 70.0 80.0 90.0 % of A S a P M a noeuv e rs “Comp le ted

*

ASaP Screening Performance of

WPC Family Physician Panel

2007-2008 (Pre-POET Implementation Phase) 2009-2010 (Early-POET Implementation Phase) 2013-2014 (Mature-POET Implementation Phase) Notes:

1. Screening percentages are “completed”, not “offered”

2. Results are for actual panel denominators – not based on ASaP sampling methodology

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Panel Management, Performance Measurement and

Reporting (PM

2

R)

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WESTVIEW

For more information, please contact:

Allan L. Bailey:

[email protected]