Phoenix Indian Medical Center Improving Patient Care

IPC Simplified

Indian Health Service 4 PrioritiesTo Renew and strengthen our partnership

with TribesIn the context of national health insurance

reform, to bring reform to IHSTo improve the quality of and access

to careTo make all our work accountable,

transparent, fair, and inclusive

IPC Program AimTo transform the Indian health system to a more

integrated, well organized, and higher performing system of care.

Develop high performing and innovative healthcare teams to improve the quality of and access to care across all ages and chronic conditions

Build a sustainable infrastructure for the dissemination of innovative improvement throughout the Indian health system.

The results will be a medical home that is accessible, patient-centered, and provides safe, timely, effective, efficient and equitable care

IPC ActionsAim Statement aligns with the mission and

strategic plan Care Teams/“Micro-systems” established The “Green Book” Clinical Self Assessment and

Process mapping - staff/clinical design and flow. Through “The Patients Eyes:” Clinic assessment

from the Patient’s perspective Model for Improvement – PDSA with Rapid Cycle Empanelment assignments Data reporting

QILN AimThe aim of the Quality and Innovation

Learning Network (QILN) is to improve health and promote wellness for American Indians and Alaskan Natives through an active learning and innovation community that provides continued support for IHS, Tribal, and Urban programs in achieving changes for the Indian Health medical home.

Changes and improvements will continue to be tested and implemented as they were in IPC.

PCMC and Peds Clinic are now both a part of the QILN

So where does PIMC fit in?

PIMC VisionBy 2020, we will be the

"Medical Home” for all who choose

PIMC VisionWe will build a network to actively manage

chronic conditions of our patients ('12) We will deliver health care without walls

('12) We will eliminate waste & thereby expand

capacity ('12) We will specialize inpatient services in

areas of excellence that meet the high priority needs of our beneficiaries ('12)

We will support our staff to innovatively design & implement solutions ('12)

PIMC CommunityLargest facility in the Phoenix AreaOver 350 Tribes use the Phoenix Indian

Medical CenterSurrounding Service Unit Tribes (7)

Salt River Pima-Maricopa Indian CommunityFort McDowell Yavapai NationSan Lucy District of the Tohono O’odham NationTonto Apache TribeYavapai-Prescott Indian TribeYavapai-Apache Indian TribeGila River Indian Community (District 6 /7)

Challenges for PIMC “Un-Worried, Un-Well” populationPIMC has a very large, diverse and mobile

population that is difficult to track Many patients have other PCP’s and utilize

PIMC as more of an urgent care center to avoid insurance copays for acute illnesses

Difficult to achieve successful large-scale changes and staff buy-in with such a large facility

IPC Phases

IPC 1 - 14 pilot sites in 2007IPC 2 - 39 sites joined in Fall, 2008

PCMC was a member of this phaseIPC 3 - 68 sites joined in January,

2011Peds Clinic was part of this phase

IPC 4 - 33 sites joined in May, 2012

IPC in Action: Creating the “Medical Home”

Creating the “Medical Home” Care Centered on the Patient and Family

IPC Goal: Health programs design their services to put the patient and

family at the center of care, to provide great customer service and to support them as they strive toward wellness.

PIMC Actions: Improvements in customer service was made a top

priority in the PIMC 2012-2013 Strategic PlanCreation of a Welcome Desk in the front lobby

Phone system upgradeSelf-management support

Creating the “Medical Home” Care TeamsPCMC:

Teams consist of 4 providers, 1 RN Clinical Care Coordinator, 1 LPN, 2 NA’s and 1 MSA

Each team has 3200-4000 empanelled patients100% of patients are empanelled and only empanelled

patients receive appointments Team names: Coral, Silver, Juniper, Ocotillo

Pediatric Clinic: Teams consist of 2.5 – 3 providers (nursing and support

staff change daily)Open access system allows un-empanelled patients to

make appointments and these patients are encouraged to pick a provider during their visit

Approx 15% of the pediatric user population (6,000 patients) are currently empanelled

Team names: Panda, Tiger, Zebra, Monkey

Creating the “Medical Home” Access and Continuity IPC Goal:

Every patient has a relationship with a provider and care team, and has consistent and reliable access to that provider and care team.

PIMC Actions: PCMC has 100% empanelment of patients

Clinical care coordinators help manage care of patients with chronic conditions

Peds clinic provides open-access scheduling so patients are able to make same-day and next-day appointments with their personal provider or another provider on their care team

Creating the “Medical Home” Clinical Information Systems: IPC Goal: Organize patient and population

data to facilitate efficient and effective care.

PIMC Systems used: iCareEHRRPMS

Creating the “Medical Home” Quality and Transparency IPC Goal:

Everyone in the system has the skills and tools for making improvement, and uses measurement and data to build better care.

PIMC Actions: Bulletin boards in common areas and waiting rooms allow

staff and patients to view current projects and progress Surveys allow patients and staff to voice opinions.

Survey data should be visibly posted in care areas and uploaded to the IPC knowledge portal on a regular basis

Clinical care is consistent with scientific evidence and patient preferences.

Ideas for change and improvement should be encouraged and systematically tested using the PDSA Model

Change Implementation: PDSA

Model for Improvement: PDSA

The Plan-Do-Study-Act (PDSA ) cycle is a process for testing a change: (Plan) –develop a plan to test the

change, (Do)- carry out the test, (Study) – observe and learn from

the consequences, (Act) – determine what

modifications should be made to the test.

Model for Improvement: PDSA

Model for Improvement: PDSA

Now Try it!

IPC Terms and Resources

IPC Terms and Resources IPC Home Page: http://www.ihs.gov/ipc/index.cfm Advanced Access: A model to reduce delays and wait times in the clinical setting. The

core principle of Advanced Access is that patients calling to schedule a clinic visit are offered an appointment the same day. The goal of Advanced Access is to build a system in which patients have the opportunity to see their own provider when they choose. For additional information about Advanced Access see http://www.ihi.org/explore/PrimaryCareAccess/Pages/default.aspx

Chronic Care Model (CCM): A model that represents the ideal system of healthcare for people with chronic disease and an approach to re-designing healthcare to mirror that ideal system. Developed by Improving Chronic Illness Care, the model has six components: community resources and policies, healthcare organization, self-management support, decision support, delivery system design, and clinical information systems. For additional information see http://www.improvingchroniccare.org

“Green Book”: Officially known as “Assessing, Diagnosing, and Treating Your Outpatient Primary Care Practice” and can be found at http://www.clinicalmicrosystem.org. A workbook that provides tools and methods that clinical teams can use to improve the quality and value of patient care as well as the work-life of all staff who contribute to patient care. These methods can be adapted to a wide variety of clinical settings, large and small, urban and rural, community-based and academic.

IPC Terms and Resources iCare: iCare is a Population Management software tool that helps organizations

manage the care of their patients. The ability to create multiple panels of patients with common characteristics (e.g., age, diagnosis, community) allows personalization of the way patient data can be viewed. iCare is a Windows-based, client-server graphical user interface (GUI) to the IHS RPMS. It retrieves important patient information from various components of the RPMS database and brings it together under a single, user-friendly interface. http://www.ihs.gov/CIO/CA/icare/

Microsystem: a small group of people who work together on a regular basis to provide care to discrete subpopulations of patients. It has clinical and business aims, linked processes, a shared information environment, and produces performance outcomes. Microsystems evolve over time and are (often) embedded in larger organizations. As a type of complex adaptive system, they must: (1) do the work, (2) meet staff needs, and (3) maintain themselves as a clinical unit. Many resources and tools can be found at http://www.clinicalmicrosystem.org

Model for Improvement: Shown on the right, an approach to process improvement, developed by Associates in Process Improvement, which helps teams accelerate the adoption of proven and effective changes. For additional information on the Model for Improvement, go to: http://www.ihi.org/knowledge/Pages/HowtoImprove/

Process Mapping: An activity that diagrams the steps, decision points, and influencing factors in a workflow process to bring forth a clearer understanding of that process or series of parallel processes.

IPC Terms and Resources Patient Centered Care: Care that is truly patient-centered considers

patients’ cultural traditions, their personal preferences and values, their family situations, and their lifestyles. It makes the patient and their significant other(s) an integral part of the care team who collaborate with health care professionals in making clinical decisions. Patient-centered care puts responsibility for important aspects of self-care and monitoring in patients’ hands — along with the tools and support they need to carry out that responsibility. Patient-centered care ensures that transitions between providers, departments, and health care settings are respectful, coordinated, and efficient. When care is patient centered, unneeded and unwanted services can be reduced. For additional information and ideas: http://www.ihi.org/explore/PFCC/

Self-Management Support (SMS): The care and encouragement provided to people with chronic conditions to help them understand their central role in managing their illness, make informed decisions about care, and engage in healthy behaviors. http://www.ihi.org/knowledge/Pages/Changes/SetandDocumentSelfManagementGoalsCollaborativelywithPatients.asp

Transparency: Sharing performance data in an effort to make organizations more accountable and promote improvement.