SYNERGISTIC APPROACHES TO ACHIEVE BEST PRACTICE MODELS

Samuel DeLeon, MDCMO

Urban Health PlanBronx, NY

Overview of Urban Health PlanBronx, New York

Founded in 1974 by Dr. Richard IzquierdoEl Nuevo San Juan Health CenterBella Vista Health CenterPlaza del Castillo Health CenterPlaza del Sol Family Health Center (Queens)5 School Sites 4 Off SitesAdministrative SitesJCAHO2009 Nicholas E. Davies Award by HIMSS2009 PCMH Level 3 Certification 2010 Volume:222,000

Users: 43,000

ROAD TO BEST PRACTICE

1990s began improving administrative and clinical infrastructure1995 began exploring the use of technology1998 became an FQHC1999 upgraded our IT department- hired a CTO2000 purchased our first EHR2001 embraced a new QI model (Chronic Care Model) with help from BPHC 2003 developed IACH (“poor mans” IHI)2005 changed our EHR because it did not fit our model of QI and organizational infrastructure9/2006 became totally electronic4/2007 developed a P4P program for providersAt present have evolved an “exponential” explosion in quality, patient satisfaction and productivity

-

Patient

NYCDOHDME Pharmacy

340bP.A.P

Third AveImaging

State Partnership

VNS

Hospital

PATIENT-CENTERED MEDICAL HOME

Guiding PrinciplesLeadershipAdopting a new model of QIAcknowledge the importance of data collection, distribution and disseminationInstitutionalize your QIUse your resources wiselyThink always in terms of Sustainability (therefore think in terms of a systems approach)

Think always in terms of Sustainability

Think aheadFormalize, standardize and institutionalizeCreate Policies and procedures that are living documentsEnsure that Committees are formed to oversee the progress or failure

LeadershipStarts from the very topPrioritizes our QI initiatives so they are aligned with our organizational goals (Organizational Dashboard)Provides resources, support and guidance Examples:

1- Teen Obesity- changed from teens to children 0-32- Patient safety- project could not be aligned with our EMR because it required reporting on things our decision support tools could not handle

3- Helped teams decide when to spread QI initiatives using the data provided by the teams

Adopting a Model for QI

Decision: Retrospective vs. Prospective CARE MODELLEARNING MODELMODEL FOR IMPROVEMENTWe also adopted Root Cause Analysis and FMEA

Functional and Clinical Outcomes

ProductiveInteractions

DeliverySystemDesign

DecisionSupport

ClinicalInformation

Systems

Self-Management

Support

Health SystemResources and Policies

CommunityHealth Care Organization

The Care Model - A Systems Approach

Adapted from: Improving Chronic Illness Care, a national program of

the Robert Wood Johnson Foundation

www.improvingchroniccare.org

6 1

5 4 3 2

Prepared, Proactive

Practice Team

Informed, Activated

Patient/Client/Family

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

Act Plan

Study Do

•provides a framework for developing, testing and implementing changes that lead to improvement. The model has its basis in scientific method. It attempts to temper the desire to take immediate action with the the wisdom of careful study.

Learning Model (adapted from the IHI breakthrough series)

Select Topic

Planning Group

Identify Change

Concepts

Participants apply and are selected

Pre-work

LS 1

P

SA D

P

SA D

LS 3LS 2

SupportsE-mail Conference Calls Assessments Success Reports Site Visits List Serv

Time for setting aims, allocating resources, preparing baseline data leading to the first 2 day meeting.

Action period 1: Adapt and test the ideas for

improved system of care

Action period 2: further develop the system of

care at the pilot site and spread the system to

other sites &/or practitioners

National Congress and Spread

Expert Panel

Data Collection, Distribution and Dissemination

Ensured operational definitionsData must be structured if it is to be minedShared stratified data in an instant and direct mannerUse of Story Boards viewed throughout the organizationDashboard

Data Collection

Organizational Dashboard

Institutionalize your QI

Ensure sustainabilityIntegrate new ideas into your current work flow (NO ADDING-SYNERGIZE)Align your work throughout the organization (peer review,performance evaluations;P4P)QI is built into job descriptions

Use Resources Wisely

Start small and perform many pilot projects that end quicklyUse human resources from all parst of your organizationDevelop an expert panel before starting projects (nephrologist to hypertension collaborative)Watch trends in your data to make quick decisions

TAKE HOME MESSAGE

Excitement + Commitment +

Structure =POSITIVE RESULTS