the national medical home summit
DESCRIPTION
The National Medical Home Summit. March 2 and 3, 2009. Allan D. Currie, MD, FACP Chief of the Medical Service Practitioner Internal Medicine Eastern Maine Medical Center Bangor, Maine. - PowerPoint PPT PresentationTRANSCRIPT
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The National Medical Home Summit
March 2 and 3, 2009
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• Allan D. Currie, MD, FACP
• Chief of the Medical Service
• Practitioner Internal Medicine
• Eastern Maine Medical Center
• Bangor, Maine
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• Technology-based Patient Registries and Managing Population-based Preventive Care:The Foundation of the Patient Centered Medical Home
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Electronic Medical Records• Sponsorship of the EMR starts at
the top with an administration that is committed to a completely electronic patient record and technology based quality improvement
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Eastern Maine Medical Center• The only winner of the 2008
national Nicholas Davies Award for effectively using information technology to improve the safety and quality of patient care
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Primary Care Practices
• 6 practices
• 32 physicians
• 19 physician extenders
• 26 family medicine residents
• All providers certified by NCQA
• All offices certified as Patient Centered Medical Homes
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Early EMR
• Internal Medicine began to use the EMR in 1995
• Much of the data from other offices was collected from paper charts
• Data was blinded in the beginning
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Crude Beginnings in 1995
0
5
10
15
20
25
30
35
Percent
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22
Provider *Data for 1997 includes only 4 months.
1995 - 1997 Pap Smear Summary No EC
1995 % No EC
1996 % No EC
1997* % No EC
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Patient Registries
• As offices came on line with the EMR we began to compare data from office to office
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Data Gathering 2004-05Pap Smear Done in Prior 3 years,
age 21-65, Seen in Prior 12 Months
10%30%50%70%
EMMC Office
Ad
here
nce t
o
Sta
nd
ard
12/16/2004
4/15/2005
7/28/2005
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Preventive Care Screening 2004-2005
COLON CANCER SCREENING IN PATIENTS OVER AGE 49 SEEN IN
PRIOR 12 MONTHS
5%
25%
45%
65%
Bre
we
r
Eve
rgre
en
Wo
od
s
FP
Ce
nte
r
Hu
sso
n IM
Oro
no
EMMC Office
Ad
here
nce t
o
Sta
nd
ard
12/16/2004
4/15/2005
7/28/2005
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Preventive Care Screening 2004 - 2005
Mammography Done in Prior 24 Months, Age 50-69
5%
55%
Brewer EvergreenWoods
FP Center Husson IM Orono
EMMC Office
Adh
eren
ce to
S
tand
ard 4/26/2004
8/26/200412/16/20044/15/20057/28/2005
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Diabetes Measurement Internal Medicine Office
HIMS July 2005 compared to July 2006
0.0%
50.0%
100.0%
HgbA1c Total Draw n HgbA1c<7.0 HgbA1c>9.0
5-Jul 6-Jul
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Diabetes Measurement Internal Medicine Office
HIMS July 2005 compared to July 2006
0.0%20.0%40.0%60.0%80.0%
100.0%
BP<131s/<81d LDL Drawn LDL or CalcLDL<100
Total ASA
5-Jul 6-Jul
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Quality Improvement Initiatives• In 2006 we hired an RN in the
internal medicine office to help monitor and improve quality
• We protected her time. There is always pressure to use her elsewhere in the office
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Internal Medicine Physician Specific Data• By 2007 we began to look at
providers at our internal medicine office in an unblinded fashion
• We began monthly quality meetings in our office
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Preventive Care Screening
Unblinded 2007 -08Colon Cancer Screening QI: Active Patients Age 50 and Older
Sept '07 - Sept '08
0%
20%
40%
60%
80%
100%
% ColonCancerScreening
%ColonoscopyScreening
% Hemoccultscreening
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Problem List Accuracy
80%
100%
Ronco I.Sababagh
Stepanek Currie Kingsbury Sw an Bragg Husson IM
between 18-80w/BMImeasured
18-80w/BMI>30 andDx of obesity
Percent Active Patients with BMI documented and Percent with BMI> 30 and Diagnosis of Obesity
Sept '07 - Sept '08
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Trying New Approaches to Care 2006• Diabetes Group Visits . Patients met
together with provider, RN and MA for 1.5 hours every 3 months
• Concluded that patients loved group visits, providers enjoyed them, but we did not see benefit in results
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Diabetic Group Visits 2006
HGBA1c March 2006 thru June 2007
0.02.0
4.06.08.0
10.012.0
HgbA1c
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Diabetic Group Visits 2006
HgbA1c Group Visit V. Control Group
0.0
5.0
10.0
15.0
Feb-06
Mar-06
Apr-06
May-06
Jun-06
Jul-06
Aug-06
Sep-06
Oct-06
Nov-06
Dec-06
Jan-07
Feb-07
Mar-07
Group Visit Control Group
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Quality Projects 2008 -09
• We have looked at our data in – Diabetes– Vascular disease– COPD– Opiate Use– Depression– Osteoporosis
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Reconciliation of Orders
• Labs and X rays : we monitor every order and send reminder letters 3 times
• Referrals are monitored for completion
• Meds: we reconcile the medication list after every visit with copy to the patient and after every hospital discharge or transfer
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Care Management
• In 2008 we began to have our RN help manage patients with an A1C over 9
• Phone calls made every 1-2 weeks to review glucose log
• Medication changes by provider and communicated to the patient by RN
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DM Performance Improvement 2008
HIMS DM By Provider: HGBA1c less than 7.0
0%
20%
40%
60%
80%
100%
Bragg Currie Kingsbury Ronco Sabbagh Stepanek Sw an Al-Atrash
1/23/2008 3/17/2008 5/20/2008 7/15/2008 9/15/2008 10/10/2008
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DM Performance Improvement 2008
HIMS DM By Provider: HGBA1c greater than 9.0
0%2%4%6%8%
10%12%14%
1/23/2008 3/17/2008 5/20/2008 7/15/2008 9/15/2008 10/10/2008
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DM Performance Improvement 2008
HIMS DM By Provider: Blood Pressure less than 130/80
0%20%40%60%80%
100%
1/23/2008 3/17/2008 5/20/2008 7/15/2008 9/15/2008 10/10/2008
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IVD Performance 2008HIMS IVD: LDL less than 100, B/P less than 140/90,
Anti-Thrombolytic Therapy
64%
77%
97%
0%
20%
40%
60%
80%
100%
LDL or Calc LDL lessthan100
Blood Pressure lessthan 140/90
Anti-thrombolytic(Does not incudeAlerts or refused)
1/23/2008 4/14/2008 7/15/2008 10/10/200812/10/2008 1/14/2008
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IVD Performance 2008HIMS IVD: Smoking Advice, BMI, Depression Screen
0%
20%
40%
60%
80%
100%
Smoking Advice BMI Depression Screen1/23/2008 4/14/2008 7/15/2008 9/15/2008 10/10/2008
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IVD Performance 2008
HIMS DM By Provider: LDL less than 100
0%20%40%60%80%
100%
1/23/2008 3/17/2008 5/20/2008 7/15/2008 9/15/2008 10/10/2008
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IVD Performance 2008
HIMS IVD By Provider: B/P less than 140/90 (Goal 75%)
0%20%
40%60%
80%100%
1/23/2008 3/17/2008 5/17/20087/15/2008 9/15/2008 10/10/2008
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IVD Performance 2008HIMS IVD By Provider: Anticoagulation Therapy (Does not
include alerts or declines)
0%
20%
40%60%
80%
100%
1/23/2008 3/17/2008 5/17/20087/15/2008 9/15/2008 10/10/2008
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COPD Performance 2008
HIMS COPD Data: FEVI, Flu shot, Pneumovax
0.0%20.0%40.0%60.0%80.0%
100.0%
FEV1 /Spirometry(NotBlank)
FLU Shot(Data10/13/2008 on orafter 09/15/08)
Pneumovax(NotBlank)
1/24/08 2/28/08 3/17/08 4/17/08 5/22/08 6/18/08
7/16/08 8/27/08 9/17/08 10/13/08
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Opiate Monitoring 2008HIMS-MC: Medication contact & Drug screen in
the last 12 months
79.1%
60.2%
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
HIMS-MC with MedContract
HIMS-MC with DrugScreen in the last 12
months
5/27/2008
6/23/2008
7/15/2008
9/19/2008
10/14/2008
11/11/2008
12/12/2008
1/14/2009
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Latest Data on DM
• Our practice has 1000 diabetics
• 66.8 % have A1C under 7
• 6.3 % have A1C over 9
• 68 % have LDL under 100
• 56 % have BP under 130/80
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DM Performance 08-09HIMS DM HgbA1c Drawn, Less than 7.0, Greater than 9.0 (Goal:
40% and 15% respectively)94.7%
65.8%
6.0%
0.0%20.0%40.0%60.0%80.0%
100.0%
HgbA1c Total Drawn HgbA1c less than7.0
HgbA1c greater than9.0
1/30/08 4/14/08 7/15/08 10/10/08 1/14/09
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DM Performance 2009
HIMS DM By Provider: HGBA1c less than 7.0
0%
20%
40%
60%
80%
100%
Bragg Currie Kingsbury Ronco Sabbagh Stepanek Sw an Al-Atrash
1/23/2008 5/20/2008 7/15/2008 10/10/2008 12/10/2008 1/14/2009
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DM Performance 2009HIMS DM By Provider: HGBA1c greater than 9.0
0%2%
4%6%8%
10%
12%14%
1/23/2008 5/20/2008 7/15/2008 10/10/2008 12/10/2008 1/14/2009
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DM Seasonal Variation
A1c Less than 7.0 Trends: December and March Each Year
0.0%20.0%
40.0%60.0%
80.0%
Mar
-06
May
-06
Jul-0
6
Sep-
06
Nov
-06
Jan-
07
Mar
-07
May
-07
Jul-0
7
Sep-
07
Nov
-07
Jan-
08
Mar
-08
May
-08
Jul-0
8
Sep-
08
Nov
-08
Jan-
09
A1c Less than 7.0
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DM Seasonal VariationA1c greater than 9.0 Trends December and March
Each Year
0.0%2.0%4.0%6.0%8.0%
10.0%
Mar
-06
May
-06
Jul-0
6
Sep
-06
Nov
-06
Jan-
07
Mar
-07
May
-07
Jul-0
7
Sep
-07
Nov
-07
Jan-
08
Mar
-08
May
-08
Jul-0
8
Sep
-08
Nov
-08
Jan-
09
A1c greater than 9.0
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Care Manager Hired January 2009• Helping providers manage
– CHF– Asthma– COPD
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Costs and Reimbursements• We find that multiple costs are not
covered by pay for performance but it is getting closer
• The data certainly points to improved care
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Future
• Secure E Mail that links with Centricity. Pilot project under way
• Psychiatric nurse practitioner
• Linkages with all providers
• Linkages with all systems
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Sunset at the North Pole