Innovative Medical Platform Optimizing Research and Technology (IMPORT)> Background: A medical group, pharmaceutical company, and data harvesting and integration company collaborated to test an innovative approach to quality improvement (QI) that utilizes clinical expertise, advanced outcomes analytics, electronic medical records (EMR), and a cloud technology data harvesting platform. The objective of this project was to measure the ability of this collaborative project to effectively and efficiently identify quality improvement opportunities. Methods: This was a retrospective EMR analysis which utilized Solution for Quality Improvement (SQI) platform on an advanced electronic medical record system. All patients in one primary care medical practice seen from 7/1/2009 - 7/31/2011 were included. The primary outcomes were effectiveness of the platform to integrate data, measured by data density of diabetes laboratory and clinical quality performance values from structured EMR fields and unstructured physician notes; and efficiency, measured as the time period from SQI data mapping to final results analysis. A secondary outcome was the ability of the project to identify and target meaningful QI opportunities. Results: SQI collected data from 9,294 patient records, including 73,706 office visits and 35,602 physician dictated visit notes. Of these records, 6,251 cardiovascular patients were identified with diabetic patients accounting for 1,561 (25%) of these. Values and measurement dates for A1c, LDL, and blood pressure values were harvested in 83%, 75%, and 96% of these diabetic patients, respectively. The collection of other diabetic preventive services performance indicators was relatively low. Additional QI is being done to ensure complete capture of data. The time period for analysis, including 3 iterative rounds of expanded data identification, was 15 weeks total. Through this project, 3 specific areas of QI were prioritized: improve dictation/documentation of preventative diabetes care recommendations; implement diabetes panel management; and develop electronic diabetes patient reported outcomes screening tools. Conclusion: This collaboration led to an efficient and effective QI analysis in diabetes care. Results of the analysis have led to development and implementation of meaningful QI initiatives. Future implications include the use of this project’s approach to rapidly re-measure performance after implementation of the QI initiatives and expansion of the collaboration from a 4 physician practice to the network of 100 primary care physicians.
Background: Depression affects up to 20% of patients with coronary artery disease (CAD), diabetes mellitus (DM), and congestive heart failure (CHF); and is associated with poorer health outcomes. HEDIS Depression Care Measure Set includes the utilization of PHQ-9 survey to monitor depression and appropriate treatment and follow-up. The goal of this program is to design, implement, and measure the success of a quality improvement (QI) initiative addressing HEDIS depression measures in the cardiovascular (CV) population. Methods: First an analysis of current practice and HEDIS compliance was conducted; 2. A plan was developed to address gaps in care; 3. A QI program was executed in the cardiac catheter lab; and 4. Outcome measures and methods to determine program success were designed. Results: Current practice analysis of the catheter lab revealed that depression screening, monitoring, and follow-up were not routinely conducted. Further, it was identified that the PHQ-9 screener was available in the EMR system but not being utilized. Therefore, a QI program was designed with the following components: 1. Patients > 18 years old receive the PHQ-9 upon discharge from the catheter lab; 2. If a patient scores > 10 on the PHQ-9 they receive education and are scheduled for follow-up; 3. A clinical database collects information on Framingham risk scores, CV risks, PHQ-9 scores, medical history, and biometric data. These data are then used to provide customized CV care plans including depression education; 4. A shared medical appointment (SMA) format provides additional depression education and follow-up. This program was executed in January 2014. The outcomes plan evaluates the impact of this QI program on HEDIS goal attainment and CV care. A control group receives screening, initial education, and standard of care. The intervention group receives screening, initial education, entry into the disease management database, customized education, therapeutic lifestyle counselling, and participation in the SMA focusing on depression. Currently 39 patients are enrolled in each arm. Interim analysis reveals 100% depression screening in both groups and high rates of follow-up in the intervention group (2 initial components of the HEDIS goals). Conclusions: Implementing a multi-faceted depression screening and follow-up QI program addresses HEDIS goals and has shown initial success in closing identified gaps in care. Future implications include a comparative analysis of the QI program to standard of care on composite HEDIS depression measures and CV goal attainment.
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