A Little Planning Goes a Long Way

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In Brief
Azara Healthcare and five health centers within the Community Healthcare Association of New York State (CHCANYS) conducted a pilot project to demonstrate the positive impact the DRVS/ Center for Primary Care Informatics (CPCI) Pre-Visit Planning Report (PVP) can have on care delivery. When DRVS integrates into the patient-centered medical home (PCMH) workflows, it positively impacts quality initiatives, patient health and satisfaction, and improves care team collaboration – while allowing providers to make the best use of their skills, time and resources.

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PVP Anatomy
The PVP or “Huddle Report” provides actionable data listed by provider and patients in order of scheduled appointments. Care team members, such as medical assistants (MAs) and licensed practice nurses (LPNs), review the PVP before and during the morning team huddle. PVP information includes:

  • patients that are due for preventative screenings;
  • condition-relevant patient alerts, such as diabetes A1c tests and blood pressure;
  • risk factors, such as smoking, obesity, and mental health.

Health centers find value in the PVP because it aligns testing and treatment with a patient’s visit, which significantly decreases the likelihood of missed care steps. Patients receive important treatments and preventative screenings while they are at the health center, thus avoiding missed opportunities for needed services. The PVP also helps providers streamline communication with the care teams, unburden them of certain tasks that are more appropriate for others, and increase their confidence in their team’s ability to provide comprehensive care to patients. Additionally, providers benefit from more time spent with patients in the exam room to educate and motivate them about changes that can improve their overall health.

PVP SAMPLE SCREEN

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Azara & CHCANYS Set PVP Pilot in Motion
The 12-week PVP pilot provided the health centers with an opportunity to: leverage data from EHRs and CHCANYS’ CPCI at or near the point of care; optimize patient care; coordinate more aspects of patient care in advance of each visit; and implement the most efficient team approach.

Azara provided training, technical support, and mentorship to the five participating practices. Each 12-week pilot included: planning and preparation, rollout, and ongoing support. The senior-level staff at each center helped to develop the strat- egies for the pilot and to make decisions; two to four provider teams that piloted the process performed the actual tasks, and a provider led each team.

CHCANYS required that each team focus on three cancer screening measures: colorectal, breast and cervical. Also, teams were asked to consider additional measures to follow based on their:

  • likelihood to illustrate the strength of the MA/LPN role when given responsibility for a healthcare measure that could be entirely in their control;
  • likelihood of representing a partnership between MA/LPN and the provider;
  • relevance to the strategic plan of the organization (i. e., a measure that is part of Pay for Performance incentive from a health plan).

Key Screening Measures Jump to New Highs
In most cases, the pilot generated higher screening rates among all teams. Several screening measures rose significantly while many others saw at least modest gains.

A handful of teams saw some of their screening measures dip slightly, but those centers already produced high screening rates. Improving them would be more challenging than in centers reporting lower rates. Examples below:

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Standing Actions
The creation of standing actions received special attention. Azara facilitated conversation with health center management to determinne the permissions various support team members had in executing tasks that met certain criteria. It also sought to encourage the delegation of as many tasks as possible to care team support staff – and away from the provider – when appropriate. The shift allows the center physicians to focus on addressing the patient’s most critical needs – not worry about ordering tests and performing other tasks that do not require a provider’s skill level. The exercise aimed to incorporate the permissions for these tasks into the health centers’ policy and procedure manuals.

Efforts were also made to ensure that documentation by all care team members was captured as structured data. Azara and the centers worked with care team members to facilitate workflow redesign.

Mapping and documentation steps required for each of the evaluation measures used in the project were reviewed. For most teams this process exposed non-standard workflows or holes in documentation processes and gave teams the opportunity to retrain on preferred documentation methods that would result in higher quality measure results in CPCI/DRVS that more accurately reflected the care provided.

Centers Better Manage Resources, Provide Improved Care
The CHCANYS pilot demonstrated that the PVP improves patient care because care interventions are identified in advance of the opportunity for action: when the patient is present for the visit. Care team support staff (MAs, LPNs) benefited from improved collaboration with the provider and other resources, such as care managers – especially when planning for the day’s slate of patients. Team members could review patient information and develop strategies – including working directly with providers – to ensure each patient received comprehensive care during the visit. The PVP helped the health centers identify patient care needs in advance of visits, ensure those needs were met during the visits, and delegate certain tasks away from the provider. Health centers also reported patients were pleased when they realized the care team had prepared for their visits.

When used in preparation for and during provider huddle, the PVP fosters trust between provider and care team members, while allowing providers to focus on higher levels of care planning.

The health centers in the pilot saw significant improvement on several screening rates because quality improvement was hard-wired into daily care delivery operations, and the teams spread the burden of care delivery and documentation evenly.

Funding for this project was provided by HRI, the New York State Department of Health (DOH) and the Project Sponsor, the Centers for Disease Control & Prevention (CDC), sponsor number: NU58DP003879-03.  The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of HRI or the Project Sponsor.

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