MiPCT Demonstration Project

Medical Network OneFebruary 5, 2014

Agenda

Illustrate the key attributes of a care team and how to develop a team in practice

Describe the team-based practice changes that lead to improved efficiency and quality of care

Explain how to plan a team huddle Outline 2014 Metrics

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Care Model

Prepared, proactive interdisciplinary care team Planned, coordinated, protocol-driven care Informed, activated patients Trained team Community collaboration.

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Challenges to Developing Effective Teams

Different disciplines Not trained together Hierarchy Asynchronous care Lack of continuity Culture slow to change

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What is a Team?

Multidisciplinary Interdisciplinary

Interprofessional

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What is a Team?

Task-oriented vs relationship-oriented Membership defined by healthcare professional

rather than patient, family, or caregiver Teams develop around the core principle of “trust”

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Teamwork Model (Baker et al, 2005)

Organization

Team

Individual

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Team Structure

Core Team Coordinating Team Contingency Team

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The Team “Bundle” Intervention

Leadership Commitment• Practice level• Organization

The Team Development Measure• Feedback to team with discussion• Target improvements

Intra-staff communication skills training Patient/case-focused care conferences or

“huddles”

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What have we learned about teams?

Teams don’t just happen, formalized training is necessary

Requires ongoing maintenance Huddle helps the team “practice”

• Teams are a prerequisite for sustainable quality improvement

Clinical outcomes are better Organizational health improves

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Team Practice Interventions That Make a Difference

Practice re-design Protocol-Driven Standardized Processes Care Management Services Managing “Transitions” Engagement of Patients and Families

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Practice Re-Design: PCMH

One-stop shop Inter-professional care teams Multi-disciplinary care teams

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Protocol-Driven Standardized Processes

Very Important Process (VIP) Immunizations Medication Management Disease-specific management

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Immunization Pearls

Agree on immunization protocol Educate team Provide standing orders Assign the role of immunization management to a

nurse and provide appropriate training and resources

Measure and have a process for follow-up

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Patient and Family Engagement

Self-management : Disease Self-Management Program

Group visits: new patient and family orientation Quality improvement Project participation Patient Advisory Council

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Huddle Board

ComponentsMetric 1:

Metric 2

Metric 3

Daily Critical Communications

Information

Ideas in Motion

When and WhoBeginning or mid shift

5 minutes

Lead by member of unit leadership team

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Structured Huddles Action Plan

Task Responsibility Due DateObtain team buy-in

Order Huddle Board

Select huddle metrics:

Define huddle process:• Define time of day and frequency• Who will lead huddle• Expectations of staff—who will attend• Create agenda (in first huddles include overview of purpose

of huddles and huddle process)

Hang huddle board and fill in metrics

Identify when huddles will begin

Define process for changing huddle metrics

Create evaluation process: how will I know if huddles are successful?

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Selecting Metrics

Should reflect improvement opportunities that have been identified by MiPCT, aligned MiPCT goals and objectives

Must be specific and measureable – and feasible to monitor frequently

Identify who will be collecting data and updating board

Define goal for metric – this will help you decide how long to keep metric going

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A Healthcare Imperative

“In medicine, as in any profession, we must grapple with systems, resources, circumstances, people-and our own shortcomings, as well. We face obstacles of

seemingly endless variety. Yet somehow we must advance, we must refine, we must improve.”

- Atul Gawande, Better: A Surgeon’s Notes on Performance

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What Are We Measuring?

Utilization (assessed at PO level)Exceed benchmark or % improvement over previous year Primary care sensitive ED visits (NYU algorithm) Asthma ED Visits for Previously Diagnosed Asthma* Ambulatory Care Sensitive Hospitalizations Hospital Readmissions

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Claims

What Are We Measuring?

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Clinical Quality Metrics (assessed at PO level) Exceed benchmark or % improvement over previous year

Diabetes: Annual retinal eye exams Breast Cancer Screening Cervical Cancer Screening Well Child Visits - 15 months Well Child Visits - 3-6 years Adolescent immunizations

Claims

What Are We Measuring?

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Clinical Quality Metrics (assessed at PO level)

Exceed benchmark or % improvement over baseline Diabetes Control A1C < 8 Diabetes: Blood Pressure < 140/90 CVD: Blood Pressure < 140/90 Hypertension: Blood Pressure < 140/90 Tobacco Use Assessment Weight Assessment for Children and Adolescents

Registry and Claims

What Are We Measuring?

Process Measures (assessed at practice level)

Depression Screening for Patients with Chronic Health Conditions

Notification of hospital admissions and discharges Follow-Up Referrals to a Community-Based

Program or Agency Self-Management Support Offered for Chronic

Condition of Focus

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Registry, Claims and Quarterly MiPCT Report

What have we learned?

This model of care has features that produce better outcomes

Implement a “bundle” of improvement changes Interdisciplinary, interdependent team approach Planned, coordinated care Protocol-driven processes (standardization) Continually involve patients and caregivers Patients and families need to be “partners”, not just

“consumers”

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