point-of-care registries
DESCRIPTION
Point-of-Care Registries. Alan Glaseroff MD Chief Medical Officer Humboldt Del Norte IPA [email protected]. Chronic Care Model. Point-Of-Care. Administrative data vs. point-of-care Registry as a planned visit protocol - PowerPoint PPT PresentationTRANSCRIPT
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Point-of-Care RegistriesAlan Glaseroff MDChief Medical OfficerHumboldt Del Norte [email protected]
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Chronic Care Model
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Informed,ActivatedPatient
ProductiveInteractions
Prepared,ProactivePractice Team
Functional and Clinical Outcomes
Delivery SystemDesign
Decision Support
Clinical Information Systems
Self- Management Support
Health System
Resources and Policies
Community
Health Care Organization
Chronic Care Model
The Chronic Care Model was developed starting in 1993 by Ed Wagner and colleagues at the Center for Health Studies at Group Health Cooperative in Seattle. Funding from the Robert Wood Johnson Foundation supported the development of the Chronic Care Model. The large ellipse represents the community. The smaller ellipse represents the heath system delivering care to the members of the community. The four elements in the center exist at the practice or office level. Health care is a relationship between a provider team and patient, represented by the circles near the bottom, whish is shown in more detail on the next slide.
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Point-Of-CareAdministrative data vs. point-of-careRegistry as a planned visit protocolAvailability of clinical data: BMI, blood pressure, foot exam, aspirin, tobacco, self-management goalsLab, pharmacy, services billed (>30 day delay) available administratively only in managed careOffices need a single system for all patients
- Humboldt Diabetes ProjectIPA with >95% of clinicians (MDs, advanced practitioners, behavioral health professionals, podiatrists)Managed care
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Pt. enrolled in diabetic study
Data entered in registry
Monthly audit of data in registry
Prompts and reminders
Services delivered?
Registry note returned?
Data from office visit
PACES, CHCF chart audits
Pharmacy data
Lab data
yes
yes
no
Registry note CQI
Staged Diabetes Management Guideline
no
Feedback to clinicians
SDM-derived action plan to help achieve targets
Patient visit sheet
BASICS
Case management
Office visit: scheduled, random
DIABETIC PROJECT FLOW DIAGRAM
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Information/Decision SupportBuild vs. buy (public domain vs. proprietary)C-DEMS: public domain, open source, customizable, control data and reporting2770 total (803 study, 1967 registry only)Progress Note: best practice tool actualizedPatient summary: focus groupPrompts and reminders: keep it simple (HbA1c>9, no HbA1c in past 6 months)
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Planned Visit
Walk-in Visit
Registry Patient?
Prep chart
Pull chart
Download most recent Progress Note
Place PN on front of chart
Medical Assistant tells patient: Take off your shoes
Progress Note employed in visit
Progress Note returned to office staff
Progress Note faxed to IPA
IPA updates registry
Patient Info sheet sent to patient
Updated Progress Note faxed to office and placed on Registry web-site
yes
no
Chart visit in normal fashion
REGISTRY FLOW OFFICE-VISITS
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Chart1
5
21
13
31
34
27
18
37
21
32
20
27
48
34
46
48
44
60
59
74
74
77
63
104
92
100
105
135
65
107
85
112
41
36
118
151
138
110
138
112
Visits
Visits by Week
Sheet1
Visits by week
Date05/19/0305/19/0305/26/0306/02/0306/09/0306/16/0306/23/0306/30/0307/07/0307/14/0307/21/0307/28/0308/04/0308/11/0308/18/0308/25/0309/01/0309/08/0309/15/0309/22/0309/29/0310/06/0310/13/0310/20/0310/27/0311/03/0311/10/0311/17/0311/24/0312/01/0312/08/0312/15/0312/22/0312/29/0301/05/0401/12/0401/19/0401/26/0402/02/0402/09/0402/16/04
Visits521133134271837213220274834464844605974747763104921001051356510785112413611815113811013811282
Sheet2
Sheet3
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Going ForwardCo-morbidities the rule, not the exceptionPlan all care, not just chronic carePatient activation - overcoming barriersInformed consent checklistShared decision-making toolsLinks to credible informationInstantaneous QI statistical process control