quality improvement program 2009 annual report to pips report...copc primary care clinics last ......

Quality Improvement Program 2009 Annual Report to PIPS

Lisa Johnson, M.D.Medical Director for Quality Improvement Programs Community Oriented Primary Care , SFDPH

COPC Primary Care Clinics

Last Revised: 04/14/2008

Castro Mission Health Center (CMHC)

Potrero Hill Health Center (PHHC)

Silver Avenue Family Health Center (SAFHC)

Southeast Health Center (SEHC)

Tom Waddell Health Center (TWHC)

Chinatown Public Health Center (CPHC)

Ocean Park Health Center (OPHC)

Maxine Hall Health Center (MHHC) Housing & Urban

Health Clinic HUH

Curry Senior Center

Community Oriented Primary Care Administration

CHPY Cole Street Clinic

CHPY Hip Hop to Health Clinic

CHPY Balboa Teen Health Center

CHPY Hawkins Clinic

CHPY Larkin Street Clinic

Medical Respite and Sobering Center (Fell St)

Special Programs for Youth (SPY)

Medical Respite and Sobering Center (Polk St)

Presenter

Presentation Notes

Geographic distribution – note this is COPC network, also have SFCCC network

Slide courtesy Alice Chen, MD

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Presentation Notes

The world as seen from the SFGH perspective – these are the major components of the SF safety net delivery system – all working closely with SF Health plan and HSF

COPC Health Centers Primary Care clinics: serve general population

Castro Mission HC, Maxine Hall HC, Silver Avenue Family HC, Chinatown Public HC, Ocean Park HC, SouthEast HC, Potrero Hill HC

Special Population Health Centers: Geriatric Focus: Curry Senior Center (aka NMHC) Youth: CHPY (Cole, Larkin St, Hip Hop, Balboa) Forensic: SPY (Special Programs for Youth) at YGC Homeless or Marginally Housed, w/ high prevalence

psychosocial co-morbidities: Tom Waddell HC, Housing and Urban Health

Presenter

Presentation Notes

Another way to view COPC; can categorize our clinics as above BOLDED clinics are the “COPC 8” that serve as HSF Medical Homes and participate in 2008-2009 PC Redesign project

COPC QI Program: 2008-09 Focus Areas

Efficiency / Capacity / Access (HSF demand) Clinical Quality - Develop and Support: Centralized Quality Data reporting Data Driven QI initiatives at Health Centers Innovative Programs

Population Management, Team Care (HCM) Behavioral Health / Primary Care Integration

(OPHC Depression screening Program, 3 sites integrating staff this y)

Chronic Disease Care PHASE, Chronic Pain Management

Collaborations: SF and Regional Safety Net

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Presentation Notes

FOCUS AREAS for COPC in 08-09 SPECIAL CIRCUMSTANCE this year is HSF, creating pressure for Access. Our QI priority: create systems of care that will maintain and improve our quality – we want planned, not chaotic, entry of new patients into our medical homes / active pt panels.

Presenter

Presentation Notes

Will review very briefly a few metrics on access /efficiency before proceeding to the core of presentation (clinical quality)

COPC – Utilization

Active Patient Panels of COPC PCCs =35,528 FY 08-09 Utilization (Visits and Undup Pts)

Total Visits 200,894, made by 40,873 undup pts Medical Visits 119,695, made by 34,402 undup pts:

9,386 (27%) were new to the PCC COPC Capitated patients: enrollment 9/09

HSF: 14,878 total – 28% Self-report NEW SFHP 11,181 total all lines of business Some are in “Shadow Panel” = enrolled but not yet

seen, thus not counted in the active patient panel

Presenter

Presentation Notes

How MUCH Care do we deliver ? - numbers above NOTE: 4123 or 28% of HSF self report that they are NEW to our system as of 9/09 (not validated stats, just self report). We do have our encounter and LCR assignment data that shows: 9386 New Patients moved into active Pt Panel of aggregate COPC PCC’s in FY 08-09, of these, 3518 were actually new to DPH primary care, the rest represent pts moving around inside DPH Primary Care)

Efficiency/Productivity Improvement

Focus: increase Active Patient Panel at 8 COPC / HSF “medical homes” Minimum Panel size standards set: 1125 /1.0 fte

Tools for measuring and tracking capacity “shadow panel”, panel flux reports

Primary Care Redesign Project Demand moderation: return intervals, frequent flyers New Models of Care: telephone visits, group visits Team Care, health coach training, population

management

Presenter

Presentation Notes

Access at the core COPC clinics that are 8 HSF medical homes – our question: Is there additional capacity? How do we measure capacity? Range of average panel size/fulltime FTE across core COPC 8 is low of 1032 low to =>high of 1447 at OPHC (7/09)�what we have done on this issue?: Defined MINIMUM PANEL SIZE standard for PCPs for first time – and provided data on prorated panel size for each PCP (goal: decrease variability) Defined and reported stats for “shadow panel” and attrition rate (how many new pts have to be scheduled just to replace normal attrition from panel). Instituted new ways to “touch”pts that are more efficient that traditional 1 doc/ 1 room / 1 patient model

Active PCC Panel per Clinical FTE among COPC8 clinics

0200400600800

100012001400

Feb 08 Jun 08 Oct 08 Feb 09 Jun 09 Oct 09

COPC 8 PANEL SIZES (6/09): Active Patient Panel aggregate COPC 8 = 26,456Average panel size/fte for aggregate COPC 8 clinics rose from 1040 (2/08) to 1138 (6/09) Also growing: COPC 8 Shadow Panel = 8,923 enrollees

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Presentation Notes

Progress to date: AS OF END OF FY JULY 09: AVERAGE PANEL SIZE / FTE FOR all COPC clinics combined = 925 (35 FTE PROVIDERS) AVERAGE PANEL SIZE / FTE FOR COPC 8 clinics combined 1138 (23 FTE PROVIDERS) As of JULY 2009: aggregate COPC 8 Active Pt Panel =26,456 pts - at the same time COPC 8 Shadow Panel = 8923

COPC Efficiency Measures Measure Frequency NotesPANELSActive panel size q 3 mo

Active panel size per clinical FTE q 3 mo Adjusted active panel size q 3 mo Adjusted active panel size per clinical FTE q 3 mo Avg medical visits to PCC per patient per year Yearly % of active PCC panel with PCP q 3 mo EFFICIENCY and ACCESSNo show rate q 3 mo Third next available appointment q 3 mo Requires manual sampling.Panel flux (attrition from patients leaving, new pts) q 3 mo MD visits per hour (productivity) q 3 mo NP visits per hour (productivity) q 3 mo Cycle time q 3 mo Requires manual sampling.

Presenter

Presentation Notes

These are the efficiency measures we plan to put on the PC QUALITY DASHBOARD in 2010n for 2010) – currently we generate all this data – most on a schedule (Q 3 or 6 mo, or annual), a few measures are still ad hoc reports – goal is periodic routine data on a schedule in 2010 – note our planned frequency for each report

Clinical Quality: centralized reporting on measures for all COPC Active Pt Panels

Measure Frequency Notes

QUALITY

DM with HgA1c testing in past year q 6 mo NCQA/HEDIS

DM with most recent HgA1c <7, <8< , and > 9 in past year q 6 mo 2010 NCQA/HEDIS

DM with LDL testing in past year q 6 mo NCQA/HEDIS

DM with most recent LDL < 100 in past year q 6 mo NCQA/HEDIS

% of adults age 65 and over with pneumococcal vaccination ever q 6 mo USPSTF, ACIP

% of adults age 22 and over with tetanus vaccination in past 10 years

Q 6 mo ACIP

Lipid screening among men ≥ 40 yrs old and women ≥ 50 yrs old Q 12 mo USPSTF

Women age 42-51 with breast cancer screening in past 2 yearsWomen age 52-69 with breast cancer screening in past 2 years

q 3 mo USPSTF, NCQA/HEDIS

Women age 24-64 with cervical cancer screening in past 3 years q 3 mo USPSTF, NCQA/HEDIS

Adults age 51-75 with colorectal cancer screening q 3 mo USPSTF

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Presentation Notes

MOVING on to dashboard QUALITY MEASURES: list of currently reported quality data. Top 4 = chronic care measures, the rest = prevention/screening /HCM measures. Currently reported on a schedule through the PC QI committee. we always run the reports for both on and off campus PC clinics – increasing collaboration around these measures. Agreement reached in PC: SFDPH uses USPSTF clinical guidelines and AHRQ/HEDIS Reporting definitions for HCM measures. Requires discussion with speciality services in some cases

Diabetes HgA1c & LDL Testing

Primary Care Reporting Group, Community Oriented Primary Care, SFDPH, 07/2009

Presenter

Presentation Notes

Examples of reports – all are produced down to the clinic level, here I display aggregate data for 3 entities: COPC network, SFGH PC (GMC and FHC) and then all together (labeled as CHN Primary Care) V. proud of progress in appropriate testing for diabetics. Note: as testing goes up, capture more pts not in good control (to be expected). Data shown for HA1C values <7 and <8 is % of ALL diabetic pts (AS PER HEDIS definitions) For HA1C value >9, the rate reflects the % of those tested – does not include those not tested at all into the numerator.

Adult Immunizations in Primary Care


Pts age 22 and over with tetanus vax within 10 yrs

Pts ≥ 65 yrs old with pneumococcal vaccine

in lifetime

For Pneumovax: TWHC (50% to 73%), HUH (35% to 55%) had biggest gains.

Presenter

Presentation Notes

Steady gain over course of measurement Note: buried inside these aggregate figures: saw BIG gains in documentation of Pneumovax in high risk populations of TWHC and HUH

Lipid screening among men ≥ 40 yrs old and women ≥ 50 yrs old (USPSTF A)(USPSTF Rec: screen q 5 yrs, starting at men age 35, women age 45)


Women’s Cancer Screening


September 2009 Eligible Women by Age Range

Age 24-64 Age 42-69 Age 52-69

COPC Subtotal 12,645 9,879 6,795

SFGH Subtotal 10,298 5,900 3,704

CHN TOTAL 22,943 15,779 10,499

Presenter

Presentation Notes

Mammo access at SFGH very difficult this year, only recently eased up. These stats, showing modest recent increase, reflects big workflow change to aggressively support sending women out of our system if possible (MediCal, MediCare, BCCP funding). Screening Rates should be higher, Primary Care very interested in developing smoother, more patient centered reminder and direct (by the pt) scheduling systems.

COPC Allergy documentation in the LCR

Allergy Data for COPC Primary Care Clinics FY 08-09

75%62%

78% 77% 78%

30%

53%

43%31%28%

86% 79%93% 97%88%

0%20%40%60%80%

100%120%

July-08 October-08 January-09 April-09 July-09

COPC SPY OPHC

Presenter

Presentation Notes

Allergy documentation showing aggregate COPC, and the range from lowest to highest performer on documentation of allergies for patients of that HC seen in our system in that month.

COPC Fiscal Year 08-09 External Audits

Auditing Agency Sites Visited Results

HIV Qual / CARE – June 2008

TWHC, CHPY Results Pending

Anthem Blue Cross-October 2008

TWHC PASS

Title X Family Planning – December 2008

CMHC, MHHC, SAFHC,CPHC, CHPY

Addressed all findings and recommendations.

Health Care for the Homeless- July 2009

CMHC, TWHC Results Pending – due in November

San Francisco Health Plan : FY 08-09

CHPY, CMHC, PHHC, MHHC,OPHC, CPHC, SEHC, TWHC

All facility Site Reviews were 96% plusAll Chart Reviews were 94% plus

Presenter

Presentation Notes

Want to thank Maitri Vaidya, QM analyst, for good work creating database of external auditors, relationships with these organizations, and troubleshooting the many site visits and audit reports/responses at our network of clinics

UO Categories in COPC clinics COPC- UO's by type FY 08-09Top 5 categories (225 of 273)

35 3225

112

22 25

36

1621

05

10152025303540

Treatment-DiagnosisConsentIssues

Medication-Drugs

Safety/Security

Laboratory MedicalRecords

Q3-4_2008 Q1-2_2009

Presenter

Presentation Notes

Note increase security / safety – almost all at TWHC: challenging population and physical plant Medical Records issue new: this is all related to errors in progress notes in LCR that require a UO to correct

2009 Health Center Data Driven QI ProjectsAll Health Centers responsible for 2 Data Driven QI projects (2009 = YR 2)9 Health Centers participating in HSF Strength in Numbers PCC PERF MEASURE # 1 PERF MEASURE # 2 SIN project

CMHC Chronic Disease: DM Allergy documentation Chronic Pain Mgmt 02MHHC HCM: lipid screening HCM: adult IMZ Chronic Pain Mgmt 03SAFHC HCM: Ca screen (Pap) HCM: CRC screening HCM: CRC screening

04CPHC HCM: CRC screening Chronic Disease: DM Chronic Disease: Hep B 05OPHC Chronic Disease:

Depression HCM: adult IMZ Chronic Disease:

Depression

06PHHC HCM: CRC screening Chronic Disease: DM Chronic Pain Mgmt 07SEHC Chronic Pain Mgmt HCM: CRC screening HCM: CRC screening 08TWHC HCM: adult IMZ HCM: CRC screening Chronic Disease: HIV HUH Chronic Disease: DM Chronic Disease: CV N/A

CSS Chronic Disease: DM HCM: adult IMZ N/A

Presenter

Presentation Notes

This is QI work at the health center level: some based on our centralized data reporting, some improvement projects reflect the specific patient population. Data Driven Projects x 2 required annually by me as PCQI chair (started 2008) - also now see participation in Strength in Numbers Incentive Program (HSF funding through SFHP) SFHP Strength in Numbers YEAR 1: Diabetes only, short timeline YEAR 2: 8 clinics, year 1 DM measures, year 2 DM plus one other Note 5 Colorectal Cancer SCREENING AND 4 CHRONIC PAIN PROJECTS – OVERALL MORE EMPHASIS ON population management of HCM (Health Care Maintenance) For chronic conditions: addition of CHRONIC PAIN AND DEPRESSION as topics Rules for Data Driven QI Projects: Determine Baseline data / Set explicit target improvement goal to be reached by end of year / Design a strategy for improving results Re--measure and analyze results of interventions mid year and end year

Primary Care: 2009 focus on improved prevention /screening measures As part of planning for HSF: PC QI worked with

PCRG and i2i workgroup to develop Population Management tools for HCM interventions Expanded centralized reports on Health Care

Maintenance measures Updated HCM field in LCR, built interface into i2i. Now can easily preview HCM prior to clinic visit,

generate outreach / reminder lists, do statistical reporting.

Demonstrated tools, supported pilot efforts, Result is increased focus on HCM at health centers

Presenter

Presentation Notes

Innovative Programs: example of population management and team care

CPHC: Goal: 70% Td or Tdap Baseline: 56% (November 2008) QI strategies:

Train nursing staff to conduct pre-visit chart and LCR preview to identify patients due for Td / Tdap

Create standing orders to routinely administer vaccine

40%50%60%70%80%90%

100%

Nov-08 May-09 Jun-09 Jul-09 Aug-09 Sept-09

Tetanus: % of adults age 22 and over withdocumented vaccination in past 10 years

Presenter

Presentation Notes

Example of the power of reporting: first tetanus IMZ data Nov 08: CPHC not pleased w/ rate, started nursing staff effort to collect data on prior immunizations from outside sites, new workflow to offer IMZ to all eligible patients seen in clinic. Jumped 6 %age pts in 6 mo. Then continued to track monthly – now at 70% and new goal set for 90%

Why focus on preventive care? Significant disparities in receipt of preventive care

services among racial/ethnic groups and poor. Only 10% of female Medicare beneficiaries received all of 5

recommended preventive care measures (cervical, breast and colorectal cancer screening; pneumovax and influenza vaccines).

General Accounting Office congressional testimony on 3/23/02, available: www.gao.gov/cgi-bin/getrpt?GAO-02-777T.

Barriers to screening in Safety Net Patient Financial barriers, System resource constraints Literacy, language, and cultural barriers Conflicting guidelines for PCPs

7.4 hours/day to provide all USPSTF “A” and “B” services Yarnell KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care:is there enough time for prevention? American Journal of Public Health 2003; 635-641.

Slide courtesy of Alice Chen, M.D.

Presenter

Presentation Notes

We worked closely with GMC and FHC on this effort – next 3 slides courtesy of Alice Chen – part of a presentation on use of USPSTF guidelines our safety net settings

http://www.gao.gov/cgi-bin/getrpt?GAO-02-777T�

SFDPH Primary Care Approach Agreement on evidence-based guidelines, tailored

to our system’s resource constraints USPSTF guidelines - posted at Treatment Guidelines Clear referral guidelines for abnormal screening tests

Harness information technology EMR and Patient registry – LCR HCM, i2iTracks AHRQ electronic Preventive Services Selector

Systems interventions Standing orders Population Management (staff training MEAs, HW’s) Culturally and linguistically appropriate outreach

Slide adapted from Alice Chen, M.D.

Presenter

Presentation Notes

Our strategy: SFDPH’s Primary Care/Specialty Care working together on successful screening programs, backed up by specialty / diagnostic services

Example: CRC Screening Improvement Clear evidence-based guidelines, agreed upon by

both GI and PC, compatible with DPH resources SF DPH recommends annual FOBT,for screening, with

diagnostic colonoscopy for abnormals (USPSTF)

Use of HCM field in LCR for data entry and reminders, i2iTracks for reporting and outreach

Systems interventions Population Management – staff training (MEA’s, HW’s) to

capture data (ouside colonoscopies) and encourage FOBT Standing orders to dispense FOBT cards if due Culturally / linguistically appropriate outreach

Slide adapted from Alice Chen, M.D.

CRC Screening in SFDPH Primary Care 38%

57%

28%

36%

67%

33%

47%

36%

13%

15%

46%

48%

43%

47%

41%

46%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Castro-Mission Health Center

Chinatown Public Health Center

Curry Senior Center

Maxine Hall Health Center

Ocean Park Health Center

Potrero Hill Health Center

Silver Avenue Family Health Center

Southeast Health Center

COPC8 Subtotal

Housing and Urban Health

Tom Waddell Health Center (PCP panel)

COPC Subtotal

Family Health Center

General Medicine Clinic Ward 1M

SFGH Subtotal

CHN TOTAL

% age 51-75 with colorectal cancer screening(Data capture for colonoscopies not complete at some PCCs)

Presenter

Presentation Notes

Generated first report from i2i on CRC screening rates in COPC and SFGH PC clinics. NOTE the following: Data capture of outside colonoscopies not complete across clinics – some have done data backload from paper charts, others not. Benchmarks to compare: SF Kaiser (2007) CRC screening rate (Ca Office of the Patient Advocate = 58%) HEDIS 2008 Commercial 55.6%, MediCare 50.4%, and no MediCaid stat reported. National screening rate generally cited at 50-60% overall. Area of health disparities: recent study: AACR news release “ nationwide rate of colorectal cancer screening is 61 percent, with much of the lack of screening concentrated among blacks, Hispanics and those without insurance. However, results of a study published in Cancer Epidemiology, Biomarkers & Prevention, a journal of the American Association for Cancer Research, showed that the screening rate was merely 22 percent among individuals served by a safety net health system in Texas.” http://www.aacr.org/home/public--media/aacr-press-releases.aspx?d=1517

How did CRC rates improve at 2 clinics? FLU-FOBT program at Chinatown PHC. Led by Mike

Potter, Albert Yu) with CDC funds 2008: results: Flu shot only: 52.9% 57.3% eligible completed FOBT Flu shot+ FOBT: (education and pre-paid mailer)

54.5% 84.3% eligible completed FOBT Difference of 25.4 points, p<0.001

Potter MB, Phengrasamy L, Hudes ES, McPhee SJ, Walsh J. Offering annual fecal occult blood tests at annual flu shot clinics increases colorectal cancer screening rates. Annals of Family Medicine 2009; 7:17-23.

Overall CPHC rate Sept-09 = 57%7 COPC clinics to participate in similar program 2009 flu season

Ocean Park HC – gains all achieved with population management by MEAs and HWs – sustained effort over 18 months Baseline Jan-08 = 40%, Sept -09 = 67%

Slide courtesy of Albert Yu and Mike Potter

Presenter

Presentation Notes

Chinatown PHC: intervention was to offer FOBT with educational info and pre-paid mailer packet to patients coming in for flu shot. Ocean Park HC: stepwise workflow change, including careful training of Medical Assistants and clinic wide focus on process and tracking results. No longer the sole responsibility of the PCP!!

Presenter

Presentation Notes

Tools to support population management of CRC screening: HCM field in LCR: NOTE: link to screening guidelines at AHRQ website, also to local guidelines if applicable data on most recent screening test brought in from anywhere in the LCR to this field for easy review

Presenter

Presentation Notes

HCM field in LCR – this is the data entry field for date of any screening done outside of SFGH All data on this field is interfaced to the i2i disease registry which can generate screening rates and outreach work lists, etc.

Depression Program at OPHCWhy? 5th OPHC dx, co-morbidity w/ chronic disease, need to

treat in Primary Care AIM: By July 2009, screen 80% of DM patients (PHQ tool) How? Adapt IMPACT Model: 4 elements Screen in Primary Care with PHQ-2/9 tool: 494 DM pts Develop New Role: Depression Care Manager

Internationally trained behavioral health workers working as a team with Social Worker

education, SMGs, monitors depression sx closely, f/u on meds, consults with providers, social worker/ psychiatrist

Psych back-up consultation q week - CBHS collaboration Tracking process and outcome measuresTo date at 5 mos: 80% of diabetics screened. Of those

screened, PHQ score for 25% = mild (9%) or moderate (16%) depression.

Slide courtesy of Lisa Golden, MD

Presenter

Presentation Notes

Institute on Aging was just awarded $900K / 1 yr to set up similar in COPC network RESULTS: Screening: 80% of POF (Population of Focus) screened by Dec 2009. PROCESS MEASURES AND GOALS: 80% of POF with PHQ 9 ≥ 10 will have received initial assessment < 4 weeks 80% of patients diagnosed with depression will have a documented PHQ Reassessment betw 4-8 wks 80% of patients with depression will have a self-management goal documented < 12 months. CLINCAL MEASURES AND GOALS 50% of patients with depression will have 5 point reduction in PHQ9 score within 6 months of their last New Episode So FAR: 51% w/ initial assessment at 4 weeks, and 31% w/ f/u assessment at 8 to 10 weeks.

PC Chronic Pain Management Initiative Feb 08: SFDPH-Wide Pain Taskforce Report– SFGH focus April 09: Primary Care Pain Workgroup (SFCCC, SFGH PC , COPC)

-- commitment to uniform minimum standard of care

August 09: COPC Chronic Pain Management Policy and Procedureapproved by PC QI – links to tools / templates • Informed Consent for Long-Term Controlled Substances Therapy for Chronic Pain • Patient-Provider Agreement for Long-Term Controlled Substances Therapy for

Chronic Pain • Chronic Pain Assessment and Treatment Plan Documentation Form

in draft: “Special Circumstances in Use of Controlled Substances in the Treatment of Chronic Pain: Inappropriate Use and Diversion".

Registry Use at 6 clinics (5 COPC and GMC): 1594 patients identified on chronic opiate pain management (7%

of the combined active pt panel of those 6 clinics) Measures selected (example: % with pain contract in chart)

Presenter

Presentation Notes

PURPOSE: “The purpose of this policy is to define minimum standards in the approach to chronic pain management provided within COPC ……outlines the procedure by which clinics assess chronic pain, develop and monitor individualized treatment plans and document pain management in the medical record.”

Chronic Disease: PHASE Program Preventing Heart Attacks and Strokes Everyday

Kaiser funding to replicate in safety net settings

Goal: embed evidence-based CV risk reduction guidelines in day-to-day practice. Emphasis: med adherence (ASA, Statin, b-blocker, ACE-Inh) Lifestyle change: smoking cessation, diet, exercise

Implemented in 4 SFDPH clinics Jan 2008 - OPHC, CPHC, GMC, FHC - $400K over 2 years Funds used for staff training in TEAM CARE skills (panel

managers, health coaches, registry use) – partnered with Dr. Tom Bodenheimer and his training team

Applied for PHASE 2 (2010-1011) $300,000 over 2 yrs to expand program to total of 7 PHASE sites

SFDPH PHASE Results 9-09Percent of Total DM Patients with HbA1c < 7, <8

35 38 36 36 35 36 36 36 36

5761 60 61 60 62 62 63 64

343536 3535 35 35

555657 55 5656 56

0

10

20

30

40

50

60

70

80

90

100

7/1/

2008

8/1/

2008

9/1/

2008

10/1

/200

8

11/1

/200

812

/1/2

008

1/1/

2009

2/1/

2009

3/1/

2009

4/1/

2009

5/1/

2009

6/1/

2009

7/1/

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8/1/

2009

9/1/

2009

10/1

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911

/1/2

009

12/1

/200

9

1/1/

2010

% ofPatients with

HbA1c < 7

% ofPatients withHbA1c < 8

Goal for %of Patientswith HbA1c< 7

Goal for %of Patientswith HbA1c< 8

(N = 993)

Percent of Patients with LDL < 100

50 52 53 54 54 56 58 59 60 59

5249

48

48

47

47

0

10

20

30

40

5060

70

80

90

100

7/1/

2008

8/1/

2008

9/1/

2008

10/1

/200

8

11/1

/200

8

12/1

/200

8

1/1/

2009

2/1/

2009

3/1/

2009

4/1/

2009

5/1/

2009

6/1/

2009

7/1/

2009

8/1/

2009

9/1/

2009

10/1

/200

9

11/1

/200

9

12/1

/200

9

1/1/

2010

(N = 1122)Percent of Patients with BP< 130/80

38 38 38 37 37 37 38 39 41

38

38

36

36

33

32

30

0

1020

30

40

5060

70

8090

100

7/1/

2008

8/1/

2008

9/1/

2008

10/1

/200

8

11/1

/200

8

12/1

/200

8

1/1/

2009

2/1/

2009

3/1/

2009

4/1/

2009

5/1/

2009

6/1/

2009

7/1/

2009

8/1/

2009

9/1/

2009

10/1

/200

9

11/1

/200

9

12/1

/200

9

1/1/

2010

(N = 1122)

Population Size in Registry: All Patients at All Sites

500600700800900

100011001200130014001500160017001800190020002100220023002400

6/1/

2008

7/1/

2008

8/1/

2008

9/1/

2008

10/1

/200

811

/1/2

008

12/1

/200

81/

1/20

092/

1/20

093/

1/20

094/

1/20

095/

1/20

096/

1/20

097/

1/20

098/

1/20

099/

1/20

0910

/1/2

009

11/1

/200

912

/1/2

009

1/1/

2010

PopulationSize inRegistry

Subpopulation

N = 1193

DM patients (N = 1051)

SFDPH PHASE Results 9-09Percent of Patients on ASA

64 6671 72 73 74 75 77 77 79 79

68655546

44

20

30

40

50

60

70

80

90

100

7/1/

2008

8/1/

2008

9/1/

2008

10/1

/200

8

11/1

/200

8

12/1

/200

8

1/1/

2009

2/1/

2009

3/1/

2009

4/1/

2009

5/1/

2009

6/1/

2009

7/1/

2009

8/1/

2009

9/1/

2009

10/1

/200

9

11/1

/200

9

12/1

/200

9

1/1/

2010

(N = 1122)Percent of Patients on Statin

48

7175 76 76 77 79 80 82 83 84

737068

58

47

20

30

40

50

60

70

80

90

100

7/1/

2008

8/1/

2008

9/1/

2008

10/1

/200

8

11/1

/200

8

12/1

/200

8

1/1/

2009

2/1/

2009

3/1/

2009

4/1/

2009

5/1/

2009

6/1/

2009

7/1/

2009

8/1/

2009

9/1/

2009

10/1

/200

9

11/1

/200

9

12/1

/200

9

1/1/

2010

(N = 1122)

Percent of Patients on ACE/ARB

48

7075 75 76 78 80 81 82 83 84

7268

66

5647

20

30

40

50

60

70

80

90

100

7/1/

2008

8/1/

2008

9/1/

2008

10/1

/200

8

11/1

/200

8

12/1

/200

8

1/1/

2009

2/1/

2009

3/1/

2009

4/1/

2009

5/1/

2009

6/1/

2009

7/1/

2009

8/1/

2009

9/1/

2009

10/1

/200

9

11/1

/200

9

12/1

/200

9

1/1/

2010

(N = 1122)Percent of Patients on all 3 medications (Statin,

ASA, ACE/ARB) (N=1122)

30

4550 51 51 52 54 55 56 59 60

36

4345 47

2920

30

40

50

60

70

80

90

100

7/1/

2008

8/1/

2008

9/1/

2008

10/1

/200

8

11/1

/200

8

12/1

/200

8

1/1/

2009

2/1/

2009

3/1/

2009

4/1/

2009

5/1/

2009

6/1/

2009

7/1/

2009

8/1/

2009

9/1/

2009

10/1

/200

9

11/1

/200

9

12/1

/200

9

1/1/

2010

SFDPH PHASE Results 9-09Percent of Patients with Documented

Self-Management Goal EVER (N = 1122)

2934 37 41 43 44 45 47 48 50 51 52

28 31 3639

0

10

20

30

40

50

60

70

80

7/1/

2008

8/1/

2008

9/1/

2008

10/1

/200

8

11/1

/200

8

12/1

/200

8

1/1/

2009

2/1/

2009

3/1/

2009

4/1/

2009

5/1/

2009

6/1/

2009

7/1/

2009

8/1/

2009

9/1/

2009

10/1

/200

9

11/1

/200

9

12/1

/200

9

1/1/

2010

Percent of Patients with Foot Exam

34 38 4047

51 53 54 55 57 59 59 58

4539

353220

30

40

50

60

70

80

90

100

7/1/

2008

8/1/

2008

9/1/

2008

10/1

/200

8

11/1

/200

8

12/1

/200

8

1/1/

2009

2/1/

2009

3/1/

2009

4/1/

2009

5/1/

2009

6/1/

2009

7/1/

2009

8/1/

2009

9/1/

2009

10/1

/200

9

11/1

/200

9

12/1

/200

9

1/1/

2010

DM patients (N = 993)

Percent of Patients with Retinal Exam

32 32 30 3338 39 41 40 45 48 49 49

33313233

0

10

20

30

40

50

60

70

80

90

100

7/1/

2008

8/1/

2008

9/1/

2008

10/1

/200

8

11/1

/200

8

12/1

/200

8

1/1/

2009

2/1/

2009

3/1/

2009

4/1/

2009

5/1/

2009

6/1/

2009

7/1/

2009

8/1/

2009

9/1/

2009

10/1

/200

9

11/1

/200

9

12/1

/200

9

1/1/

2010

DM patients (N = 993)Percent of Patients with Smoking Status

Documented (N = 1122)

62 66 67 68 71 7381 84 87 88

14

58

59

6065

140

10

20

30

40

50

60

70

80

90

100

7/1/

2008

8/1/

2008

9/1/

2008

10/1

/200

8

11/1

/200

8

12/1

/200

8

1/1/

2009

2/1/

2009

3/1/

2009

4/1/

2009

5/1/

2009

6/1/

2009

7/1/

2009

8/1/

2009

9/1/

2009

10/1

/200

9

11/1

/200

9

12/1

/200

9

1/1/

2010

Future directionsCollaborations to coordinate care in SF SF DPH Primary Care Clinics + SFCCC Clinics Primary Care (COPC) + Behavioral Health (CBHS) Integration Kaiser Specialty Care Initiative (Specialty + Primary Care Co-

Management of Chronic Conditions) SFHP / HSF QI Committees

Move to Standard Quality Measures in Safety Net Clinical Quality / Efficiency / Patient + Staff experience

Measures CPCA Standard Measures Group membership CAPH –Safety Net institute : Seamless Care Initiative (QI

Leaders Group membership)

SFDPH Primary Care Dashboard development

Presenter

Presentation Notes

Exciting time in Primary care nationally: focus on redesign of the care model, increased use of data to drive innovation and improvement. COPC increasing collaborations with other organizations within and outside of SFDPH – regionally and statewide safety net providers. I have been invited to sit on 2 bodies convened to promote SHARED QUALITY MEASURES across safety net: striving for consensus on definitions, standardization of measures used by funders and regulatory bodies, hopefully move over time to more transparency in results reporting CAPH – SNI for public hospital networks, CPCA for networks / consortia of FQHC/ federally funded community clinics. I have been asked to particpate in both shared measure workgroups. CAPH-SNI Goal Statement: “to serve as a set of shared primary care measures and goals for primary care clinical quality and efficiency across the entire CAPH membership. We plan to take the final grant program dashboard to the CAPH board for consideration of statewide adoption, in early 2010.” CPCA SMG (Standard Measures Group): “Goal of SMG :…to standardize set of clinical measures across multiple clinics in the state”. PLAN: 2010 SFDPH Primary Care Dashboard development – core measures already in development - awaiting results of proposal to KP for funding to facilitate the project at a higher level.

quality improvement program 2009 annual report to pips report...copc primary care clinics last ......

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