Maria Flores, MD

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Maria Flores, MD
Washington State Collaborative Learning Session
3 September 11-12, 2006
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Riverton Family Medicine

• Part of Highline Medical Group
• Service area Southwest King County
• 2 FP practice, 1 part-time ARNP
• 100 patients entered in pilot population, now
  starting 2nd group

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Aim Statement

• Riverton Family Medicine will redesign its office
  practice by implementing the Chronic Care Model
  in demonstrating measurable improvement in care
  of its diabetic patients. Ultimately, skills
  learned in being participants of this
  Collaborative will prepare us in improving care
  for other chronic illnesses.

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Measures

• 50 of our diabetic patients will have HgbA1C
  less than 7. 50 will have their most recent BP
  below 130/80 mm Hg, 50 will have LDL cholesterol
  less than 130 mg/dL, 40 will have a documented
  self management goal, 60 of tobacco users will
  be offered cessation counselling, average HgbA1C
  will decrease to 7.9 and average LDL will be 125
  within the year.

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The Planned Care Model
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Key Changes in Decision Support and Clinical
Information Systems
Health System
Community
Organization of Health Care
Resources and Policies
Self Management Support
Delivery System Design
Decision Support
Clinical InformationSystems

• Guidelines
• Specialty interaction
• Provider education
• Guidelines for patients

• Registry
• Care reminders
• Pt. Subgroups
• Care-planning

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Key Changes in Community Resources and Healthcare
Organization

• Get buy-in from all RFM staff to extract info and
  enter data to CDEMS
• Newly hired Chronic Care Support person for the
  organization

• Developed resource list for our community.
• Displayed list on Bulletin Boards in all exam
  rooms

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Barriers

• How do we get the data out of the charts onto
  CDEMS?
• Which computer?Where?
• Who will help?Skills?
• Too many patients, too little time.

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PDSA Data abstraction and input to CDEMS

• PLAN
• 1. Get updated list of DM patients from Billing
  Office.
• 2. MF to educate Medical Assistants how to
  extract data from charts.
• 3. Assign fastest typist to input data.
• 4. Get IS Dept to bring separate computer,
  printer and decide location.

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PDSA Data Abstraction

• DO
• 1. Lunch meeting with medical assistants for
  teaching
• 2. Front desk to get charts, Free MA to abstract
  data
• 3. MF and ARNP abstract data during free time.
• 4. IS installs a separate computer, printer

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PDSA Data Extraction

• STUDY
• 100 charts entered and extracted as of 7/06
• Difficulty with certain items on abstractions
• ?Errors in data? Ex. Smoking Assessment
• Unable to print out dataIS issue

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PDSA Data Extraction

• ACT
• Print-out of CDEMS Talk on CDEMS box as
  reference.
• As MF sees patients, correct data, review smoking
  data again
• IS to permit legitimate users to be able to
  access data, and print

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ltInsert 2-3 Run Chartsgt

• One that is going up based on activities that you
  tried
• One that is not what you expected based on what
  activities you tried

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Keys to Success

• Team work!
• Supportive staff
• Planning
• Clear documentation