Quality in Rural Health Care: Innovations in Planned Care at the Sells Service Unit

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Quality in Rural Health CareInnovations in
Planned Careat the Sells Service Unit
CAPT Lisa Tonrey Director of Professional
Services
June 11, 2008

• Peter Ziegler, MD
• Clinical Director

Sells Service Unit Tucson Area Indian Health
Service
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Innovations in Planned Care
Sells Service UnitPerformance Improvement Plan
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Tohono Oodham Nation
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• 11 Districts
• 3M Acres
• 76 Mile Border
• Members 28K
• Reservation- 13,000
• OIM 1,500
• Off-Reservation- 13,500

The Tohono Oodham Nation
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IPC-Pilot Sites
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Planned Care

• A proactive approach to health care that
  involves an informed, empowered patient working
  together with a prepared practice team. The care
  interaction is
• Patient driven
• Timely and efficient
• Coordinated
• Evidence-based

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The Health System in the Past?
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Current System

• We are tired of saying
• Sorry you had to wait so long to see me
• Sorry that I did not call you back
• Your test was normal three months ago
• Sorry, we need to send you back to the lab for
  more blood tests
• Let me see where I can overbook you so that I
  can see you next month
• But you missed your last appointment

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Sells Service Unit Aim Statement

• Create a system-wide patient centered
  environment of care focused on improving health
  and quality of life through a multidisciplinary
  approach.

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Priorities

• Create a Medical Home
• Improve Access to Care
• Patient-Centered Care

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Care Model
Health System Leadership
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems
DeliverySystem Design
Self-Management Support
Decision Support
Productive Interactions through effective asset
based partnering over time
Informed, Empowered Patient and Family
Prepared, Proactive Practice Team
Patient Driven
Coordinated
Timely and Efficient
Evidence-based and Safe
Improved achievement of patient and community
goals
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Leadership

• Sells Service Unit CEO sponsorship of the
  Innovations in Planned Care (IPC) at Sells
• Tucson Area Director supportive of IPC
• IPC was endorsed by leadership as the Performance
  Improvement Plan for the entire Sells Service
  Unit
• Increasing awareness of the Initiative and
  involvement by all SSU departments

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Get on the BusApril 4, 2008

• Patient and Staff surveys identified priorities
• Customer Service
• Teamwork
• Focus upon the Innovations in Planned Care
• Get on the Bus Toward Improvement

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Care Model
Health System
Community
Health Care Organization
Resources and Policies
DeliverySystem Design
ClinicalInformationSystems
Self-Management Support
Decision Support
Productive Interactions through effective asset
based partnering over time
Informed, Empowered Patient and Family
Prepared, Proactive Practice Team
Patient Driven
Coordinated
Timely and Efficient
Evidence-based and Safe
Improved achievement of patient and community
goals
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Delivery System Design

• Identified a Microsystem for testing change
• Patient Empanelment
• Improve Access to Care Team
• Nurse Case Managers providing leadership in the
  care team and as liaison with patients
• Phone system infrastructure improvements
• Care Team Tools such as Appointment Cards with
  reminders and information

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Delivery System Design

• Alternative care delivery models including Group
  Visits
• Improving pharmacy services
• Pharmacist in outpatient clinic area to meet with
  patients immediately after the visit with Doctor
• TV Monitor of patient names who have medications
  ready for pickup

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Sells Service UnitTeam Huddles Cut Cycle Time
by 65!

• Case Managers and Nurse lead huddles
• Pharmacist in Clinic at point of care
• Patient Registration involved to streamline visit

• Change in chart routing and location
• Sponsor (CEO) and Nurse Exec involvement has been
  critical to accelerating progress

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Delivery System Design

• Create a welcoming environment for patients
• Patient Advocate volunteer program
• Mural Painting in a patient education and meeting
  area
• Mural Paintings in new facility at San Xavier
  campus

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Delivery System Design

• Created a Direct care Ophthalmology program to
  improve services on-site and off-site (St. Joseph
  Hospital in Tucson)
• Redesign of clinical space at San Xavier Health
  Center
• Family Care Model
• New Physical Therapy Services

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In August 2007, the TAO Facilities Board approved
a proposal to convert the old SX Dental building
into clinical space that would provide physical
therapy and space for other clinics that fit into
the SSU organizational wide PI Project,
Innovations in Planned Care (Chronic Care
Collaborative).
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Apedag Juki Ki The Healing Rain House

• Innovations In Planned Care IPC
• Creating a system-wide patient centered
  environment
• of care focused on improving health and quality
  of life
• through a multidisciplinary approach

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Apedag Juki Ki The Healing Rain House Blessing
and Dedication April 8, 2008
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End Medical Homelessness
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Delivery System DesignFuture Plans

• Continue to improve patient access to pharmacist
  and medication delivery
• Pharmacist in outpatient setting to improve
  efficiency of medication review and dispensing
• Optimize medication refill phone line
• Improve medication refill process and efficiency
• Partner with VA on medication refill (CMOP)
• Pursue telemedicine options in Emergency Room,
  Radiology, and Nutrition Counseling Services

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Care Model
Health System
Community
Health Care Organization
Resources and Policies
ClinicalInformationSystems
DeliverySystem Design
Self-Management Support
Decision Support
Productive Interactions through effective asset
based partnering over time
Informed, Empowered Patient and Family
Prepared, Proactive Practice Team
Patient Driven
Coordinated
Timely and Efficient
Evidence-based and Safe
Improved achievement of patient and community
goals
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Clinical Information SystemsCurrent Activity and
Future Plans

• Full integration of Resource and Patient
  Management System (RPMS) for all SSU Clinical
  Sites (Unified Database)
• Full implementation of the Electronic Health
  Record
• Full integration of iCare Case Management into
  Care Team efficiency
• Intranet to make resources available at point of
  care

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Care Model
Community
Health System Leadership
Health Care Organization
Resources and Policies
ClinicalInformationSystems
DeliverySystem Design
Self-Management Support
Decision Support
Productive Interactions through effective asset
based partnering over time
Informed, Empowered Patient and Family
Prepared, Proactive Practice Team
Patient Driven
Coordinated
Timely and Efficient
Evidence-based and Safe
Improved achievement of patient and community
goals
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Community Resources

• Community Members are part of our Core Team
• Monthly Collaborative Meetings to share ideas
• Include Community Partners in the meetings
• Tohono Oodham Behavioral Health Program (TOBH)
  participation
• Participation in Training Sessions
• Murals painted by youth

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Community Resources

• Participation in Community Events
• Health and Wellness Fair
• Rodeo Days
• Womens Wellness Day
• KOHN Radio weekly Health Show
• Work with Legislative Council to pass initiative
  to address childhood obesity through the schools
  and community

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Community Resources

• Developing partnerships with local, tribal, and
  other community resources to address disparities
  in care delivery, improve care management.
  Immediate plans include
• CHR Program
• Health Transportation
• TOPD
• Elder Care Consortium

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In summary.
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Key elements of success and enthusiasm include

• CEO and Leadership are sponsors
• Care Model adopted as SSU-wide PI project
• Clinical Staff are engaged
• Successful in weekly Team teleconference
• Opportunity to share ideas and demonstrate the
  high level of activity
• Community members are active participants in our
  improvement efforts

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Key elements of success and enthusiasm include

• New Nurse Case Manager positions
• Leadership in Care Team
• Acceleration of improvement efforts
• KOHN Health Show
• Team Huddles improving efficiency
• New technology tools EHR, iCare, Intranet
• Progress toward SSU unified RPMS database

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Key elements of success and enthusiasm include

• Productive dialogue with Community Partners
• Improving partnerships with Community and Tohono
  Oodham Health Department Programs
• Improving spaces in Sells Hospital to create a
  welcoming environment
• Mural Painting in Library
• Patient Advocate Program

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To be Continued
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Questions?

• Peter Ziegler, MD, SSU Clinical Director
• 520-383-7211
• Peter.Ziegler_at_ihs.gov
• Lisa Tonrey, Director Professional Services
  520-383-7251
• Lisa.Tonrey_at_ihs.gov