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Posterboard Number:
69
Organization Name:
Crozer Keystone Health System/Camden Coalition of Healthcare Providers
Contact Name:
Wendell Kellum
Contact Email:
wekellum@gmail.com
Description:
The 2011 New Yorker article “The Hot Spotters” brought national attention to the work of Dr. Jeffrey Brenner who used hospital data to study geographic clustering of healthcare utilization in Camden, NJ. This is an update about the progress and lessons learned from work with one of the original hotspots.
Aim:
To improve quality and reduce cost in a residential “hotspot” of hospital-based healthcare utilization
Actions Taken:
Northgate II, a high-rise providing subsidized housing to seniors and people with disabilities, was on of the original “hotspots.” Several initiatives where undertaken to try to improve care and lower cost for the residents of the building – foremost of which was the establishment of a primary care practice onsite.
Summary of Results:
The onsite primary care practice did not successfully engage the majority of the highest utilizing residents. The experience gained from the initial interventions highlights the importance of segmentation, “the hotspot within the hotspot,” when working to improve care in geographically clustered areas of high utilization.
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Posterboard Number:
88
Organization Name:
Thomas Jefferson University
Contact Name:
Bryan Hess
Contact Email:
bryan.hess@jefferson.edu
Description:
An interdisciplinary practice effort, including 1 physician, 1 nurse practitioner, 1 coordinator, and 2 front desk staff, to reach out to patients with HIV to schedule medical visits with a prescribing provider, two or more times, at least 3 months apart, within a year.
Aim:
To improve the percentage of patients with HIV with a recent medical visit
Actions Taken:
A list of patients who meet the criteria is automatically generated and then distributed to staff, who call patients to schedule visits. The following week, a 2nd phone call is made to any patient now scheduled. The next week a letter is mailed to any patient not scheduled.
Summary of Results:
Improvement in scheduled appointments was immediate at 1-month follow-up for 60 days (42% to 53%) and 90 days (49% to 63%). Gradual improvement was seen in the retention of care measure but the holiday season and limitations in physician scheduling are likely barriers to further improvement.
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Posterboard Number:
48
Organization Name:
Novant Health
Contact Name:
Deanna Rattray
Contact Email:
djrattray@novanthealth.org
Description:
A need was identified at Novant Health to standardize the perioperative/periprocedure handling of anticoagulation therapy. As part of anticoagulation bridge therapy, patients need to understand somewhat complex bridge therapy plans clearly and be able to easily and safely transition between outpatient clinic and surgical or procedure areas.
Aim:
To improve the safety, patient education and communication of anticoagulation bridge therapy
Actions Taken:
Standardized bridge order forms were created, along with patient education templates. Patient education included calendars to help with visualizing anticoagulation bridge plans and enhance adherence. A pharmacist run clinic was established for 1/2 a week in a cardiology out patient practice.
Summary of Results:
Patients who are educated with the new standardized bridge forms appear to have a better understanding of their bridge plan and the plan is better communicated accross providers. The pharmacy run bridge clinic has been successful in helping with education and communication as well, including communication through the EMR.
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Posterboard Number:
9
Organization Name:
Barts Health NHS Trust
Contact Name:
Rebecca Ellard
Contact Email:
ellard.rebecca@gmail.com
Description:
Fragility fractures, the clinical manifestation of osteoporosis affect 9million people worldwide, and 300,000 in the UK, equating to £2billion/year in the UK. Unlike other chronic diseases, osteoporosis is poorly detected and managed. Early intervention at first fragility fracture can reduce further fractures by 50% and alleviate service pressures.
Aim:
Evaluate the management of fragility fractures, and raise awareness on the importance of early detection
Actions Taken:
Data was collected using an electronic database of all registered patients. The search used pre-determined Quality and Outcomes Framework (QOF) criteria and identified patients who had a fragility fracture, undiagnosed fragility fracture or low impact fracture (likely fragility fracture). Patients were assessed on appropriateness of their investigations, management and diagnosis.
Summary of Results:
We identified 51% of patients with a fragility fractures or potential fragility fractures, who had been incorrectly diagnosed and managed. Results highlighted poor detection and coding of fragility fractures, with consequentially absent osteoporosis management. A template was designed to identify at risk patients and guide on appropriate investigation and treatment.
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Posterboard Number:
15
Organization Name:
British Columbia Medical Association
Contact Name:
Rivian Weinerman
Contact Email:
rivian.weinerman@viha.ca
Description:
Most MH patients see Family Physicians (FPs) first. Specialists are few. A joint BC Medical Association/Ministry provincial QI module training over 1400/3300 FPs increased their comfort/confidence and patients’ experience with mental health issues. (1). We hypothesized that the training/tools could lead to a decrease in healthcare provider stigmatizing attitudes.
Aim:
Decrease healthcare provider stigma using QI module training/tools fitting FP time constraints/fees.
Actions Taken:
Successful office redesign using a BC QI MH change package including screening and Cognitive Behavioral Supported Self Management training/tools, led to a novel antistigma hypothesis tested in partnership with the Mental Health Commission of Canada (MHCC) Opening minds(OM) using a pre/post validated OM survey at Canadian Family Medicine Forum Workshop.
Summary of Results:
Survey results showed significant 10% decrease in healthcare provider stigmatizing attitudes, largest finding to that date by MHCC in any venture. This module provided behavior-changing tools that then changed attitudes. A Randomized Control Trial will now follow in partnership with BC/MHCC/Nova Scotia to formally test efficacy and antistigma effect.
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Posterboard Number:
85
Organization Name:
Silverman Institute for Quality and Safety, Beth Israel Deaconess Medical Center
Contact Name:
Carolyn Wheaton
Contact Email:
cwheaton@bidmc.harvard.edu
Description:
Traditionally, patient safety, quality and risk efforts have been focused on inpatient settings. An increase in outpatient visits and lawsuit/claims activity led to the recognition of the need to build an infrastructure to support safety/quality efforts in Ambulatory areas.
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Building An Infrastructure in Ambulatory Setting
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Posterboard Number:
64
Organization Name:
North Shore-LIJ Health System
Contact Name:
Fran Ganz-Lord
Contact Email:
ganzlord@gmail.com
Description:
In the current healthcare environment, everyone is being asked to do more with less. Using minimal funding, existing resources were leveraged to create an online quality dashboard at a mixed attending-resident practice. This dashboard has multiple levels of information—from practice and specific provider percentages to patient-level data.
Aim:
To build an online dashboard for easy distribution and tracking of quality metrics and initiatives.
Actions Taken:
Numerous outpatient quality reports were developed (13 on various outpatient measures and 8 specific to diabetes management). A secure online site was located and 5 reports were chosen for the initial display based on overlap with PCMH initiatives and variation from HEDIS goals (when available).
Summary of Results:
An online quality dashboard is a powerful tool for increasing awareness and simplifying data distribution. Ours was launched incurring only programming costs. Providers can compare themselves with peers and see specific patients in need of interventions. Quality leaders can identify and target outliers and track the results of system interventions.
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Posterboard Number:
102
Organization Name:
Massachusetts General Hospital
Contact Name:
Sanja Percac-Lima
Contact Email:
spercaclima@partners.org
Description:
Poor adherence to medical appointments negatively impacts quality of care and reduces access to care for other patients. In 2012, the Massachusetts General Hospital Chelsea HealthCare Center adult medicine practice had the highest no-show rate in the hospital’s primary care network.
Aim:
Evaluate impact of text message (TM) reminders on appointment attendance in an RCT.
Actions Taken:
We implemented an informatics tool that sends TM reminders to patients prior to appointments. Patients were randomly assigned to usual care (phone call two days prior to appointment) or intervention (usual care + TM seven and one day prior to appointment). RCT lasted six months.
Summary of Results:
Of 3592 intervention patients, 23.4% consented to receive TM, 3.1% opted out, 73.4% did not respond. The no-show rate was 18.0% (intervention) vs. 19.8% (control) (p=0.10). Within the intervention group, the no-show rate was 13.8% (consented to receive TM) vs. 19.1% (not consented to receive TM) (p < 0.0001).
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Posterboard Number:
31
Organization Name:
Hamad Medical Corporation
Contact Name:
Reham Hassan
Contact Email:
rhassan@hmc.org.qa
Description:
The Clinical Care Improvement Training Program (CCITP) is a Hamad Medical Corporation initiative, established 2011, as collaboration of the Medical Education Department and Corporate Medical Administration focused on physicians improvement training in the areas:
•Clinical Quality Improvement methodology
•Leadership
•Team Work
•Change Management
•Clinical Project management incorporating Multi- disciplinary teams
Aim:
Teaching basics of clinical quality/process improvement and coach participants to apply to real life problem
Actions Taken:
Each clinician is engaged in planning, data collection/analysis and implementation of improvements. The course takes place over 3-4 months, with a 2 full-day module taking place monthly. In the interval between the modules the teams are guided by a group of trained coaches through different phases of their projects
Summary of Results:
The past 5 cycles of CCITP graduated more than 150 doctors, who with around 400 different multi- disciplinary team members from different areas, successfully completing more than 70 projects, providing benefits to their microsystems. some projects are recognized locally, regionally and internationally. The program created a team of 22 coaches.
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Posterboard Number:
82
Organization Name:
Hôpital Saint-Michel de Jacmel
Contact Name:
Jhenny Polinis
Contact Email:
bonaparte.ronald81@hotmail.com
Description:
Hôpital Saint-Michel de Jacmel, in Haiti, is the south-eastern regional referral hospital for 575,293 inhabitants. Its HIV/AIDS Department counts 45 personnel, serving 1003 people living with HIV/AIDS (PLWAH). In December 2012, 24.4% of 94 PLWHA benefited from CD4 at enrollment. CD4 assessment is critical to guide proper care for PLWHA.
Aim:
The project aimed to reach a performance of 75% from February to June 2013.
Actions Taken:
A project team was created. Brainstorming sessions and Fishbone diagram identified barriers to better performance. PDSA cycles tested strategies and results analyzed through the country-wide electronic medical record (iSanté) performance reports. A list of eligible patients was regularly updated for tracking, education and awareness were reinforce. Patients’ circuit was modified.
Summary of Results:
In June 2013, 75.8% (n=95) PLWHA benefited from CD4 evaluation at enrollment. Patients received adequate care in a timely matter with better prognosis and quality of life. Availability of reliable data facilitates decision making and monitoring. Better management of materials and equipment ensures delivery of effective and efficient services.
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