November 2013 Newsletter

AHRQ Toolkit to Help Improve Office Testing Processes


With nearly half of primary care office visits including at least one medical laboratory test, office personnel need a reliable, efficient process to order and track tests and then record and share test results with patients.

A new toolkit from the Agency for Healthcare Research and Quality - 'Improving Your Office Testing Process: Toolkit for Rapid-Cycle Patient Safety and Quality Improvement' - may help. The toolkit recognizes that every office is unique and provides modifiable tools related to: assessing office readiness for practice improvement, planning for improvement, assessing your testing process, patient engagement, using the patient handout, chart audits, and electronic health record evaluation.


The toolkit encourages practices to devote at least 30 minutes of each team meeting to process and quality improvement. It recommends measuring performance before, during, and after changes are tested to know which changes produce the desired results.


The toolkit notes that:

  • Well-designed office systems make errors less likely.
  • Breaking complex processes into parts will help you decide where a change might make a difference. One change can impact many parts of the testing process.
  • Regular staff meetings can improve communication and collaboration and promote shared responsibility for office processes.
  • Even if an improvement involves change for only a few people, it is important to include everyone in the improvement process to foster a culture of safety in your office.Almost 40% of primary care office visits include at least one medical laboratory test. This tool offers steps to improve office safety and quality. 
Population-Based Health Care Central to New Payment Models 


New health care payment models are holding physicians and their care teams accountable for their population of patients. This approach is called population-based health care and it involves taking care of the patients you see regularly in your office and those that you don't.


Population-based health care is central to new payment models for accountable care organizations and for payments that reward Patient Centered Medical Homes. It also is a foundation for most pay-for-performance payment models.


Health insurers in Pennsylvania increasingly are adopting payment models based on population-based health care. Population-based health care also is called for in the "Health Care Innovation Plan" Pennsylvania is preparing as a road map to achieving the Triple Aim of better health, better health care, and lower costs. Nearly 300 stakeholders have helped to develop Pennsylvania's plan over the past 6 months as part of a federal  State Innovation Model planning grant.


A brief published by the Tufts Managed Care Institute defines population-based health care and notes the value of this approach to care. The authors call population-based care "a positive force for both treating individual patients and caring for populations."


As the brief describes, populations of patients can be defined broadly (e.g., all of the patients assigned to or choosing the practice for their care) and more narrowly (e.g., all of the female patients over age 50 or all of the patients with diabetes).


By identifying populations of patients, providers can most effectively and efficiently ensure patients are receiving the care they need according to evidence-based guidelines-both individually and as an entire population.


Performance is measured using numerators and denominators. The denominator is the defined population. The numerator is the number of patients in that population receiving the service or meeting the parameters being measured.


Proactive population-based care focuses on increasing (or in some cases, decreasing) the numerator to improve overall outcomes for the population. Good clinical information systems (e.g., registries, EMRs) allow you to identify the patients not counted in the numerator so you can reach out to them to schedule an appointment to fill any gaps in care or intensify treatment (e.g., add or change a medicine, offer more self-management support, follow up more frequently.)


As the Tufts brief notes, population-based health care is best implemented in a team-based approach, where everyone in the office is assigned a role-and is clear on that role and accountable for doing it-in improving both patient- and population-level outcomes.


For more information on how to manage your population of patients, check out the instructional materials, tools, and resources on the PA SPREAD website .


Your Participation is Needed:
Survey on the Patient-Centered Medical Home 


The PCMH is an emerging healthcare delivery system with the potential to address the healthcare needs of the nation. As we incorporate PCMH concepts into the medical curriculum and clinical practices, we seek your input to inform us in these initiatives. You are being invited to participate in a research study that has been reviewed by the Penn State University IRB. You participation is completely voluntary. Please take a few minutes to complete a survey on PCMH. Your responses are anonymous and results will be reported in aggregate. There is no identifiable risk associated with participating in this study beyond those of daily life or casual group conversation.  Completion of the survey implies consent to participate in the research study.  


Click here to complete the survey.

If you have questions or concerns about this research, contact Dr. Shou Ling Leong at Penn State Hershey at 717-531-4660.

In The Literature 

2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atheroslerotic Cardiovascular Risk in Adults


The American College of Cardiology (ACC) and American Heart Association (AHA) released new guidelines for evaluating and treated elevated cholesterol. They also released a new risk calculator to identify those at 7.5% CVD risk in 10 years. Key points:


All patients over age 21 with any form of CVD or LDL-C ≥ 190 mg/dl: Treat with high dose statins (e.g. Atorvastatin 40-80 mg or Rosuvastatin 20-40 mg) with the aim to reduce LDL-C by >50 %


All patients ages 40-75 with diabetes with LDL-C 70-189 mg/dl, without any evidence of CVD should receive statin therapy as follows: Moderate dose statin (e.g. Atorvastatin 10-20mg, Rosuvastatin 5-10 mg, Pravastatin 40-80 mg, Simvastatin 20-40 mg) with the aim to reduce LDL-C by 30-50 %. However, consider high dose statin as above if 10-yr risk by new risk calculator >7.5%.


If using high dose and moderate dose statins as described above, a specific target of LDL-C goal (< 70 or <100) is not recommended.


As before, all patients must receive intensive lifestyle management.


A summary of these guidelines can be found online at the Joslin Diabetes Center.  



Systematic Review of the Application of the Plan-Do-Study-Act Method to Improve Quality in Healthcare 


Delivering improvement in the primary care office is hard. The Plan-Do-Study-Act (PDSA) rapid cycle testing process is a way to incrementally transform processes, communication, strategies, organization - virtually anything - that can be improved upon in the workplace. Here are some key steps:


Plan small test of change. Only focus on changing one process at a time.


Do rapid, iterative cycles of change. Because changes are small, they should be completed frequently. Be sure to measure your results!


Study the results of the change. Was it helpful? Did it fail? Are there small changes you can make to improve even more?


Act upon the results. Implement what you've learned and continue the improvement process!


Common failures include failure to document results, failure to complete iterative rapid cycles, and lack of adherence to small scale testing.    


PA SPREAD is excited to announce their partnership with Aligning Forces for Quality-South Central PA in supporting PCMH implementation in the primary care practices of Carlisle Health Care Alternatives, Inc., affiliated with Carlisle Regional Medical Center.
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