Domain

Learning Health System

Type

Case Study or Comparative Case Study

Theme

effectiveness; population; quality

Start Date

7-6-2014 1:15 PM

End Date

7-6-2014 2:45 PM

Structured Abstract

Introduction:

The National Quality Strategy calls for the transformation of healthcare delivery within medical practices with more stringent adherence to quality performance. Consequently, new partnerships must form, with each contributing unique capabilities to achieve greater outcomes then when solving quality issues alone. Although the benefit of online education, performance support tools and patient engagement to impact clinician performance has been demonstrated separately, there is limited research demonstrating how these three interventions can be integrated meaningfully to effect change. A pilot quality improvement project was initiated between a national electronic health record (EHR) company and a medical education company to determine if more consistent delivery of care could be achieved and measured when technology clinical decision support point-of-care interventions, patient engagement strategies, and online education modules are combined. Under the American Recovery and Reinvestment Act of 2009 (ARRA), physicians will begin experiencing reimbursement penalties in 2015 for non-adoption of these technologies. This pilot leverages and enables participating providers to align CME with these federal mandates to use EHR technologies and report quality measures under ARRA, which will drive value-based purchasing through the Affordable Care Act.

Methods:

A preliminary assessment of practice gaps related to the HIV/AIDS Bureau (HAB) and the Health Resources and Service Administration (HRSA) HIV Core Clinical Performance Measures revealed areas for improvement. The study population was pulled from Greenways’ network of community health centers and HIV clinics opting to participate. Physician and patient inclusion and exclusion criteria were set based on two HRSA/HAB measures and recommendations from a panel of expert clinicians. Criteria were translated into machine-readable codes. The three-pronged, innovative intervention set blended multidisciplinary HIV healthcare team education with technology in the form of EHR delivered clinical decision support and population management tools, such as patient reminders, alerts, population management tools, and point-of-care patient activation questionnaires.

A performance-level assessment plan will determine the impact of the interventions. Primary outcome was change in performance against two evidence-based HIV quality standards.

Findings:

The interventions launched on January 13, 2014, with 8 group practices, including 24 clinic locations, 24 physicians, and 4 nurse practitioners initially opting into the project and serving as the intervention group. EHR database extractions of physician and patient reported data generated through encounter documentation and patient questionnaires at 6-months prior to, and 3- and 15-months post participation will be analyzed to determine the impact of the interventions. The baseline assessment of performance is being conducted and both the baseline and the interim assessment will be available at time of presentation.

Discussion:

Results of the quality improvement project on the practice patterns of HIV and Primary Care physicians caring for patients with HIV will be described. Technical specifications developed will be made available for use by any EHR vendor to develop population health management algorithms.

Conclusion:

New partnerships resulted in efficient, quick, and cost-effective delivery of a quality improvement-focused initiative that drove clinician engagement in education and interventions that they needed the most and measurement of the impact of these interventions for research and provider feedback.

Acknowledgements

This quality improvement initiative was funded through an independent medical education grant from Bristol-Myers Squibb.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

Share

COinS
 
Jun 7th, 1:15 PM Jun 7th, 2:45 PM

Improving the Quality of HIV Care via a Partnership between an EHR and Medical Education Company

Introduction:

The National Quality Strategy calls for the transformation of healthcare delivery within medical practices with more stringent adherence to quality performance. Consequently, new partnerships must form, with each contributing unique capabilities to achieve greater outcomes then when solving quality issues alone. Although the benefit of online education, performance support tools and patient engagement to impact clinician performance has been demonstrated separately, there is limited research demonstrating how these three interventions can be integrated meaningfully to effect change. A pilot quality improvement project was initiated between a national electronic health record (EHR) company and a medical education company to determine if more consistent delivery of care could be achieved and measured when technology clinical decision support point-of-care interventions, patient engagement strategies, and online education modules are combined. Under the American Recovery and Reinvestment Act of 2009 (ARRA), physicians will begin experiencing reimbursement penalties in 2015 for non-adoption of these technologies. This pilot leverages and enables participating providers to align CME with these federal mandates to use EHR technologies and report quality measures under ARRA, which will drive value-based purchasing through the Affordable Care Act.

Methods:

A preliminary assessment of practice gaps related to the HIV/AIDS Bureau (HAB) and the Health Resources and Service Administration (HRSA) HIV Core Clinical Performance Measures revealed areas for improvement. The study population was pulled from Greenways’ network of community health centers and HIV clinics opting to participate. Physician and patient inclusion and exclusion criteria were set based on two HRSA/HAB measures and recommendations from a panel of expert clinicians. Criteria were translated into machine-readable codes. The three-pronged, innovative intervention set blended multidisciplinary HIV healthcare team education with technology in the form of EHR delivered clinical decision support and population management tools, such as patient reminders, alerts, population management tools, and point-of-care patient activation questionnaires.

A performance-level assessment plan will determine the impact of the interventions. Primary outcome was change in performance against two evidence-based HIV quality standards.

Findings:

The interventions launched on January 13, 2014, with 8 group practices, including 24 clinic locations, 24 physicians, and 4 nurse practitioners initially opting into the project and serving as the intervention group. EHR database extractions of physician and patient reported data generated through encounter documentation and patient questionnaires at 6-months prior to, and 3- and 15-months post participation will be analyzed to determine the impact of the interventions. The baseline assessment of performance is being conducted and both the baseline and the interim assessment will be available at time of presentation.

Discussion:

Results of the quality improvement project on the practice patterns of HIV and Primary Care physicians caring for patients with HIV will be described. Technical specifications developed will be made available for use by any EHR vendor to develop population health management algorithms.

Conclusion:

New partnerships resulted in efficient, quick, and cost-effective delivery of a quality improvement-focused initiative that drove clinician engagement in education and interventions that they needed the most and measurement of the impact of these interventions for research and provider feedback.