HCCN Network QI Call
December 15, 2015
Attendees: Anje Van Berckelaer, Careta Grant, Debra McGrath, Diane Lee, Holly Nagy, Jennifer Wise, Karen Breitmayer, Kerri Walton, Marielle Fromuth/Pam Deloretta, Natalie Levkovich, Rana Watterson, Sherrie Gilkey, Stuart Allen, Yolounda Barlow, Kirsten Johnson Martin, Dr. Whitmore, Les Book, Jenifer Kabir, Suzanne Cohen
Jen Kabir – question around dental sealants – HFP will follow-up with DVCH individually.
PHQ process/updates from sites?
Spectrum - Described process. For new and established patients, ages 12+, doing annually. MA does PHQ-2 during intake. If positive, referred to BHC for PHQ-9. If BHC not available, provider does it, and sends flag to BHC.
PHN - Just implemented process and numbers are starting to go up. Using form in Centricity (what is follow up item in GE?) Nurse does PHQ-2. If positive, then PHQ-9 and any follow-up provided is based on the score.
EHC - If positive PHQ-2, patient referred and documentation done by BHC, behavioral health visit = follow-up.
What threshold is used to consider PHQ “positive”?
Threshold for positive: PHQ-2 - above 2, (3 or higher) is widely accepted? PHQ-9
Research does show different sensitivities /specificities.
Threshold is a clinical decision - should be made by clinical leadership/behavioral health leadership. A helpful reference for this discussion is Table 3 from the following article, which describes the sensitivity and specificity of various cut-points: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495268/
Make sure people have the training to understand what that means.
Having a well-defined process for what you want your staff to follow when you get positives is key.
Denominator will be determined by who had a medical visit. Numerator includes both negative screens, and positive screens that have had follow-up, but it does not have to be the provider who does follow-up.
PHN - Have had explicit conversation around what the appropriate threshold is.
GPHA - MA asks PHQ-2, if positive, does the provider have to do the screening and follow-up, does follow-up have to be on the providers’ encounter?
Kerri Walton - At the PACHC UDS training, the trainers repeatedly said that PHQ9 counts as follow-up to PHQ-2.
Anje – Needs to be a clinical decision. Going through mapping - clinical decisions at many points.
Don’t forget about exclusions. Map ICd9, ICD10 codes, and problems.
PDSA Cycles on Colorectal Cancer Screening – Site Updates:
Careta - CH-DC – Also attended summit in Harrisburg. At least 2 providers have taken on goal to improve measure. Got FIT kit, trying to roll out flu/FIT - reaching out to patients due for both. Provide education on use of FIT.
PHN - Also piloting flu/fit at 5 sites. Not seeing great difference in overall numbers yet, but may be site level improvements.
Health center represented at summit - did flu/fit, had great success, patients brought card back into the office - they resulted it internally. FIT test has to be developed in an accredited lab. Not CLIA-waived. Confused about that - from this one health center presentation. Some sites collect cards and then mail to lab.
**Note: after the call, we confirmed that the Insure FIT is CLIA-waived and can be developed in the office. The website lists further details on test development: Http://www.insuretest.com/medical/resources.php
ChesPenn – Currently piloting at one site. Also attended summit. Currently talking to ACS, use advisory committee to reach out to community members for outreach to diverse populations. Pilot site - continuing to follow up with patient, resident is tracking people who’ve gotten the test, need for repeated follow-up. At summit, saw that there is a lot of support for using the FIT for populations that would not go for the colonoscopy. Important to work with docs to consider it for those who are not interested in colonoscopy.
SELHS (Kirsten) - Were doing FOBT testing - looking at switching to FIT. Flu clinics - large number of people coming in, unfortunately, these are not aligning with CRC screening population. Need to re-strategize. Increased from 12-17%. Need to look at the data.
GPHA - Still in process of getting testing in place. Not using FIT test to date. What to do about uninsured.
Anje - Discovered while at DVCH that it does require some additional MA time and training - different instructions for different kits. Both LabCorp and Quest very happy to help out. Bargain with the lab vendors - $15-$20.
ChesPenn - gets $15.
PHN - brand name of iFit?
brand names: InsureFIT, HemoSure
2016 Q1 PDSA cycle plans:
SELHS - BMI documentation.
DVHC - CRC, improving documentation.
AVB - PI projects done at DVCH in past promoted MA engagement by sharing with them the numeric results of the MA’s offering the iFIT. This led to a cycle of positive reinforcement.
Use formal tools to document QI efforts - PDSA tool, share with group, send out samples.
Esperanza -
PHN - Continuing to work on CRC screening with 5 sites, expand project to more sites. Continuing to work on diabetes - looking at Hba1c >9 - ldl screening, micro albumin, eye exam. Got sites involved in tracking diabetics in i2i - using it as a registry - cleaning up the data, defining the true diabetics in their registry.
ChesPenn - Diabetics a1c>9 - tracked population, at Upper Darby - HPC/Quality Insights - DSME program, referral to community site, anecdotally - going well. Tracking referrals - goal, more ability to have information flow back and forth, looking at whether it would work through HSX.
CH-DC - CRC screening, Hypertension
GPHA: BMI capture, CRC, Hypertension - making sure CPT codes are added?
AVB Suggestion - make sure medication mappings are updated for all your relevant QI measures.
Spectrum: Hypertension - elevated BP, no diagnosis; Uncontrolled HTN, smokers, high BMI; Initiatives around diabetics - a1c>9, nutritionist taking the lead - care message; YMCA referrals
UDS Manual from i2i for 2015 is now out - look for software update.