• Improving Performance on High Priority Outcome Quality Measures through Collaboration

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    March 07, 2018
    Improving Performance on High Priority Outcome Quality Measures through Collaboration with Kentucky Department for Public Health and Kentucky Primary Care Association
    Submitted by:  Amal Iftikhar, M.D., Practice Transformation Advisor, Trudi Matthews, Managing Director and Mary Luvisi, Technical Project Specialist, Kentucky Regional Extension Center

    Kentucky ranks eighth highest nationwide for cardiovascular disease rates, with 30% of all deaths in Kentucky attributed to cardiovascular disease. The Kentucky Regional Extension Center (REC) at the University of Kentucky began working with the Kentucky Department for Public Health and members of the Kentucky Primary Care Association to investigate innovative solutions leading to improved performance of clinical quality measures. Through their collaborative efforts, the group was able to pilot a unique project focused on improving performance on two high priority outcome measures: Hypertension: Improvement in Blood Pressure (NQF 0018) and Diabetes: Hemoglobin A1C Poor Control >9% (NQF 0059) in September 2014. The purpose of the pilot was to validate practice data reporting capacities, monitor practice data on a real-time basis, and use clinical quality data from electronic health record systems to support population health improvement.

    There are currently six practices/health systems, with more than 96 providers across 36 locations, participating in the pilot:

    Juniper Health
    London Women’s Care
    Cumberland Family Medical Center, Inc.
    Murray Medical Associates
    Mountain View Family Practice
    Mountain Comprehensive Health Corporation
    The collaborative efforts of the KYREC, KDPH Chronic Disease Prevention Branch and members of the KPCA have resulted in a team approach to assist practices in improving performance on the identified quality measures. This approach focuses on:
    • Assigning practice advisors to assist practices/health systems to use evidence-based interventions (EBIs) focused on provider reminders, patient reminders, reducing barriers and provider assessment and feedback. 
    • Reporting of validated monthly clinical quality measure data to drive improvement in hypertension and hemoglobin A1c control.
    • Providing guidance and support as practices test and implement changes to clinical workflows through Plan, Do, Study, Act (PDSA) cycles.
    • Increase practice capacity for regular monitoring of aggregated and standardized quality measures at the provider and system level on a consistent basis for continuous quality improvement. 
    One of the participating practices, Juniper Health, implemented a PDSA on improved blood pressure measurement techniques. They utilized the CARE Collaborate, a blood pressure awareness tool, to facilitate patent engagement in their quality improvement efforts. Participating providers were able to achieve a 17.17% improvement (from 66.66% in 2016 to 83.83% in 2017 YTD) in the percentage of patients with adequately controlled blood pressure (< 140/90), versus 3.65% (73.025% in 2016 and 76.68% in 2017 YTD) for non-participating providers. In addition, this practice started providing and referring patients to group Diabetes Self-management Education and Support (DSMES) sessions and has reduced the percentage of patients with uncontrolled diabetes (HbA1c >9) by 6.6% (from 32.3% in 2016 to 25.6% in 2017 YTD). In September 2017, the Juniper Health DSMES program achieved national accreditation with the American Association of Diabetes Educators.

    Another exceptional achievement of the collaborative efforts between KY REC and KDPH has been the release of a comprehensive toolkit aimed at equipping providers in the state of Kentucky with usable tools and tips to address different aspects of clinical quality improvement. The Improving Cardiovascular and Diabetes Care and Outcomes toolkit is a convenient resource for practices embarking on the journey to quality improvement as well as tenured practices refining their current processes. The toolkit offers a wealth of quality improvement ideas covering operational efficiency, evidence based interventions, patient self-management and data driven quality improvement. The toolkit can be accessed through the KYREC and KDPH websites through the following link:

    Another practice has recently implemented the CARE Collaborative focused on patient education regarding cardiovascular health and high-risk conditions such as stroke and acute myocardial infarction. Other initiatives include but are not limited to utilization of patient generated health data and remote monitoring for real-time patient engagement. All practices have shown positive changes to their reporting rates for the two measures.

    The Kentucky REC has also hosted a number of educational events including a series of Healthcare Transformation Survival Seminars across the commonwealth, and participated in the annual Kentucky Primary Care Association Conference reaching out to 440 members of the community including close to 80 primary care providers. These events targeted to provide an in-depth look at principles of quality improvement with a focus on hypertension and diabetes poor control in addition to other topics such as the new regulations under Medicare and CHIP Re-authorization Act and the Quality Payment Program and their impact on daily clinical operations.

    The quality improvement team at the Kentucky Regional Extension Center has a focus on collaborating with community partners and shared education. Whether it is through the statewide Kentucky Diabetes Symposium, the CARE Collaborative training through the Kentucky ShareFest, or the continuing educational webinars we host, we aim to bring the best resources to the Kentucky providers and practices.

    How to Connect with Kentucky Regional Extension Center:
    For years, the Kentucky REC at the University of Kentucky has provided comprehensive, individualized support to health care providers across the commonwealth.
    For more information on the Kentucky REC’s quality improvement resources, please visit: http://www.kentuckyrec.com/services/macra/quality-improvement/, or contact the Kentucky REC by phone at (859) 323-3090 or email at kyrec@uky.edu.

    Lindey Young, MBA, Membership Coordinator
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