Montana Regional Outcomes Project

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Montana Regional Outcomes Project

• Mike McNamara, MS., ACSM-ES
• Secondary Prevention Specialist - Cardiovascular
  Health Program
• Montana Department of Public Health Human
  Services
• President Montana Association of Cardiovascular
  Pulmonary Rehabilitation
• AACVPR National Outcomes Committee Member
• AACVPR J-3 MAC Committee Member
• mmcnamara_at_mt.gov

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Objectives

• Discuss the development of a regional outcomes
  project
• Review the first 2 plus years of outcomes data
• Provide information on how programs can take part

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Brief History of the Outcomes Project

• Summer of 2005 the CVH Program and the state
  cardiac rehab association (MACVPR) discussed
  collaborating on a regional outcomes project

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Step 1 Measure Level of Interest

• Surveyed all 33 programs in MT and northern WY to
  gauge interest in the regional outcomes project
• 20 (61) of the 33 programs were involved in an
  outcomes project
• Nearly 90 of programs surveyed expressed
  interest in participating in the regional
  outcomes project

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Cardiac Rehab Survey
http//www.dphhs.mt.gov/PHSD/cardiovascular/cardio
-reports.shtml
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Step 2 - Indicator Selection

• Used indicators that were already being collected
  in the region
• Selected meaningful indicators
• Added other indicators for a complete outcomes
  package based on AACVPR Guidelines (fourth
  edition)
• Emphasizing
• Ease of implementation
• Program certification

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Domains Indicators

• Demographic
• Age
• Gender
• Ethnicity Caucasian, American Indian, Black, or
  other
• Diagnosis Diabetes, MI, CABG, PCI, MI/CABG,
  MI/PCI, Angina, other
• Number of visits
• Number of patients

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Clinical Domain

• BP at goal (lt140/90 or lt130/80 with DM)
• Average of the last 3 resting blood pressures
• BMI (new 2008)
• LDL at goal (lt100)
• Lipid-lowering medication (LLM)
• contraindication for LLM
• Duke Activity Status Index (DASI) score (METs)
  Pre-Post
• Generic Outcomes Forms\DASI Montana Outcomes
  Project.rtf
• A1C for DM (within the last 6 months)
• Value

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Health Domain

• Health/Quality of Life surveys Pre-Post
• SF-36 V2
• Licensed product
• Dartmouth COOP Health Survey

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Behavioral Domain

• Smoking status
• Smoking status 1 month prior to event vs. smoking
  status within the last month of rehab
• Block Dietary Fat Screen Pre-Post
• Generic Outcomes Forms\Fat Screener.pdf
• Licensed product

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Service Domain

• Patient satisfaction survey
• Generic Outcomes Forms\Patient Satisfaction
  Montana Outcomes Project.doc
• Phase II completion rate
• gt 12 visits completed

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Step 3 - Kick-off Preparation

• Presented proposal at MACVPR conference
• Developed an outcomes binder
• Included overview of the program
• Survey administration and scoring instructions
• Generic Outcomes Forms\SF-36 Scoring V21.xls
• Data submission instructions
• Generic Outcomes Forms\Patient Tracking Form
  Montana Outcomes Project.doc
• Generic Outcomes Forms\MasterExcelV2.xls
• Examples of feedback
• Organized 2 conference calls to provide
  additional information as needed

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Step 4 Data collection

• Data collection began in July of 2006
• First reporting period was January of 2007 and
  consisted of patients that started rehab between
  July and September 2006
• De-identified data e-mailed to CVH Program for
  analysis
• Quarter 1 -- received data from 19 programs in
  MT WY

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FeedbackInterpreting Program Specific DataWhat
you get back
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Demographic and diagnostic characteristics among
Facility A cardiac rehab patients and Regional
Outcomes Project participants, July - September
2006
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Health, Behavioral Service Domain Individual
Data vs. Regional Data
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Clinical Domain Individual Data vs. Regional Data
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Montana Outcomes Project 2009

• Currently programs from 10 states are reporting
  data
• 63 programs reported data in Jan 2009
• Sample size 1002
• Total database consists of 3215 patients
• Expect approx. 10 additional programs reporting
  in April

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Aggregate Data Q1 2009
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Aggregate Data Q1 2009
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Outcomes Data Aggregate Data Trends 2007
2009
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Demographics
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Demographics Diagnosis Data
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Clinical Domain Blood Pressure at Goal
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Clinical Domain LDL at Goal and LLM Medications
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Clinical Domain A1c Testing
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Clinical Domain DASI Change
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Health Domain Dartmouth
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Health Domain SF-36
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Behavioral Domain Smoking Status
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Behavior Domain Fat Screener
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Service Domain Completion Rate
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Service Domain Patient Satisfaction
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Overall Impression

• BP at goal and LLM usage very high (gt90)
• Positive trend
• LDL at goal difficult to standardize
• Negative trend
• A1c testing gt80
• Positive trend
• DASI - gt 1/3 improvement
• Positive trend
• Awaiting the impact of the QI project (July 2009)

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Overall Impression Cont

• Dartmouth 25 improvement
• Positive trend
• SF-36 Physical 25 improvement
• Positive trend
• SF-36 Mental 11 improvement
• Positive trend

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Overall Impression

• Smoking Rates significant decline in smoking
  rates
• Fat Screener - gt25 improvement in scores
• Positive trend
• A positive spike was noted post QI project
  highest level of improvement (32)

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Overall Impression

• Completion Rate gt80
• Negative trend
• Patient Satisfaction Very high and consistent

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Benefits of Participating in a Regional Outcomes
Project

• Access to a complete out of the box outcomes
  project works for big or small programs
• Eight programs were not collecting any outcomes
  prior to joining
• Full-time staff member provides support
• Data management

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Benefits Continued

• Adaptability - indicators can be changed or
  tailored to meet specific needs
• Receive quarterly feedback
• Have the ability to compare your outcomes to the
  regional average

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Recommended Uses For Data

• Send report to your referring physicians to
  promote your program to increase referrals
• Submit to your hospitals QI/QA committee
• Cornerstone for AACVPR certification
• Potential reimbursement issues
• Talking points for JCAHO survey
• Program justification to administration
• Highlight what you are doing well
• Identify areas you need to improve - QI

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Opportunities for Improvement

• Programs can utilize the information they get
  back to focus on areas that are below the
  regional mean areas for quality improvement
• This can be done on a facility by facility basis
  or organized by the states outcomes committee
• MT Examples

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If you are interested in participating in the
regional outcomes project, please contactMike
McNamara mmcnamara_at_mt.gov(406) 444-9170
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Questions