UNION COUNTY HEALTH FOUNDATION featuring ALCESTER MEDICAL CENTER

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UNION COUNTY HEALTH FOUNDATIONfeaturingALCESTE
R MEDICAL CENTER
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Background Information
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Team-Alcester site
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Team-Elk Point site
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Team dynamics

• Team meetings Monthly at first, then as needed
  CIC Collaborative meetings were weekly initially,
  now about every three weeks
• Meeting agendas Discussion of ideas we have
  tried and whether they are working also what
  made them either succeed or fail discussion of
  national goals and our numbers
• Decisions by consensus, but some problems with
  carrying out the decisions since not all staff
  are notified of the decision at the time

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Organization of Health Care

• Leadership support CEO approves time for
  meetings, incorporates HDC updates into Board
  meeting once/year
• Day-to-day leadership for continued clinical
  improvements? Providers/ Physician Champion/Nurse
  Manager
• Incorporation into your Quality Improvement
  program? Yes Business plan? Yes Performance
  Improvement program? Yes-OPR visit May 2005
  included CVD goals

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Decision Support

• Use evidence-based standing orders/guidelines?
  Standing orders in place guidelines discussed
  at QI meetings at time of annual audit focus
• Staff education on the guidelines? Articles,
  flow-sheets, laminated teaching tools for exam
  rooms
• Patient education on the guidelines? Laminated
  teaching tools for exam rooms, newsletter
  articles, patient handouts, face-to-face time

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Delivery System Design

• Protocols in place for staff role/duties/tasks
  during pt. visit? Basic nursing duties vitals,
  lab draws and occasionally SM goal setting
• Proactive staff, not reactive staff? Varies
• Follow-up? Case management? Physician champion
  runs audits monthly, nurses call patients who
  need visits at Elk Point site. In Alcester,
  provider places sticky note in chart noting when
  next lab draw or other testing are duethis is
  done at the time she reviews most recent labs and
  are available for nursing. Also labs/other
  testing needed dictated into progress notes

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Delivery System Design

• How do you meet patients special needs? We ask
  about barriers we do many Patient Assistance
  Programs for meds and All Women Count program to
  assist with testing on women
• Do you do group visits? Yes, just started
• Any work flow studies at your center? Patient
  cycle time study performed October 2006, data
  available March 2007

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Clinical Information System

• Use of data QI meetings monthly, also
  disseminated at team meetings
• Handling patient recalls? Nurses call only after
  chart audit reveals deficiencies
• Handling data entry? Nurses enter data 1-2 days
  post visit, when lab data available
• How do you prompt providers (PECS sheet or
  Reminder sheet)? PECS sheet has reminders in red,
  plus we use neon colored post it notes in charts
  detailing missing items

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Self-Management

• Patient goal setting We review suggested goals
  on our SM goal sheets at least annually, discuss
  realistic options with patients at time of goal
  setting
• Tools used? Goal sheet specific for Diabetes and
  another general one for CVD
• Follow-up and monitoring goals? We are trying to
  type goals onto PECS sheets as reminders
• Use of community resources to achieve goals?
  Fitness center, free medications

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Community

• Community partnerships for
• Medication costs? Patient Assistance Programs
  Education? Avera and Mercy Health Systems
  Materials? SD Office of Diabetes Control
• Awareness/Outreach? SD Office of Diabetes
  Prevention and Control/Lions Club
• Have you been awarded any grants?
• 3000 from State for Diabetes spread in 2004
• Grant application to Wellmark submitted early
  February 2007

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Diabetes Measures

• National Goal
• Average HbA1C 7.0
• At least 2 HbA1C in the last 12 months (gt90 days
  apart) 90
• Self-Management goal in last 12 mo. 70

• UCHF
• Elk Point 7.9
• Alcester 7.7
• Elk Point 72
• Alcester 66
• Elk Point 80
• Alcester 91

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Cardiovascular Measures

• National Goal
• Patients with BPlt140/90-50
• Patients with BP taken 2X/yr.-90
• Self-Management goal in last 12 mo.-70
• Fasting lipids done in last 12 mo.-80

• UCHF
• Elk Point 47
• Alcester 63
• Elk Point 85
• Alcester 86
• Elk Point 66
• Alcester 91
• Elk Point 96
• Alcester 97

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Showcase your most successful graph from the
measures graph template data report
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Showcase your most challenging graph from the
measures graph template data report
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Strengths

• Lipid testing
• Friendly competition between two sites
• Team meetings are lively and good ideas generated
• QI meetings used to review Collaborative progress
  monthly (all staff attend)
• Change concepts have penetrated into many
  processes at the two sites

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Opportunities for Improvement

• More consistent team meetings with set agendas
  and more delegation of duties
• Better communication of PDSA ideas/decisions to
  all staff
• Huddles need to be done consistently
• Overcome clinical inertia re blood pressure and
  glycemic control goals
• Watch out for tyranny of the urgent!

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Questions from the audience?

• Dances with Wolves
• Vs
• Dancing with the Stars

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Dancing with Diabetes

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Dancing with Diabetes
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Dancing with diabetes

• http//www.rottentomatoes.com/m/bringing_down_the_
  house/gallery.php?page3sizeloresnopop1
• http//www.youtube.com/watch?vN4IQXHDoU4M