PEBB Board Presentation

1
PEBB Board Presentation

• Kaiser 2006 Quality Initiatives

2
Northwest Region Quality Vision

• Our vision is to provide the highest quality care
  in the world
• We will measure success by achieving 90th
  percentile on HEDIS effectiveness of care (EOC)
  quality measures

3
Quality Populations/Measures for 2006 (2005
HEDIS Rank)

• Adult Women
• Breast Cancer Screening (50th)
• Cervical Cancer Screening (10th)
• Diabetic Members
• Lipid screening (25th)
• Lipid control lt 130 (90th)
• Lipid control lt 100 (75th)
• HgbA1c screening (50th)
• Poor Hgba1c control (75th)

4
Quality Population/Measures for 2006 (continued)

• Patients with CV conditions (new measureno
  rankings)
• Lipid screening
• Lipid control lt130
• Lipid control lt100

5
JCAHO AMI Measures

• ACE Inhibitor for LVSD (89)
• Smoking cessation advice/counseling (74)
• Aspirin at arrival (100)
• Aspirin at discharge (98)
• Beta blocker at arrival (99)
• Beta blocker at discharge (99)
• (Thrombolytics)
• KSMC 2004 results

6
Quality Populations/Measures for 2006 (continued)

• Children/ Adolescents
• Immunizations children (90th)
• Immunizations adolescent (75th)
• Appropriate asthma meds
• Age 5-9 (50th)
• Age 10-17 (10th)

7
Quality Populations/Measures for 2006 (continued)

• Patients with depression
• Practitioner contact (25th)
• Acute phase treatment (90th)
• Chronic phase treatment (75th)

8
ICP Service Quality Targets
Measure 2006 Threshold 2006 Target 2006 Stretch
Recommend KP to friend 46.5 47 48
Saw own PCP 71 73 75
Time to Appt Primary Care 71 72 74
Time to Appt Specialty Care 65.7 66.7 68.7
MD Listened Primary Care 82 83 84.5
MD Listened Specialty Care 84 85 86.5
MD in work unit support me in providing quality service 76 78 80
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Quality Improvement OpportunitiesPEBB

• Beta blocker post-MI
• Diabetes nephropathy screening

10
Beta Blockers Post-MI

• For 2006 one of our quality goals regionally is
  improvement in all the JCAHO AMI measures,
  including beta blocker use post-MI
• At KSMC this is a primary quality initiative for
  2006
• All plan hospitalsSt. Vincents, SWWMC, St.
  Johns, Salem are participating in IHI 100,000
  lives campaign with AMI bundle as a core strategy
• Six month adherence to beta blocker use is a new
  HEDIS measure, we are currently considering
  strategies to ensure compliance

11
Diabetic Nephropathy Monitoring

• Those patients at risk for diabetic nephropathy
  can be identified with newer urinalysis tests
  microalbuminuria testing
• HEDIS adopted microalbuminuria testing as a
  standard annual test for all diabetics
• Kaiser had microalbuminuria as a standard test on
  our panel diabetes lab ordering process

12
Diabetes Nephropathy Monitoring (continued)

• Context Diabetics develop macrovascular (large
  vessel) and microvascular (small vessel)
  atherosclerosis
• Macrovascular disease causes heart attacks and
  strokes and is the leading cause of death in
  diabetes
• Microvascular disease causes diabetic retinopathy
  leading to blindness and diabetic nephropathy
  leading to end stage renal disease (ESRD)
  resulting in dialysis or kidney transplant

13
Historical Perspective

• Research on microvascular disease, specifically
  diabetic nephropathy, has shown that early
  detection of those diabetics at risk of renal
  disease and specific treatments can slow the
  progression and prevent ESRD/dialysis
• The main treatments are Improved blood pressure
  controlgoal bp lt 130/80, and use of specific
  medicationsACE-I and/or ARB

14
Macrovascular Disease Research

• Research on macrovascular disease has
  demonstrated that all diabetics given ACE-I (or
  ARBs) had lower rates of macrovascular disease
  (heart attacks/strokes)
• Based on this information Kaiser Northwest and
  nationally felt microalbuminuria screening was
  unnecessary and removed it from the panel
  diabetes order
• As a result our HEDIS nephropathy scores have
  fallen

15
Current Consensus

• HEDIS has proposed changing the nephropathy
  screening measure for 2007 such that any patient
  on ACE-I or ARB will count as having had
  nephropathy monitoring
• Kaiser Northwest region has decided to add
  microalbumin testing back to our panel diabetes
  order
• By the end of 2007 our nephropathy screening rate
  will be significantly higher

16
Tools to Achieve Improved Diabetes Quality Goals

• Health maintenance alerts for any diabetic who
  has not had diabetic labs in past 9 months
• Health maintenance alerts when last recorded
  blood pressure is not at goal
• Promotion of ALL Aspirin, Lovastatin, Lisinopril
  use in all members
• Monthly rosters for health care teams listing
  diabetics with LDL gt 100, or no LDL in past 9
  months, hgba1c gt 9 or no hgba1c in past 9 months,
  no microalbuminuria testing in past 9 months, bp
  not at goal