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Pfizer — MEG 2012 Quality Improvement: Lessons from Practice webinar
83 slides from Pfizer's conference presentation, Jun 20, 2012
Slide 1: MEG 2012 Quality Improvement: Lessons from Practice
MEG 2012 Quality Improvement: Lessons from Practice June 20, 2012 Presented by the Pfizer Medical Education Group
Slide 2: Agenda
Agenda • Introductions • Goals for the session • Presentations • Q&A 2 | It all starts here. Company Confidential and Proprietary – Internal Use Only – Draft – Not to be implemented without Legal & Regulatory Review and Approval
Slide 3: Quality Improvement: Lessons from Practice
Quality Improvement: Lessons from Practice. • Moderators: Bob Kristofco and Laura Bartolomeo Pfi Pfizer M Medical di l Education Ed ti • Presenters: • Cynthia Kear-CCMEP, Senior Vice President of the California Academy of Family Physicians. Prior to joining the CAFP 11 years ago Ms Kear was Founder/
Slide 4: Presenters
Presenters • Shelly Rodrigues, CAE, FACME, CAFP Deputy Executive Vice President (DEVP) California Academy of Family Physicians, has more than 27 years’ experience in medical society management, the past 19 years with the California Academy of Family Physicians. Shelly is a graduate of the Institute
Slide 5: Presenters
Presenters • Lee Ann Grajales vice president for quality initiatives for the Pennsylvania Academy of Family Practice Foundation (PAFP/F) is responsible ibl for f allll programs, projects j t andd activities ti iti on iimproving i quality lit in primary care, including practice-based research, the pa
Slide 6: Presenters
Presenters • Angie Halaja-Henriques Halaja Henriques has worked at the Pennsylvania Academy of Family Physicians since 1999 – first in communications then public health and now as Quality Initiatives Grants Director Director. She works with various stakeholders that are key to family medicine, inclu
Slide 7: Presenters
Presenters • William J. Warning II, MD, CMM, FAAFP, CAQ SpMed: Dr. Warning is a board certified family physician with a CAQ in Sports Medicine and a Certificate of Medical Management from Carnegie Mellon University. He is the Program Director of the Crozer-Keystone Family Medicine Residency Program
Slide 8: Goals for Today's Session
Goals for Today’s Session This webinar is intended to provide insights into quality lit iimprovementt iinitiatives iti ti ffrom ttwo di diverse perspectives. It will: • Describe a collaboration that has resulted in important strides in educational planning to address a public health emergency • Revi
Slide 9: Collaborative for REMS Education (CO*RE)
Collaborative for REMS Education (CO*RE) Cynthia Kear, MDiv, CCMEP Shelly Rodrigues, CAE, FACEHP Pfizer Webinar Series | June 20, 2012
Slide 10: Katherine Galluzzi, DO, family physician, geriatrician and pain specialist
Katherine Galluzzi, DO, family physician, geriatrician and pain specialist
Slide 11: Cynthia Kear and Shelly Rodrigues disclosures
Cynthia Kear Shelly Rodrigues Cynthia and Shelly declare no financial relationships with any corporate entity supporting the work done on this project. The CO*RE Needs Assessment and Educational Design project was supported in part by unrestricted educational grants from Pfi Pfizer, IInc. and dPPurd
Slide 12: CO*RE Partners
CO*RE Partners American Academy of Hospice and Palliative Medicine (AAHPM) American Academy of Nurse Practitioners (AANP) American Academy of Physician Assistants (AAPA) American Osteopathic Association (AOA) A American i P Pain i SSociety i t (APS) American Society of Addiction Medicine (ASAM) Cali
Slide 13: CO*RE mission and goal
Y CO*RE’s immediate mission is to ensure that LA/ER opioids are prescribed, when indicated, in an appropriate manner that enhances patient well-being and does not contribute to individual or public harm harm. Y The overarching goal of CO*RE, a collaboration that includes primary care, addiction medi
Slide 14: Driven by a desire to avoid past results
Y We were driven by y a desire to avoid the results of: Y Accutane: Physicians simply decided to opt out Y AB 487: The medical board was left holding the bag
Slide 15: AB 487 requirements
Y AB 487, signed into law on October 4, 2001, requires most California-licensed physicians to take, as a one-time one time requirement, 12 units of continuing medical education (CME) on “pain management” t” and d “th “the appropriate i t care and treatment of the terminally ill.” Y The bill,, which
Slide 16: Medical Board course acceptance
Y The Medical Board will accept courses or programs that address one or both topics. The courses or programs must qualify for Category 1 credit and be presented by an organization accredited to provide CME by the Accreditation Council for Continuing Medical Education (ACCME), the American Medical As
Slide 17: Dividing the 12 units
Y The 12 units may be divided in any way that is relevant to the physician’s specialty and practice setting. Acceptable courses may address either topic individually or both topics together. For example, p , one physician p y might g take three hours of “painp management education” and nine hours of
Slide 18: AB 487 timelines and requirements
Y Physicians y with an active license before Januaryy 1,, 2002, had until December 31, 2006, to obtain the 12 hours. Y Physicians Ph i i lilicensed d on or after ft JJanuary 11, 2002 2002, mustt complete the mandated hours by their second license renewal date or within four years whichever comes fir
Slide 19: AB487 and resulting rules
Y AB487,, and the resulting g rules/regulations g o Had no consistent content based on needs assessment, practice gaps, evidence-based guidelines, or documented research o Had no consistent educational design or format o Had no consistent evaluation or outcomes measurement Y And as a result o Cannot
Slide 20: Building a collaboration to address a public health crisis
Y Building g a Collaboration to address a p public health crisis Y Ensuring stakeholders voices are included, consulted and heard
Slide 21: CO*RE origins in 2009
Y In September 2009, CAFP leaders first met with a representative of the Industry Work Group G (IWG) ( G) who sought to engage the voice off family f physicians in the REMS process, especially California-based physicians because of their experience with AB487. Y The CAFP Board of Directors approved
Slide 22: First CO*RE Summit
First CO*RE Summit Y On June 10, 2010, representatives p from 12 organizations g attended the first CO*RE summit in Chicago. The group developed the CO*RE competencies for safe and effective p pain management g and opioids p p prescription. p The competencies were adopted by all of the organizations
Slide 23: Second CO*RE Summit
Second CO CO*RE RE Summit Y During g the first q quarter of 2011, the infrastructure documents necessary to formalize the CO*RE relationship were developed, including a Participation Agreement g and Addenda. All eight g foundinggppartners have signed the agreement. Y In March 2011, on behalf of CO*R
Slide 24: Needs assessment project findings
Y The four‐armed needs assessment project provided CO*RE partners with baseline knowledge about clinicians’ perceived and actual practice gaps, concerns about treating persons living with pain, barriers to optimal care care, and attitudes toward REMS and voluntary or mandatory education. This baseli
Slide 25: Clinician barriers to best practices
Y Additionally, clinicians perceive many barriers to best practices. Both primary care providers and specialists expressed concern about accidental overdose and patients’ concerns th t th that they may b become d dependent d t or addicted. ddi t d Primary care providers also listed among the top bar
Slide 26: Third CO*RE Summit
Third CO*RE CO RE Summit Y In March,, 2012 the partners p and clinical experts p met in Chicago to discuss and develop an efficacious educational design and system approach for the seven- part FDA module. module
Slide 27: Next steps
Y Finalize infrastructure Y Continued process planning o Launch website: http://www.core-rems.org/ Y Awareness campaign with Medscape o http://www.medscape.org/viewarticle/763585 Y Out reach o Associations – local, state, national and specialty o Government o Payors Y Wait and see…
Slide 28: CO*RE progress since 2009
Y Since the fall of 2009, the CO*RE partners have progressed from a group of eight discrete organizations to a unified collaborative partnership committed to advancing best education in pain management and safe use of long-acting opioid medications. Y The group has undertaken countless hours of rese
Slide 29: Lessons learned
Y Transdisciplinary p y approach pp is vital Y Hesitancy due to inexperience and competition Y Clarity is essential Y Managing expectations is key Y Letting organizations participate to their highest comfort level is required Y EAPs o Don Moore,, PhD o Marcia Jackson, PhD o Nancy Bennett, PhD
Slide 30: Cynthia Kear and Shelly Rodrigues contacts
Cynthia Kear – ckear@familydocs.org ckear@familydocs org Shelly Rodrigues – srodrigues@familydocs.org
Slide 31: Pennsylvania IPIP
Pennsylvania IPIP Improving Performance In Practice JJune 20, 20 2012 Pfizer Medical Education Group QI: Lessons from Practice
Slide 32: Contacts
Contacts Lee Ann Grajales Vice President, Quality Initiatives lgrajales@pafp.com 717‐635‐7577 Angie Halaja‐Henriques Quality Initiatives Grant Director ahalaja@pafp.com 717‐884‐2872
Slide 33: What is the PAFP?
What is the PAFP? www.pafp.com The PA Academy of Family Physicians (501C6) is the professional association for family physicians in Pennsylvania. • Established in 1948 • ~4,800 members; MDs and DOs, residents and medical students; t d t 77% market k t share h i PA in • Largest sole specialty physici
Slide 34: What is the PAFP Foundation?
What is the PAFP Foundation? www.pafp.com The PAFP Foundation (501C3) was created in 1985. • CME Programs • 3 Annual Live CME Conferences • Fall Regional Member Lecture Series • Maintenance of Certification Part V Programs • Lots of online CME • Public Health Grants • Connect public health to family
Slide 35: Status Quo
Status Quo • Pandemic of chronic disease1 • United States: worse outcomes, highest cost per capita2 • Demoralized health care professionals3 1. http://www.who.int/topics/chronic_diseases/en/ 2. http://www.commonwealthfund.org/Content/Publications/Fund‐Reports/2010/Jun/Mirror‐Mirror‐Update.aspx?page=
Slide 36: What We Offer
What We Offer • Evidence‐based adult education + systems change models • Healthier patients • Happier health care workforce1 • Positive clinical and process outcomes • Opportunity for long‐term QI community • Experienced faculty and productive, competent staff • Healthy organization (PAFP) at the co
Slide 37: Pennsylvania IPIP
Pennsylvania IPIP All Pennsylvania Academy of Family Physicians Foundation (PAFP/F) quality improvement and practice transformation initiatives are operated through the PA IPIP (Improving Performance in Practice) Program Program.
Slide 38: Pennsylvania IPIP
Pennsylvania IPIP • Sponsored p byy the PA Primaryy Care Coalition – PA Academy of Family Physicians – PA Chapter, Chapter American Academy of Pediatrics – PA Chapter, American College of Physicians • Strong partnership with PA Association of Community Health Centers • Operated O dbby the h PAFP FFo
Slide 39: What is PA IPIP?
What is PA IPIP? Improving p g Performance In Practice ((IPIP)* ) • Started as a national initiative • PA IPIP programs qualify as a performance improvement activity for Maintenance of Certification with the Family Medicine Medicine, Internal Medicine and Pediatric Boards – Primary Pi care physician
Slide 40: PA IPIP Mission Statement
PA IPIP Mission Statement • Accelerate quality improvement among primary care practices; • Support primary care physicians and their care teams to provide consistently high quality care that improves patient health; • Motivate M i collaboration ll b i at state, regional i l and d practice i levels;
Slide 41: PA IPIP Core Services
Support Education: Data & Clinical, Collection & Facilitation | Process, QI Sharing Collaborative Network ae ? Pennsylvania IPIP www.pafp.com/IPIP ea |
Slide 42: Current Projects
Current Projects • Data management g for statewide Chronic Care Initiative, operated by Pennsylvania Dept. Of Health – Contractor since the beginning in 2007 – Originally provided coaching and data services – Practices have “graduated” out of coaching – Now: N d data collection, ll i analysis l i an
Slide 43: Current Projects
Current Projects • Colorectal Cancer Screening Collaborative – Funded by DOH – Improve CRCS rates using systems‐based changes – Full range of services: data, education, support from staff/physician faculty – Open to any primary i care practice! i ! – More than 85,000 patients • Residency Program (RP
Slide 44: Residency Program & Community Health Center Collaboratives
Residency Program (RPC) & Community Health Center Collaboratives (CHCC) GOAL: • Transform participating practices so that they both teach and practice quality improvement and patient‐centeredness.
Slide 45: Why these practices?
Why these practices? • Medicare and Medicaid were the primary payers for 71.4 % of diabetes hospitalizations for Pennsylvanians in 2009 2009. Diabetes Hospitalization Report, 2009 Data. Pennsylvania Health Care Cost Containment Council. November 2011 • Makes sense to focus on safety net providers
Slide 46: RPC & CHCC Objectives
RPC & CHCC Objectives • Improve care for those patients served by participating practices, whose patient populations include the most vulnerable members of our communities. • Spread system change by teaching residents how to practice the principles of the Patient‐ Centered Medical Home. Home
Slide 47: Patient Population
Patient Population unt 8‐75 Cou dication Count Count Collaboraative VD > 18 C DM Pts 18 HealthInd TTotal Pt C IV H D C RPC Diabetes 9,336 RPC IVD 2,705 CHCC Diabetes 7,064 CHCC IVD 460 Current as of 6/18/2012 Total 16 400 3,165 16,400 3 165 19 565 19,565
Slide 48: Learners
Learners • 28 teams in RPC – all family medicine residency programs • 17 teams in CHCC – 16 CHCs, 1 residency program • Typically about 200 people attend learning sessions • Does D not include i l d the h physicians, h i i providers id and d staff impacted by change back at the practice
Slide 49: Multiplier Effect
Pennsylvania IPIP www.pafp.com/IPIP
Slide 50: Team Members
Team Members 3 PERSON TEAMS: 3‐PERSON • Physician (required) • Resident id (required) ( i d) or Administrator d i i • Non‐physician staff (office manager, CRNP, nurse)
Slide 51: Team Requirements
Team Requirements • Attend live sessions (3x/year) − Many teams bring more than 3 people • Participate in monthly calls • Report monthly data • Workk with h a physician h mentor – Use feedback form • Apply for NCQA PCMH Recognition
Slide 52: Faculty
Faculty • Chairperson, Chairperson Co‐Chairperson Co Chairperson Plus 6 Faculty – All primary care physicians, all faculty at residency programs • Develop and deliver the education • Work W k directly di tl with ith llearners – Each are assigned to a group of teams • Review and interpret data – Comp
Slide 53: Curriculum
Curriculum • What we teach • How we teach it
Slide 54: Change Package: Chronic Care Model
Change Package 1 Chronic Care Model 1. – Clinical Information Systems (ex: EHR systems or patient registries) – Decision Support (ex: algorithms) – Patient Self‐Management (ex: action plans) – Delivery System Design (ex: team‐based care)
Slide 55: Change Package: Patient-Centered Medical Home
Change Package 2 Patient 2. Patient‐Centered Centered Medical Home – Population management – Expanded team care – Patient‐centeredness – Performance P f measurementt – Care coordination – Evidenced‐based E id d b d care – Plus NCQA recognition
Slide 56: Implementation
Implementation 3 Model for Improvement 3. – PDSA (Plan‐Do‐Study‐Act) cycles 4 Breakthrough Series 4. – 12 month cycles – 3 live learning sessions (1‐day ( events)) – Monthly phone conferences
Slide 57: Measurement
Measurement • In God we trust trust, everybody else needs data data. • If you don’t measure it, it never happened.
Slide 58: Measured Outcomes
Measured Outcomes Moore’s Outcomes‐Based CME Evaluation Model1: Level 1 Participation Level 2 Satisfaction L l 3A Level L Learning: i D Declarative l ti K Knowledge l d (K(Knows)) Level 3B Learning: Procedural Knowledge (Knows How) Level 4 Learning: Competence (Shows How) Level 5 Performance (Does)
Slide 59: Tools to Measure Outcomes
Tools to Measure Outcomes • Standard evaluations + Pre/post‐tests – Measure baseline knowledge – Predispose learners to primary messages – Inform faculty of gaps in knowledge • Practice assessment – 14 areas, 75 indicators • NCQA PCMH recognition program • Patient‐level data collection – Clinical an
Slide 60: Data Collection
Data Collection • Robust data systems – Expert staff – Stable, Stable scalable platforms • Add measures, teams, whole collaboratives • Education stresses data integrity • Reporting is user friendly for learners • Slice/dice data • Statisticallyy significant g
Slide 61: Measures & Outcomes
Measures & Outcomes William Warning Warning, MD Faculty Chair, Residency Program & Community Health Center Collaboratives Program Director, Crozer Keystone Family Medicine Crozer‐Keystone Residency Program Springfield PA (near Philadelphia) Springfield,
Slide 62: DM Measures
DM Measures • Good HbA1C Control (<7) • Statin Prescribed • Intermediate HbA1C Control ((<8)) • Nephropathy p p y Attention • Poor HbA1C Control (>9) • ACE/ARB Prescribed • HbA1C Documented • Self‐Management Goals • Intermediate LDL Control (<130) • Tobacco Use Documented • Good LDL Control (<100) •
Slide 63: IVD Measures
IVD Measures • Count IVD • Blood Pressure (<140/90) • Lipid Testing – includes total cholesterol, TG, HDL‐C, LDL‐C • LDL Result (< 100 mg/dL) • Lipid Therapy • Aspirin or Antithrombotic • Smoking Status Smoking Counseling
Slide 64: NEW: Depression Measure
NEW: Depression Measure Measure Numerator Denominator Status Additional Information Screened for # Patients 18‐75 screened Total DM Required Example of tool: Depression i annually ll for f d depression i with i ha patients i 18 18‐75 PHQ‐2 Q 2 or PHQ‐9 Q9 standardized tool
Slide 65: NEW: Obesity Measure
NEW: Obesity Measure Measure Numerator Denominator Status Additional Information Adult Weight Patients with BMI calculated Total DM Optional Parameters: age Screening in the past six months and a patients 18 18‐75 75 65 and older BMI and Follow follow‐up plan documented if >/= 30 or <22; age Up the
Slide 66: Results
Results • NCQA recognition statistics • Satisfaction survey with the collaborative concept faculty and staff concept, • Self‐assessment survey of practices as PCMHs • Process and clinical outcomes data
Slide 67: NCQA Recognition
NCQA Recognition Recognition g statistics for the 22 teams in the RPC as of June 2012: NCQA Recognition (100%) Level 3: 18 teams (82%) Level 2: 1 team (4%) Level 1: 3 teams (14%) CHCC p practices are expected p to achieve recognition g in 2012.
Slide 68: RPC Learner Survey March 2012
RPC Learner Survey March 2012 • 93%: glad their practice is participating • 91%: Collaborative is valuable • 92%: Collaborative is a key resource to support practice transformation • 74%: 74% C Collaborative ll b ti is i iimproving i care att th their i practice • 76%: helped to educate residents ab
Slide 69: Practice Self-Assessment
Practice Self Self‐Assessment Assessment • Self-reported experience with transformation • PCMH indictors are on the rise (even with challenging processes such as care coordination being tracked) Ï Access & Scheduling Ï Care Coordination Ï Curriculum Redesign Ï Practice Climate ÏÏ MH/BH Integration Ï
Slide 70: RPC Diabetes Outcomes
RPC Diabetes Outcomes J l 2010 ‐ May July M 2012 Type Measure Start% End% Improve% mGoal CompToGoal Process Self‐Management Goals 13.05 46.87 33.82 90 ‐43.13 Process Eye E e Referral 7 85 7.85 39 86 39.86 32 01 32.01 90 ‐50.14 50 14 Process Pneumococcal Vaccination 35.98 64.11 28.13 90 ‐25.89 Proces
Slide 71: CHCC Diabetes Outcomes
CHCC Diabetes Outcomes J l 2011 July 2011‐May M 2012 Type Measure Start% End% Improve% mGoal CompToGoal Process Tobacco Use Documented 67.6 90.28 22.68 90 0.28 P Process E R Eye Referral f l 23 72 23.72 42 02 42.02 18 3 18.3 90 ‐47.98 47 98 Process Influenza Vaccination 41.18 56.77 15.59 90 ‐33.23 P
Slide 72: RPC IVD Outcomes
RPC IVD Outcomes J l 2011‐May July 2011 M 2012 Type yp Measure Start% % End% % Improve% p % mGoal CompToGoal p Process IVD Tobacco Use Documented 67.63 94.42 26.79 90 4.42 Process IVD Statin Prescribed 67.29 70.61 3.32 90 ‐19.39 Process IVD Aspirin Use Documented 73.46 75.3 1.84 90 ‐14.7 Outcome IVD
Slide 73: CHCC IVD Outcomes
CHCC IVD Outcomes • Stay tuned! • IVD data collection begins this summer
Slide 74: Team-Level Feedback
Team‐Level Team Level Feedback Allows for: • teams to be self reflective • specific faculty suggestions
Slide 75: Team feedback report example
Keep up the great work. Consider trying 1-2 focused PDSA's, perhaps foritem#17, maybe 10? Previous Difference Difference Goal Month% _betweenmonths to Team% See my Nov PITT comments - this is such a critical ane number to move, you may want to essentially make this ahigh priority, as-toanextent-it’s
Slide 76: Evaluation & Final Thoughts
Evaluation & Final Thoughts Lee Ann Grajales State Director, PA IPIP Vice President of Quality Initiatives, PA Academyy of Familyy Physicians y Foundation
Slide 77: Evaluation
Evaluation • Penn State University – Contracted by the PAFP Foundation for an independent study to analysis the effectiveness of our intervention both in the p practices and amongg residents • CDC Evaluation – Awarded throughg a competitive p evaluation p program g (nominated by the PA DOH) – 1 of 2
Slide 78: Summary
Summary • The PAFP Foundation’s Foundation s Residency Program & Community Health Center Collaborative is a successful long successful, long‐term term intervention to build a primary care community around transformation that leads to better patient care, happier physicians and providers and true pat
Slide 79: Follow Us On-line
Follow Us On‐line On line • www.pafp.com www pafp com • http://www.facebook.com/PAFPF • Twitter i – #PAFPandF – #PAIPIP – #RPC
Slide 80: Stay In Touch
Stay In Touch • Lee Ann Grajales Vice President, Quality Initiatives lgrajales@pafp com lgrajales@pafp.com 717‐635‐7577 • Angie A i H Halaja‐Henriques l j H i Quality Initiatives Grant Director ahalaja@pafp.com 717‐884‐2872
Slide 81: Thank You!
PENNSYLVANIA ACADEMY OF i} FAMILY PHYSICIANS FOUNDATION 1 PA | Residency Program Collaborative a ) Community Health Center Collaborative —— | 1 - Ce | ~ IMPROVING PERFORMANCE IN PRACTICE / Pennsylvania IPIP www.pafp.com/IPIP
Slide 82: Questions
Questions 82 | It all starts here. Company Confidential and Proprietary – Internal Use Only – Draft – Not to be implemented without Legal & Regulatory Review and Approval
Slide 83: Mark Your Calendars!
Mark Your Calendars! N tW Next Webinar: bi S t b 19, September 19 2012 Topic: 2012 Update- MEG Request for Proposal Strategies 83 | It all starts here. Company Confidential and Proprietary – Internal Use Only – Draft – Not to be implemented without Legal & Regulatory Review and Approval
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