General Internal Medicine – Access Health Columbus Vaccine Improvement Project December 7, 2012 – Nazhat Taj-Schaal, MD John J. Davis, RN
1)
EFINE
What was the problem? Variable rates for vaccinations (TDaP, Pneumo) among providers.
How was the improvement project identified? Technical assistance from Access Health Columbus (Krista Stock) on a project charter.
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2)
EASURE
What was the key measure? Immunization Rates for several Providers
Grever Jonaus Li
6/1/12 TDAP 36.3% 22.2% 16.8%
Grever Jonaus Li
6/1/12 Pneumovax 38.3% 35.1% 41.2%
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3)
NALYZE
 What root causes were identified?
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4)
MPROVE
Increase the TDAP vaccination rate in patients aged 19+ 10% in 3 months
25% in 5 months
Increase the Pneumovax vaccination rate in pts age 65+ 10% in 3 months
25% in 5 months
Improve documentation rate of historical immunizations. Educate and train clinic staff and physicians. Improve the process of educating patients.
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“Quality is never an accident; it is always the result of high intention, sincere effort, intelligent direction and skillful execution; it represents the wise choice of many alternatives.�
William A. Foster
4)
MPROVE (continued)
New Workflow
What intervention was tried? Introduce patients to vaccine importance with registration stamp. Provide patient education materials in exam rooms. Train MAs to ask patients about TDaP, Pneumo. MAs to enter historical vaccines if possible. MAs to pend vaccines. Providers to sign pended orders. MAs to administer vaccines. 9
4)
MPROVE (continued)
What were the results? 10% & 25% Goals were met for TDaP Monthly TDaP Rates vs Goals 55.0% 50.0% 25%
45.0%
TDaP %
39.4%
10%
40.0%
Grever Grever Goal Jonaus
35.0%
Jonaus Goal
36.0%
Li
30.0%
25%
Li Goal Others (avg change)
10%
25.0%
Others Range: -10.8 to + 20.9
25% 20.0%
10%
15.0% 6/1
6/28
8/6
9/4
10/4
11/1 10
4)
MPROVE (continued)
What were the results? 10% & 25% Goals were met for Pneumovax Monthly Pneumo Rates vs Goals 65.0%
62.3% 60.0%
60.5%
Grever
Pneumo %
55.0%
Grever Goal 25%
50.0%
25%
Jonaus Jonaus Goal
Others Range: -17.8 to + 12.3
Li 45.0%
25%
10%
Li Goal Others (avg change)
10% 40.0% 10% 35.0% 6/1
6/28
8/6
9/4
10/4
11/1 11
5)
ONTROL How was the process monitored? Monthly Reports out of Epic/IHIS Impromptu “huddles” with floor staff Monthly meetings to discuss progress
Celebrate Success
Address Issues 12
Next Steps
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Move from Stamp to Rooming dot phrase Add Shingles Vaccine Expand to all of General Internal Medicine Track monthly progress for Gen Med & NCQA Apply performance data to NCQA 2011 Standard 6 for submission as a PCMH
TEAM MEMBERS Neeraj Tayal, MD - Division Director Gail Grever, MD - Morehouse Lead Physician Nazhat Taj-Schaal, MD – Core Team Physician John Davis, PCMH RN – Core Team Member Krista Stock, MHA – AHC Project Leader – THANK
YOU!!
Sarah Jonaus, MD – Morehouse Physician Guibin Li, MD – Morehouse Physician
Charlotte Boyer – Clinic Manager Charlene McMahon – Clinic Nurse Maxine Jefferson - MA
Stacy Muck- MA Nicole Rittenhouse – MA Registration & Pharmacy 14
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