Q4 Learning Session: OSU General Internal Medicine

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.

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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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