TOP HONORS | HONORABLE MENTION | KAISER PERMANENTE AWARD
Honored at the CAPH Annual Conference on December 3, 2009, this year's awarded programs address four critical focus areas:
- Clinical Quality Improvement
- Improvements in Patient Experience
- Creating Equitable Health Systems, and
- Political Effectiveness and Community Support.
TOP HONORS:
Ventura County Healthcare Agency, Ventura County Medical Center
Improving Critical Care Outcomes – the Future of ICU Data Collection and Analysis
The medical center instituted a Web-based program, “ICUTracker,” to enable the facility to gather and analyze ICU outcomes data in order to optimize the ICU’s quality and performance. This system delivers data needed to measure and improve clinical results. Previously, staff would need to gather data by hand, which left little time or resources to analyze whether the many enhancements the center had undertaken were actually having a positive effect on patient outcomes.
Much work went into making sure that the new ICUTracker system was utilized correctly by staff so that bundled best practices would be captured. The results have been remarkable: not only is the medical center able to collect data more quickly and efficiently, but it has seen a significant improvement in patient outcomes. In the last quarter of 2008, the ICU saw an unprecedented outcome of no ventilator-associated pneumonias and no catheter- or central line-related infections. The center is using the new system to expand improvements into other areas, and the agency plans to implement the program at its Santa Paula Hospital as well.
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San Francisco General Hospital and Trauma Center
Automated Telephone Self-Management (ATSM) Support Model for Diabetes
This demonstration project combined accessible, multi-lingual communication technology with targeted interpersonal support to improve health outcomes for Type 2 diabetes patients. The effort grew out of the Improving Diabetes Efforts across Language and Literacy (IDEALL) project that was developed at San Francisco General Hospital/Community Health Network of San Francisco.
The ATSM model tailors the system’s technology with the literacy and language needs of the target populations. The system provides weekly calls with rotating queries, in patients’ native language, regarding self-care (e.g., symptoms, medication adherence and diet), psychosocial issues, and referrals for preventive services. Patients respond to questions via touchtone commands. Depending on the response to an individual item, patients might receive automated health education messages or a call back from a nurse care manager who can help the patient with his or her concerns. This system has been found to be far superior in terms of improved diabetes-related health outcomes and patient safety, and is cost-effective. The project is now being expanded to enroll hundreds more patients in the coming months.
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Santa Clara Valley Health and Hospital System
Seismic Safety Project
The Santa Clara Valley Health and Hospital System undertook the Seismic Safety Project as part of its effort to educate the public regarding the need to rebuild part of the system’s Santa Clara Valley Medical Center (SCVMC) that did not meet state-mandated seismic safety requirements. The project dovetailed with Santa Clara County’s Yes on Measure A campaign, which aimed to pass a bond measure to support the hospital rebuild.
The project involved a county-wide communications effort to reach a broad base of residents and voters, including a public education campaign conducted in several languages, a media relations component, and a speakers bureau created to inform employees throughout the county about the services that SCVMC provides to the county and to patients. The project succeeded in raising the public’s awareness of SCVMC’s significant role in the county, including its status as a level 1 trauma and burn center and its function as a safety net provider. The proof of the project’s success came on Election Day, when Measure A won by a resounding 78 percent of the vote.
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HONORABLE MENTION:
Harbor-UCLA Medical Center
Concurrent ORYX Review Program (CORP)
The medical center implemented an innovative new strategy designed to improve its core quality measures and thereby enhance patient safety. By shifting data collections for core measures from retrospective, “after-the-fact” review of clinical documentation to concurrent review of medical records by registered nurses with “real-time” intervention with clinical staff, the center was able to improve documentation of care and impact changes in safety practices. The concurrent review allows nurses to identify documentation issues and potential care omissions prior to a patient’s discharge, and enables them to work with clinical staff to assure that the best recommended care is provided and documented.
As a result of a shift to this new program, the medical center has seen dramatic improvements in performance on the core measures they sought to influence. Among the improvements were significant increases in: primary PCI received within 30 minutes of hospital arrival for acute myocardial infarction, documentation of discharge instructions in patients with heart failure, and pneumococcal vaccinations of patients with pneumonia. The program also saw considerable increases in appropriate prophylactic antibiotic selection and discontinuation, and in the number of patients who received recommended venous thromboembolism (VTE) prophylaxis.
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San Francisco Department of Public Health – Community Oriented Primary Care Division
Active Patient Panels: Use in Patient Capacity Assessments and Quality Improvement Efforts
This concept was created as part of the Healthy San Francisco health access program in order to find a more accurate way of tracking patient enrollment, clinic utilization and potential capacity. The Active Patient Panel includes all patients assigned to a primary care clinic who have been seen there for one or more outpatient medical visits during the past two years. The implementation and widespread acceptance of the Active Patient Panel definition has helped the clinics develop a more comprehensive, team-based focus to population management of their patients.
As a result of this program, staff now have data on the number of actively managed patients at each primary care clinic as well as data on the panel sizes of individual providers within each clinic – a necessary tool for determining unused capacity and planning for increased access in an equitable manner. Patients can now be assigned to a medical home and providers are better able to manage their panels of patients. And thanks to the development of a “Shadow Panel” at each primary care clinic, patients who are enrolled in the program but not yet seen can be identified for outreach and other efforts to improve access to health care.
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University of California at Davis Health System
Toolkit for Constructing the Medical Home and Improving the Patient Experience
This pilot program in a Family Practice clinic was developed to create the Medical Home environment and aimed to improve the patient experience, operational workflows and clinical efficiencies. The program initially had three distinct components that were integrated as part of building the medical home and providing personalized, coordinated care: formation of the Team Huddle, development of the “personal physician” concept for residents that provides patients with a continuous relationship with a provider and a care team, and a redesign of workflow and tasks for nurses and medical assistants to enhance the use of resources and job roles.
The program has enhanced workflow and clinic efficiencies, improved medication management and reduced wait time delays. This effort also has resulted in improved satisfaction of both patients and providers. Patients are particularly pleased by the new “in-exam room one-stop shop” experience; providers are communicating more effectively and residents’ adaptation to the clinic environment is more seamless, fluid and comprehensive.
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KAISER PERMANENTE CLINICAL SYSTEMS DEVELOPMENT AWARD:
Kern Medical Center
Impact of Clinical Pharmacists’ Involvement in Direct Patient Care as Mid-Level Practitioners
In an effort to enhance access to medical information and improve health outcomes, especially for those with certain chronic conditions such as diabetes and hypertension, Kern Medical Center instituted an innovative program to utilize clinical pharmacists as mid-level practitioners. These pharmacists are uniquely trained to be part of the health care team, particularly in the case of patients diagnosed with a chronic disease where much of the treatment involves complex medication regimens, education, and lifestyle changes.
Kern Medical Center’s clinical pharmacy services have improved access to health care for patients, who can receive needed information and guidance about their medications and related issues between physician visits and can better manage their chronic disease. Thanks to this program, the medical center has seen reduced utilization of its ER for previously uncontrolled disease states and medication refills. The clinical outcomes of the pharmacy services are above the national benchmark and are in line with a growing body of evidence in medical literature regarding the benefits of including clinical pharmacists in direct patient care roles.
Click here to learn about the QLA Webinar Series featuring three QLA awardees.
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