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Improvement of PPD Percentages Caring Together Program. Family First Health – York, PA Caring Together Quality Improvement Team Shannon McElroy, Program Manager Alina Popa, MD Chris Echterling, MD Robin Bohanan, CRNP Connie Scott, LPN Cheri Peters, LPN

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Improvement of ppd percentages caring together program
Improvement of PPD PercentagesCaring Together Program

  • Family First Health – York, PA

    Caring Together Quality Improvement Team

    • Shannon McElroy, Program Manager

    • Alina Popa, MD

    • Chris Echterling, MD

    • Robin Bohanan, CRNP

    • Connie Scott, LPN

    • Cheri Peters, LPN

    • Chris Carney, Administrative Coordinator

    • Jan Hufnagle, Pharmacist

    • Karen McCraw, Chief Program Officer

    • Majel Marshall, LPN

    • Nicole Friend, Data Specialist

    • Tanya Barr, CMA


The problem
The Problem

  • The problem: Clients are not consistently returning to have their PPD read, which is causing consistently low numbers in the performance measure.

  • Goal: Increase the percentage of the TST (read) performance measure to at least 80%.


Baseline data
Baseline Data

  • July 1, 2010 – June 30, 2011:

    36.02% of clients had their PPD read


Nikki distributes an encounter form to the provider that indicates if PPD is needed

Nikki researches which clients need PPD’s completed

PPD Process Map

Give client information to Nurse Care Manager’s regarding clients who need PPD’s

NCM will schedule client to come in

Provider calls CSS or NCM to complete

Patient refuses PPD

Client does not come in

Client comes in

Attempt to get PPD at next appointment.

Place PPD and ask client to return in 72 hours

NCM will attempt to reschedule

Client returns

Client does not return

Place PPD and ask client to return in 72 hours

Client returns

Client does not return

NCM will attempt to reschedule

PPD is read and reported on

PPD is read and reported on


Causal analysis
Causal Analysis indicates if PPD is needed

Workflow process analysis identified the following problems:

  • Clients not returning to get PPD’s read (transportation issues, forget to return, no time to return, return too soon or too late, etc.)

  • Attempts to reschedule fail (client doesn’t return calls, phone disconnected, etc.)


Pdsa plan q1 q2
PDSA – Plan (Q1 & Q2) indicates if PPD is needed

  • Discuss and develop process map with team

  • Brainstorm session:

    • Using Quantiferon blood draws to replace traditional PPD

    • Having nurses or case managers call to remind clients to come back in.

  • Quantiferon:

    • Quantiferon would be a good replacement for traditional PPD because it is a one step process.

    • Fiscal achievability – Team to research cost on the lab level

    • New lab process – Team to research what the lab requirements (tubes needed, storage directions, etc.)


Psda do q3
PSDA - Do (Q3) indicates if PPD is needed

  • Fiscal achievability:

    • Cost found to be feasible in making the switch to Quant (under $70 at the lab level)

    • Medicare and Medical Assistance will cover

  • Lab process:

    • The correct tubes have been obtained for the collection process

    • Nurses have been educated on how to collect and store the blood

    • Nurses at FFH will begin contacting those clients who need the

      TB testing and schedule them to come in immediately

    • At Wellspan, providers will begin making a note on their lab slip

      that Quantiferon is requested rather than the traditional PPD

  • The process can begin immediately, will re-evaluate at the next meeting


Pdsa study act q4
PDSA – Study/Act (Q4) indicates if PPD is needed

  • Study:

    • As of June 30, 2012 – 76.8% of clients completed Quantiferon lab work, satisfying the TST (read) measure

    • 40.78% increase from June 30, 2011

    • No issues reported with roll-out of new process

    • Lab is processing and billing the Quantiferon correctly

  • Act:

    • Team agree that Quantiferon should permanently replace traditional PPD in our processes

    • At FFH Quantiferon will be drawn during normal labwork to increase efficiency moving forward

    • Nurses will continue outreach to the 23.2% of clients who have yet to receive the Quantiferon drawn


Overall findings
Overall Findings indicates if PPD is needed

  • FY 2011 = 36.02%

  • As of June 30, 2012 = 76.8%

  • As of July 31, 2012 = 80.68%

  • As of May 31, 2013 = 88.33%

  • The fact that the original suggestion of using Quantiferon was spearheaded by providers and nurses, as something that would also make their jobs easier, helped to implement the change faster

  • Overall an easy change to make with little difference in the steps the staff had to make (substitution rather than “change”) created a dramatic increase


Moving forward
Moving Forward indicates if PPD is needed

  • Program Manager will continue to monitor results quarterly and report on any changes

  • Nurses will continue to draw Quants during normal labwork

  • Nurses will continue to contact clients who have not had a PPD or Quantiferon read to come in for lab work


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