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MaineHealth Clinical Integration Annual Reports FY2008 Evaluation (October 2007 – September 2008). AMI/PCI Improvement. Goals / Aims

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Clinical Integration

Annual Reports

FY2008 Evaluation

(October 2007 – September 2008)

ami pci improvement
AMI/PCI Improvement
  • Goals / Aims
  • Individuals who experience an ST-Elevation Myocardial Infarction (STEMI) in the MaineHealth community will receive the highest quality of care and achieve the best possible outcomes, regardless of their point of entry into the system.
  • Outcomes
  • Increased the percent of patients that received timely diagnosis and treatment.
  • All hospitals are following best practice guidelines from the ACC/AHA.
  • Activities
  • Analyzed and trended hospital-specific data quarterly and fed back to respective hospitals
  • Updated and customized treatment tools.
  • Built new relationships with EMS providers.
  • Lessons Learned / Next Steps
  • Using EMS providers as an extension of the ED improves STEMI patient care.
  • Prompt feedback to hospital providers encourages continuous quality improvement.
ah asthma health
AH! Asthma Health
  • Goals / Aims
  • Improve asthma diagnosis and increase asthma self-management education
  • Support and train providers in quality care
  • Reduce hospitalizations and emergency visits
  • Outcomes
  • Patients receiving asthma education increased 20%
  • ACT utilization increased by 7%
  • MMC admissions decreased 23.8% to 0%; ED visits decreased 22.2 to 4.6% in 6 mo. post education
  • Pediatric patients receiving complete care increased from 30 – 49%
  • Activities
  • Update, redesign and distribute Asthma Clinical Guidelines flipchart; revise provider and patient tools based on new clinical guidelines
  • Encourage automatic asthma education referral
  • Encourage assessment of asthma control
  • Create & select provider & patient COPD tools; distribute on MH, PHO and JS McCarthy websites
  • Lessons Learned / Next Steps
  • Support development of AH! Program at Stephens and Waldo County
  • Obesity in AH! Program patients is high; collaborate with healthy weight initiatives
  • Collaborate with statewide COPD partners; Healthy Homes partners for asthma environmental intervention
cardiovascular health
Cardiovascular Health
  • Goals / Aims
  • Reduce the burden of CVD in Maine
  • Contribute to the continuing enhancement of CVH care delivery design and support healthcare team education
  • Outcomes
  • Successful completion of Healthy Living Club; membership was 389 at closure, 49% above goal
  • Distribution of over 22,356 patient education materials in 2008; 17,000 were CVD Patient + Family Ed booklets
  • Lessons Learned / Next Steps
  • Healthy Living Club well-received; model needs to be modified for sustainability and cost reduction
  • Cardiac Rehab data collection challenge due to lack of clinician time/support
  • Focus on collaborative projects related to cross-cutting topics of primary prevention + back-to-basics
  • Activities
  • Healthy Living Club ~ innovative employee health improvement pilot
  • Development of materials and services for patients and providers
  • Cardiac Rehab Sub-Committee
ed psychiatric care
ED Psychiatric Care
  • Goals / Aims
  • Improve quality of psychiatric patient care in all MaineHealth EDs.
  • Standardize care of psychiatric patients across all MaineHealth EDs.
  • Outcomes
  • Reduction in orders for unnecessary labwork.
  • Standardization of medications used to treat agitated patients.
  • Activities
  • Developed Medical Clearance Protocol for IP transfers
  • Developed Treatment of the Agitated Pt
  • Lessons Learned / Next Steps
  • Measuring incidents of restraint
  • Working to lower length of stay
heart failure
Heart Failure
  • Goals / Aims
  • Sustain support for high quality HF care within acute care facilities
  • Expand program to outpatient management of HF patients
  • Standardized approach to HF care
  • Outcomes
  • Rate of discharge instructions  from 70.8% in 2007 to 86.3% in 3Q08
  • Workgroup endorsement of Home Health Clinical Pathway for HF Care
  • 932 scales distributed to pts. since 2002
  • Lessons Learned / Next Steps
  • Strengthen patient-centered care by focusing on outcome measures (e.g. readmission rates) and outpatient services
  • Collaboration across the care continuum, senior level support and workgroup composition is critical to program success
  • Innovative provider + pt. offerings, i.e. home health nurse ed modules
  • Activities
  • Creation of Home Health Clinical Pathway for HF Care
  • Develop + support materials/ programs for patients: Weigh Every Day Scales Program, Healing Hearts Newsletter
  • Collect + assess data to act on areas in need of improvement ~ focus on discharge instructions in ’08
infection prevention
Infection Prevention
  • Goals / Aims
  • Develop hand hygiene improvement plan
  • Establish statewide infection prevention and control consortium
  • Outcomes
  • Hand Hygiene plan, tools, protocols developed
  • Statewide infection prevention group established
  • Activities
  • Engaged every hospital in S. ME in hand hygiene efforts
  • Worked with Maine Quality Forum to develop strategy to inform Maine Legislature
  • Lessons Learned / Next Steps
  • Clearly agreed-upon, effective process is vital
  • Begin gathering hand hygiene data systematically
  • Employ PDSA cycles to apply hand hygiene data to quality improvement

MaineHealth Learning Community

  • Goals / Aims
  • To support primary care practices in making improvements in care and outcomes for the patients and families they serve.
  • Outcomes
  • % of MPHO Members Reached: 64%
  • Overall Satisfaction Results:* 92%
  • * Participants who completed the evaluation that agreed or strongly agreed with the overall quality of the program.
  • Activities
  • Practice Improvements Series Mtgs. (PRISM)
  • Regional Improvement Mtgs. (RIM)
  • Practice Networking
  • Quarterly E-News Letters
  • Lessons Learned / Next Steps
  • High demand, satisfaction and demonstrated growth
  • Obsolete operational processes in place
  • Single prong delivery method
  • Expand beyond traditional approach
  • Invest in new technology to increase efficiencies and better serve our customer
primary care mental health depression
Primary Care Mental Health - Depression
  • Goals / Aims
  • Improve care for patients with depression cared for by PCPs by:
    • Screening adults at risk for depression
    • Improving PCP knowledge and skills in depression care
  • Outcomes
  • PCPs trained in the use of SM & CM in depression treatment
  • Patients with depression engaged in Self-Management (SM) & Care Management (CM)
  • Patients with diabetes or CVD screened annually for depression by their PCPs
  • Activities
  • eLearn Module 3: Use of Care Management and Self-Management in Depression Treatment
  • Depression care training for PCPs at Regional Improvement Meetings (RIMs) and Practice Improvement Series Meetings (PRISMs)
  • Lessons Learned / Next Steps
  • eLearning, RIMs, and PRISMs are effective ways of training large numbers of PCPs
  • Brief screening and treatment for common mental health comorbidities of depression will enhance care for patients by PCPs
  • Goals / Aims
  • Complete strategic planning process
  • Identify Priorities
  • Gain endorsement of plan from each MaineHealth member & affiliate hospital
  • Outcomes
  • Strategic plan developed
  • Process of gaining endorsement is under way
  • Activities
  • TBD
  • Next Steps
  • Outline set of priorities with strategies
  • Find champions / leaders to lead each initiative
palliative care
Palliative Care
  • Goals / Aims
  • Complete strategic planning process
  • Identify priorities
  • Outcomes
  • Identified priorities in Maine
  • Activities
  • TBD
  • Next Steps
  • Advance the use of POSLT in Maine
  • Increase clinical & community awareness of palliative care
  • Identify quality metrics for use in hospice and palliative programs
  • Goals / Aims
  • Develop patient & family education tool
  • Provide MH providers with tools to improve efficiency and effectiveness
  • Outcomes
  • Developed and implemented practice 3 new stroke practice tools
  • Developed MaineHealth stroke guide for patients and families
  • Activities
  • Collaborated with hospitals to develop and apply practice tools
  • Collaborated with stakeholders to in development of stroke guide
  • Assisted in development of MMC – MGMC telestroke project
  • Lessons Learned / Next Steps
  • Centralization of data collection & analysis will be valuable
  • Develop new practice tools for TIA and hemorrhagic stroke
  • Assist hospitals in QI and primary stroke center certification
target diabetes
Target Diabetes
  • Goals / Aims
  • Prevention
  • Public Awareness
  • Patient Education
  • Provider Support
  • Outcomes
  • Diabetic patients in the Maine PHO
  • Process: 55% recorded on all 6 specified measures
  • Outcomes: 15% = optimal range
  • 31% = intermediate range
  • Activities
  • Increased focus upon Inpatient Glycemic Management among all MH hospitals; IpGC conference October 2008
  • Patient Self-Management support via development of education tools
  • Provider support via development of clinical tools
  • Lessons Learned / Next Steps
  • Outcomes data key to assisting improvement processes within MH community - Inpatient/Outpatient.
  • Continue development of IpGC initiative throughout MH hospitals