2008 Performance Improvement Project: Improving the documented use of aspirin in MSHO

1. 2008 Performance Improvement Project: Improving the documented use of aspirin in MSHO/MSC/MSC+ seniors with diabetes or ischemic heart disease Developed by Jackson Thatcher MD FACC FSCAI Presented by Theresa Zeman NP To insert this slide into your presentation Save this template as a presentation (.ppt file) on your computer. Open the presentation that will contain the image slide. On the Slides tab, place your insertion point after the slide that will precede the image slide. (Make sure you don't select a slide. Your insertion point should be between the slides.) On the Insert menu, click Slides from Files. In the Slide Finder dialog box, click the Find Presentation tab. Click Browse, locate and select the presentation that contains the image slide, and then click Open. In the Slides from Files dialog box, select the image slide. Select the Keep source formatting check box. If you do not select this check box, the copied slide will inherit the design of the slide that precedes it in the presentation. Click Insert. Click Close. To insert this slide into your presentation Save this template as a presentation (.ppt file) on your computer. Open the presentation that will contain the image slide. On the Slides tab, place your insertion point after the slide that will precede the image slide. (Make sure you don't select a slide. Your insertion point should be between the slides.) On the Insert menu, click Slides from Files. In the Slide Finder dialog box, click the Find Presentation tab. Click Browse, locate and select the presentation that contains the image slide, and then click Open. In the Slides from Files dialog box, select the image slide. Select the Keep source formatting check box. If you do not select this check box, the copied slide will inherit the design of the slide that precedes it in the presentation. Click Insert. Click Close.

2. 2008 Performance Improvement Project

3. Scope, Evidence & Disclosures The scope of this project is limited to seniors age 65-84 covered under the senior Medicaid plans: Minnesota Senior Health Options (MSHO), Minnesota Senior Care (MSC) or Minnesota Senior Care Plus (MSC+) The scientific statements in this PowerPoint are drawn from the Project Executive Summary and References and ACC-AHA Cardiovascular Disease Guidelines

5. Why Aspirin? Aspirin is fundamental to the care of patients with cardiovascular disease

9. Why Aspirin? Utilizing the senior OTC aspirin benefit would provide data documenting the quality of care in eligible patients

20. So How Does Aspirin Reduces the Risk of Heart Attacks and Strokes? Aspirin irreversibly binds to cyclo-oxygenase (COX-1) on the platelet Aspirin blocked COX-1 cannot catalyze the formation of thromboxane A-1, which stimulates platelet activation

24. How Many Seniors are at Risk? Risk increases in lower income populations Substantial numbers of seniors have lower income

27. What is the Current Data for Use? Patients with prior MI or diabetic patients have a 20% risk of new/recurrent cardiovascular events within 3 years Patients with diabetes and prior MI have a risk of over 45%

33. So I have Good News and Bad News, Which news do you want first?

34. Lecturer�s prerogative First the Bad News

35. The Bad News Medicine can be expensive

36. OK then, so what�s  The Good News?

37. The Good News At least we can afford aspirin

38. Relative Generic Costs per Year Aspirin $5.00 X Lisinopril $30.00 6X Carvedilol (Target/Sam�s) $48.00 10X Lovastatin (Target/Sam�s) $48.00 10X Metoprolol (QD formulation) $75.00 15X Simvastatin $200.00 40X Atorvastatin (not generic) $1300.00 260X Clopidogrel (not generic) $1900.00 380X

39. What are the Current Criteria for Use?What is Anticipated in the Future? Aspirin, along with beta-blocker, converting enzyme inhibitor and a statin are AHA-ACC Guideline Indicated (Class 1) in vascular disease and diabetes unless contraindicated Studies in diabetics like the ACCORD trial examining the results of optimal glucose control on top of hypertension control, lipid treatment, beta blocker, and aspirin therapy may reduce cardiovascular events by over 50% results anticipated by 2011

42. Where Does All This Lead? If we plan now we could have a real jump on a DHS Senior performance improvement project for 2011!

43. Changing Lanes Moving from what we need to do, To what may make it difficult to accomplish Despite our best effort, tools, and successes to date

44. Why is ASA Treatment Documentation so Poor? As an OTC product aspirin is not routinely administered via written prescription

48. Providers ? Physicians Providers include: Physicians MDs DOs Mid Level Providers (MLPs) Physician Assistants Nurse Practitioners Advanced Practice Nurses Workable solutions for this problem must include all care providers

49. So how do we make a measurable improvement? Educating all Minnesota providers to write OTC aspirin prescriptions for all eligible patients will prove a difficult task Getting all eligible patients to submit this prescription may also prove difficult They may already have aspirin at home They may forget to bring the prescription since it is not required to obtain the medication and aspirin is inexpensive

51. So how do we make a measurable improvement? Care Coordinators can help by ensuring all eligible patients are aware of the benefit Patients must understand their use of the aspirin prescription benefit will also document their receipt of Best Care Assisting the clinician with the name/fax+phone number of the patient�s preferred pharmacy might expedite the process

54. So how do we make a measurable improvement? In process improvement an average solution that is very well executed will always beat a better solution that is not well disseminated or multiple conflicting solutions

65. Promoting the use of the OTC aspirin benefit in covered Medicaid seniors Is a big step in the continuing effort to provide superior healthcare to all Minnesotans

66. Good Luck with your project

67. Improving the documented use of aspirin in MSHO/MSC/MSC+ seniors with diabetes or ischemic heart disease Questions