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PEBB Board Presentation. Kaiser 2006 Quality Initiatives. Northwest Region Quality Vision. Our vision is to provide the highest quality care in the world We will measure success by achieving 90 th percentile on HEDIS effectiveness of care (EOC) quality measures.

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Pebb board presentation

PEBB Board Presentation

Kaiser 2006 Quality Initiatives

Northwest region quality vision
Northwest Region Quality Vision

  • Our vision is to provide the highest quality care in the world

  • We will measure success by achieving 90th percentile on HEDIS effectiveness of care (EOC) quality measures

Quality populations measures for 2006 2005 hedis rank
Quality Populations/Measures for 2006 (2005 HEDIS Rank)

  • Adult Women

    • Breast Cancer Screening (50th)

    • Cervical Cancer Screening (10th)

    • Diabetic Members

      • Lipid screening (25th)

      • Lipid control < 130 (90th)

      • Lipid control < 100 (75th)

      • HgbA1c screening (50th)

      • Poor Hgba1c control (75th)

Quality population measures for 2006 continued
Quality Population/Measures for 2006 (continued)

  • Patients with CV conditions (new measure—no rankings)

    • Lipid screening

    • Lipid control <130

    • Lipid control <100

Jcaho ami measures
JCAHO AMI Measures

  • ACE Inhibitor for LVSD (89%)*

  • Smoking cessation advice/counseling (74)*

  • Aspirin at arrival (100)*

  • Aspirin at discharge (98)*

  • Beta blocker at arrival (99)*

  • Beta blocker at discharge (99)*

  • (Thrombolytics)

    * KSMC 2004 results

Quality populations measures for 2006 continued
Quality Populations/Measures for 2006 (continued)

  • Children/ Adolescents

    • Immunizations children (90th)

    • Immunizations adolescent (75th)

  • Appropriate asthma meds

    • Age 5-9 (50th)

    • Age 10-17 (10th)

Quality populations measures for 2006 continued1
Quality Populations/Measures for 2006 (continued)

  • Patients with depression

    • Practitioner contact (25th)

    • Acute phase treatment (90th)

    • Chronic phase treatment (75th)

Quality improvement opportunities pebb
Quality Improvement OpportunitiesPEBB

  • Beta blocker post-MI

  • Diabetes nephropathy screening

Beta blockers post mi
Beta Blockers Post-MI

  • For 2006 one of our quality goals regionally is improvement in all the JCAHO AMI measures, including beta blocker use post-MI

  • At KSMC this is a primary quality initiative for 2006

  • All plan hospitals—St. Vincent’s, SWWMC, St. Johns, Salem are participating in IHI 100,000 lives campaign with AMI bundle as a core strategy

  • Six month adherence to beta blocker use is a new HEDIS measure, we are currently considering strategies to ensure compliance

Diabetic nephropathy monitoring
Diabetic Nephropathy Monitoring

  • Those patients at risk for diabetic nephropathy can be identified with newer urinalysis tests— microalbuminuria testing

  • HEDIS adopted microalbuminuria testing as a standard annual test for all diabetics

  • Kaiser had microalbuminuria as a standard test on our “panel diabetes” lab ordering process

Diabetes nephropathy monitoring continued
Diabetes Nephropathy Monitoring (continued)

  • Context: Diabetics develop macrovascular (large vessel) and microvascular (small vessel) atherosclerosis

  • Macrovascular disease causes heart attacks and strokes and is the leading cause of death in diabetes

  • Microvascular disease causes diabetic retinopathy leading to blindness; and diabetic nephropathy leading to end stage renal disease (ESRD) resulting in dialysis or kidney transplant

Historical perspective
Historical Perspective

  • Research on microvascular disease, specifically diabetic nephropathy, has shown that early detection of those diabetics at risk of renal disease and specific treatments can slow the progression and prevent ESRD/dialysis

  • The main treatments are: Improved blood pressure control—goal bp < 130/80, and use of specific medications—ACE-I and/or ARB

Macrovascular disease research
Macrovascular Disease Research

  • Research on macrovascular disease has demonstrated that all diabetics given ACE-I (or ARB’s) had lower rates of macrovascular disease (heart attacks/strokes)

  • Based on this information Kaiser Northwest and nationally felt microalbuminuria screening was unnecessary and removed it from the “panel diabetes” order

  • As a result our HEDIS nephropathy scores have fallen

Current consensus
Current Consensus

  • HEDIS has proposed changing the nephropathy screening measure for 2007 such that any patient on ACE-I or ARB will count as having had nephropathy monitoring

  • Kaiser Northwest region has decided to add microalbumin testing back to our “panel diabetes” order

  • By the end of 2007 our nephropathy screening rate will be significantly higher

Tools to achieve improved diabetes quality goals
Tools to Achieve Improved Diabetes Quality Goals

  • Health maintenance alerts for any diabetic who has not had diabetic labs in past 9 months

  • Health maintenance alerts when last recorded blood pressure is not at goal

  • Promotion of ALL= Aspirin, Lovastatin, Lisinopril use in all members

  • Monthly rosters for health care teams listing diabetics with LDL > 100, or no LDL in past 9 months, hgba1c > 9 or no hgba1c in past 9 months, no microalbuminuria testing in past 9 months, bp not at goal