Christine's Weblog

One year and beyond dreams...

Thu, 31 Jul 2003 17:26:25 GMT

With the task of transforming the health care system in Whatcom county and beyond, it is not often when the Pursuing Perfection core team can pause long enough to be in the same place at the same time thought or location wise. We have staff meetings on a regular basis, but occasionally we need a longer period of time together as a team to update, reflect and dream. This last week we had a wonderful team retreat where one of the team activities was to share our dreams for the future. Here are our dreams for one year and beyond… dreams, goals, sustainability and success.

Patient involvement – patient initiates, clinic follows

Website: more info to the right person at the right time – patients control info that goes to them

Education process through community - electronic, standardized, color printed

Inter-team communication through web or tool such as groove

Primary docs routinely meet to discuss patient needs

All clinical staff fill out shared care plans as primary priority

Spread patient centered care as norm beyond county

Bulleto used for migrant community as focus of their care

Ease in access to electronic information

Support groups across community

Any healthcare professional will know how to define/use SCP and P2

Process established to support creation of SCP for anyone in community

SCP easily connected across organizations without duplicated effort and automatically

National healthcare program, like Sweden, or transformed healthcare

Reimbursement for email, group visits to prove economic sustainability for chronic care

Motivational interviewing takes hold among all clinicians

Electronic guidelines, always current, user friendly and always available

Healthcare professionals feel balanced in their practice, with patient centeredness and sufficient time to work

Patients experience is empowered, feeling like part of collaborative team

Awareness of need for transformation and belief in our approach among total community – spreading the awareness

Sustainable, automated system to continue data collection/analysis

All FCN clinics, Lummi, Interfaith and Mt Baker family as P2 sites

More CCS’s

Patient outreach coordinator

More diseases that are better managed

Network of 13 P2 sites all following P2 community model

Integrated SAFE electronic med list

System is patient driven

Management of chronic conditions resemble one another to ease provider adoption

Forum for patient and others involved to discuss complex issues

Options for care located in a place called Chronic Urgent Care

Include all who share work on patient care in the center – not just patient-centered

Support and sustained balanced lives for heath care transformers

P2 patients being advocates of transformation among providers and other patients

Other fundamental aspects of healthcare, IE profit, are examined for transformation

Examine incentives in system to reinforce those that benefit patient

Spread beyond Whatcom county

Improvements so apparent and recognized that people demand them

Cross clinic team on going

More efficient change through systems dynamics modeling

Bi-directional, transparent med list

Clinicians and patients work together, caring for entire patient care team integrated into excellent, satisfying care

Sense of alone-ness, of being a disease rather than a whole person, disappears

More prevention and support for behavior change

Patients with chronic diseases support one another in prevention

Whatcom community knows what health indicators are and uses them and existing assets to support P2 and pool resources for prevention

Community takes responsibility for sustainability

Spread to OR, WA and non peace heath communities through leaders connecting and learning how to transform chronic care

More CCS’s, solid value-added, lean, effective structure

Patients advocating effectively to promote and sustain change at local, state and national levels

Patients feel strong and effective

World Peace

Computer in every exam room

All payors pay for P2 aspects and assure that healthcare pays for itself

Have Olympic take over Medicare payment for P2

Immediate feedback (money) for providers/payors doing the right thing

P2 at center of international transformation

P2 Whatcom county as case study of sociology of collaborative community

Company that does P2 as a service in any community

Physicians will want to stay in our brand of healthcare

All medical records tied together and patient can access through shared care plan all info on the condition

All Whatcom county patients supported by P2 process

E-SCP available nation –wide

Patients continue central role in design

Communities will use web-logs; stated personal values, to form virtual communities with free, easy access to information

Local systems dynamics modelers

Pharmaceutical companies fund electronic updates and spread to more communities

Patients show increased relationships, self-management and communication

Idealized design of clinic process solves all access problems in Whatcom county

Models expand to 5 diseases

Communities learn that they can transform their own health care

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Wed, 14 May 2003 20:27:39 GMT

This is a test of FM Radio

Thu, 21 Nov 2002 19:08:20 GMT

Week In Review
(Week ending 11/22/02)

1) Completed and submitted the analysis of the SJH Inpt PSAT P2 specific questions for the month of August. In addition, August data was compared to July using a line (run) chart. This chart will be transitioned into a SPC chart once we have enough data points to do so. Thanks to Sarah Jane Satre of the PeaceHealth MOMS Team for her strong knowledge of SPSS and continued help with this analysis.

2) Later this week we will begin the first analysis of the Clinic PSAT Touchscreen Survey data. We currently have >250 completed surveys in the hopper which is a perfect amount to create the necessary anchor file. In addition to the creation of the anchor file we will also be able to provide the clinics with actual PSAT scores. With the feedback gathered from the most recent Implementation meeting we will hope to reformat the clinic specific PSAT report into a more user friendly manner. The PeaceHealth Survey Subteam of Aaron Ignac, Sarah Jane and of course Bill Mahoney will be instrumental in making this analysis a reality.

3) Began work on the Systems Dynamics data pull for Congestive Heart Failure. This has proven to be a bit confusing and more complex than the Diabetes data pull. At the very least it looks like an impressive challenge that we look forward to tackling.

One of the main challenges is staying in compliance with the patient confidentiality rules and regs, especially the new HIPAA regs that go into effect April 2003. While all of us truly have patients at the center and have an enormously high regard for patient confidentiality the new HIPAA regs are creating some challenges not previously experienced. Simply relying on our self judgment of what is "reasonable" doesn't cut it anymore. The HIPAA regs are very specific and have teeth. Violating these regs, even inadvertently, could sink our efforts, on a personal level as well as community level.

The first step of the Systems Dynamics pull is fairly straight forward and we should be able to submit "Phase I" data to the consultants in the very near future. The phase I data does not involve the release or sharing of any pt identified data so we will be able to move quickly on completing this request.

Many thanks to Dori Robart from SJH and Sarah Donelson of the MOMS Team for providing their continued support and guidance with the security and confidentiality rules and regs.

4) We created a database to assist us in tracking the rate of completion of the clinic PSAT survey. This has proved useful in providing the clinics with immediate (daily) feedback on the # of surveys completed at their offices. Run charts are faxed or emailed to each pilot site on a weekly and/or daily basis depending on their preference.

5) Data collection for the measure: 3rd Next Available Appt was conducted and completed. This is the second month of data collection for this measure. The processes, established last month, created a very useful and efficient template for this month's data collection. We hit a few barriers with contact folks being out of the office but in each instance the specific clinics responded positively and quickly to getting the issues resolved and helping us complete the data collection. A big thanks to all of the pilot sites!!

Thu, 31 Oct 2002 18:39:12 GMT

Week in Review 10/31/02

1) Updated and ran weekly macros for providing information to the Clinical Care Specialists on Diabetes and CHF ED visits as well as patient surveys.

2) Gained perspective on systems dynamics information from meetings with systems dynamics people. Diabetes model explained.

3) Updated queries and macros with new provider info for new care providers at clinics.

4) Researching CHF community statistics through the CDC to attain a percentage of CHF patients in this community.

5) Systems dynamics meeting with consultants to discuss CHF measures and data to use for model.

6) Starting month end IHI and clinic reports.

Thu, 24 Oct 2002 22:38:54 GMT

Week in Review 10/24/02

1) Completed first frequency reports on hospital inpatient patient satisfaction survey questions around P2. Learned SPSS and process from Sarah Jane Satre on MOMS team. Distributed report to Marc P. and Mary M. via email.

2) Installed SPSS and started tutorials for processing of info for both frequency reports and upcoming initial RASCH analysis data for clinic PSAT reports.

3) Created Macros in Statit to improve efficiency of monthly reporting needs.

4) Added new CHF queries for additional CHF reporting needs brought up in Implementaion meeting for info relating to patients taking beta blockers, ACE inhibitors or both. Integrated these measures into the IHI-CHF report.

5) Working on P2 storyboard for upcoming HID university.

6) Continued to assist in adjusting the clinic PSAT survey.

Wed, 16 Oct 2002 19:58:57 GMT

Week in Review 10/17/02

1) 3rd Next Available Appointment info collected from all the clinic pilot sites.

2) Documentation of CSH systems dynamics queries.

3) Macro for updating CHF scratch pad created.

4) Further adjustments and tweaking of Clinic Pt Satisfaction Survey.
     -Bolded some text to provide more emphasis to key words
     -Changed the response categories for the following questions: Can I email my provider… and There are group visits at my clinic… to Yes, No, I don’t know. This change was approved by Bill.
     -Discovered some errors in the Spanish translation. Working through those now and should have them fixed shortly.

5) Contact made with the Bellingham Fire Dept for gaining access to their data. Need to report to IHI: # of pts with known CHF that called 911. Will hope to set up a meeting with them and the necessary members of the P2 team as soon as possible.

6) Agreed on an initial reporting template for the PSAT reports as well as identified the process to create those reports. Will look for continued support from the MOMS Team, specifically Sara Jane and Aaron Ignac, to get Brian and I up and running.

Thu, 10 Oct 2002 22:53:44 GMT

Week in Review 10/9/02

1)     Center for Senior Health Systems Dynamics info sent off to Gary on Wed.
The file did not contain any financial info. Gary requested that we turn the file in as is, without the financial numbers and when Dan Philpot is able to complete the financial portion of the pull we will then fwd on to Gary.

2)     Clinic specific IHI reports completed and presented at Implementation meeting.
Gathered some great feedback and clarification on the CHF and Diabetes measures. Clinics seemed please to be able to receive clinic specific reporting.

3)     CHF registry and scratch pad retreat with MOMS team members for design and implementation of new CHF scratch pad. CHF scratch pad area almost complete.
This “scratch pad” will mimic the DWAP scratch pad and allow us to report CHF clinical measures over time. Further more, we feel that it eventually should be usable for other regions that implement the CHF registry.

4)     Meeting with Erez Gordon and Adam Miller to discuss survey input and processing.
Plan to touch base every other week for review of needs and update on any barriers around survey data storage.

5)     Meeting set up with MOMS team members to coordinate survey data reporting.
Will hope to produce a draft proposal that will cover all of the P2 Survey related reporting needs. Looking forward to working with and learning from Aaron and Sarah Jane!