Use the following information as a guideline to create a system or change the way you currently practice. Based on the MedQIC Care Management Roadmap, developed by the Virginia Health Quality Center’s Physician Office Quality Improvement Organization Support Center (PO QIOSC).

Example of a new Process/System
Helpful Tips

Change How Your Practice Runs

Practices that rely on systems to deliver preventive services are more consistent than those that rely solely on physician’s recall and focus during visits.

Assess how your practices runs, define new staff roles and implement process changes. Monitor changes and communicate progress with staff until new processes become routine.

Example of new processes/protocol: A monofilament sensation test is one type of screening useful for Diabetic neuropathy screening. Ensuring that all patients with diabetes receive this test annually requires team effort. Here is how one Washington State based primary care practice implemented the guideline. Referenced from the Chronic Care Model- Steps for Improvement Manual.

Helpful Tips

• If available, program electronic health records with reminders and prompts of overdue preventive and chronic care services.
• Use flow sheets/protocols/checklists to ensure care is mapped correctly.
• Keep forms in convenient places.
• Pre-audit charts with stickers or reminder notes before or at check-in.
• Print flowsheets and reminder notes on colored card stock so its easily noticed in patient charts.
• Use desk references and laminated reminder sheets on office walls.
• Ask patient about preventive services sought outside of practice.
• Provide referrals to outside sources (nutritionist, case management, community support programs).
• Follow-through with referrals.
• Distribute educational materials (in-office and via mail).
• Make follow up phone calls (reminders to schedule tests, reinforce healthy habits and exercise).
• Reduce occurrence of no show rates by calling patients one day before a scheduled appointment.
• Implement a collaborative approach where providers and patients work together to define problems, set priorities, establish goals, create treatment plans and solve problems together.

Define Patients in Need of Care Management

• Focus on specific patient populations; Diabetes, Cardiovascular Disease etc.
• Identify patients needing services using a patient registry, database, spreadsheet, Practice Management System, Electronic Health Record, or Member List provided by BCBSTX.

Choose a Set of Measures

If patients receive recommended services (the processes), then the health (the outcome) for the population as a whole should improve. To satisfy this goal, focus on a defined set of measures. Define who needs services, what services are needed, and how often the service should be provided. Develop interventions and follow-up procedures, set short-term goals and track progress via chart audits or registries. Reference the Plan-Do-Study-Act Cycle (PDSA) for assistance.

As part of BlueCompare, BCBSTX has identified measures that have been nationally recognized by respected organizations and reviewed by physicians practicing in Texas. To view these measures visit http://www.bcbstx.com/provider/ebm_index.htm

The American Medical Association (AMA)-convened Physician Consortium for Performance Improvement ®’ (Consortium) has developed a comprehensive set of evidence based clinical performance measures. View the PCPI Measures

Identify Areas for Improvement in Your Practice

Efficient organization of clinical systems and patient flow can result in more productive use of staff members' skills and improved delivery of target services.

Track Quality Measures

An EMR system captures and tracks the quality measures used for quality improvement. This information is used to guide medical decisions at the time of care, reach out to patients in need of services, as well as generate feedback reports to physicians on overall performance.

If your practice does not have EMR then consider creating a simple excel spreadsheet to list patients that are still in need of services. Creating a database allows you to track outcomes, print summaries at time of visit, and track monthly progress reports.

Helpful Resources for Implementing Registries and EMR:
Downloadable Diabetes Tracking Excel Worksheet
American College of Physicians List of Patient Registries
TMF Health Quality Institute- Doctors Office Quality- Information Technology

Analyze Results

Be sure to measure performance before the implementation of the new workflow in order to establish a baseline for quality improvement, and then re-measure the same physician performance measurement set after implementation to monitor progress. Evaluating your new system for delivering preventive services should be an ongoing process.

You can use questionnaires and chart audits, staff meetings and lunches, and elicit patient feedback to help you evaluate your improvement system. To evaluate your system effectively, it is necessary to set times for ongoing evaluation, keep lines of communication open and assess whether staff is working as a team and whether goals are being met.

Evaluate areas of excellence as well as areas of deficiency. You may want to suggest that staff change roles within the system. People who "cross-train" will not only appreciate the work done by others, but will learn how to better support each other. Provide rewards and recognition for staff members that are performing well or are displaying high levels of commitment and enthusiasm.

Improving Performance on Evidence Based Measures
National Models for Quality Improvement
Downloadable Tools and Resources