Improvement Report: An Integrated Approach to Improving Patient Care

CareSouth Carolina, Inc.
Hartsville, South Carolina, USA

Team

Two improvement teams are responsible for testing new changes and driving spread to other health center providers: a "Microsystem Team" focuses on rapid cycles of change leading to improvement, while a Senior Leader/Support Team focuses on broader strategic improvement at the macrosystem level.

 

Microsystem Team
Ken Moyd, Physician Provider
Abbie Presnell, Licensed Practical Nurse
Teshia Bacote, Medical Office Assistant
Phyleshia Murray, Health Information Specialist
Rhonda Fedorchuk, Care Manager
Chaneka Linton, Day-to-Day Team Leader

 

Senior Leader/Support Team
Joy Gandy, Director of Administrative Services, Team Senior Leader
Ann Lewis, Chief Executive Officer
Kathy Spann-Hampton, Chief Operating Officer
Lin Eaddy, Director of Healthcare Support
Tom Jones, Director of Performance Improvement
Gail Daniels, FNP, Assistant Clinical Director

 

Aim
CareSouth Carolina (CSC) will improve care for all our patients by making improvements in clinical office practice that impact the six IOM dimensions of quality, plus the added dimension of vitality. Our initial focus will be to link our improvements in chronic care management to improving access to appointments and decreasing patient cycle time within the dimensions of efficiency and timeliness. By the end of the first year, we will begin spreading our changes to practices within the other primary care sites of CSC.

Measures

Our measures are organized according to the six IOM dimensions of quality:

  • Safety
    Percentage of medication lists updated at every visit
  • Effectiveness
    ASTHMA: Average symptom-free days (Goal: 10 or more symptom-free days out of 14)
    DIABETES: Average HbA1c for patients with diabetes (Goal: 7.0 or less)
    DEPRESSION: Percent of patients diagnosed with Clinical Significant Depression with a 50 percent reduction in their Patient Health Questionnaire (Goal: 40 percent or more)
  • Patient Centeredness
    Percent of self-management goals set by patients being met(Goal: 80 percent)
  • Efficiency
    Average amount of time spent in a face-to-face encounter with a provider and ancillary services (Goal: 80% or more of the total office visit time)
    Average amount of time spent with the clinician in an office visit (Goal: 12 minutes or more)
  • Timeliness
    Days to third next available appointment (Goal: 0 days)
  • Equity
    Disparity by race for each key Effectiveness measure (Goal: 0)
  • Vitality
    Number of office team members reporting a somewhat or very stressful work environment (Goal: 0% of the office team)

 

 

Changes
Our changes are organized according to the components of the Chronic Care Model:
  • Organization of Health Care
    We are in the process of organizing a Clinical Microsystem for our physician, Dr. Ken Moyd, and also for our other four providers at our Society Hill site. Each Clinical Microsystem will consist of the provider, a nurse, a MOA, a CCM, and a Health Information Specialist (responsible for managing the Medical Record and entering registry data). We have struggled with issues in timeliness, working down the backlog, and open access. We feel that with the development of the Clinical Microsystem, the team will be more aware of patients’ needs and be able to structure the provider's schedule in order to work down the backlog.
  • Community Resources and Policies
    We have signed a contract with Department of Health and Environmental Control (DHEC) to provide a certified diabetes educator (CDE) to our Society Hill site. The CDE will participate in group visits, individualized nutritional counseling, and home visits, and will provide education handouts.
  • Self-management Support
    Since we have revised our measure for capturing self-management goals met, we have realized that our patients are taking an active part in their own health care. We are in the process of testing a new self-management goal form, along with educational brochures that are problem-specific according to their chronic disease.
  • Delivery System Design
    Our CEO, Ann Lewis, is participating in a Collaborative sponsored by the Bureau of Primary Health Care on Redesigning the Office Visit. We hope to integrate our work in IHI’s IMPACT with the BPHC's Health Disparities Collaboratives lessons.
  • Decision Support and Clinical Information Systems
    We are beta testing an electronic registry upgrade. This upgrade will allow us to manipulate the system in order to provide us with more report, referral, and reminder features. We are also working on our appointment schedule so that we can provide staff with a brief description of why the patient is coming in that will print out on the appointment list.



Results
Graph_CareSouth_EffectivenessDepressionReduction.gif
Graph_CareSouth_EffectivenessDiabetesHBA1C.gif

Graph_CareSouth_AsthmaSymptomFreeDays.gif

Summary of Results / Lessons Learned / Next Steps

We have adopted the Chronic Care Model as an organization-wide approach to the way we deliver health care. By steadily redesigning the way we deliver care, we have achieved better health outcomes for our patients.


Contact Information
Ann Lewis
CEO
CareSouth Carolina
annlewis@caresouth-carolina.com

 

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