Su1604 QUALITY IMPROVEMENT CAMPAIGN LEAD TO HIGHER SURVEILLANCE RATE FOR HEPATOCELLULAR CARCINOMA IN PRIMARY CARE CLINIC

2020 ◽  
Vol 158 (6) ◽  
pp. S-1353-S-1354
Author(s):  
Kanit Bunnag ◽  
Amarat Kongsompong ◽  
Wit Jeamwijitkul ◽  
Worayon Chuerboonchai ◽  
Chutatip Charoenthanawut ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Primary Care ◽  
Quality Improvement ◽  
Primary Care Clinic ◽  
Care Clinic

Quality improvement campaign led to higher surveillance rate for hepatocellular carcinoma in primary care clinic

2020 ◽  
Vol 73 ◽  
pp. S729
Author(s):  
Kanit Bunnag ◽  
Amarat Kongsompong ◽  
Wit Jeamwijitkul ◽  
Worayon Chuerboonchai ◽  
Chutatip Charoenthanawut ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Primary Care ◽  
Quality Improvement ◽  
Primary Care Clinic ◽  
Care Clinic

Synchronizing advance directives among patients across a health system.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 233-233
Author(s):  
Sherri Rauenzahn Cervantez ◽  
Sadiyah Hotakey ◽  
Amanda Hernandez ◽  
Stephanie Warren ◽  
Jennifer Quintero ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health System ◽  
Advance Care Planning ◽  
Primary Care Clinic ◽  
Care Planning ◽  
Care Clinic ◽  
Care Plans ◽  
Palliative Oncology ◽  
Advance Care

233 Background: Advance directives (ADs) are legal tools that direct treatment or decision making and appoint a surrogate decision-maker (health care proxy). The presence of ADs is associated with decreased rates of hospitalization, use of life-sustaining treatment, and deaths in a hospital setting. Additionally, completed ADs lead to increased use of hospice or palliative care, more positive family outcomes, improved quality of life for patients, and reduced costs for healthcare. Despite the benefits of advance care planning, only 18-36% of adults have completed advance care plans. The aims of our pilot study were to 1) implement a synchronized system for advance care planning across the UT Health San Antonio health system and 2) improve advance care planning rates in a primary care clinic and palliative oncology clinic. Methods: During a 10-month prospective period, system processes for advance care planning were reviewed with identification of three primary drivers for advance care plan completion: a) electronic/EMR processes, b) clinical workflows and training, and c) patient resources and education. As a result of this quality improvement initiative, standardized forms, resources, and processes for obtaining advance care plans were implemented in the selected clinics. Results: At baseline, the primary care clinic had 84/644 (13%) patients and the palliative oncology clinic had 25/336(7%) with completed advance care plans. With the implementation of a standardized process, 108 patients (23% increase in rate of completion) in the primary clinic and 56 patients (71% increase in rate of completion) in the palliative oncology setting completed advance care planning (ACP). Additionally, there was a 5-fold increase in billing of ACP CPT codes within the clinics during the first 6 months compared to the prior full year. Conclusions: While this quality improvement pilot initiative was limited to two clinics, the synchronized modifications suggest that the system changes could be expanded to other clinics in our UT health system to promote ACP discussions, completion of plans, and ultimately improved patient care.

Measuring Perceived Level of Integration During the Process of Primary Care Behavioral Health Implementation

2017 ◽  
Vol 33 (3) ◽  
pp. 253-261 ◽  
Author(s):  
Erin M. Staab ◽  
Mara Terras ◽  
Pooja Dave ◽  
Nancy Beckman ◽  
Sachin Shah ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Behavioral Health ◽  
Primary Care Clinic ◽  
Health Clinic ◽  
Care Clinic ◽  
Primary Care Behavioral Health ◽  
Item Level ◽  
Levels Of Integration

Provider- and staff-perceived levels of integration were measured during implementation of a primary care behavioral health clinic; these data were used to tailor and evaluate quality improvement strategies. Providers and staff at an urban, academic, adult primary care clinic completed the 32-item Level of Integration Measure (LIM) at baseline and 7 months. The LIM assesses 6 domains of integrated care. Overall and domain scores were calibrated from 0 to 100, with ≥80 representing a highly integrated clinic. Response rate was 79% (N = 46/58) at baseline and 83% (N = 52/63) at follow-up. Overall, LIM score increased from 64.5 to 70.1, P = .001. The lowest scoring domains at baseline were targeted for quality improvement and increased significantly: integrated clinical practice, 60.0 versus 68.4, P < .001; systems integration, 57.0 versus 63.8, P = .001; and training, 56.7 versus 65.3, P = .001. Ongoing quality improvement, including organizational and financial strategies, is needed to achieve higher levels of integration.

scholarly journals A quality improvement project aimed at adapting primary care to ensure the delivery of evidence-based psychotherapy for adult anxiety

2018 ◽  
Vol 7 (1) ◽  
pp. e000066 ◽  
Author(s):  
Mark D Williams ◽  
Craig N Sawchuk ◽  
Nathan D Shippee ◽  
Kristin J Somers ◽  
Summer L Berg ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Controlled Trial ◽  
Primary Care Clinic ◽  
Data Entry ◽  
Care Practice ◽  
Original Research ◽  
Improvement Project ◽  
Care Clinic ◽  
Primary Care Patients

Primary care patients frequently present with anxiety with prevalence ratios up to 30%. Brief cognitive–behavioural therapy (CBT) has been shown in meta-analytic studies to have a strong effect size in the treatment of anxiety. However, in surveys of anxious primary care patients, nearly 80% indicated that they had not received CBT. In 2010, a model of CBT (Coordinated Anxiety Learning and Management (CALM)) adapted to primary care for adult anxiety was published based on results of a randomised controlled trial. This project aimed to integrate an adaptation of CALM into one primary care practice, using results from the published research as a benchmark with the secondary intent to spread a successful model to other practices. A quality improvement approach was used to translate the CALM model of CBT for anxiety into one primary care clinic. Plan-Do-Study-Act steps are highlighted as important steps towards our goal of comparing our outcomes with benchmarks from original research. Patients with anxiety as measured by a score of 10 or higher on the Generalized Anxiety Disorder 7 item scale (GAD-7) were offered CBT as delivered by licensed social workers with support by a PhD psychologist. Outcomes were tracked and entered into an electronic registry, which became a critical tool upon which to adapt and improve our delivery of psychotherapy to our patient population. Challenges and adaptations to the model are discussed. Our 6-month response rates on the GAD-7 were 51%, which was comparable with that of the original research (57%). Quality improvement methods were critical in discovering which adaptations were needed before spread. Among these, embedding a process of measurement and data entry and ongoing feedback to patients and therapists using this data are critical step towards sustaining and improving the delivery of CBT in primary care.

scholarly journals MAKING OLD BONES: QUALITY IMPROVEMENT IN OSTEOPOROSIS MANAGEMENT IN A GERIATRIC PRIMARY CARE CLINIC

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S975-S976
Author(s):  
Meredith Gilliam ◽  
Sabrina Vereen
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Decision Making ◽  
Quality Improvement ◽  
Fragility Fracture ◽  
Primary Care Clinic ◽  
Health Clinic ◽  
Care Clinic ◽  
Osteoporosis Screening ◽  
Osteoporosis Management

Abstract Osteoporotic fractures and their sequelae are a leading cause of morbidity and mortality in older adults. In the United States, nearly 50% of white women and 20% of black women and white men will suffer a fragility fracture in his or her lifetime. Osteoporosis medications reduce the risk of major fragility fracture by 31-62%, but numerous care gaps exist, including screening rates as low as 1-47% and treatment rates as low as 16-30% even after a fracture has already occurred. From January to August 2019, we conducted a multi-faceted quality improvement project at a university hospital-based geriatric primary care clinic, with a goal of improving our rates of osteoporosis screening and treatment. We designed and tested electronic health record-based registries of eligible patients, and developed patient outreach workflows and physician “inreach” workflows. We piloted a bone health clinic. While we did not meaningfully affect the rate of osteoporosis screening, our efforts resulted in an increase in treatment of osteoporosis from 49% to 53%. Documentation of osteoporosis decision making among eligible patients improved from 66% to 80%. In our clinic, ongoing barriers to evidence-based osteoporosis management include competition for time with other medical issues, patient mistrust of medications, and the complexity of decision making around osteoporosis in older adults with polypharmacy and limited life expectancy. Future work must balance the broad application of treatment guidelines via population health tools with the need to individualize treatment decisions for each patient’s overall health and goals of care.

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