Current Focus
After the stabilization of our new EHR and the re-creation of former reports, the program began to engage divisions in new measures. We still focus on chronic disease management and vaccinations but instead try to create a unified approach across multiple divisions within the DOM. Building upon our previous work in the renal division, over the past year we convened a hyper-tension work group comprising physician leads from endocrine, cardiology, renal, primary care, gerontology, neurology, pharmacy, and obstetrics. The goal of these meetings is to optimize blood pressure management across different patient populations by creating a centralized hospital approach with an algorithm agreed upon by the physician workgroup. We were able to secure additional internal grant funding to develop a pilot project where bluetooth blood pressure cuffs are given to eligible hypertensive patients in our pilot ambulatory practices. The daily blood pressure readings are transmitted into the EHR and a nurse practitioner or pharmacist contacts the patient at defined intervals to address any barriers and titrate medications as necessary. Analysis of the outcomes will be presented this fall. Similarly with vaccinations we are creating an automated order form within the EHR that will appear whenever a specialist places an order to start immunosuppressive medications. This will prompt the provider to order appropriate labs and vaccinations recommended for the course of treatment.
In addition to expanding upon previous metrics, we have expanded our scope to focus on patient safety measures, specifically, missed and delayed cancer diagnoses of the lung and colon. We are working on processes to track every patient with an abnormal finding from point of notification to completion of recommended follow-up at the appropriate intervals. Also we have now have 3 projects in the inpatient setting: chronic obstructive pulmonary disease (COPD) readmissions, and 2 standardized clinical assessment and management pathways (SCAMPs), one on acute kidney injury and the other on congestive heart failure [20]. The COPD project aims to have every patient admitted with COPD receive a pulmonary and respiratory consult during their stay and a follow-up visit with a pulmonologist. The goal of any SCAMP is to standardize care in an area where there is a lot of variability through the use of clinical pathways.
Communication Strategy
In order for the DOMQP to ensure that multiple quality requirements are met by all divisions, we have established a robust communication strategy with the goal of clear, concise, and relevant information-sharing with physicians and staff. We engage physicians through direct meetings, regular emails, and data reporting. The purpose of our outreach to the division faculty is threefold: (1) to educate physicians about hospital-wide programs, (2) to orient them to specific action items required for success, and (3) to funnel questions back to project leaders to ensure that the feedback of clinicians was incorporated into hospital wide quality initiatives. Our first challenge is to provide context for physicians about the project, be it based on accreditation, credentialing or a federal mandate. We work with the hospital project leaders to learn as much as possible about the efforts they are promoting so we can work in concert with them to highlight key messages to physicians.