Quality & Safety Initiatives
Our team works closely with the divisions within the Department of Medicine to establish new programs and improve patient care. Our initiatives include years of training and analysis to help our doctors assist patients efficiently and effectively, resulting in happier patients and preventing repeated hospital visits.
Anticoagulant Therapy Screening: A multidisciplinary effort to improve the rate of patients appropriately prescribed anticoagulants. This includes the use of newer novel anticoagulants such as dabigatran, rivaroxaban or apixaban, as well as warfarin. The safe use of these medications, including proper INR monitoring and kidney function screening, is being monitored for improvement.
Direct Access Colonoscopy Program: A collaborative effort between Gastroenterology and Internal Medicine to ensure that patients age 50 and older whom meet certain safety criteria have access to a colonoscopy procedure without a separate GI visit.
Retention in Care : An interdisciplinary team effort underway to schedule patients for appointments and call patients who cancel or fail to show for an office visit. Reports of patients meeting these criteria are run on a monthly and weekly visit respectively and are equally divided and distributed among the nurse practitioner, office coordinator and front desk staff for telephone calls to these patients. If contact cannot be made after two attempts by phone, or if the phone number is incorrect/disconnected, staff will mail a form letter to the patient. The staff is also working to verify telephone numbers and e-mail addresses when making telephone calls and when patients arrive.
STD Screening: A project in development to provide in-office screening for chlamydia, gonorrhea and syphilis; effective results could provide lessons learned for future in-house screenings requiring blood draws. A medical assistant-led effort would involve a patient education card with latest lab dates and values filled out prior to patient arrival. The provider reviews with the patient, updates any information in the EMR, and the patient takes the card with the next lab dates with them.
Jefferson Internal Medicine Associates Quality Committee: An interdisciplinary team comprised of physicians, a nurse practitioner, nurse, medical assistant, health coach, and pharmacist meet monthly to develop quality improvement initiatives for the practice. Current initiatives include:
Complete Diabetes Care—An in-reach effort to ensure that all patients with diabetes have their indicated labs and exams addressed during the office visit.
Diabetes Patient Education Brochure—A brochure was developed to facilitate the conversation with multiple providers/staff. The diabetes health coach completes the brochure for each diabetes mellitus patient, noting labs, exams, and pneumovax that are current, including the latest recorded value when applicable; scripts are generated for patients needing labs. The health coach provides the brochures and any scripts to the Medical Assistants (MA), who provide the patients the appropriate scripts. For patients needing eye exams and/or foot exams, the MA will ask them if they have had a recent exam and make note of any dates that the patient provides on the brochure. The physician or Nurse Practitioner will discuss the lab values with the patient and enter any updates noted on the brochure into the electronic medical record. The patient will take the brochure home with them.
The next step in the Quality Improvement cycle will be to triage patients with an A1c greater than 8.5 to the diabetes nurse practitioner for outreach.
Retinal Eye Exam—Coordinated effort with Wills Eye to provide a trained technician one day a week to perform dilated eye exams.
Mammogram Screening—Coordinated in-reach/outreach effort by the health coach and the medical assistants to ensure that patients indicated for a mammogram receive scripts in a timely manner.
Smoking Cessation—The practice pharmacist and pharmacy students contact patients listed as current smokers and ask them about their willingness to quit. Patients are invited to attend a smoking cessation group visit with a pharmacist or a one-on-one visit with a nurse practitioner. Patients less willing will receive information by phone or mail.
High-Risk Diabetes Program : A Medical Assistant-trained Health Coach oversees the High-Risk Diabetes Program and performs pre-visit planning for:
DM lab draws
Retinal eye exams
Outcomes being tracked are improved performance in HbA1c, LDL, microalbumin screening, retinal eye and foot exams for patients with diabetes. Criteria for high-risk includes patients with an A1c > 9, no visit within 6 months, no routine diabetes labs within 1 year and identified as a “potentially motivated for change” patient after discussion with patient’s Primary Care Physician (PCP).
Transitions of Care Coordinator Initiative : This initiative is examining process measures related to quality hospital discharges, including:
Correct PCP identified for every patient
Communication with the PCP during the admission
Assignment of a PCP to patients admitted without primary care
Rates of PCP follow-up appointments arranged at discharge
Forwarding of discharge information to PCP by team
The aim is to decrease Length of Stay (LOS), reduce readmissions, and increase patient satisfaction. Two Transition of Care Coordinators (TCC) are embedded on the four Green Medicine teams. The TCCs’ focus is solely on patients’ transitions into and out of the hospital, following a standardized but modifiable protocol. Data is collected via flow sheets for each patient on a continuous basis in order to measure the TCC’s effectiveness at achieving various process measures.
Chronic Kidney Disease: Process improvements to increase retention in care and improve compliance with laboratory testing are ongoing. Measures being tracked include CBC screening for patients with Chronic Kidney Disease (CKD) and the percentage of patients with CKD III, IV or V on active vitamin D screened for calcium/phosphorus levels.
Pulmonary & Critical Care
As part of the National Committee for Quality Assurance (NCQA) Patient-Centered Specialty Practice certification, Jefferson Pulmonary Associates has implemented the following projects:
Increase documentation of smoking status in patients with COPD/asthma in order to initiate counseling of smoking cessation
Increase pneumococcal vaccination among patients with COPD/asthma who are at greater risk of complications and hospitalization due to pneumococcal disease
Ensure that patients diagnosed with a solitary lung nodule have a follow-up CT scan within 1 year
Interdisciplinary effort to involve medical assistants in performing bronchodilation after assessment of spirometry results
Decrease frustration with wait times by increasing the number of communications from staff while patients are waiting