One of the more enjoyable parts of my job is working on practice-wide interventions to improve the health of our patients. Reimbursement for health care services is moving more toward quality and value-based payments and away from payment for the clinic visit and this is forcing us to think more broadly of how we can affect the health of our patients outside of the clinic visit. It also makes me realize that everyone who works in our building and beyond can contribute to these activities and affect the health of our patient population. I will share some examples.
In spring of 2016 we noticed lower-than-expected rates for pneumonia vaccination in our adult patients over 65 years old. Help from our partners in the Duke Well care management program and the DHTS support services resulted in the delivery of a weekly list of all patients in this age group scheduled to be seen in our practice who had not been vaccinated.
One of our residents, Brian Blank, M.D., did a short study and confirmed the hypothesis that getting this information ahead of time, and having someone prepare the vaccination orders for that encounter, would result in higher rates of vaccination. We continued that process for several months and brought our rates from a low of 72 percent to a current rate of 84 percent for this patient population.
Another project involved looking at our population of patients with diabetes to see if our providers are appropriately prescribing statin medications. Most people with diabetes between the ages of 40 and 75 would benefit from taking statin medications to reduce risk of heart disease and stroke. When I initially discussed this with our providers, there was concern that patients do not tolerate the medications, or do not want the prescription.
A group of medical students and physician assistant students with supervision from our resident physicians helped us audit the charts of over 200 patients to figure out why they were not prescribed statin medications. This included confirming the patients qualified for the medication and searching clinic notes to find if statins were ever discussed or recommended.
We discovered that only a minority of the patients had either refused or did not tolerate the statin medication and in most cases the medication had never been discussed. Interventions to improve our rates were directed more toward provider education regarding current guidelines for statin use, plus reminders to both providers and patients to discuss.
Since July of 2016 we have increased our rates of statin use in this population from 68 percent to 74 percent. This is a great example of how data can disprove assumptions and help guide the appropriate intervention to improve care. Data — whether that comes in monthly score cards or dashboards on our electronic medical record — can help providers objectively see where they need to focus on improvement.
Lorraine Sease is medical director of the Duke Family Medicine Center. Email lorraine.sease@duke.edu with questions.
Editor’s note: A member of the Duke Family Medicine Center leadership team guest blogs every month. Blogs represent the opinion of the author, not the Duke Family Medicine Center, the Department of Community and Family Medicine or Duke University.