Post on 20-Jan-2016
I. MOQC UPDATEI. MOQC UPDATE
Douglas Blayney, MDJeffrey Smerage, MD, PhDPhysician Leads, MOQC
SESSION OBJECTIVESESSION OBJECTIVE
By the end of this session, participants should be able to:Identify at least one QOPI targeted area of improvementIdentify at least one QOPI improvement strategy
Today’s Agenda:Today’s Agenda:
I. Aim- MOQC 2011/2 GoalsII. Measure
A. Results of National AssessmentB. MOQC Fall 2011 PerformanceC. New MOQC Oral Measures
III. Change/ Improvements Palliative Care Demonstration
Project
IV. Next Steps
1. AIM: MOQC Goals 1. AIM: MOQC Goals 2011/22011/2A. Improve QOPI participation in
Michigan including achievement of QOPI Certification
B. Improve Michigan performance on QOPI Symptom Management measures
C. Improve Michigan performance on QOPI End of Life measures
II. MeasureII. Measure
A. Comparison with 5 years of National QOPI Data
B. MOQC Fall 2011 PerformanceC. New MOQC Oral Measures (see
oral chemotherapy section)
Analytic Data SetAnalytic Data Set
Table 2.2 Mean score of Indicators by incident participation by Domain
Domain Non-MOQCN
(practices)N (charts
abstracted) MOQCN
(practices)N (charts
abstracted) Diff (1-2)
P-value (Satterthwaite)
Breast Cancer 0.92 136 688 0.95 20 63 -0.03 0.18
Care at End of Life 0.73 136 316 0.73 20 110 0.00 0.94
Colon and Rectal Cancers 0.90 136 356 0.85 20 23 0.05 0.32
Core 0.77 136 1,392 0.77 20 299 0.00 1.00
Lung Cancer (non-small cell) 0.65 136 161 0.71 20 9 -0.07 0.67
Non-Hodgkin's Lymphoma 0.75 136 147 0.53 20 10 0.21 0.07
Symptom/ Toxicity Management 0.67 136 337 0.56 20 43 0.12 0.07
Mean of scores
Note: Inclus ion cri teria for medica l practices are 30+ new patients , Not fel lowship programs, US based, participated 2+ rounds
MOQC Performance Comparison Fall 2011Study
Table 3. Results for Fixed Effects Estimates 95 % Confidence Interval
Variable Variable values Odds Ratios P-Value Lower Bound Upper BoundIntercept 2.05 0.28 0.56 7.52Practice-level variablesSpecialty Multi-specialty 1.05 0.82 0.71 1.54
Oncology only ref .missing 1.06 0.90 0.41 2.78
Affi liation Employee 2.20 0.04 1.03 4.70
Private independent 1.52 0.22 0.78 2.98
Private with academic affiliation 2.77 0.02 1.15 6.66
missing 0.44 0.36 0.08 2.51
Academic full time ref .
Number of patients 500 to 1500 0.72 0.17 0.46 1.15More than 1500 0.77 0.38 0.42 1.39Fewer than 500 ref .
Number of physicians 5 to 10 1.37 0.25 0.80 2.32More than 10 1.05 0.87 0.60 1.83Fewer than 4 ref .
missing 1.53 0.54 0.40 5.80US Region Midwest 1.08 0.78 0.64 1.82
Northeast 1.00 1.00 0.54 1.88South 1.38 0.23 0.82 2.35West ref .
MOQC Status Yes 1.63 0.12 0.88 2.99No ref .
Measure-level variablesLevel of Evidence High 1.83 0.29 0.59 5.68
Medium 0.71 0.56 0.22 2.30Low ref .
Documentation Yes 0.70 0.52 0.23 2.09No ref .
Instituted New Practice Yes 0.01 <.0001 0.00 0.05No ref .
Time related variablesAbstraction Round 1.09 <.0001 1.07 1.12Interaction of Abstraction Round & Instituted New Practice
Instituted New Practice1.40 <.0001 1.36 1.43
Not ref .Note1: Inclus ion cri teria for medica l practices are 30+ new patients , Not fel lowship programs, US based, participated 2+ rounds
MOQC Pain Initiative
MOQC Pain Initiative
III. Change / Improvements:III. Change / Improvements:Palliative Care Demonstration Palliative Care Demonstration ProjectProject
◦Collaborative Overview◦Palliative Care- Key Concepts◦Quality Improvement Model◦Experience of Participants
Palliative Care Palliative Care Demonstration Project Demonstration Project ParticipantsParticipants
Toledo Clinic Cancer Centers
Sparrow Cancer Center
Cancer and Hematology Centers of Western Michigan
Marquette General Hematology Oncology
Center of Cancer Care & Blood Disorders
Karmanos Cancer Center
IHA Hematology & Oncology Consultants
University of Michigan Comprehensive Cancer Center
PALLIATIVE CAREPALLIATIVE CARECONSTRUCTSCONSTRUCTS
J. Cameron Muir, MD, FAAHPM
EVP, Quality and Access, Capital Caring
Clinical Scholar, Georgetown Center for Bioethics
Assistant Clinical Professor, Johns Hopkins Oncology
Past President, Am. Academy of Hospice and Palliative
Medicine
Framework: Integrated Framework: Integrated Palliative CarePalliative Care
Palliative Care
Disease Modifying Treatments
Hospice
DiagnosisTreatments to Relieve Suffering/Improve QOL
6Mo Death
Bereavement
Measures: ASCO QOPI “Palliative Measures: ASCO QOPI “Palliative Subset” (Core Measures)Subset” (Core Measures)
Pain Assessment◦ 3. Pain assessed by the second office visit (%)◦ 4. Pain intensity quantified by the second office visit (%)◦ 5. For patients with moderate to severe pain, documentation
that pain was addressed (%) Narcotic analgesic assessment◦ 7. Effectiveness of pain medication assessed on visit following
new narcotic prescription (%)◦ 8. Constipation assessed at time of or at first visit following
new narcotic analgesic prescription (%)◦ Psychosocial support (Test)◦ 21. Chart documents patient’s emotional well-being was
assessed by second office visit (%)◦ 22. For patients identified with a problem with emotional well-
being, the chart documents that action was taken by second office visit (%)
19
Measures: ASCO QOPI “Palliative Measures: ASCO QOPI “Palliative Subset” Subset” (Care at End of Life Measures)(Care at End of Life Measures)
Pain assessed and documented near the end of life
◦ 35. Pain assessed on the second to last or last visit before death (%)
◦ 36. Pain intensity quantified on second to last or last visit before death (%)◦ 37. Plan of care for patients with moderate to severe pain documented on either last 2
visits
◦ Dyspnea assessed near the end of life
◦ 37. Dyspnea assessed on second to last or last office visit before death (%)
◦ 38. Action taken to ease dyspnea on second to last or last office visit before death (%)
Timing of hospice enrollment
◦ 39. Patient enrolled in hospice before death (%)
◦ 40. Patient enrolled in hospice/referred for palliative care services before death (%)
◦ 41. Patient enrolled in hospice within 3 days of death (%) (Lower Score - Better)
◦ 42. Patient enrolled in hospice within 1 week of death (%) (Lower Score - Better)
◦ 43. For patients not referred in last 2 months of life, hospice/palliative care discussed (%)
Timing of chemotherapy administration before death
◦ 44. Chemotherapy administered within the last two weeks of life (%) (Lower Score -Better) 20
QUALITY IMPROVEMENT QUALITY IMPROVEMENT CONSTRUCTSCONSTRUCTS
Kevin DeHorityLean Coach
University of Michigan Health System
Adoptd from: Langley GL, Nolan KM, Nolan TW, Norman CL, and Provost LP. The
Improvement Guide: A Practical Approach to Enhancing
Organizational Performance. Jossey-Bass, 1996.
• Institute for Healthcare Improvement (IHI) web site, “How to Improve,”
Rules of ThumbRules of ThumbBasic pointers to encourage participant along the way…
What can we do by next Tuesday? Keep it simple, and get it startedSet stretch goals that will make it worthwhileGo for the low-hanging fruit by starting with easier changes You can only fix what you can measureIf we keep doing what we have been doing, we will keep getting what we have been getting.To get something better, we have to start doing something differently
Change ManagementChange Management
The following activities were recommended as a part of this collaborative…Use of the IHI Change Packet Concept
◦ Defines Aim- Measures –Changes◦ Details process flow, accountabilities and due dates
Visually Display Performance Tracking System in work area◦ Create a visual presence of your goals and metrics◦ Allow folks to be thinking and documenting issues and ideas in between
meetings
Update Performance Tracking System every 1-2 weeks◦ Create responsibility and cadence for updating the metrics
SHARING BEST SHARING BEST PRACTICESPRACTICES
Center of Cancer Care & Blood DisordersTallat Mahmood, MD
Helen Shock
Center for Cancer Care and Center for Cancer Care and Blood DisordersBlood Disorders
1540 Lake Lansing Rd Lansing, MI
About Our PracticeAbout Our Practice
3 Physicians 2 Physician
Assistants 4 Registered Nurses 3 Medical Assistants Offices in Lansing
and Owosso Chemotherapy,
supportive care, iron, provide infusion care for PCP
Multi-Specialty physician owned practice
Celina Windnagle PA-C
Eman Issawi PA-C
Palliative Care Palliative Care DemonstrationDemonstration
Dr. Tallat Mahmood◦Physician Team
Leader
Patty Morley RN ◦Clinical Manager
Helen Shock◦Patient Financial
and Billing Specialist
Dr. Dan Williams
Dr. Tallat Mahmood
Dr. Shalini Thoutreddy
MMP Team GoalMMP Team GoalClarify the roles of primary oncologist
versus palliative care team◦ Differences in clinical/disease management
Streamline process to address symptom control
Utilize a tool for ongoing evaluation of symptoms
Research treatment options for symptom management
Supportive Care Conference Annually ◦ Education for oncology team
Center of Cancer Care & Blood DisordersESAS Tool Integrated into EMR as Flowsheet
Center of Cancer Care & Blood DisordersEMR- Ability to Trend Symptoms Over Time
Center of Cancer Care & Blood Center of Cancer Care & Blood Disorders:Disorders:Lessons LearnedLessons Learned
Patients: ESAS-r tool relatively easy to complete; patient instructions should be available from the start
Physicians: ESAS-r facilitates targeted discussion of symptoms with patient saving time; trending results are helpful but manual process too difficult to complete on each patient encounter
Center of Cancer Care & Blood Disorders:Center of Cancer Care & Blood Disorders:Lessons LearnedLessons Learned
Implementation Process:◦Limited number of patients in target
population can cause confusion for staff determining who should get the form
◦Incremental improvement/ change is helpful so not to get too overwhelmed
◦Visible tracking performance and issues is helpful for the team
MOQC Next Steps:MOQC Next Steps:
Palliative Care Demonstration Project: Spread best practices/lessons learned including standardize use of ESAS
QOPI Certification: MOQC Lunch & Learn Webinar I –Getting Started
January 31, 2012 12 -1pm (for details: http://moqc.org)
MOQC Lunch & Learn Webinar II – Self Assessment February 21, 2012 12 -1pm (for details: http://moqc.org)
Mock Surveys