Preventive Health Partnership Our organizations came together in 2004 to: – Harness the individual strengths of each to collectively engage the issue of prevention – Create consistent prevention and screening guidelines – Reach widest constituency to increase awareness and inspire action – Further collective goals through joint initiatives

Prevalence of Chronic Diseases 1 Heart Disease and Stroke Statistics ACS Cancer Facts and Figures million American adults have one or more types of cardiovascular disease 1 As many as 1 in 3 American adults will have diagnosed diabetes in 2050 if present trends continue 2 Approximately 1/3 of cancer deaths are related to overweight or obesity, physical inactivity and poor nutrition, and nearly 1/3 are caused by tobacco use; more than 2/3 of cancer deaths are potentially preventable 3 Improved screening and counseling can result in prevention, treatment and early detection

Framework for Collaboration Focus on four things that can help prevent cancer, diabetes, heart disease and stroke: Be physically active Eat well (maintain a healthy weight) Don’t smoke See your health care provider regularly

–A joint program of the American Cancer Society, the American Diabetes Association, and the American Heart Association –Each organization has long developed scientific statements and guidelines specific to prevention and disease management –Shared goals: –Sets national goals and objectives that compliment their guidelines –Common interest in translating those guidelines into practice What is The Guideline Advantage? The Tri-Agency Relationship Program Advantages Reaching a broad range of patients Expanded feedback for quality improvement Multiple participation models Online improvement tools Working with existing technology Research and Recognition opportunities

To improve the health of all patients through widespread application of primary and secondary prevention guidelines in the United States through data collection, analysis, feedback and quality improvement in the ambulatory setting. Vision & Goal Vision To improve the long-term compliance with the ACS, ADA and AHA/ACC guidelines, which in turn supports our shared organizational mission to prevent chronic diseases and to improve the lives of those living with the nation’s most prevalent chronic diseases. Goal The Guideline Advantage is based on the success of nearly 10 years experience in inpatient quality improvement and over 2 millions lives touched.

Providers can use several different technology platforms Technology vendors submit collective clinical data to DCRI for The Guideline Advantage Data are processed, analyzed and sent back to the providers or medical practices Performance is measured, Professionals can set measureable goals and chart improvements in performance 4 Program Model

There are three main approaches to populating the registry with clinical data: Description The electronic health records (EHR) vendor enables the data to flow by mapping to the data warehouse on behalf of its customers (the practices); Direct Vendor Model Medical practices that have technical staff on site can map to the warehouse directly; Practice Managed Model Medical practices that do not have technical staff on site can submit a “flat file” of data, and DCRI will map those data into the warehouse for the practice. Zero Configuration Model Important Things to Understand 1.Data quality and performance reports are then generated on a quarterly basis to help practices identify where they may have areas for improvement. 2.The Guideline Advantage offers an array of CE/CME opportunities, better practices, tools and resources for health care professionals to consider incorporating into their practices to improve. Additional information at: What are the different participation models?

As a part of quality improvement, clinical data must be aggregated into a data warehouse to facilitate analysis and reporting. Database De-identification & Data Extract (data submission process) Data import DATA WAREHOUSE AND REPORTING ELECTRONIC MEDICAL RECORD Data Staging Area Key activities include: -Cleaning data -Reconciling data -Standardizing data -Transforming data Report Data Research & Analytics Feedback Reports Technically speaking… how does it work?

The Guideline Advantage’s Ideal Data Elements (2011) Ideal Data Elements DemographicsRisk Factor Medical History HospitalizationsLabsVital SignsMedications Contraindications Mortality *full list of elements can be found at

Mock Report New Data Elements New Measures Cervical cancer screening Breast cancer screening Colon cancer screening Pneumococcal Vaccine Influenza Vaccine Sodium Dental exam in previous 12 months Currently Pregnant Mortality Cancer Prevention Measures:  Cervical Cancer Screening  Breast Cancer Screening  Colon Cancer Screening ABCS (Aspirin, Blood Pressure, Cholesterol, Smoking), including those measures used in initiatives like Million Hearts.  A: Aspirin or other antithrombotic in IVD  B: Screening for high blood pressure  B: Controlling High Blood Pressure  C: Cholesterol: Fasting LDL and risk- stratified LDL  C: Complete lipid panel and LDL control in IVD  S: Smoking: Tobacco use screening and cessation intervention Pneumococcal vaccine Influenza Vaccine

The difference in The Guideline Advantage metrics and those reported by PQRS is the code sets used to calculate them. To date the program has faced challenges in receiving all of the codes sets required to calculate PQRS measures (specifically, CPT codes). Efforts to further align with PQRS measures -Continue to ask for CPT codes from all participants (just received our first ones!) -Exploring creation of a limited report focusing on the cardiac prevention measures for QIO’s The Guideline Advantage Alignment with PQRS

Cardiology Family Medicine Geriatric Medicine Internal Medicine Neurology What specialties are eligible to participate? OB/GYNs Osteopathic Medicine Oncology Endocrinology Patient Inclusion Criteria ALL Patients 18 and Over

How does a provider register? Additional information at GuidelineAdvantage.org Key Takeaways Register on our website at guidelineadvantage.org to express your interest. Upon registration, a member of our team will contact you and begin work to identify which data transfer model may be best for your practice.

Site Implementation Timeline Site Gather Glossary/Fields (1 day) DCRI Shares Contracts (Participation Agreement and Business Associate Agreement) and Technical Specifications and Implementation Packet with Site (3-5 days following registration) Site Map Coded Fields (3 days) Site Transfer Data Sample (2 days) DCRI Test Data Sample (5 days) DCRI Verify/Validate Data Transfer (3 days) Site Submit Historical Data (3 days) Site Registers online Site Completes Contracts

HIPAA HIPAA applies to The Guideline Advantage since Protected Health Information (PHI) is used in the program. The Guideline Advantage is considered Quality Improvement as opposed to a clinical trial/research, so the disclosure of PHI to DCRI, including direct patient identifiers, falls under healthcare operations.

Leading practices for effective participation Use existing EHR platform; don’t interrupt work flow to collect data; offer multiple ways for data to flow (from EHR vendor, from intermediary vendor, directly from practice, etc.) Provide tools and resources (Webinars, CME programs, etc.) to help develop a culture of quality improvement Provide feedback reports and consult with practices on how to share information Encourage focus on 1-2 areas only Direct practices to resources to support improvement Recognize and link to incentives These are just a few of the best practices shared by the program.