1. Using Data to Help Our Patient-Centered Medical Homes Meaningful to our Patients Scott A. Fields, M.D., M.H.A. Vice Chair, OHSU Family Medicine

2. Objectives Describe the process of building a set of quality indicators from the ground up, with an understanding of how each new question builds upon the previous inquiry. Define how this agenda should affect the care of patients at both a population and individual level, while reinforcing practice improvement and quality initiatives Define the skill set of a functional Quality Data Team

3. OHSU Family Medicine Our mission is to serve our patients and communities through excellence in clinical care, education, research and leadership in Family Medicine. Our vision is to be a supportive and collaborative organization that transforms primary care and inspires future leaders by demonstrating the best in Family Medicine.

4. Strategic integrity philosophy Aligning strategy and execution at all levels of the organization. Includes integrity of character, organization, product, and of management. Strategic integrity requires adaptation, and adaptation requires innovation. Integrity in what and how we measure. Sinofsky S, Iansiti M. One strategy: organization, planning, and decision making. Hoboken, NJ: John Wiley & Sons, Inc, 2010.

5. Strategic Integrity You measure what matters, and what you measure matters

6. Thomas Edison “Hell, there are no rules here – we are trying to accomplish something.” Winston Churchill “Success is the ability to go from one failure to an other without any loss in enthusiasm.”

7. Balancing Competing Agendas Patient Satisfaction Care Quality Operational Efficiency Performance Productivity

8. Clinical Data Team Access Structured approach to data Clinician guidance Data recovery expertise Data presentation expertise Respected by customers

9. Clinical Data Team Stephen Stenberg, Mandy Drougas, Peter Brink, Andi Smith Skill set Quality set Sustainability

10. The Data

11. Key issues to be addressed Data relevance Data sourcing Data quantity Data quality Data governance Davenport TH, Harris JG. Competing on analytics: the new science of winning. Boston: Harvard Business School Publishing Corporation, 2007

12. Qualities of Data that are of Quality Correct Complete Current Consistent Contextual Controlled Correct Complete CurrentConsistent Contextual Controlled Davenport TH, Harris JG. Competing on analytics: the new science of winning. Boston: Harvard Business School Publishing Corporation, 2007

13. Data governance What rules and processes are needed to manage data from its creation to its “retirement” Acquiring the data Cleaning the data Organizing and storing the data Maintaining the data Davenport TH, Harris JG. Competing on analytics: the new science of winning. Boston: Harvard Business School Publishing Corporation, 2007

14. Taking population-based data and drilling down to the level of the individual patient

15. Who are our patients? Are we seeing our own patients? - continuity

16. PATIENT AGE & GENDER SUMMARY By Center --> Provider Type --> PCP Center: OHSU FAMILY MEDICINE AT SOUTH WATERFRONT Visit Dates: 4/1/2009 to 3/31/2012

17. Continuity of Care

18. Why are we seeing our patients? Problems Visit diagnoses Procedures

22. How well are we doing caring for our patients? Health maintenance Disease management Hospital care Maternity care

23. Resident driven request “I want to improve the rate of HPV immunization of women in our practice.”

24. Resident driven request Who are our patients? – Women 11-26 – Men 11-21 What are we trying to improve? – Complete set of immunizations – 3 shots – Time 0, time + 2 months, time + 6 months – All females 13-15 with all 3 shots Populations: 11-12, 13-15, 16-18, 19-26 Challenges – Health Maintenance – Modifiers (discussed/refused) – Override (declined)

25. Mammography Report

26. Mammogram Report

27. Diabetes report

28. Diabetes Dashboard

29. CHF Dashboard

30. Inpatient Service Transitions of care Care management

31. Inpatient Service

32. Maternity Care Patients

33. Inpatient Report

35. Readmissions

39. Management of a Clinical Enterprise with Balanced Scorecards

40. The balanced scorecard – measures that drive performance. Kaplan RS, Norton DP. Harv Bus Rev 1992;70:71–9. “… managers should not have to choose between financial and operational measures.” “They realize that no single measure can provide a clear performance target or focus attention on the critical areas of the business.”

41. Balanced Scorecard Clinic level Team level Clinician level

42. Clinic Level Scorecard

43. Fields SA, Cohen D. Performance Enhancement Using a Balanced Scorecard in a Patient-centered Medical Home. Family Medicine. 2011, 43(10):735- 739.

44. Pneumovax – clinic level

45. Hemoglobin A1c – clinic level

46. Through-put time – clinic level

47. Clinic Level Scorecard

48. Team Level Scorecard

49. Clinician Level Scorecard

50. BP control – clinician level

51. Performance Enhancement Using a Balanced Scorecard in a Patient-centered Medical Home Scott A. Fields, Deborah Cohen

52. Parkinson’s First Law Cyril Northcote Parkinson British naval historian and author of some sixty books, the most famous of which was his bestseller Parkinson's Law, which led him to be also considered as an important scholar within the field of public administration. “Work expands so as to fill the time available for its completion.”