1. UNC Hospitals geriatric specialty clinic (GSC) AT CAROLINA POINTE II
COHORT 5 PCIC PRACTICE
QI Golden Nuggets For Treating Patients In Their Golden Years:
Using an Evaluation Framework to Assess Practice Readiness for
QI Initiatives with Aging Populations
PCIC Operations Meeting
Presented By: Sabrina Vereen, Quality Coach
7/27/17

2. About Us UNC Hospitals Geriatrics Specialty Clinic (GSC) at Carolina Pointe II
Address: Farrington Rd #101, Chapel Hill, NC 27517
Phone: (984)
UNC Division of Geriatric Medicine was established in 2003 to address the growing demand for care of older adults
Division consists of 14 board-certified geriatrics, one full-time PhD faculty member, 8 adjunct faculty, and 4 fellows (AY16/17)
Geriatric Specialty Clinic at Carolina Pointe II (GSC) is the only UNCHCS outpatient clinic site dedicated solely to geriatric care
The GSC inter-professional care team includes clinical staff (CMAs, LPNs), APPs, physical therapist, pharmacist, hospital-based and ACO- assigned case managers.
The Geriatric Specialty Clinic also has a joint Memory Disorders Clinic staffed by Geriatric Medicine, Neurology, and Psychiatry.
PCIC COHORT 5 (FY18) CONTACTS
Medical Director | Steve Kizer MD
Nurse Manager and Quality Improvement Lead (QIL) | Lisa Beaver LPN
Clinic Manager | James Malley
Epic SuperUser | Marvin McBride MD
PCIC RESOURCES:
Quality Coach | Sabrina Vereen
Clinical Improvement Coach | Beth Caviness

3. Patient Panel: Approximately ~3400 active patients with GSC PCPs
Cervical Cancer Screening
Breast Cancer Screening
CRC Screening
Diabetes Measures
Statin w/o Prior Hx
HTN (Test)
Department average: 9% New Patients (91% Established)
Non-Age Specific PCIC Clinical Quality Measures:
ASCVD
Depression Treatment
PneumoVax
Data Source: Provided by Hunter Gay, 1/19/17 Reporting

4. Transforming Practice: Train  Gain  Sustain
Experience
Learning
Process
CURRENT STATE ANALYSIS
Division Presentations and Leadership Meetings with Quality Groups (PCIC, PQI, VCAG, UNC Senior Alliance)
Clinic training
Clinical Staff Workflow Analyses
BPAs Launch and Evaluation
Process Redesign and Team Functioning
Patient and Provider Surveys
Chart Reviews and Documentation Barriers

5. Improvement Work: 1st Chart Auditing
Randomized patient panel provided by PQI analyst with goal to manually chart abstract
~100 – Kizer charts
~100 – All other GSC provider charts
Designed audit process with clinical team to evaluate FY17 PCIC and ACO measures
What action has to be taken for it to be considered done? (numerator)
Who is eligible? (denominator)
What are the exclusions? (denominator exclusions)
Additional evaluation criteria included:
Cognitive impairment/dementia dx (look for=cognitive disorder, dementia, mem loss, delirium, confusion)
AAA screening
Shingles
Tetanus

6. Chart Audit Results (Feb - Mar 2017)
Three types of missed opportunities:
Done or potential reasonable exclusion  not charted appropriated
Addressed but no follow-up  not done
Not addressed in chart

7. 2nd: Identified Opportunities Based On Clinical Workflow Evaluation
Specialty vs. Primary Care practice model
Do not do “annual wellness visits”
ACO patients have received “incentive” letters to schedule and attend an annual wellness visit
Providers do not document in structured data fields
Unique patient population
More cognitive decline
Chronic falls
Co-morbidities - multiple conditions to manage
Providers against more documentation burden
Some measures previously/currently done as part of rooming process (i.e. falls)

8. 2nd: Identified Opportunities Based On Clinical Workflow Evaluation
Roles/responsibilities of clinic staff (administrative, CMA, LPN, RN care manager, social worker, NPs)
Opportunity to work at “top of license” for clinical staff
Provider, Staff, Leadership Turnover
Uneven patient scheduling
Capacity to address upcoming BPAs and evolving metrics

9. 2nd: Identified Opportunities Based On Clinical Workflow Evaluation
Roles/responsibilities of clinic staff (administrative, CMA, LPN, RN care manager, social worker, NPs)
Opportunity to work at “top of license” for clinical staff
Provider, Staff, Leadership Turnover
Uneven patient scheduling
Capacity to address upcoming BPAs and evolving metrics

10. 3rd: Preparing for Next Steps (FY18)
Phase 1: Screening and Immunizations; Advanced Care Planning
Decision Points:
Depression screening
What to do about cognitive impairment and positive screening
Fall screening – Epic view has changed
Example: Could Kristi uses the problem list to identify chronic falls risk so that BPAs would not continue to fire
Phase 2: Disease Management (cardiovascular, diabetic issues)  
Phase 3: Other Quality Initiatives

11. Questions?