1. 1 Quality Improvement Series Session 10 Windy Stevenson Cindy Ferrell

2. 2 Todays Agenda

3. 3 Recap AIM: >95% of patients >2yo seen by a provider in the gen peds clinic or Westside clinic (including acute care; excluding healthy lifestyles) who have a BMI >85%ile will have BMI; category listed on their problem list

4. 4 Current status Future state Pt >2yo checked in and ht/wt recorded EPIC uses ht and wt to generate BMI and flags if >85%ile Provider sees banner under Quality issues and clicks associated smart set Acute care visit- problem added; follow up appt made with PCP Family stops at desk to get appt WCC- provider adds problem; uses smart set to guide care

5. 5 Next Steps 1.Assess feasibility of weights for all visits 2.Align efforts with Healthy Lifestyles Clinic 3.PDSA trial of BPAs and Smart Sets (flip the switch?) 4.EPIC request to populate problem list from an smart set 5.EPIC process for driving PCP follow up appointments 6.Exploration of adding prompt to notes template 7.Options for optimizing problem list designation for kids already identified (457 of them)

6. 6 The baseline data The pull: patients >2yo and 85%ile, with stratification of those who have any of the identified problems noted on their problem list Adjustments recommended: –Exclude pts >18yo –Combine gen peds and adolescent –Clarify %ile divides to match BPAs

7. 7

8. 8 The baseline data 37% 37% overall success (457/1220 patients)

9. 9 The Science of Reliability Reliability LevelReliability Expression Reliability RateFailure Rate Level 110¹80-90% reliable1-2 failures in 10 opportunities Level 210²95% reliable<5 failures in 100 opportunities Level 310³99% reliable<5 failures in 1000 opportunities Level 6 (Six Sigma) 106<5 failures in 1,000,000 opportunities

10. 10 >99% Problem List Baseline Data, continued

11. 11 Age and BMI n=191 n=230 n=241 n=213 n=212 n=121

12. 12 Future State- data Transparency- who gets it, in what form? How can we use it to motivate and maintain? We envision monthly reports of: % pts 2-18 with BMI >85%ile who were seen in the past 30 days by a provider in clinic (DCH peds and adolescents, Westside) who have this designation on the problem list by the end of the month With the ability to stratify by age, gender, zip code, acute vs well visit, BMI category, provider name