Wisconsin Collaborative for Quality Healthcare

Site Visits with High Performing Clinics Provide Insights, Tools for Improvement

As a collaborative dedicated to improving the quality of care and outcomes for patients in Wisconsin, WCHQ advances this mission through special learning opportunities for its members. Recently, WCHQ organized site visits to high performing clinics / systems that have achieved - and sustained - impressive quality of care and outcomes in three targeted areas:

  • Colorectal Cancer Screening - UW Health Digestive Health Center
  • Diabetes - ThedaCare Physicians clinics in Darboy and Kimberly
  • Hypertension - ThedaCare Physicians clinic in Waupaca

 

Colorectal Cancer

Diabetes

Hypertension

Clinic / system visited

UW Health/UW Health Digestive Health Center

ThedaCare Physicians clinics in Darboy & Kimberly

ThedaCare Physicians clinic in Waupaca

No. of providers

1,324 UW Health Physicians / 45 gastroenterologists, hepatologists, and colorectal surgeons at the Digestive Health Center

Darboy:
3 family practice physicians; 1 family practice nurse practitioner

Kimberly:
4 family practice physicians; 1 family practice nurse practitioner

14 primary care physicians; 9 nurse practitioners & physicians assistants

No. of patients / visits

2,414,484 visits

Family Practice visits only: Darboy: 13,000 annual visits Kimberly: 15,600 annual visits

2,634 patients with hypertension; 21,000+ patients total; 56,000 visits per year

Performance score

80.46% (UW Health system) of patients screened for colorectal cancer per WCHQ Colorectal Cancer Screening measure

77.82% (Darboy) and 78.50% (Kimberly) of patients with good A1c control per WCHQ Diabetes: Blood Sugar (A1c) Control measure

87.21% (Waupaca) of patients with hypertension have their blood pressure controlled per WCHQ Controlling High Blood Pressure measure

WCHQ designed these site visits for its three Quality Improvement Steering Teams [link to fall 2014 newsletter article about the steering teams], as well as newer WCHQ member organizations that are eager to improve their care and outcomes.

The site visits included:

  • Presentations by clinician and quality leaders at the high performing clinic / system
  • Gemba walk through the clinic, as feasible, to observe clinicians and/or frontline staff in action
  • Discussion and idea exchange between hosts and visitors

The clinics are using a variety of improvement strategies to achieve and sustain high quality care and outcomes for their patients. Below, we showcase a few of the best practices that our site visit participants found interesting.

Colorectal Cancer Screening

Follow up with Standard Work for Colorectal Cancer Screening:

UW Health shared its between visit activities, which include:

  • Appointment status letter for patients who did not schedule appointment
  • Central outreach letter for patients due for Health Maintenance
  • Patient alert in MyChart
  • PCP generated list of overdue screening
  • Quick centralized colonoscopy scheduling with direct order transmission.
  • Referring provider notified if their patient declines procedure or if patient is unable to be reached
  • Gastroenterology enters results and follow up after colonoscopy

Staff researched whether phone calls or mail were more effective and determined that direct contact, such as phone calls, improves colorectal cancer screening rates.

By utilizing standardized follow up work, staff knows how to perform the process and eliminates chance of rework. This emphasizes team-based care and communication.

Diabetes

Visual Management & Transparency:

ThedaCare reviews monthly data on WCHQ’s diabetes A1c testing, A1c control, BP control, and all-or-none outcome measures. ThedaCare noted their A1c >9 trending up, so PDSA cycles were initiated. They monitor progress of A1c trending via their Quality Scorecard, which provides visual management and transparency. This quality scorecard is available by call group, while also drilling down to each provider monthly by red/green designations for process and outcome measures. The Quality Scorecard promotes discussion and sharing of successes. The WCHQ Diabetes A1c Control metric is one of ten in a tier system for physician compensation. At ThedaCare, 15% of provider compensation is based upon these quality metrics.

Hypertension>

Pre-Visit Planning:

A day or more prior to a patient’s office visit, the “cell lead” – a medical assistant (MA) with additional training and responsibility to coordinate the workflow for a care team of providers and staff – reviews the patient’s chart to identify if any lab tests or blood pressure checks are due. This process, called “chart scrubbing,” ensures that the provider and staff are prepared to address any needed health maintenance during the patient’s visit.

In order to select high performing clinics for these site visits, the WCHQ Diabetes and Hypertension Quality Improvement Steering Teams each reviewed performance scores for all clinics reporting the respective targeted metric, then using this data the team selected 2-3 health systems with one or more clinics within the top 15. WCHQ staff interviewed clinical and quality leaders at each health system to learn more about the characteristics of their high performing clinics and improvement activities. Information from the interviews was compiled and presented to each team, which then selected the clinic that would meet their learning objective for the site visit.

The WCHQ Colorectal Cancer Screening Quality Improvement Steering Team followed a slightly different process for selecting the high performing clinic for its site visit. The team assessed the top five WCHQ performers in colorectal cancer screening, reviewed the individual clinic scores and volumes and discovered that UW Health had two of its clinics scoring at above eighty-nine percent. They were asked to host the site visit and willingly volunteered.

“The site visits were a very effective way for WCHQ members to share and learn best practices first hand, and we would like to continue holding such visits in the future,“ said Theresa Mees, RN, BSN, MS, WCHQ’s Chief Operating Officer. WCHQ is planning more site visits, as well as webinars and other collaborative learning opportunities.

If you would like to participate in an upcoming site visit, host one at your clinic, or join a WCHQ Quality Improvement Steering Team, contact Judy Nowicki, WCHQ Quality Improvement Specialist, at 608-828-8544 or jnowicki@wchq.org.