practice facilitation to improve behavioral health...
TRANSCRIPT
objective
To use quality improvement (QI) practice facilitators in a community primary care pediatric
practice in Ohio’s Appalachia to increase routine adolescent screening, diagnosis and
management of depression.
Example of a practice-specific aim statement:
Increase use of a validated depression screening tool from 0% to 30%, and for those
diagnosed with depression, the use of a management plan from 43% to 85% by
6/30/2016 and sustain through 12/31/2016.
results
Figure 5. Depression screening performance
Initial interventions: Depression screening increased from 0% to 42%.
Subsequent interventions: Performance increased to 91% and the
centerline shifted to 80%.
background
Depression affects 12% to 20% of adolescents and up to 30% of Appalachian residents.
Universal adolescent depression screening and management is recommended by the
American Academy of Pediatrics. Still, routine depression screening is limited. QI practice
facilitators can help clinicians standardize care, remove unwanted variation and improve
outcomes.
The QI practice facilitation model may improve depression screening and management at
community pediatric practices by:
• Improving screening rates
• Equipping pediatricians to manage mild cases
• Creating referral paths for patients diagnosed with depression
Partners For Kids, an accountable care organization affiliated with Nationwide Children’s
Hospital (NCH), offers practice facilitation services to guide community pediatric practices
through QI projects. Practice facilitation is an evidence-based approach using an external
coach (practice facilitator) to:
• Manage QI projects aimed at improving patient outcomes
• Train staff on QI methods
• Use practice-level data to drive change
• Help practices sustain improvements
conclusion
• Implementing behavioral health recommendations using practice facilitation led to
increased screening, diagnosis and management of depression at an Appalachian primary
care practice.
• Practice facilitation using QI methodology can help community practices effectively
implement evidence-based clinical recommendations.
aim and key driver diagram
Figure 3. Practice-specific aim and key driver diagram
Practice Facilitation to Improve Behavioral Health
Management at a Pediatric Practice in Ohio’s Appalachia
Suzanne Hoholik, MBA, MBOE
Christina Toth, MPH
Mike Fetzer, BSISE
Rebecca Baum, MD
Stephen Cardamone, DO, MS, FAAFP
Sean Gleeson, MD, MBA
In early 2016, a non-NCH-owned practice in Ohio’s Appalachia region initiated a
depression screening and management project with 6 months follow-up.
Practice facilitators trained practices on the IHI Model and led recurring, on-site meetings
where tests of change were discussed.
Figure 1. Depression management tip sheet
Initial interventions:
• Complete
checklist
• Participate in
training with
specialist
Subsequent
interventions:
• Develop
screening
process
• Add dot phrases
to EHR
• Standardized
patient charting
Figure 2. Depression screening process map
methods
Figure 4. Practice depression management performance
Documentation of evidence-based management of patients with
depression increased from 43% to 85%.
Depression Management Project Tip Sheet
Screening checklist Things to have in place before your office begins universal screening. Processes:
Scoring and documentation process
Management of confidential concerns
Crisis plan — staff trained on what to do in emergency
Skills:
Performing an assessment
Recommending interventions
Managing emergencies
Resources:
Patient handouts
Referral sources
Consultation tools
Components of an Effective Management plan Things to document in the chart to meet the quality metric definition. All criteria should be completed within 1 month
of the visit.
Screening results
Safety assessment (if positive for self-
harm questions on PHQ-9; if negative,
don’t need additional discussion)
Interventions (first line advice, referral,
consultation or medication)
Follow up plan (can be PRN, esp. if they
refer out)
Process map for Depression Screening June 2016
Pat
ien
t Fl
ow
Phase
Yes
Provider takes chart, PHQ-9 from
outguide, reviews/adds
score
Provider starts exam. During
exam, asks parent to leave, if present
Patient fills of PHQ-9
When rooming pt.,
MA/nurse takes form and adds to
chart, puts in outguide
outside of room.
Provder reviews with pt.
Asks if they want this
shared with parent
Patient decides
Parent asked back in, PHQ-9 reviewed. Provider
discusses next steps, if necessary and notes in
EMR and on PHQ-9
Yes
Provider discusses next steps
with patient, if necessary, adds notes to EMR and
PHQ-9
No
Exam continues and ends. Provider
puts PHQ-9 with chart
in outguide.
MA takes chart and PHQ-9, leads pt. to
check out. Gives chart/PHQ-9 to front desk
for scanning
When time available, front desk staff scans in PHQ-9 into EMR
Billing office sees code and scanned PHQ-9 in EMR, bills for service
Process ends
PHQ-9 given to pt. at check-in on
clipboard