By: Erin Jech, OAFP’s Director of Performance Improvement
Reprinted from the winter 2018 issue of The Ohio Family Physician.
On April 7, the Ohio Academy of Family Physicians hosted a Quality Improvement Summit bringing 64 practice teams from across the state together in a quality improvement (QI) initiative focused on understanding the importance of effective and efficient teamwork and its impact on patient care. Teams also gathered to work collaboratively on streamlining patient communication to mobilize community-based resources so that health equity can be maximized.
Topics included Colorectal Cancer Screening Improvement, Breast and Cervical Cancer Prevention and Early Detection, Diabetes Prevention and Management, and Hypertension Management. After five months of implementing practice improvement change, the evaluation results of the QI project are in and the outcomes are quite remarkable!
Colorectal Cancer Screening Improvement
According to the American Cancer Society (ACS), colorectal cancer is the third leading cause of cancer-related deaths in men and women in the United States. Colon and rectum cancer is the fourth-leading cause of cancer death in Ohio, comprising more than 9% percent of total cancer deaths, according to the Ohio Department of Health’s 2018 Ohio Annual Cancer Report.
Teams involved in the colorectal cancer screening track gained insight into the benefits of a team-based approach to care, and were taught the importance of setting an office protocol that supports colorectal cancer screening improvement utilizing the How to Increase Colorectal Cancer Screening Rates in Practice: A Primary Care Clinician’s Evidence-Based Tool Kit and Guide materials developed by the Thomas Jefferson University Department of Family Medicine in collaboration with the ACS.
Eleven practice teams completed the project, utilizing an online module for data collection and practice assessment. Each practice that completed the module received a pre- and post-assessment measurement result, as well as information about the effectiveness of the interventions and processes that were implemented on the practice level.
Of the practices that completed the program, an average of 31% saw an increase in colorectal cancer screening rates. Collectively, the rate of improvement among these practices is significant with 55% of practices reaching the ACS’s goal of 80% of Americans screened for colorectal cancer by 2018.
Notably, the OAFP was awarded the 80% by 2018 National Achievement Award, a national honor recognizing leadership in the ongoing effort to increase colorectal cancer screening rates across the United States, by the National Colorectal Cancer Roundtable, an organization co-founded by the ACS and the Center for Disease Control and Prevention.
The 80% by 2018 National Achievement Award recognizes individuals and organizations who dedicate their time, talent, and expertise to advancing needed initiatives to reach the national goal of regularly screening 80% of adults age 50 or over for colorectal cancer. Over 1,600 organizations, including medical professional societies, academic centers, survivor groups, government agencies, cancer coalitions, cancer centers, and payers have signed a pledge to make this goal a priority.
Breast and Cervical Cancer Prevention and Early Detection
According to the ACS Facts & Figures for 2018, an estimated 268,670 men and women will be diagnosed with breast cancer and 41,400 will die from the disease. In addition, an estimated 13,240 women will be diagnosed with cervical cancer in 2018, and 4,170 will die from the disease. Now more than ever, it is important for physicians and care teams to know and incorporate the latest guidelines into practice regarding screening for cervical and breast cancers.
The breast and cervical cancer prevention and early detection track included a curriculum plan that was designed to help primary care practices streamline office protocols, build stronger team comradery, and help providers better understand the importance that patient engagement has on individual and community health related to the prevention and early detection of breast and cervical cancer.
Twelve practice teams completed the project, utilizing an online module for data collection and practice assessment. Each practice that completed the module worked through two phases: a pre-intervention phase and a post-intervention phase. The online tool provided assessment measurement results, as well as how effective the selected intervention was on the practice level.
One important component of practice change is assessing the way a practice functions, and in this case, especially as it impacts the delivery of breast and cervical cancer prevention and screening for female patients.
Teams were asked to focus on a specific age group in order to measure the effects of the intervention. Prior to starting the project, teams chose to focus on young women (between the ages of 21 and 26) studying HPV immunization and appropriate pap testing, or on middle-aged women (between 50 and 65 years of age) studying appropriate pap testing and mammography screening.
Twice during the project, practices were asked to assess the way their office functions, both before implementing an intervention and after implementation. Of the practices that completed the program, an average of 52% saw a minor to extreme change in the practice’s delivery of care.
- 67% of participating practices saw a minor to extreme improvement in creating new partnerships with community organizations such as gynecology offices and imaging centers.
- 83% of participating practices saw minor to significant improvement in team engagement. With survey results sharing, “I used to have to do almost everything if I wanted to be sure our patients receive the cancer prevention services they need, and now, we have regular staff meetings in which we discuss specific issues to improve cancer prevention and screening for our patients.”
- 58% of participating practices shared that now, after reviewing their protocols and implementing an invention in their practice, have a registry of cancer prevention and screening services tied to guidelines that provides prompts and reminders about needed health services.
When beginning the project, the majority of practices indicated cancer prevention services for women did not exist. After completing the program, 58% of participating practices shared that in their office, performance feedback for cancer prevention services for women is timely and specific to each physician. It is routinely reviewed and used to address deficiencies as quickly as possible.
Diabetes Prevention and Management
Family physicians care for patients of all ages and treat a variety of conditions, both acute and chronic, in numerous clinical settings. Patients who have prediabetes or diabetes who are not adequately screened, who go undiagnosed, or who are diagnosed but do not adequately control their disease can experience a host of complications. The family medicine teams are usually the first line of defense to screen, diagnose, and treat chronic diseases such as diabetes.
Family physicians and their care teams who attended the QI Summit gained education and training on how to screen and diagnose patients with prediabetes and diabetes to help decrease the number of patients who go undiagnosed and untreated.
Those teams who participated in the diabetes prevention and management track heard from expert speakers in pre-diabetes and diabetes, learning best practices in screening protocols, up-to-date guidelines, the importance of QI in patient care, and population health as a whole.
Twelve practices completed the online data collection and practice assessment module. Each practice that completed the module received a pre- and post-assessment measurement result, and were able to review a post intervention analysis showing each team their rate of success. Teams were required to implement one intervention focused on prediabetes and one intervention focused on diabetes.
Teams were asked to report on two additional measurements: number of patients diagnosed with diabetes and number of patients with controlled diabetes. After the five month intervention period, the practices reported outcomes data of nearly a 6% increase in controlled diabetic patients.
One module user stated, “We were able to implement a decision support tool to flag patients who needed to be screened.” After reviewing their practice analysis in the module, another user shared, “We saw significant improvement in HbA1c control for my entire practice during the study period!”
It is with changes such as these that we hope to continue to see a positive impact on Ohio’s diabetic population.
Hypertension is the most treatable type of cardiovascular disease, and simple interventions can help improve the care provided to patients diagnosed with high blood pressure. Now more than ever, family physicians and their care teams have the opportunity to improve hypertension control rates across Ohio. Eighteen practice teams participated in the QI Summit with the hope of doing just that!
Participants gained insight into the importance of team engagement and quality improvement, heard directly from a patient how the team-patient relationship impacts hypertension management, and were able to work together as a team to create an office protocol to fit the practice and improve patient care.
Over the span of five months, practices were asked to provide baseline and outcomes data on hypertension control rates in their practice. The project included more than 15,000 diagnosed hypertensive patients across the 18 practice teams during the five-month study period. Of those hypertensive patients seen in practice, 72% of these patients were in control of their blood pressure which equates to a 7% project improvement.
Teams used an online module to measure practice outcomes related to their delivery of care. As part of the module application, users were asked to assess the way their office functions, both before implementing an intervention and again after implementation. Of the practices that completed the program, more than 50% saw a minor to extreme positive change in the practice’s delivery of care. Most notably, 73% of practices saw minor to extreme change in their work to improve the care of their hypertensive patients using protocols, incorporating tools, and even setting clear practice improvement strategies to meet established patient-centered goals.
Participating practices also saw positive changes in relation to clinical decision support tools – half seeing significant improvement going from zero clinical decision support tools to utilizing clinical decision support tools at the point of care. According to tallied evaluation results, practices graded their experience during this quality improvement process at a 90% satisfaction rating. In the current environment, where administrative burden can be overwhelming, we’re proud to see practices taking the steps needed to improve control rates of hypertensive patients, and enjoying the process to get there! This is just one way they are making an impact on population health in their communities.
All the practices involved in the QI Summit are well on their way to having a huge impact on the care of their patients and their communities as a whole. Not to mention they have the tools necessary to begin making connections to community resources to link their patients with the assistance they need outside of the clinic walls – all making huge strides in the fight against social determinants of health.
Thank you to our program partners, the ACS East Central Division, the Ohio Department of Health, and the American Academy of Family Physicians Family Medicine Philanthropic Consortium and to other organization supporters, the Ohio Association of Community Health Centers, CliniSync, the Health Services Advisory Group, and LifeCare Alliance.
Are you looking for a QI project for your office in 2019? Register today for our CRC Screening Improvement Team Training Day on Saturday, April 6, 2019, at the Embassy Suites in Dublin, OH.