Getting national guidelines into practice: It takes more than education

Transcription

1 Getting national guidelines into practice: It takes more than education AI Collaborative Group 2 September 12, 2017 Lynette M. Wachholz, MN, ARNP, CPHQ lwachholz@everettclinic.com

2 The Everett Clinic Established in th largest private employer in Snohomish County The Boeing Co. is #1 355 physicians & 140 Advanced Practice Clinicians Multi-specialty clinic 45+ specialties

3 The Everett Clinic 20 practice sites Admit to a community hospital Patient base: 315,000+ patients Visits: 942,000+ annually EMR: Epic Go Live 2006

4 1. National Guideline National Guideline into Practice 6. Clinical Decision Support Tools 5. Patient Education 2. Primary Care Quality Advisory Committee 3. Clinic Guideline 4. Provider & Staff Education 4

5 National Guidelines Abdominal Aortic Aneurysm (AAA)Screening HIV Screening Hepatitis C Screening Pneumococcal (PPSV23) Vaccination in Patients with Chronic Conditions

6 Abdominal Aortic Aneurysm

7 Abdominal Aortic Aneurysm Repair

8 USPSTF Recommends Screening TEC Screening Guideline Approved Recommends One-Time Screening for Men Years of Age with Hx of Smoking or Family Hx of AAA in 1 st Degree Relative May Primary Care Practice Updates February & March AAA Screening Recommendations July Health Maintenance Prompt Goes Live

9 Post-Health Maintenance Prompt Population: 4756 eligible men July 2015 Jan % of men have been screened

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11 Human Immunodeficiency Virus (HIV) Infection Estimated 1.1 million people in the U.S. living with HIV infection ~1 in 5 infected individuals unaware of their diagnosis 40% of new cases each year due to transmission from those who don t know they re infected Identifying individuals with undiagnosed HIV has the potential to Improve disease outcomes Live with rather than die from HIV Reduce incidence of new infections

12 CDC Recommends HIV Screening in Adults USPSTF Recommends HIV Screening in Adults TEC Guideline Approved One- Time Screening in Adults Years of Age December Primary Care Practice Updates February & March HIV Screening Recommendations May Health Maintenance Prompt Goes Live

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14 Hepatitis C Virus Infection ~3.2 million individuals living with Hep C infection in the U.S. Estimated 16,500 new cases of Hep C infection each year 75% of adults in U.S. living with chronic Hep C infection were born between 1945 and 1965 May have chronic Hep C infection for decades before symptoms develop Often unaware of their diagnosis Places patients at risk for liver cancer, cirrhosis, and end-stage liver disease liver transplant or death Curable

15 CDC Recommends Routine Screening of Adults USPSTF Recommends Routine Screening of Adults TEC Screening Guideline Approved One Time Screening Adults Born & Injection Drug Users December Primary Care Practice Updates March & April Hepatitis C Screening Recommendations May Health Maintenance Prompt Goes Live for Birth Cohort

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17 Pneumococcal Disease Streptococcus pneumoniae Non-invasive Pneumonia Sinusitis Otitis media Invasive Empyema Meningitis Septicemia Case fatality rate for pneumococcal bacteremia 20% all adults As high as 60% among elderly

18 ACIP Recommendations Pneumococcal Vaccines Year Vaccine Indications 1987 PPSV23 > 65 yr yr Chronic illnesses (incl CSF leaks) Functional or anatomic asplenia Immunocompromised Living in LTC facilities Alaska Natives/Native Americans 2002 PPSV23 Cochlear implants 2010 PPSV yr with asthma yr smokers 2012 PCV yr Immunocompromised Functional or anatomic asplenia CSF leaks Cochlear implants 2014 PCV13 > 65 yr

19 PPSV23 Vaccine for Patients with Chronic Conditions ACIP Recommendation PPSV23 for 65+ Years & Chronic Conditions ACIP Updated Recommendation PPSV23 for Chronic Conditions Primary Care Practice Updates ACIP February & Recommendation March - PCV13 for 65+ Years Epic Goes Live with a Basic Health Maintenance Prompt for PPSV23 at 65 years Sequential Health Maintenance Prompt for Age-Based Pneumococcal Vaccinations Goes Live January Health Maintenance Prompt for PPSV23 for Chronic Conditions Goes Live

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21 Summary Takes a long time for a national guideline to be adopted Teaching providers & staff the why alone does not drive change in behavior Health Maintenance prompts (CDS) make it easy for teams to do the right thing Health Maintenance prompts (CDS) make it more difficult to do the wrong thing Delivering high-quality care that the patients deserve takes a collaborative effort IT EMR Data warehouse Imaging Lab Materiel Management Quality Point-of-care teams Having a system in place helps to drive improvement