Best Project Award in Transformational Category Psoriasis Comorbidities AHS

Transcription

1 Best Project Award in Transformational Category Psoriasis Comorbidities AHS

2 Content Main Information The first criteria: Study and define project objectives The second criteria: Project Team The third criteria: Resource Management and Control The fourth criteria: Risk Management and Project sustainability The fifth criteria: Project execution The sixth criteria: Results Project Name: Psoriasis Comorbidities Quality Improvement Project 2

3 How to create the best Psoriasis Care Package? Diagnosis of Psoriasis Treatment options Screening for comorbidities Referral to specialties Support and long-term management Give information and advice A summary of the project and its reasons: The project was initiated in AHS to educate, support, and give psoriasis patients the best quality care that will prevent psoriasis comorbidities and mortality. In turn, this would decrease the long term economic burden on Health Authorities. Psoriasis is a chronic systemic disorder that affects 2% of the general population. It is associated with increasing rates of morbidity and mortality. This includes psoriatic arthritis, autoimmune diseases, psychiatric conditions, metabolic syndrome, cardiovascular disease and others. The improvement strategies targeted patients and their families, healthcare providers (physicians and nurses) and general public. A comprehensive awareness program about Psoriasis comorbidities was organized and conducted in 2016/2017. In addition to implementation of screening tools (PEST for Psoriatic Arthritis and DLQI for psychological conditions) in Cerner with noticeable clinical improvements. In conclusion, increasing knowledge of patients and healthcare providers and implementing screening tools in Cerner, should allow for early recognition and diagnosis of psoriasis comorbidities. Project Managers: Rahma Alshkeili, MD and Naeema Al Suwaidi, MD Dermatology Department/ AHS Main members of the project team: 1. Luena Palacios (The quality department) 2. Fatima Al Hajeri (The quality department) 3. Hiede Reginio (IT department) 4. Manal Abdul-Rahman (The nursing department) 5. Lubna Haggag (Marketing department) Project Starting Date 4/1/2016 to 30/9/2017 The person who can be contacted in with any issues related to the project submission: Rahma Alshkeili, MD The First Criteria: Study and define project objective 1. Identify and set goals and project document 3

4 In line with the vision of our organization to provide appropriate health and disease prevention, psoriasis comorbidities quality improvement project is conducted in Ambulatory Healthcare Services (AHS). AHS offer easier access to primary and secondary care including comprehensive laboratory and modern diagnostic facilities. This makes AHS the most appropriate place to run this project. The goal of this project is to improve quality of healthcare and long-term management of patients with psoriasis in Abu Dhabi, the capital of the UAE. Psoriasis is a chronic inflammatory systemic disorder that affects approximately 2% of the general population (Figure-1). It is associated with increasing rates of morbidity and mortality (Figure-2). This includes psoriatic arthritis, autoimmune diseases, psychiatric conditions, metabolic syndrome, cardiovascular disease and others. Assessment of problem: 1. A survey was done to assess patients knowledge (33 patients) about psoriasis comorbidities (Figure-3). 2. A 357 psoriasis patients medical records were checked if metabolic and cardiovascular risk factors screening was done within the last 2 years (Figure- 4). 4

5 3. A survey was applied on 25 physicians to identify the top challenges for early recognition of psoriasis comorbidities (Figure-5). Data gathering showed that there are many patients and healthcare providers are unaware of Psoriasis comorbidities. In addition, Electronic Health Record System (Cerner) doesn t contain screening tools to early detect rheumatologic and psychiatric comorbidities. As a solution, increasing knowledge of patients and healthcare providers and implementing screening tools in Cerner, should allow for early recognition and diagnosis of psoriasis comorbidities. This will improve the outcome for patients and consequently decrease the long term economic burden on Health Authorities. Although we have no statistics in UAE, Psoriasis costs U.S. up to $135 billion a year (table 1) Table (1): 5

6 2. Project Plan and Execution Current situation was analyzed and deficits were identified (Gap analysis). A quality improvement model (PDSA) was adopted. A program was developed to improve screening methods and preventive strategies. The old data showed that only 46.22% of psoriasis patients were screened for lipids and 49.86% were screened for glucose level. DLQI or PEST screening tools were not applied on any of those psoriasis patients. The team agreed on the main objective: To increase screening tool application on Psoriasis patients to reach 60% for metabolic risk factors (lipid and glucose blood tests) and 30% for Psychological and Rheumatological comorbidities (DLQI and PEST) in all AHS centers in Abu Dhabi and Al Ain by the end of Major activities in an organized timeline were set and distributed among team members. Information and statistics from surveys, questionnaires and workshops feedback were analyzed. 3. Develop an organized and comprehensive plan for internal and external communication 6

7 Communication is essential to the success of this project; the team deploys several approaches to ensure information is shared to all stakeholders at all levels Stakeholders Project Team Physicians Nurses Patients Mallafi Team Marketing Team AHS Staff Community Internal External Communication Approach Regular meetings Phone calls s Lectures Workshops s Booklets Lectures Workshops s Workshop Campaigns Educational brochures Meeting Telephone Calls Meeting Telephones s s Campaigns Campaigns Social media Purpose Progress of Project Raising awareness about psoriasis Training on screening tools Raising awareness about psoriasis Training on screening tools Raising awareness about psoriasis comorbidities Encourage healthy living Implementation of tools in Mallafi Development of brochures Reinforcing awareness through s and social media Reinforcing awareness of Psoriasis Raising awareness about psoriasis Support psoriasis patient 4. Develop a quality assurance plan The improvement Intervention and Strategy for change included: 1. Patient education: o Psoriasis awareness day included lectures and activities. o Educational leaflet for psoriasis patients (in Arabic and English). o Patients feedback. 2. Improving physicians practice: o Improve knowledge and skills of physicians on dealing with psoriasis patients (workshops). o Psoriasis Patient s Care pathway for Primary Care Physicians was designed. o Physicians feedback. 3. Involving nurses in psoriasis assessment: o Study the estimated mean time for application of Dermatology Life Quality Index (DLQI) and Psoriasis Epidemiology Screening Tool (PEST) questionnaires in a busy clinic o Education on psoriasis comorbidities (workshops) 7

8 o Practice improvement by adding DLQI and PEST to psoriasis patient assessment. o Nurses feedback 4. Implementing new screening tools in Cerner (DLQI and PEST) to facilitate early detection of psychological and rheumatologic comorbidities. 5. Increase awareness among general public to support psoriasis patients. (campaign) The Second Criteria: Project Team A taskforce comprising of representatives from quality department, medical affairs, health information management, IT, Marketing and nursing department was formed. By Brain Storming, we thought of analyzing the current situation, design plans, develop strategies and implement new changes and go through the cycle again and again. Main members of the project team Luena Palacios and Fatima Al Hajeri (The quality department) o Provides guidance, logistic support and facilitates project implementation with core team. o Coordinates with other departments in areas that required multidisciplinary input. o Develops metric and assist in data collection and analysis. Hiede Reginio (IT department) o Creation and designing the electronic screening power form for DLQI, CDLQI and PEST. o Getting the required approval for implementation in Cerner. o Series of testing to ensure working properly. Manal Abdul-Rahman (The nursing department) o Facilitates nurse training in Abu Dhabi and Al Ain. o Obtain CME accreditation for all workshops. o Design a workflow for the nurses on Psoriasis Comorbidities Screening Lubna Haggag (Marketing department) a. Identify the project stakeholders from marketing perspective and develop and implement the marketing and PR plan for the project accordingly b. Design all required project materials and develop bilingual content for the materials c. Oversee the production of all required marketing material d. Garner media attention and interest in the project through press releases and success stories e. Support in the provision of gift items and preparation of appreciation certificates for the project sponsors and team members f. Developed an online registration process for physician registration to reduce cost and increase process efficiency. Third Criteria: Resource Management and Control A comprehensive educational program for physicians, nurses and patients was designed. This included lectures, training workshops, brochures and many other activities. Moreover, a psoriasis awareness campaign was done with limited financial budget but still AHS centers managed to conduct it successfully. 8

9 The project leads met all AHS managers to raise their awareness regrading psoriasis comorbidities, to get their support in encouraging their staff on doing the needful screening to all psoriasis patients and to ensure that all informational materials were distributed among them. The project faced some limitations related to insurance coverage of metabolic screening blood tests. This problem was solved by encouraging all physician to do Weqaya screening for all psoriasis patients. This should minimize the denial issues of insurance companies. Fourth Criteria: Risk Management and Project sustainability Team approaches to ensure sustainability and address risks are: 1. Management support in the change process 2. Ongoing project evaluation to capture the effectiveness 3. Electronic extraction and data collection process 4. Integration of measure into AHS monitored KPI 5. Continues community awareness and education 6. Staff training and involvement 7. Information Sharing Fifth Criteria: Project Execution The improvement Intervention and Strategy for change included: 1. Patient education: o Psoriasis awareness day included lectures and activities (Figure-6). o Educational leaflet for psoriasis patients (in Arabic and English) (Figure- 7). o Patients feedback (Figure-8). As a part of the project, AHS launched the Psoriasis Comorbidities Awareness day under the slogan United to overcome Psoriasis. The awareness day took place on Saturday Feb at Novotel Al Bustan and was led by the two project leads, Dr. Rahma Alshkeili and Dr. Naeema Al Suwaidi. The psoriasis awareness day aimed to educate psoriasis patients about the disease and debunk common myths surrounding the disease. It included training the patients on how to cope with psoriasis and adopting a healthy lifestyle to improve their quality of life. The workshop further aimed to educate the patient s family on how to manage the patient and provide the needed support in order to integrate psoriasis patients into society. The patients and their families were impressed with the interactive workshop. They wished if this workshop can be repeated. They addressed their needs from healthcare providers. 9

10 In addition, a printed leaflet for psoriasis patients (in Arabic and English) was designed and is distributed in all AHS centers. 10

11 2. Improving physicians practice: o Improve knowledge and skills of physicians on dealing with psoriasis patients (2 workshops) (Figure-9). o Psoriasis Patient s Care pathway for Primary Care Physicians was designed (Figure-10). o Physicians feedback (Figure-11). In order to improve knowledge and skills of the physicians on dealing with psoriasis patients, 2 accredited workshops were held on 27/2/2016 at Novotel Al Bustan Hotel/ Abu Dhabi and 21/5/2016 at Al Bustan Rotana Hotel/ Al Ain. The workshop involved training the doctors on how to manage psoriasis patients and how to early detect psoriasis comorbidities. 11

12 Psoriasis Patient s Care Pathway for Primary Care Physicians and when to refer was shared to physicians. 12

13 3. Involving nurses in psoriasis assessment: o Study the estimated mean time for application of Dermatology Life Quality Index (DLQI) and Psoriasis Epidemiology Screening Tool (PEST) questionnaires in a busy clinic: 2.3 minutes (DLQI) and 1.25 minutes (PEST) o Education on psoriasis comorbidities: 6 workshops (143 nurses) (Figure- 12) o Practice improvement by adding DLQI and PEST to psoriasis patient assessment. o Nurses feedback (Figure-13)9 13

14 4. Implementing new screening tools in Cerner: o Implement DLQI and PEST to facilitate early detection of psychological and rheumatologic comorbidities (Figure-14+15). 14

15 2 screening tools were implemented in Cerner for early detection of psychiatric conditions and psoriatic arthritis. There is significant psychosocial morbidity associated with psoriasis that should not be underestimated. This can be early recognized by using Dermatology Quality life index Questionnaire (DLQI). Physicians should refer patients with DLQI score >10 to psychology department for evaluation and management. Quality of life improves if psychological aspects are properly dealt with and subsequently Psoriasis will improve. Psoriatic Arthritis is a progressive irreversible joint damage. That s why it requires prompt intervention with the appropriate therapy. This can be early recognized by using Psoriasis Epidemiology Screening Tool (PEST). Physicians should refer patients with PEST score 3 or more to rheumatologist for further assessment and management. Before the tool implementation, the patient used to fill the questionnaire manually by himself or with the aid of the nurse. Then the nurse will calculate the final score manually and submit it to the physician. After the tool implementation, the nurse feeds the system with patient s answers and the score will be auto-calculated by Cerner. Physician can simply pull results from nurse assessment into physician s documentation. Thanks to Cerner for being a flexible system to accept modifications and addition of the needed screening tools. It was a great innovation to have the electronic dermatology screening power form for DLQI and PEST. This was created through 15

16 proper change management process to ensure standard documentation. It was requested to the IUC down to SEHA for approval. Series of testing was done in both CERT/PROD to make sure that the form was working accordingly. Having this tool electronically allows the clinician to capture data in a reliable manner; this data can be utilized for research and practice improvement. 5. Increase awareness among general public to support psoriasis patients: Recently, under the slogan of Psoriasis inside out a big awareness campaign was conducted in all AHS healthcare centers (13-19 August 2017). The campaign targeted psoriasis patients and their families, healthcare providers and general public. The overall goal is to raise the awareness among those groups in order to provide the best quality of care given for psoriasis patients. All AHS centers were engaged in this campaign. Although the project team provided a theme poster and brochures only, each clinic added its own creative fingerprint to attract as many attendees as possible (figure 16). 321 healthcare providers and 1730 public attended the campaign and their feedback is shown in (figure 17 and 18). 16

17 6. Other stakeholders best practice sharing of SEHA entities: 2 main hospitals (SKMC and Tawam) requested to share our experience in implementing and using screening tools (DLQI and PEST) for psoriasis patients. We met them and shared the best practice care given for psoriasis. Sixth Criteria: Results Measurement of improvement: A 10-month audit (Figure-19-22) among all AHS clinics of screening for DLQI, PEST, Lipid profile and Glucose was done. The audit is still going on to ensure the sustainability. 17

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19 The audit results in the run chart was promising at the beginning, and then a drop was noted in subsequent months. This drop can be attributed to the change in ICD 9 to 10 in January 2017 as not all healthcare providers are familiar with the new code of Psoriasis. In addition, this can be explained by the absence of reminders of tool application for nurses and doctors in their busy clinics. That s why we are in the process of adding an alert connected to the diagnosis code of Psoriasis to improve the results and ensure sustainability. This way no psoriasis cases will be missed from tools application. After preventive strategies implementation, more awareness was noticed among physicians and nurses in applying screening tools on psoriasis patients. Back to the main objective, we can say that we exceeded the target of screening 30% of our psoriasis patients with DLQI and PEST and 60% for metabolic risk factors. In the near future we are planning to include other health facilities in Abu Dhabi using Cerner system in application of the screening tools. We are happy to give training sessions to any interested facility. Hopfuly we can also build an infra-structure baseline Registry for psoriasis patients in UAE in order to have accurate figures of incidence and prevelance of psoriasis and its comorbidities. In addition this registry can be used as quality care improvement program for psoriasis patients. The registry needs to have the approval and support of Health Authority of Abu Dhabi. Lessons learnt: Team work necessity, buy in from end users Clear deliverables with timeline to all stakeholders is important Monitoring and addressing issues along the way Sharing of results Rapid cycle improvement is vital (changes are made and tested) 19

20 Conclusion: The project was initiated in AHS to educate, support, and give psoriasis patients the best quality care that will prevent psoriasis comorbidities and mortality. In turn, this would decrease the long term economic burden on Health Authorities. The improvement strategies targeted patients and their families, healthcare providers (physicians and nurses) and general public. A comprehensive awareness program about Psoriasis comorbidities was organized and conducted in 2016/2017. In addition to implementation of screening tools (PEST for Psoriatic Arthritis and DLQI for psychological conditions) in Cerner with noticeable clinical improvements. Increasing knowledge of patients and healthcare providers and implementing screening tools in Cerner, should allow for early recognition and diagnosis of psoriasis comorbidities. 20

21 Testimonial and Press release: Abu Dhabi Health Services Company SEHA Conducts Psoriasis Awareness day Under the slogan United to overcome psoriasis 21

22 Official Twitter of SEHA covering the awareness day. Thanking letter from a patient atternded the workshop. 22

23 Appreciation certificates distributed byahs CEO Dr Mariam Al Mazrouei as a recognition of the project s efforts. Press release: Psoriasis Awareness Week Campaign in all AHS centers August

24 Coverage of the activities of Psoriasis Awareness Week Campaign in social media. A Kuwaiti Lady was impressed and sent her appreciation words through social media. 24