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| You Want Me to Measure What?! |
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by Kimberly Spering, MSN, FNP-BC - March 21, 2011
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 Provided by Clinician 1
As usual, I find that when I’m frustrated, I tend to find topics to blog about. This week is more of the “patient-centered medical home” issues that have come to light.
If you’ve read previous posts, I’m learning new terminology about PCMH all the time. OK, I think, this ‘ole dog ain’t THAT old...she can learn new tricks. So I dove into this new world, reading everything I could about “meaningful use,” Pennsylvania goals for collaborative care among practices, “visibility walls,” PDSA (plan-do-study-act) forms, etc.
So, on average, besides my normal 40-hour patient-work week, I’m putting in about 20-plus hours per week doing PCMH data-mining, data-entry, and essentially, becoming a detective to figure out WHO our diabetic population is, and determining how to get those who have NOT been in for visits recently into our office.
I must say, this has been a great collaborative effort by our entire office team. By putting our heads together, we changed some things:
1. We restructured our scheduling template to include “diabetes visits” to alert all staff of these patients. Now, from the front office staff, to the MA checking-in the pt., to the provider – we all know that it’s a DM visit, from start to finish.
2. We started our visit reminder calls 4 days ahead of the visit (instead of 2 days) to make sure that patients had their labs done AHEAD of the visit. We estimated this saved about 5 steps AFTER the visit (we can review everything AT the visit VS. get the labs in, review them, triage the lab results & pt. message to the MA, then the MA call-back to the pt.)
3. Every chart is “diabetic prepped” prior to the visit: are labs done ahead of time? Are preventative services up-to-date? Is the pt. on a statin, ACE-I or ARB, & ASA? If not, this is marked in the front “alert” section to notify the provider
4.Now that my diabetic database is identified, I am running our medical home spreadsheets at least every other week, to pick up patients who have not had labs done or a recent visit. This allows me to quickly target those people. After I make out an electronic lab slip, I send a triage to my staff to call the pt. to schedule a visit.
So...to get to the frustrating parts:
As you might imagine, this has taken us several months to get it moving smoothly. Many quirks along the way. The biggest pain-in-the-derriere was that Quest Lab was not inputting our LDL parameters correctly, and I had to manually enter about 140 patients’ results. I still am not sure what the problem is, as the Quest IT guy doesn’t know, and our Medent rep says it is an IT problem. (sigh)
However, yesterday took the proverbial cake. We have had some meetings with “coaches” who are to help us with this process. One of the things we need to have is a “visibility wall,” a virtual snapshot of what you are working on in the practice. On it, we have to show these plan-do-study-act things we are doing in the practice.
After reviewing the above #1 – 4, he looked at me, and SERIOUSLY asked, “Well, that’s great. But how can you MEASURE IT?”
I must have looked as confused as I felt. “Measure...WHAT?”
“Measure what you are doing?” was his response.
Now...wait a sec. I’m a clinician. I’m not a mathematician, a statistician, or anything of the kind. And why the heck do I have to “measure” ANYTHING? It’s WORKING! We’re getting the patients IN to the office! I’m down to only THREE patients who have not gotten their labs yet (but have lab slips AND appointments)...down from 23 in the past month.
His point was that I’m supposed to come up with a “measurable” formula, a PDSA for our visibility wall.
My point is: are-ya-kiddin-me?
I can see that there are things to be measured to see if they work. And certainly, if they work in our practice, then these things can be replicated elsewhere. I just think that the statistics had better be left to someone who isn’t THIS nurse practitioner.
But I’ll have to figure out a formula for that. (smile)
 Kim Speringis a family nurse practitioner who currently works at BrndjarMedical Associates, P.C., a family practice in Emmaus, PA. Her past experience includes the fields of medical/surgical ICU, open heart/trauma ICU, labor and delivery, nursing education, nursing supervision, and as a nurse practitioner in both family practice and OB/GYNsettings. She currently serves as a NP preceptor for her graduate school alma mater, DeSalesUniversity, as well as for local baccalaureate programs. She is passionate about patient education and helping patients understand that they are ultimately responsible for their own health. She also firmly believes that the public needs to be educated on the value of NPsand PAsin meeting the health care needs of the next decade and beyond. In her free time, Kim enjoys family vacations with her optometrist husband, Mark, and her two sons, Matthew and Connor.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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| Kim Spering (Emmaus, PA) |
on 25 Mar 2011 at 7:19 am |
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@ Duke: yes, thank you for your input. I do know the formulas for my medical home criteria. However, he was asking me about measuring how we got the diabetics IN for their labs, visits, etc...the process itself.
What I plan to do is use hard data: "x" number of patients did not have their labs or visits in Dec., Jan, etc.; "y" number have had labs and visits by March, etc.
My frustration stems from the fact that he was looking at numbers, while we are looking at results. Our efforts are working, and so the "measurement" of the process is less important than the patient measurements and outcomes. At least, IMHO. :) |
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| Al Hu (Norris, TN) |
on 23 Mar 2011 at 9:10 pm |
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| I think that is key: "collect your data while you do your routine of patient care". My preceptor has worked 12 hour days/ 4 days a week for years and the patients love her but what has it cost? |
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| Duke (Duke Place) |
on 22 Mar 2011 at 8:35 pm |
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| The PDSA measurement is: numerator equals patients meeting all criteria, demoniator equals all diabetic patinets. This produces a ratio which can be simplified as, for example, 87/100 or .87 (87 %). This is a meaningless number if you do not control for other variables that effect patient adherence since we won't know which intervention produced the result. Unfortunately, medical home does no more than any quality program before it that is based on staitistical approaches from Demming to today. The other thing you need to measure is if you are salaried, invested 20 more hours per week to do you job, then your salary converted to hourly wage will show a rapid decline. If you are hourly, you just cost your practice 20 hours of overtime. Neither situation should be acceptable (see Kaizan). If you can't collect your data while you do your routine of patient care, your costs go up for only marginal patient quality gains. |
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