LAS VEGAS—Outpatient settings now have an option to engage in a strategic performance measures initiative to improve preventive health outcomes through a health IT-enabled registry, based on positive outcomes presented Feb. 21 at the 2012 Healthcare Information and Management Systems Society (HIMSS) conference.
The Preventive Health Partnership is a joint effort on the part of the American Cancer Society (ACS), the American Diabetes Association (ADA) and the American Heart Association (AHA), forged in 2004, to collectively engage the issue of prevention and to create consistent prevention and screening guidelines, explained co-presenter Alan J. Balch, PhD, vice president of the partnership.
The initial and basic framework for the partnership is a patient focus on four strategies that can help prevent cancer, diabetes, heart disease and stroke: be physically active; eat well; don’t smoke; and see your healthcare provider regularly. Balch noted that the latter is very helpful in screening for any of the most common chronic disease states.
The partnership discovered that clinicians and patients are concerned about addressing risk across multiple chronic diseases, even though those patients with a diagnosed condition are likely to have or be at risk for another chronic condition, Balch noted. “When it comes to prevention, there is a great need to think outside of traditional disease silos, particularly around lifestyle interventions. The lifestyle interventions across chronic disease states that are needed to address common risk factors are basically identical, as are the systems of care needed to deliver them,” said Balch, exemplifying cholesterol as a risk factor across disease states.
The ACS, ADA and AHA are in the “guidelines business,” says Balch, and with increasing emphasis on expanding health IT, “the timing is right for a national clinical registry and quality improvement effort that spans the major chronic diseases.”
He added that improved documentation is needed to improve quality, as the lack of documentation may prevent consideration for various therapies and monitoring of conditions. Thus, he urged that practice-specific performance improvement strategies are needed.
“EHRs may better assist documentation, but are not sufficient by themselves for quality improvement, as the data need to be usable. Health IT should be coupled with quality improvement strategies to achieve performance improvement and patient outcomes,” Balch said.
Thus, Vincent J. Bufalino, MD, president and CEO of the 50-cardiologist Midwest Heart Specialists (MHS) in Elmhurst, Ill., which was recently acquired by Advocate Medical Group, outlined his practice’s physician performance measures with the registry. MHS initiated its involvement in January 2004, and since then has reported data at a physician-specific level for 28 consecutive quarters and for 87,450 distinct patients through December 2010. Overall, as of December 2010, they had tracked 523,676 patient visits.
“Initially, our physicians were convinced that they were doing a good job, and were surprised to see the compliance data,” Bufalino said.
In the first quarter in January 2004, 7.4 percent of the patients were listed as smokers, with only 14.5 percent advised to quit by the physician. In the 28th quarter in December 2010, 4 percent of the patients were listed as smokers, but now, 95.9 percent were advised to quit by their physician. For patients with coronary artery disease, 91.6 percent of the patients were on antiplatelet therapy at baseline, with 94.7 percent by December 2010. By the 28th month, the practice succeeded in getting the LDL cholesterol of 83.6 percent of patients to less than 100, up from 70 percent in the first month.
In addition to patient outcomes, MHS improved its documentation due to its involvement with the project. Documentation of ejection fraction went from 52.5 percent to 97 percent during this period in patients with coronary artery disease, and from 60.2 percent to 91 percent in heart failure patients.
Since the Get With the Guidelines project began in 2001 for the inpatient setting, more than 1,600 U.S. hospitals and three million patient records have been included in the program. Importantly, Bufalino said that more than 1,200 hospitals have received recognition and the data have resulted in 92 peer-reviewed publications.
“The recognition of the outcomes is a good encouragement within a practice to continue with proper documentation