PEBB Board PresentationKaiser 2006 Quality Initiatives

2 3/21/06

Northwest Region Quality Vision

Our vision is to provide the highest quality care in the world

We will measure success by achieving 90th percentile on HEDIS effectiveness of care (EOC) quality measures

3 3/21/06

Quality Populations/Measures for 2006 (2005 HEDIS Rank)

Adult Women Breast Cancer Screening (50th) Cervical Cancer Screening (10th) Diabetic Members

Lipid screening (25th) Lipid control < 130 (90th) Lipid control < 100 (75th) HgbA1c screening (50th) Poor Hgba1c control (75th)

4 3/21/06

Quality Population/Measures for 2006 (continued)

Patients with CV conditions (new measure—no rankings) Lipid screening Lipid control <130 Lipid control <100

5 3/21/06

JCAHO AMI Measures

ACE Inhibitor for LVSD (89%)* Smoking cessation advice/counseling (74)* Aspirin at arrival (100)* Aspirin at discharge (98)* Beta blocker at arrival (99)* Beta blocker at discharge (99)* (Thrombolytics) * KSMC 2004 results

6 3/21/06

Quality Populations/Measures for 2006 (continued)

Children/ Adolescents Immunizations children (90th) Immunizations adolescent (75th)

Appropriate asthma meds Age 5-9 (50th) Age 10-17 (10th)

7 3/21/06

Quality Populations/Measures for 2006 (continued)

Patients with depression Practitioner contact (25th) Acute phase treatment (90th) Chronic phase treatment (75th)

8 3/21/06

ICP Service Quality Targets

Measure2006

Threshold2006

Target2006

Stretch

Recommend KP to friend 46.5% 47% 48%

Saw own PCP 71% 73% 75%

Time to Appt – Primary Care 71% 72% 74%

Time to Appt – Specialty Care 65.7% 66.7% 68.7%

MD Listened – Primary Care 82% 83% 84.5%

MD Listened – Specialty Care 84% 85% 86.5%

MD in work unit support me in providing quality service 76% 78% 80%

9 3/21/06

Quality Improvement OpportunitiesPEBB

Beta blocker post-MI Diabetes nephropathy screening

10 3/21/06

Beta Blockers Post-MI

For 2006 one of our quality goals regionally is improvement in all the JCAHO AMI measures, including beta blocker use post-MI

At KSMC this is a primary quality initiative for 2006 All plan hospitals—St. Vincent’s, SWWMC, St. Johns,

Salem are participating in IHI 100,000 lives campaign with AMI bundle as a core strategy

Six month adherence to beta blocker use is a new HEDIS measure, we are currently considering strategies to ensure compliance

11 3/21/06

Diabetic Nephropathy Monitoring

Those patients at risk for diabetic nephropathy can be identified with newer urinalysis tests— microalbuminuria testing

HEDIS adopted microalbuminuria testing as a standard annual test for all diabetics

Kaiser had microalbuminuria as a standard test on our “panel diabetes” lab ordering process

12 3/21/06

Diabetes Nephropathy Monitoring (continued)

Context: Diabetics develop macrovascular (large vessel) and microvascular (small vessel) atherosclerosis

Macrovascular disease causes heart attacks and strokes and is the leading cause of death in diabetes

Microvascular disease causes diabetic retinopathy leading to blindness; and diabetic nephropathy leading to end stage renal disease (ESRD) resulting in dialysis or kidney transplant

13 3/21/06

Historical Perspective

Research on microvascular disease, specifically diabetic nephropathy, has shown that early detection of those diabetics at risk of renal disease and specific treatments can slow the progression and prevent ESRD/dialysis

The main treatments are: Improved blood pressure control—goal bp < 130/80, and use of specific medications—ACE-I and/or ARB

14 3/21/06

Macrovascular Disease Research

Research on macrovascular disease has demonstrated that all diabetics given ACE-I (or ARB’s) had lower rates of macrovascular disease (heart attacks/strokes)

Based on this information Kaiser Northwest and nationally felt microalbuminuria screening was unnecessary and removed it from the “panel diabetes” order

As a result our HEDIS nephropathy scores have fallen

15 3/21/06

Current Consensus

HEDIS has proposed changing the nephropathy screening measure for 2007 such that any patient on ACE-I or ARB will count as having had nephropathy monitoring

Kaiser Northwest region has decided to add microalbumin testing back to our “panel diabetes” order

By the end of 2007 our nephropathy screening rate will be significantly higher

16 3/21/06

Tools to Achieve Improved Diabetes Quality Goals

Health maintenance alerts for any diabetic who has not had diabetic labs in past 9 months

Health maintenance alerts when last recorded blood pressure is not at goal

Promotion of ALL= Aspirin, Lovastatin, Lisinopril use in all members

Monthly rosters for health care teams listing diabetics with LDL > 100, or no LDL in past 9 months, hgba1c > 9 or no hgba1c in past 9 months, no microalbuminuria testing in past 9 months, bp not at goal