2015 Quality Improvement

2015 Quality Improvement Projects

Clinical Care Coordination, Chronic Pain Management, Patient Experience, and Health Information Systems continue as priority quality improvement initiatives for 2015. The information below outlines the activities being worked on, and provides a 2014 progress summary.


CLINICAL CARE COORDINATION

Project Aims:  

• Reduction of Emergency Department utilization
• Reduction of inpatient readmissions
• Establishment of a Medical Home
• Improved access to appropriate care

Background:

During 2009, a Federally Qualified Community Health Center network was established to provide Family Medicine, Internal Medicine, Pediatric, Obstetrical, and Mental Health Services. Our health center locations include Springfield, Chester, Ludlow, Rockingham, VT, and Charlestown, NH.  This action provided the community a unique opportunity for the development of a partnership between the Community Health Center network, Springfield Hospital and its specialty services, and with regional health care resources.

Project Description:

Clinical Care Coordination will be improved linking Springfield Hospital, the Community Health Center network, specialty services, and community resources to improve the management and coordination of patient care.

Project Goal:
•    Reduction of Emergency Department Utilization by improving access to primary care.
•    Reduction of all cause inpatient readmission
•    Improve access to appropriate care

Evaluation Metrics:
•    Emergency Department volume
•    Fast Track volume
•    All cause readmission rate
•    Community Health Center utilization

2014 Progress Report:

The process for the collection of data and management of Clinical Care Coordination has been established. Early coordinated care improvements include:
• Patients utilizing our Emergency Department Services are being successfully provided follow up scheduled through our Community Health Center network.
• Dental patients utilizing the Emergency Department are provided the opportunity be seen by our Community Health Center dental provider.
• Patients being discharged from the Springfield Hospital are provided a follow up 
appointment in our Community Health Center network within one week of discharge and, 
as a result there has been a significant reduction in readmission rates.
• Fast Track has been implemented in the Emergency Department, redirecting 22% of Emergency Department patients to more efficient treatment.

During 2015/16, efforts will continue to reduce Emergency Department utilization, reduce readmissions, and improve access to the Community Health Center network.


CHRONIC PAIN MANAGEMENT

Project Aims:  

• Improve treatment and safe management of acute and chronic pain

Time Frame:
 
Ongoing

Background:

Societal expectations have increased in the last decade regarding effective management of acute and chronic pain. At the same time, prescription drug misuse and abuse is a significant local problem in many communities in Vermont, as well as regionally and nationally. These competing trends have made chronic pain management in the primary care setting a difficult and time-consuming task, with significant implications for patient safety and medical practice.

Project Description:

Health care providers are committed to providing patients pain relief. This project focuses on improving pain assessment, documentation, follow up care, and developing an individualized plan of care that is responsive to the needs of the individual while providing appropriate and safe pain relief.

Project Goal:
• Establish safe standards of practice for the management of acute and chronic pain.

Evaluation Metrics:

• Utilization of appropriate screening and assessment tools
• Documentation of progress in meeting individualized goals
• Providing an appropriate plan of care that supports meeting individualized goals

2014 Progress Report:
We have established safe and effective chronic pain management practices throughout all of our patient care areas. These practices are meant to provide a reliable method of evaluating changing care needs and improving communication of these needs throughout our system of care.
Documentation of patient care plans through our electronic medical records system has improved communication and coordination of patient care needs in the areas where a patient receives their care.
Mental health services have been integrated into our primary care practices, which allow us to serve our patients in their local communities on an outpatient basis, in a pre-emptive way, with the goal of providing needed services at the right time, in the right place, and avoiding unnecessary emergency department visits.

During 2015/2016 we will continue our improvement efforts to sustain our commitment to effective pain management.

CLINICAL CARE COORDINATION

Project Aims:  

• Reduction of Emergency Department utilization
• Reduction of inpatient readmissions
• Establishment of a Medical Home
• Improved access to appropriate care

Background:

During 2009, a Federally Qualified Community Health Center network was established to provide Family Medicine, Internal Medicine, Pediatric, Obstetrical, and Mental Health Services. Our health center locations include Springfield, Chester, Ludlow, Rockingham, VT, and Charlestown, NH.  This action provided the community a unique opportunity for the development of a partnership between the Community Health Center network, Springfield Hospital and its specialty services, and with regional health care resources.

Project Description:

Clinical Care Coordination will be improved linking Springfield Hospital, the Community Health Center network, specialty services, and community resources to improve the management and coordination of patient care.

Project Goal:
•    Reduction of Emergency Department Utilization by improving access to primary care.
•    Reduction of all cause inpatient readmission
•    Improve access to appropriate care

Evaluation Metrics:
•    Emergency Department volume
•    Fast Track volume
•    All cause readmission rate
•    Community Health Center utilization

2014 Progress Report:

The process for the collection of data and management of Clinical Care Coordination has been established. Early coordinated care improvements include:
• Patients utilizing our Emergency Department Services are being successfully provided follow up scheduled through our Community Health Center network.
• Dental patients utilizing the Emergency Department are provided the opportunity be seen by our Community Health Center dental provider.
• Patients being discharged from the Springfield Hospital are provided a follow up 
appointment in our Community Health Center network within one week of discharge and, 
as a result there has been a significant reduction in readmission rates.
• Fast Track has been implemented in the Emergency Department, redirecting 22% of Emergency Department patients to more efficient treatment.

During 2015/16, efforts will continue to reduce Emergency Department utilization, reduce readmissions, and improve access to the Community Health Center network.


CHRONIC PAIN MANAGEMENT

Project Aims:  

• Improve treatment and safe management of acute and chronic pain

Time Frame:
 
Ongoing

Background:

Societal expectations have increased in the last decade regarding effective management of acute and chronic pain. At the same time, prescription drug misuse and abuse is a significant local problem in many communities in Vermont, as well as regionally and nationally. These competing trends have made chronic pain management in the primary care setting a difficult and time-consuming task, with significant implications for patient safety and medical practice.

Project Description:

Health care providers are committed to providing patients pain relief. This project focuses on improving pain assessment, documentation, follow up care, and developing an individualized plan of care that is responsive to the needs of the individual while providing appropriate and safe pain relief.

Project Goal:
• Establish safe standards of practice for the management of acute and chronic pain.

Evaluation Metrics:

• Utilization of appropriate screening and assessment tools
• Documentation of progress in meeting individualized goals
• Providing an appropriate plan of care that supports meeting individualized goals

2014 Progress Report:
We have established safe and effective chronic pain management practices throughout all of our patient care areas. These practices are meant to provide a reliable method of evaluating changing care needs and improving communication of these needs throughout our system of care.
Documentation of patient care plans through our electronic medical records system has improved communication and coordination of patient care needs in the areas where a patient receives their care.
Mental health services have been integrated into our primary care practices, which allow us to serve our patients in their local communities on an outpatient basis, in a pre-emptive way, with the goal of providing needed services at the right time, in the right place, and avoiding unnecessary emergency department visits.

During 2015/2016 we will continue our improvement efforts to sustain our commitment to effective pain management.