In January 2013, providers in the Mount Nittany Physician Group pediatrics practice began a voluntary project through Highmark’s Quality Blue program to provide efficient, high quality healthcare.
To qualify to participate in the Highmark Quality Blue project, a minimum of 25 primary care providers from Mount Nittany Physician Group needed to have met specific meaningful use requirements.
Meaningful use is a set of guidelines set by the Centers for Medicare & Medicaid Services that oversees and certifies the use of electronic medical records in healthcare facilities.
Having met the requirements, ten pediatrics providers accepted the challenge of representing Mount Nittany Physician Group in the Highmark project. Their challenge was to improve the delivery of care by meeting certain quality measures from two distinct categories.
“This project was a major undertaking for our providers,” said Rian Roan, revenue cycle training and systems specialist/quality systems assistant, Mount Nittany Physician Group. “Not only did we increase the quality of care we’re delivering to our pediatric patients, but we enhanced our workflow processes, and that will continue even after the project period ends.”
For the project, the pediatrics practices collected and submitted the following data:
- Weight assessment counseling in children and adolescents: taking the height and weight during all visits, discussing body mass index percentile, physical activity and nutritional counseling for patients aged 2 – 18
- Childhood immunization status by age 2: the percentage of children 2 years of age who were given required immunizations
- Blood pressure assessment: percentage of patients aged 5 – 17 years who had blood pressure recorded
- Asthma assessment: percentage of patients aged 5 – 40 with a diagnosis of asthma who were evaluated for the frequency of daytime and nocturnal asthma symptoms
- Spirometry assessment: improvement in the percentage of patients age 6 and older with asthma that had a spirometry evaluation or peak flow monitoring documented
- Treatment of upper respiratory infections: improvement of the percentage of children who were given a diagnosis of an upper respiratory infection and were not dispensed an antibiotic prescription
Roan explained that the first three quality measures listed above were part of the core category required by Highmark, and the last three quality measures were from a respiratory category that was chosen by the providers.
“We chose respiratory because we wanted to focus on a category that affects a large proportion of our population,” said Craig Collison, MD, pediatrics, Mount Nittany Physician Group, one of the physician champions for the project. “It is not uncommon to see respiratory issues in our pediatric patients, so we really felt that we could make a difference in improving care for our patients in this category.”
The results from each of the above quality areas were collected through the group’s electronic medical record system and through manual chart audits performed by the group’s quality team, and then submitted to Highmark.
In order to show that the delivery of care was improving, accurate data collection was essential. For example, the electronic medical record team—part of the information services department for Mount Nittany Health—was involved in creating flow sheets and note types to collect discrete data with minimal work flow changes. Similarly, Robert Huffard, MD, and Caryl Waite, PA-C, were instrumental in refining a note system for accurate data collection in the weight assessment counseling measure.
Kristie Kaufman, MD, was also celebrated as a positive influence in keeping the project’s momentum going, as she helped to determine ways to implement improvements with as little disruption as possible.
“The providers worked so well together during this project, but it’s also important to note that the nursing staff was extremely flexible and agreeable as well,” said Roan. “They were willing to do whatever was needed to ensure the data was captured correctly and that patient care was always top priority.”
In addition to meeting the specific measurements for each requirement, the group’s quality team collectively identified lessons learned, barriers, successes and obstacles throughout the project.
“This project went extremely well, but it’s really only a stepping stone to allow us to continue to move forward in terms of quality improvement,” said Dr. Collison. “With our electronic medical record, we’re able to track and follow patients and their conditions long-term, which will ultimately be very beneficial to care delivery."