Medical group finds preventive care acclaim’
New visit tool tracks preventive care needs
HealthSystem Minnesota in Minneapolis views every office visit as a chance to catch up on preventive care needs. With that new attitude, HealthSystem’s 15 primary care sites tripled their percentage of patients who are up-to-date on all preventive services.
The Preventive Care Initiative also won HealthSystem Minnesota the first Acclaim Award from the American Medical Group Association (AMGA) in Alexandria, VA. The award comes with a $60,000 grant, which the integrated delivery system plans to use toward new quality improvement projects.
In addressing preventive care needs, Health-System Minnesota’s broad focus and simple approach produced dramatic results. In 1996, only 14% of patients were up-to-date on all preventive care. By 1998, that had risen to 43%. (For other results, see chart, below.)
"Our intervention wasn’t focused on just increasing mammogram rate or Pap smears," notes David Abelson, MD, associate medical director of Supporting Best Care and clinical information systems for HealthSystem Minnesota, which includes the Park Nicollet clinics. "It was focused on a process to audit whether all the preventive care services were delivered on time.
"I think it’s actually easier because what you’re creating is a process to audit how a system and a patient are doing with preventive care services, and use this one process to look at all the various services," he says. "It would be impossible if you created a separate process for each service."
Before launching the initiative, HealthSystem Minnesota implemented numerous guidelines, but the guidelines themselves didn’t produce results.
Despite spending more on routine health maintenance than any other area, such as cancer or heart disease, the organization still was falling far short on preventive services, says Abelson. That is typical of other primary care sites around the country, in which patients may not come in for regular physicals and doctors focus more on acute rather than preventive needs.
"It wasn’t because our doctors didn’t know what they were supposed to do or they didn’t think preventive care was important," says Catherine Spurr, RN, manager of the Supporting Best Care department. "So it had to be the process."
A task force that included senior leadership developed strategies that didn’t require new technology or personnel. A visit planning tool called the Health Profiles form helped track preventive care as well as allergies, medications, and medical complaints.
Nurses complete a form for all patients who will come in each day, including notations for smoking status, colon and cervical cancer screening, immunizations, and allergies, among other items. (See sample form, inserted in this issue.)
HealthSystem Minnesota used a fast-track method to create and test the form, piloting it with just a few physicians and allowing changes even after it became widely used. "It is still constantly being revised, but the basic shell remains pretty much the same," says Spurr.
Meanwhile, providing the care became easier. Once nurses scanned the medical record and computer database to complete the form, new policies authorized them to initiate certain orders, such as for mammography, cholesterol tests, or immunizations. So when a patient showed up with a sore throat who hadn’t had a pneumonia shot or colon cancer screening within the recommended time frame, the nurse or physician would offer to take care of it immediately rather than advising the patient to schedule a routine physical.
Nurses and physicians were able to adapt and work within the new process, says Spurr. Over time, it becomes less time-consuming, as the patients are caught up on services and the form needs only to be updated, she says.
While the practical tools are important, Abelson notes that effective quality improvement requires a strong commitment from the organization’s CEO and leadership. "The single most important organizational resource is focus," he says. "It has to be a part of a strategic goal to improve the quality of care. With the organizational backing comes some resources."
In fact, Acclaim award judges were impressed by the systemwide commitment, from top leadership to front-line staff, who took on additional responsibilities to make the project a success, says Julie Sanderson-Austin, RN, vice president of quality and operations improvement for AMGA. "This could not have happened without the extreme vision and focused leadership that HealthSystem Minnesota had in place for this project," she says.
Improvement can build on itself. Bouyed by its success, HealthSystem Minnesota is now expanding the Health Profiles form to include chronic diseases, beginning with diabetes and heart disease. The form will include indicators such as hemoglobin A1c and lipid levels.
Once again, nurses will play a key role as they follow up with patients who aren’t meeting their goals or who need help with lifestyle changes. HealthSystem Minnesota also will reach out to patients and ask them to come in for needed care, says Spurr.
The success of the Preventive Care Initiative has made the extra effort worthwhile, says Abelson. In addition to the Acclaim award, HealthSystem Minnesota recently ranked No. 1 among 20 area clinics for certain preventive care indicators.
"There’s a sense of pride," he says. "It’s something we worked hard on. It’s nice to see our accomplishments, first for our patients and then to have it recognized."
[Editor’s note: The AMGA Acclaim Award honorees were Edmonds (WA) Family Medical Clinic; University of Pennsylvania Health System in Philadelphia; Lovelace Health System in Albuquerque, NM; and Health Care Partners in Torrance, CA.]
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