Measure by Measure: Enhancing the Patient Experience through Quality Reporting
With help from MEDITECH's Data Repository, Adena Health System improves patient access to their providers, as well as best practices for chronic disease management.
(10/14/2010)

With over a half million residents in the area they serve, Adena Health System (Chillicothe, OH) set out several years ago to take a more cohesive approach to the patient care they deliver, much of which occurs in outpatient settings. Thus, the organization decided to optimize their use of the MEDITECH HCIS—at as many integration points as possible—throughout the entire care continuum.

"At Adena, our approach was to tie a thread through the patient's entire encounter and experience," says Jason Monroe, director of business intelligence at Adena. "With the Enterprise Medical Record, Data Repository, and LSS's Medical and Practice Management, we knew we could maximize quality, improve patient safety, and provide a better patient experience."

Although the right tools were in place, Adena Health's quality initiatives didn't really take off until the organization implemented quality reporting, spurred on by Monroe's own experience: He stopped by Adena's family practice clinic to schedule an appointment with a new primary care physician, and learned none of the physicians in the practice were accepting new patients.

Accessing Primary Care
Monroe was frustrated by his inability to see a physician, so he and his team examined the data to figure out what was happening at the family practice clinic. "After we looked at the data, we learned the practice was booked at 110% utilization, but functioned at only 80% utilization. They hadn't accounted for the 35% no-show/cancellation rate," he explains. "The practice was turning away patients, simply because they hadn't maximized scheduling."

So, using MEDITECH's Data Repository, along with Medisolv, Adena Health's I.T. staff created a report that enabled the practice to measure utilization. As the practice took steps to improve physician scheduling, blocks of time began to open up, increasing patients' access to their primary care physicians. In addition, physicians were able to take on new patients.

Says Monroe, "When providers control care through the physician practice, their patients' experience is enhanced. We saw a reduction in unnecessary trips to the ED, and a greater sharing of patient information."

Tracking Compliance to Manage Chronic Diseases
Adena's success with improving access to primary care formed the basis for quality initiatives to help their providers better manage chronic diseases. The first quality initiative targeted physician compliance with providing basic diabetes care, which was appropriate given that Adena's service area includes communities with some of the highest rates of diabetes in Ohio.

Using their reporting tools, Monroe and his team tracked physician compliance for a diabetes care "best practice," ordering and resulting hemoglobin A1C testing. They learned that compliance rates for Adena's providers measured only 50-60%, so they began to track physician ordering of the test.

"Compliance tracking created peer pressure among physicians," says Monroe. "By publishing the results within our organization, physician compliance with the best practice increased by 30%. Since this initiative has encouraged many physicians to improve the quality of care they provide to their patients, we're going to see if there are other ways we can help physicians better adhere to best practices."

Promising Future Initiatives
Adena's second quality initiative focuses on mammogram testing for women over 40. Physician compliance with these best practices measured an alarming 28%. Although this initiative is still in its early stages, Monroe is confident Adena will see the same increase in compliance as they saw with tracking hemoglobin A1C testing.

"By identifying and tracking these areas of concern, and tying in information collected from across the continuum, we've been able to start streamlining care and improving the patient experience," explains Monroe. "These efforts are truly making a difference for our community's residents--not just when they're visiting providers, but also throughout their day-to-day lives."

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