Measurable Impact

RPCN 2017 Adult Medical Health Patient Satisfaction Survey Results

Patient satisfaction is a key element in providing the best quality care possible. Satisfied patients have a sense of wellbeing and support from their providers, are more likely to adhere to their treatment plan, and are more likely to recommend our health centers to family and friends. So it’s no surprise that RPCN invests both money and staff time in measuring patient satisfaction. This measurement also helps us understand where we need to do better and whether we’re improving in aspects of patient satisfaction.

Each quarter, we distribute a satisfaction survey that asks patients to report about their experience with the last provider they saw and their overall experience at our Centers. This survey is called the Consumer Assessment of Healthcare Providers and Systems (CAHPS®). Designed by the National Committee for Quality Assurance (NCQA), it’s the same survey that 101,953 patients receive nationally from other providers.

This year, July 1, 2016 – June 30, 2017, the adult medical version of the survey was mailed to patients seen at Rushville Family Health Center and Utica Community Health Center. Because it’s a new site, Valley Family Health Center’s patients were sent surveys for the first two quarters of 2017. There are currently five focus areas for the adult health survey:

1. Access
2. Communication
3. Self-management support
4. Provider discussion about mental/emotional health
5. Office staff

Responses for each focus area are combined into an average score for each area. RPCN uses the results of the national average as a benchmark. Below are bar graphs comparing the results for our sites vs. the national benchmark. The blue bars show the RPCN scores while the red bars show the national average.

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For Rushville Family Health Center patients, you can see that in two of the five focus areas, a greater share of Rushville patients are satisfied than all patients nationally. These areas self-management support (providers giving patients help taking care of themselves) and providers paying attention to patients’ mental and emotional health. In the areas of provider communication and office staff being helpful, courteous, and respectful, Rushville patients were just as satisfied as patients across the nation. Fewer Rushville patients were satisfied with access (getting timely appointments, care, and information) as compared to the national average.

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Scores show that a greater share of Utica patients are satisfied than those in the national sample. These areas of higher satisfaction include self-management support (providers giving patients support for them to take care of themselves) and providers paying attention to patients’ mental and emotional health. In three focus areas, a smaller percentage of Utica patients reported being satisfied than the national group. These include: getting timely appointments, care, and information; provider communication with patients; and office staff being helpful, courteous, and respectful.

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In all five areas, a larger percentage of Valley Family Health Center patients were satisfied than all patients nationally. It is important to note that being the newest health center, Valley providers saw more new patients. Additionally, Valley’s is a smaller sample of patients than Rushville or Utica, and its results are subject to greater error.

RPCN administrative staff will be tallying the results from the child health and dental surveys to report results. Staff and transformation teams will be further analyzing all survey results to identify priorities for improvement and to test changes in workflow.

 

 

RPCN Efficiency and Care Coordination Measures

More and more patients and payers are looking at health care organizations to determine whether or not they are cost efficient and able to effectively coordinate patient care across various settings. RPCN measures how well we do in both of these arenas.

In terms of efficiency, RPCN tracks our patients’ use of emergency rooms and hospitals as well as our own providers’ ordering of x-rays for low back pain problems as possible indicators of overuse or waste. 

Patients, staff, and payers want people to be hospitalized and go to the emergency room only when necessary.  RPCN is currently in the process of linking with hospitals, regional health information organizations, and others to get real-time data on when our patients are in the emergency room or in the hospital. This data will help us provide timely follow up care to those using these services. It would also enable us to identify a group of patients who may benefit from care management. RPCN currently has some data to help us understand our patients’ use of the emergency room or hospitals since RPCN provides transition of care (TOC) visits for these patients. In the first half of 2017, 9% of patients seen in Rushville, 9% of Utica patients, and 3% of Valley patients had a TOC visit related to an emergency room visit or hospitalization. RPCN will continue to track these numbers.

Below is a graph which shows other factors that RPCN tracks related to efficiency and care coordination. In terms of efficiency, the medical evidence shows that most patients with low back pain do not need x-rays within the first month of their initial diagnosis. The evidence also underscores the importance of patients keeping their referral appointments and the need for primary care offices to receive a report from specialists. Tracking patient medications after a TOC is also important to ensure that our providers are aware of any medication changes that may have resulted from an emergency room visit or hospital stay. Our centers reconcile medication for almost all of our patients following a transition of care.

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As you can see, many of our patients diagnosed with low back pain do not receive inappropriate x-rays. Our centers all need to improve upon the number of referral reports we get back for patients after they complete a specialist visit. Finally, several months ago, our nursing department started an intensive quality improvement effort towards ensuring that our patients complete their referral appointments and that we receive notes back from the specialists to ensure appropriate follow up.

Quality Incentives

 We have good news to report about the quality of care provided to medical patients at our three centers. With your help, for most of the key measures we are tracking, our care is improving—yet large areas of improvement remain.

Each month, RPCN measures how well we are doing on key quality measures for the patients seen the previous twelve months. We look at the patients who need to have the service (for colorectal cancer screening we look at patients ages 50-75), the service that they need to meet the measure (an annual FIT test or a colonoscopy every 10 years), and whether or not it is documented in the right place in the chart (if a patient had a colonoscopy the results need to be attached to a diagnostic imaging order and filed in the x-ray section of the patient document). We establish a percentage based on the number of patients who had the service documented appropriately over the number of patients who needed the service and report this.

Below are the results of the snapshot of our quality of care based upon the services provided to our patients seen between June 1, 2016 and May 31, 2017. We will continue to work together to determine how we might ensure that more of our patients get the care that they need.

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RPCN Care Coordination and Cost Efficiency Data

As part of monitoring quality at RPCN, we keep track of data that helps us understand how well we coordinate patient care and provide cost efficient services. RPCN collects data that shows how well we are doing at:        

  1. Medication Reconciliation
    When we identify all of the medicine (prescription and over-the-counter) on a patient’s medication list when the patient visits us for a “transition of care visit” (e.g. sees us for the first time or visits us following a discharge from a hospital, rehabilitation, psychiatric or nursing home unit, or an emergency room visit). Medication reconciliation is important to do at these visits so we can be sure patients are on the right medications that treat new and existing problems/conditions.  
  2. Referrals
    Helping our patients complete their referrals and obtaining and appropriately filing the consult notes from these referrals. This provides us with assurances that our patients completed the referral and that we stay informed about the results of the referral and file them in a place where we can have quick and easy access to them.   
  3. Giving Kids Antibiotics Only When Needed
    Research has shown that antibiotics are sometimes given to kids when they are not needed. When this happens, patients can develop a resistance to antibiotics so that when they really need them, the antibiotics will no longer fight the infection. To collect data on how well we do this, we keep track of the number of pediatric patients with a sore throat who had a strep test ordered before an antibiotic was prescribed and the number of pediatric patients with upper respiratory infection who did not receive an antibiotic. 
  4. Not Ordering Certain Tests
    Holding back from ordering an x-ray or other image within 28 days of diagnosing a patient with low back pain. Most chronic low back pain problems go away within 28 days, therefore, ordering an imaging test is not usually necessary.  

Below are the results of the data collected for each of these measures at Rushville and Utica Health Centers. The biggest gap lies in making sure that our patients complete their referrals, that specialists send us a consult note following the referral appointment, and that we file the note where it can be found most easily in our electronic health record. All of our Health Centers are now focusing on making some improvements in this area. The improvements include: reminding our patients how important it is to go to a referral appointment and helping our patients identify and address barriers that impede their ability to keep these appointments. Kudos to our staffs continued work in these areas.

 

2015-2016 RPCN Adult Health Survey Results

RPCN used to distribute its patient experience of care survey, or CAHPS Survey, annually in July. This year, RPCN decided survey patients on a quarterly basis rather than annually. So a survey was mailed out in the fall, winter, and spring to patients seen during the previous three months asking for feedback on the last provider they saw and the care they received.

RPCN distributes two health surveys—one containing questions for adult patients about the health care that they received—and a second for parents/guardians to complete regarding the health care their child received. There are six focus areas for the adult health survey and there are several questions in each category:

  1. Access
  2. Communication
  3. Shared decision making
  4. Self-management support
  5. Comprehensiveness of discussions about behavioral  health and respect
  6. Helpfulness of office staff

Responses to the questions in each category are tallied for one overall composite average. The higher the score for each subject, the larger the percentage of patients felt positive about the focus area.

RPCN uses National Committee for Quality Assurance’s (NCQA) uniform CAHPS Survey, which is sent to more 50,000 people nationally each year. This lets the organization benchmark its scores against the national average.

Below are bar graphs comparing RPCN’s results to the rest of the nation. The green bars illustrate the composite results from RPCN’s 2015 annual survey. The red bars show the RPCN 2016 year to date score (an average composite score based on the results from three of the four quarterly surveys sent out since the last annual one.) The blue bars are the national average composite scores.

Above are the results from Rushville Family Health Center. You can see that in five of the six categories, Rushville patients reported being as satisfied or more satisfied than people nationally.  Shared decision making was the only area where Rushville patients were less satisfied than the national respondents. Interestingly, when comparing the results of the 2015 annual survey to the 2016 year to date results, Rushville patients were more dissatisfied about shared decision making this year than last. Shared decision making questions have to do with how often a provider discusses prescription medicines with the patient him/herself.

Utica Community Health Center scores show something different. Utica patients were more satisfied than the national sample in two of the six focus areas. In four categories, Utica patients reported being less satisfied than the national group. The largest gap between the national response and Utica adult patients can be seen in the area of access. Access questions relate to how long a patient has to wait for an urgent or routine appointment, how long he or she must wait for a phone call to be returned, or for a provider to see him/her.

RPCN is currently developing strategies to improve the areas where our patients are less satisfied than the national group. After new strategies are implemented, the results of the next year of surveys will be analyzed to see if they have helped address patient concerns.      

Quality Improvements in Rushville and Utica

We have good news about the quality of care provided to patients in Utica and Rushville. With your help, on many measures our care is improving!

Each quarter, RPCN measures how well we are doing on key quality measures. At the end of the quarter we collect data on patients seen the previous 12 months or Trailing Year. Measurements are based upon “correct” documentation, defined as documentation done in a structured data field (not just typed into a note by someone) in the manner in which our reporting systems can “see” it; e.g. having the results of a FIT test contain the acronym “FIT” in it and the results entered into one of the yellow highlighted cells in the lab result screen.

RPCN recently took a snapshot of the percentage of our medical patients at Utica and Rushville who were receiving the services that the medical evidence says that they should be receiving. Because Ilion has not yet been open 12 months we could not take a snapshot of how well they are doing yet. The following two graphs show the results. You can see that for many measures we have improved. Over the next few weeks we will be drilling down to determine how well we might continue to improve on both the measures that we have increased as well as those that  still challenge us. As quality director I will gladly take any suggestions, nor matter how small they are, on how to do this: x7353 or mmilano@rpcn.org

 

Patient Experience of Care Surveys

Adult Medical Health Survey

Click to enlarge.

In July and August, 2013, Rushville Community Health Center (RCHC) and Utica Community Health Center (UCHC) distributed CAHPS surveys, a national experience of care survey developed specifically for use in Patient Centered Medical Homes. The surveys contained 20-40 questions about the care our patients received over the past 12 months. 
The chart above shows the percentage of respondents who completed the adult medical survey and answered “usually or always” to having their needs met in each of the categories.   
Both health centers scored highest on doctors communicating with patients—explaining things in a way that was easy to understand, showing respect for patients, and listening carefully to them.  Both health centers also scored well on office staff performance. Providers frequently spoke to their patients about medication choices and listened to patient concerns so patients could share in the decision making process.  
Health center staff is now focusing on the few areas where there are gaps in care. They will discuss goals of care and barriers to reaching these goals with their patients.  They will ask questions about feeling sad, stressed and worried.  Patients told us that they had not been receiving follow up information on lab test results, the centers have started to use our patient portal to provide these results. Patients also told us that when they called the Health Center, they wanted their questions answered more quickly. We made some updates to our phone system which will help in this area. 

Child Medical Health Survey

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Surveys were also mailed to the parents/guardians asking for feedback about the care provided to their children. The chart below shows the percentage of respondents who answered “usually or always” to having their needs met as pertains to different aspects of their children’s care.  
Parents/Guardians told us that they were happy with the ease of talking to RPCN providers and that their children were given information that was easy for them to understand. Our office staff was rated as courteous, helpful, and respectful.  
Our doctors and nurses often did not discuss with parents the goals for keeping their children healthy and managing their health problems and other barriers to meeting these goals. Parents noted that often they waited longer than 15 minutes to see a provider, and when needing care on the weekends and evenings, they had a difficult time getting it. Parents commented that they hadn’t spoken to their children’s doctors or nurses about any existing family problems the children might have experienced or any child safety issues that might be present. Some parents also noted that they had not spoken to their children’s doctor or nurse about any possible learning delays or social or emotional problems.   

Adult Dental Survey 

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Livingston Community Health Center (LCHC), Rushville Community Health Center (RCHC), and Utica Community Health Center (UCHC) also mailed out surveys to their dental patients. The chart below shows the percentage of adult patients who answered “usually or always” to having their needs met in each of the categories listed.
 Dental patients felt that their providers listened carefully to them, spent enough time with them, and gave them answers they understood. Office staff was helpful, respectful, and courteous. In terms of timeliness of information, the majority of dental patients felt that when phoning the office after hours, they did not get answers as soon as they needed and if needing care on weekends and evenings, care was not as available as they would have liked. Patients noted that they spent little time setting specific goals for dental care and discussing barriers to meeting these goals.


Child Dental Health Survey

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Dental surveys were also mailed to parents/guardians whose children were seen by RPCN dentists. The chart below shows the percentage of parents/guardians who answered “usually or always” to having their children’s needs met in each category listed.
Parents of children who were seen by our dentists were happy with provider communication, saying that their dental providers explained things in a manner easy for them and their child to understand and their dental providers also listened carefully to them and their child. Parents said that when they weren’t with the child during the appointment, they were given sufficient information following it. Our dental providers did not educate a large percentage of patients about how certain food and beverages affected their child’s teeth. Two or three of our offices were unable to provide parents with dental appointments for their children as soon as the parents wanted to get them in. 

We Heard You 

In response to our patient’s concerns, RPCN is working hard to more fully implement all aspects of being a Patient Centered Medical Home (PCMH). PCMH requires us to focus more on discussing patient goals and barriers to care, and working together as a health care team to meet patient needs. As a Patient Centered Medical Home, we are committed to providing our patients with more information about patient satisfaction and quality of care. We are developing quality improvement strategies to address the gaps in care noted above—and proactive strategies to try to prevent major issues from developing.  Likewise, we are incorporating this patient-centered approach into our dental practices—working as teams, making adjustments based on patient feedback, and focusing on those quality measures that our patients have told us are important to them.

Colorectal Cancer Screening

What is the Colon?

Your colon is your large intestine: the long, hollow tube at the end of your digestive track where your body makes and stores stool for a bowel movement.

Colon Cancer

Colorectal cancer is common in men and women and occurs when tumors form in the lining of the large intestine. People over the age of 50 are much more likely to develop colorectal cancer and should be screened for it regularly.  When colorectal cancer is caught early, it is treatable.

In October, 2013, we only had complete colorectal cancer screening results for 7 out of 100 patients ages 50-75 at RCHC.

In October, 2013, we only had complete colorectal cancer screening results for 7 out of 100 patients ages 50-75 at RCHC.

In October, 2013, we only had complete colorectal cancer screening results for 10 out of 100 patients ages 50-75 at UCHC.

In October, 2013, we only had complete colorectal cancer screening results for 10 out of 100 patients ages 50-75 at UCHC.

Take Charge of Your Health 

  • Talk to your doctor about whether or not you need this test, especially if you are between the ages of 50 and 75
  • Get the test done right away if it is necessary
  • If you have to see another doctor for your colonoscopy, please remind him/her to send your test results to your provider at the Center
  • Tell your doctor or nurse if you have had the test done outside of our Center—and fill out a form with the results of your test so we can complete your health record 

 

Cervical Cancer Screenings

What Is the Cervix?

The cervix is the lower, narrow part of the uterus (womb). It forms a canal that opens into the vagina (birth canal) and leads to the outside of the body. 

Cervical Cancer

Cervical cancer is a cancer in the cervix.  The most common way to test women for cervical cancer is to perform a Pap test (screening). This screening looks for changes in cervical cells that could turn into cancer.  It is important that any changes are found early so you get the best treatment possible.  

Most women ages 21 – 65 should get a Pap test at least every 3 years.  To make sure this happens, our doctors and nurses need to know when you had your last Pap test—and we need to know the results of your test to know if you need to be seen sooner. 

In October, 2013, we only had 15 out of 100 Pap test results noted in the health records for our female patients ages 21-65 at RCHC.

In October, 2013, we only had 15 out of 100 Pap test results noted in the health records for our female patients ages 21-65 at RCHC.

In October, 2013, we only had 32 out of 100 Pap test results noted in the health records for our female patients ages 21-65 at UCHC.

In October, 2013, we only had 32 out of 100 Pap test results noted in the health records for our female patients ages 21-65 at UCHC.

We need to know if you had a Pap test done.  If you have had the screening done outside of our Centers, please let us know the date of your test and your results so your health record is complete and we can remind you when it’s time for your next Pap.   

Take Charge of Your Health 

  • Tell your doctor or nurse if you have had a Pap test done within the past 3 years
  • If another doctor performs your Pap test, remind him/her to send your test results to your provider at the Center 
  • Give us permission to get your test results so we can  file them in your health record
  • Let your doctor or nurse if you have not had a Pap test done within the past 3 years so we can give you one