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.
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.
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.