Sharon Levine on integrated care - the role of multispeciality medical practice in promoting integration
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Sharon Levine, Associate Executive Medical Director of the Permanente Medical Group, outlines how the Kaiser Permanente integrated care system operates and describes the role of multispeciality medical practice in promoting integration.
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Sharon Levine on integrated care - the role of multispeciality medical practice in promoting integration
- 1. A 60 Year Journey, With No End in Sight Sharon Levine, M.D. Associate Executive Director The Permanente Medical Group March 31 2011 Copyright © 2011 Kaiser Permanente Multispecialty Group Practice Leveraging Integration, Partnership and Physician Responsibility to Deliver Performance
- 15. Systematic approach Copyright © 2010 Kaiser Permanente … and accountability across the continuum from prevention to management of acute and chronic cardiovascular disease Primary Prevention Secondary Prevention Acute Care Chronic Care
- 17. Increase Hypertension Control Copyright © 2010 Kaiser Permanente Primary Prevention Dissecting the process, making the process clearer and easier…enables action Action Description Outcome Check Was BP taken and recorded? Documentation Was BP high? The denominator Treat Was treatment intensified ? Upward titration of dose and/or medication type Repeat Was there another BP taken within 4 weeks? Follow up care Was the f/u BP lower than the initial BP? Better Control of BP Was the f/u BP in control? Controlling BP
- 18. Primary Prevention NCAL Leads in Smoking Cessation Copyright © 2010 Kaiser Permanente Spectrum of Cardiac Care Adult Smoking Prevalence 2002 vs. 2005 USA Calif. KP (NCAL) 12% 2010 Target
- 22. ST Elevated MIs are declining Copyright © 2010 Kaiser Permanente ST Elevated Myocardial Infarction - Age/Sex Adjusted Hospitalization Rates for Kaiser Permanente, 1998 - 2007
- 23. Improving outcomes Copyright © 2010 Kaiser Permanente 52% reduction in AMI hospital deaths since 2005 Year Total AMI Admissions Total AMI Hospital Deaths % Mortality 2005 6,406 390 6.1% 2006 5,947 356 6.0% 2007 5,576 279 5.0% 2008 5,473 256 4.7% 2009 5,156 188 3.6%
Notes de l'éditeur
- This is a picture of Richmond quality performance in the fall of 2002. Up until that time, we had had 2 very bad years of quality performance. On the 4 PHASE type quality measures our performance was lowest in the region in 3 and almost there on the 4 th . On most measures, we were 20% below the regional average. We had been using the old quality model where the region set quality targets, the PIC assigned them to the chiefs and the chiefs, lacking much in the way of administrative or analytical support, basically counseled his department that they should do better. We had champions, held educational sessions and provided physicians with lists of patients needing inteventions, lists destined for a spot in the corner of their desk gathering dust and guilt. We were short providers, there were strongly competing initiatives like access and unlike other medical centers the measure it and talk about it approach wasn’t getting us anywhere. In the fall of 2002, we consciously adopted a population management approach to quality improvement. Switched to analyzing the population at risk, determining barriers to improvement and developing systems that leveraged and supported the physician to make doing the right thing easier.