1 Leveraging Population Health Analytics to Achieve Quality Targets for Integrated Behavioral Health in Primary Care Kathleen Tatem, MPH Office of Population Health, NYC Health + Hospitals
NYC Health + Hospitals: 2 • Largest Safety-Net health system in the country • Mandate to care for uninsured and underserved New Yorkers • 11 acute care hospitals, 6 diagnostic and treatment centers, 5 long-term care facilities, 70+ ambulatory care centers, and correctional health services • Over 1 million patients and 6 million visits per year
3 Integrated Behavioral Health in Primary Care Quality Performance Metrics Population-based Collaborative Care Team Model Registry CC Nurse Patient Consulting or Social Psychiatrist Worker Provider *Percent of patients enrolled 70+ days demonstrating clinically significant improvement (e.g. 50% reduction from baseline PHQ9 or PHQ9 less than 10 )
4 Data Challenges and Poor Outcome Metrics in 2015 • Quarterly depression improvement rate was 17.7% • Data was not routinely entered in the registry • Staff education/buy-in needed on the value of the registry (e.g. patient tracking, and outcome assessment)
Solution: Analytics Enabled Collaborative Care 5 1. Actionable & responsive data tools 2. Data transparency 3. Staff training and support
1. Actionable & Responsive Data Tools 6 Weekly Patient Lists • Workflow-driven • Outreach List • Psychiatric Consultation List • Graduation List • Delivered weekly to point-of-care • User friendly – designed with user in mind
2: Data Transparency 7 Monthly Dashboards • Share data widely with frontline staff and leadership • Engage in continuous quality improvement • Connect patient care workflows and treatment to data and metrics
8 3: Staff Training and Support • Provide education and support to frontline staff and leadership on the use and benefits of data tools and metrics through… WebEx and online Personalized On-the-ground User guides and trainings emails and remote trainings and support material ‘Office Hours’ support/coaching Image Credit: Arfan Khan Kamol from Noun Project
Following Implementation of Analytic Support and Buy-In, 9 Exceeded Quality Outcome Metric Target
Transparent/Actionable Data and Stake Holder By-In is Key to 10 Achieving Quality Patient Care and Quality Targets
11 THANK YOU! • Kathleen Tatem, MPH • Office of Population Health, NYC Health + Hospitals @ KathleenTatem
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