Implementation Parag Agnihotri ,MD Medical Director, Continuum of - PowerPoint PPT Presentation

Implementation Parag Agnihotri ,MD Medical Director, Continuum of Care Sharp Rees-Stealy Medical Group San Diego, California

What are we trying to achieve?

Implementing Choosing Wisely Reduce Inappropriate care Appropriate Appropriate imaging for low antibiotic usage back pain Achieve reduction in cardiac stress testing

How do we achieve this as part of the ABIM/RWJF Challenge ?

Goal Setting Baseline rate Improvement Commercial HMO by 2018 Avoidance of  75% antibiotics for Acute 20%  25% Bronchitis fewer antibiotics Reduce inappropriate  83% imaging for low back 20%  17% pain Fewer images Reduce pre-operative 20%  /? 8.75/1000 rate cardiac stress testing fewer cardiac stress Need to improve tests

Our Steps Align Stakeholders Education Practice Variation Resources Technology Patient Engagement Measure Effectiveness

How do you address this in a large multispecialty medical group with … 250,000 assigned patients 1.4 million visits 500 Physicians 60 NP/PA 2000 Clinic staff 21 Clinic locations

Aligning Stakeholders Antibiotic Primary Urgent Care Use Care Primary Back Imaging MSK/PM&R Neurology Care Primary Stress Test Cardiology Care

Clinical Guidelines Cardiac Stress Testing Guidelines

Clinical Guidelines Low Back pain Management Guidelines

Appropriate Coding Education

Appropriate Coding Education Example

Provider and Staff Educational Resources

Practice Variation Reports by Site Sharp Rees-Stealy Medical Centers Monthly Antibiotics for Acute Bronchitis Commercial Members 18 - 64 yrs August 2015 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% Site 1 Site 2 Site 3 Site 4 Site 5 Site 6 Site 7 Site 8 Site 9 Site 10 Site 11 Site 12 Site 13 Site 14 Site 15 0% Current LBP Rate Baseline 2014 SRS Goal: 95% SRS Overall: 75.21%

Peer to Peer Consult Process Established

Web Portal Links Education to Appointments

Shared Decision Making: Engage the Patient Form personal connection Face to face interaction Step by step wellness plan Coordination of care Patient specific education material Shared care plans Medication adherence reporting

Shared Decision Making: Consumer Reports

Shared Decision Making: Consumer Reports

Change

Implementation at Sharp Rees-Stealy Parag Agnihotri MD parag.agnihotri@sharp.com Sharp Rees-Stealy Medical Group San Diego, California