Microsystem Assessment

and Innovation Plan

Rachel Soles
University of Detroit Mercy

Kalkaska and Forest Area

Teen Health Corner
Purpose: Providing health care, health
education, counseling, and connection to
community resources to underserved
youth ages 10-21 in Kalkaska County
without regard to ability to pay.

Patient has health-care

related appointment

Youth interact with staff in

health education setting
Professionals:
2 Registered Nurses
2 Physician Assistants
1 Medical Assistant
1 Nurse Practitioner
1 Manager (Registered
Nurse)
2 Counselors (contract)

Patien
t

Risk assessment, plan care

Care provided, referrals,
follow-up appointment(s)
made

Exit
Patterns: Outreach vs clinic time
demands, summer sports physical
rush, after-school volume, follow-up
logs, referral tracking, clinic space,
computer availability, reporting
requirements, lost charts, quality
improvement data collection,
food/activity preparation

Metrics that Matter

Grant funded clinic with quarterly
reporting required.
Many items to be reported outside of meaningful
use information e.g. pregnancy statistics, STI data,
top risks from risk assessment by insurance status,
etc.
Current QI focus areas include asthma (grantdirected), obesity and pregnancy prevention.
Patient satisfaction, staff engagement
Grant funding potentially threatened if data collection
process for reporting is not improved

Significance
CAHC issues report cards to centers annually
CAHC will not issue a report card to the Teen
Health Corner until data submitted meets
expectations
Teen Health Corner reapplies annually for
continued funding, lack of a report card may
jeopardize funding if correction plan not in place

 Teen Health Corner plans to implement an EHR

system by December 2015
EHR system mandated by fiduciary does not have
capability to report out required data without
customization (estimated 10-20 hours at $200/hr)
Current plan is for continued use of check
sheets for data collection and 100% chart review
for quarterly and annual reports.

(Aim)
To improve the data collection and reporting
process in the Kalkaska and Forest Area Teen
Health Corners.
Expected outcomes: reporting to CAHC will meet
expectations, data collection will also facilitate
better in-clinic QI
Urgency: clinic funding is threatened, current QI
process data-limited

Patients: Effective Care

CAHC-required data focuses on care quality and
effectiveness.
The health center shall provide a range of health
and support services based on a needs
assessment of the target population/community
and approved by the community advisory
committee. The services shall be of high quality,
accessible, and acceptable to youth in the target
population. The use of age appropriate prevention
guidelines and screening tools must be utilized.
(MDCH, 2014)

Patients: Effective Care

(cont.)
AHRQ recommends that practices define
clinical performance measures and set
benchmarks (2013). In order to effectively
report out on performance measures and
determine whether benchmarks are met,
data collection must improve.

Processes: Efficiency
Practices should strive towards collecting the
just right amount of data. The goal is to
use data to drive QI, too much data (or too
onerous data collection process) inhibits
effective QI (IHI, 2015)
Systems must work to eliminate Health IT
constraints that limit data collection or
quality (AHRQ, 2014)

Data Collection Plan

Quarterly report data collection and chart auditing
coincided with project timeframe.
Data of interest:

Number of charts reviewed

Staff time spent on data collection
Manager time spent on CAHC report completion
Methods of data collection
What data is collected

Findings

138 unduplicated user charts

Staff time: MA: 3.5 hours, RNs: 9 hrs, PAs/NP: 1 hr
Manager time: Unavailable
Methods:
MA: pull all billing sheets from previous quarter, remove
any duplicate user billing sheets, tally up reportable
items, pull 100% of charts from previous quarter,
determine insurance provider as needed.
RNs: randomly pull 20 charts for chart audit QI (chart
completeness, obesity, pregnancy prevention), divide all
charts and tally up CAHC required data (requires looking
in 3 different locations in paper chart).
PAs/NP: verify/explain apparent discrepancies in charts,
help to locate missing required data.

Findings (cont.)
Data collected
# of unduplicated users
Percent of visits by insurance status (uninsured, public insurance, private insurance)
Race
# visits by provider type (NP, PA, MD/DO, MSW, RN, etc)
Pregnancy tests administered/# positive
Chlamydia and Gonorrhea tests done/# positive
HIV tests confidential vs nonconfidential/# positive
Physical exams, PCP?
Immunizations, insurance/VFC status
# of patients offered Medicaid assistance, # enrolled
# of patients who received sexual health education and # general health promotion
education
# patients seen for general medical visits
Top 5 diagnoses by insurance status
Top 5 medical diagnoses, top 5 mental health diagnoses, top 5 CPT
# users that have an up-to-date CPE, vaccinations (ACIP), up to date risk assessment
Diagnosis of Asthma. Action plan? Spirometry in previous year?
# clients with BMI >95th percentile, # with BMI 85-95th percentile, # received
counseling
#tobacco users, #tobacco cessation counseling

Analysis
Data collection process was labor intensive and
frustrating for staff involved
Staff identified that finding random charts from
previous quarter was challenging, so they often
looked at billing data to pull charts to audit.
Information for some data categories could be found
in 3-4 different places in the chart, staff
acknowledged that human error could impact results.
Bias?
As this was the first time 100% of charts were
evaluated for quarterly report, process may
improve/speed up with time even if unchanged.

Innovation Project #1Improve Data Collection Measures

Customize EHR system to clinic needs.

Staff time calculated was for 1 quarterly report
that did not include any evaluation of evidencebased programming (likely would increase time
spent)

Innovation #2Meaningful QI
CAHC requirements call for CQI. Each clinic is
required to have a CQI leader.
Current practice is to set benchmarks based
on previous in-clinic benchmarks
Improved data collection can facilitate a
more meaningful QI process

References
Agency for Healthcare Research and Quality. (2013). Module
7: Measuring and benchmarking Clinical performance.
Retrieved from: http://www.ahrq.gov/professionals/preventionchronic-care/improve/system
Agency for Healthcare Research and Quality. (2014). Module
5: Improving data collection across the health care system.
Retrieved from: http://www.ahrq.gov/professionals/preventionchronic-care/improve/system
Institute for Healthcare Improvement. (2014). Across the
chasm: Six aims for changing the health care system.
Retrieved from:
http://www.ihi.org/resources/Pages/ImprovementStories/Acros
stheChasmSixAimsforChangingtheHealthCareSystem.aspx
Michigan Department of Community Health. (2015). CAHC
program data. Retrieved from: http://www.michigan.gov/cahc.