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Quality Improvement Activities

HCA's Quality Improvement Program is led by Drs. Mark Aronson, Gila Kriegel and Hans Kim. Working collaboratively with HCA's nursing, physician and administrative leaders, they are responsible for an ongoing peer review process, monthly Quality Improvement (QI) meetings, a quarterly conference and optimizing performance measures.

QI Dashboard

This committee has created the QI Dashboard, a powerful tool that provides regular updates and monitory of multiple areas, including but not limited to:

  • Access
  • Record-completeness
  • Care of HIV patients
  • Care of patients on anticoagulation

Areas Being Tracked


I. Timeliness

  • New patient appointments - % 0-7 days
  • New patient appointments - % did not show
  • Average time to third available appointment - new and follow-up patients
  • Percent calls answered
  • Average telephones answer time
  • Mystery shopping

II. Documentation

  • Average and median number of unsigned notes - attending, nurses, residents
  • Average and median number of unwritten notes - attending, nurses, residents
  • Percent of records with allergy list documented
  • Percent of records with medication list documented
  • Percent of records with problem list documented

III. Effectiveness


A. Preventive Health

  • Pap smear - follow-up on abnormals
  • Mammography - follow-up on abnormals
  • FOBT - follow-up on abnormals
  • Bone health screening
  • Colon cancer screening
  • Chlamydia screening
  • Flu vaccination
  • Pneumovax vaccination
  • Mammography screening rates

B. Disease Management - Diabetes

  • HgbA 1 C done annually
  • HgbA 1 C value, distribution
  • Microalbumin done annually if no known aluminuria; not on ACEI/ARB
  • Microabumin value, distribution
  • LDL one annually
  • LDL value, distribution
  • Eye exam (annual)
  • Foot exam (annual)
  • BP management
  • Pneumovax vaccination
  • LFT's check q6 months on metformin

C. Disease Management - Chronic Pain

  • Percent on chronic narcotics with contacts in problem list
  • Percent with satisfactory contracts
  • Percent on chronic narcotics seen within 3 months
  • Percent on chronic narcotics evaluated by ortho, neuro, pain unit

D. Anticoagulation Management Service

  • Episodes/complications: major bleed, thrombotic, other
  • Hospitalizations
  • ED visits
  • Last outpatient INR
  • Last INR checked prior to event
  • Percent of patients in Therapeutic INR range

E. Disease Management - HIV/AIDS

  • Number of visits (last 12 months)
  • Number of hospitalizations (last 12 months)
  • CD4 count
  • ARVs
  • Antibiotic prophylaxis
  • Tests/labs
  • Co-morbidities

IV. Equitable Care

  • Percent Medicaid
  • Percent free care

V. Safety

  • Electronic prescribing

VI. Patient-centered

  • Results from the patient satisfactory survey

HCA has met or exceeded external insurance industry benchmarks for diabetes care, mammography and efficient use of prescription drugs.

We monitor medical record documentation for missing and incomplete notes, allergy lists, medication lists, and problem lists. Since implementation of a computerized reminder system for allergy documentation, documentation rates increased from 60% to 98%. HCA generates more than 100,000 encounter notes annually and we initiated a clinician-reminder system for missing notes that allows providers to complete notes in real time. Implementation of voice recognition technology in our dictation (E-scription) has resulted in more rapid availability of electronic clinic notes (often within hours of patients' visits).

In 2006, HCA physicians followed up on 100% of abnormal Pap spears, mammograms and stool blood tests. With a grant from the Risk Management Foundation, Dr. Kriegel automated our program for following up abnormal cancer screening tests, leading to improved and more efficient care for our patients.

Subcommittees

The committee investigates medical cases brought to the directors where questions about the quality of care have been raised. These cases are examined with the goal of improving the systems to prevent future errors. Often, this has resulted in the formation of subcommittees. Subcommittees of the QI committee are working on issues such as:

  • Narcotics-prescribing in HCA
  • Urgent care and access
  • Improving care of patients with diabetes
  • Regular review of all medical and psychiatric code

Working with an HCA pharmacist, the committee investigates all medication errors.

The QI committee started an educational initiative with BIDMC housestaff, teaching QI techniques and applying them to several areas, including influenza, immunization, narcotics and diabetes care. The QI committee also oversees guidelines development and has been working with nursing on phone triage protocols. Our nurses are doing regular chart review of colon cancer screening and we plan to review this and implement changes to improve our performance.

Contact Information

General Medicine and Primary Care
Department of Medicine
Beth Israel Deaconess Medical Center
Carl J. Shapiro Clinical Center
330 Brookline Avenue
Boston, MA 02215
617-754-9600