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Friday, April 12, 2013
Learning Objective 1: The learner will be able to describe how true collaboration results from interdisciplinary teamwork and can improve patient outcomes measurably.
Learning Objective 2: The learner will be able to list 3 steps in effective decision making: 1) authentic leadership; 2) appropriate staffing; and 3) skilled communication.
Background: Nurses, residents and faculty physicians at a residency clinic determined through a chart review that compliance of 884 patients diagnosed with hypertension and blood pressure (BP) of 140/90 or less was 35%, while the national standard is 65% (NCQA). The interdisciplinary clinic team employed true collaboration and appropriate staffing to design a quality initiative using evidence-based medicine to increase patient compliance. Review of 2010 data revealed that of 7,509 patient visits, only 1,899 visits were covered by private insurance, while 75% were uninsured, underinsured or indigent. Patient interviews indicated that BP medications were unaffordable for many, hampering compliance. Objective: To see 45% of patients achieve a measured BP of 140/90 or less over 6 months. Outcome: Preliminary data shows project is on track to achieve goal. Hypertension compliance increased 10% over 6 months. Over 12 months, 50% of patients attained the pre-defined BP goal. Conclusions: Effective decision-making/authentic leadership undertaken by staff to improve compliance included: 1) accurate baseline recording of BP; 2) patients with a BP greater than 140/90, medication compliance reviewed by a physician during follow-up appointment; and 3) meaningful recognition/skilled communication: the patient’s BP was recorded in the electronic medical record, those greater than 140/90 flagged with standardized documentation. Interventions included inquiry into patient’s finances, establishing medication regimen targeting affordability, patient and staff education involving a BP control algorithm. By introducing this quality initiative using an evidence-based, effective decision-making, interdisciplinary collaborative process, the team achieved quality patient outcomes.