Wednesday, August 31, 2011

Highlighting Gaps in Care

Today primary care physicians generally lack the time, resources, and support to provide the recommended preventive screening and chronic care services to patients. In fact only about half of adult patients receive all recommended preventive care services.

As a result, standing orders are not always given. Standing orders authorize nurses and other non-physician clinical staff to provide services according to a preapproved protocol without a physician’s examination. Standing orders have been shown to improve provision of vaccinations and other health screenings but in many cases, standing orders are not yet routinely used.

To try to eliminate the problem, AHRQ funded a two year grant standing order project with the Practice Partner Research Network (PPRNet) for $458,000 to study if screening gaps in patient’s EMRs were highlighted, then would better preventive care services be provided.

PPRNet established by the Medical University of South Carolina includes 193 physicians practicing in 42 states with more than 1,000 providers and serves 2 million patients. PPRNet participants use a common EMR to submit quarterly data, to receive benchmarking and performance improvement reports, and to participate in research studies.

PPRNet launched the standing order project after successfully responding to an RFP from AHRQ. The study enables eight PPRNet primary care practices to authorize non-physician clinical staff to view a template used in the EMRs to help highlight gaps in care for 15 preventive services that can affect patients.

The eight practices include five family practices, one internal medicine practice, and two multi-specialty practices located in rural and urban regions in eight different states. Clinics ranged in size from two providers serving 1,200 patients to 25 providers serving 28,800 patients.

To start the study, each practice developed an implementation plan, which involved working with technology savvy staff to make changes to the template, create a standing order protocol for the staff, and develop a communication plan.

During the patient’s visit, a non-physician discusses preventive care needs with the patient and administers or provides a referral for all services the patient agrees to receive. The review with the patient includes preventive care screenings such as for diabetes and immunizations.

The results show that the program significantly improved the ability of the practices to accurately identify care gaps before visits and address those specific gaps during the visit, which led to significant increases in the percentage of eligible patients receiving needed services.

For more information, contact Lynne Nemeth PhD, RN at the Medical University of South Carolina or call (843) 792-9122.