ADVANTAGE Health Solutions - Quality Improvement

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Quality Improvement

Medical Clinical Practice Guidelines

Clinical Practice Guidelines (CPG) are standards developed to assist the practitioner and patient in making decisions about appropriate health care for specific conditions. CPG’s are developed by organizations that use rigorous review including, analysis of peer reviewed research and the use of expert teams. ADVANTAGE Health Solutions, Inc.^sm, (AHS) Physician Advisory Committee has reviewed and adopted the following CPG's to be used by our network physicians.
These CPG's are also the basis of our disease management programs.

Asthma:

Source:	Department of Health and Human Services, National Institutes of Health, National Heart Lung and Blood Institute
Most recent update:	2007
Guidelines URL:	http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm
Measurements:	HEDIS-Use of Appropriate Medication for People with Asthma
Review:	05/03/2011

Asthma Tools

Guidelines

Action Plan

Provider SOAP

Analysis:

Use of Appropriate Medication for people with asthma	AHS Score	QC 90th
5-9 year olds	98.8%
10-17 year olds	94.01%
18-56 year olds	96.63%
Total	96.39%	94.94%

AHS asthma medication compliance demonstrates good understanding of the clinical practice guidelines in place.

Congestive Heart Failure:

Source:	American Heart Association, American College of Cardiologist
Most recent update:	2009
Guidelines URL:	http://circ.ahajournals.org/cgi/content/full/119/14/1977
Measurements	HEDIS-Cholesterol Management for People with Cardiovascular Conditions; LDL-C screening and control in patients with a cardiac condition
Review:	05/03/2011
CHF Tools

Guidelines

Action Plan

Keeping Track Of Your Weight

Analysis:

Cholesterol Management for people with Cardiovascular Conditions	AHS Score	QC 90th
LDL-C Screening performed	91.86%	92.13%
LDL-C Control	61.69%	69%

AHS screening score demonstrates good understanding of the importance of screening. Control at 61.69% is not far from QC 90th percentile.

Coronary Heart Disease:

Source:	Institute for Clinical Systems Improvement
Most recent update:	2009
Guidelines URL:	http://www.icsi.org/coronaryarterydisease...
Measurements	HEDIS-Controlling HTN, Cholesterol Management for patients with Cardiovascular Disease
Review:	05/03/2011
CAD Tools

Guidelines

Keeping Track Of Your Heart Health

Your Guide To Living Well With Heart Disease

Analysis:

Cholesterol Management for people with Cardiovascular Conditions	AHS Score	QC 90th
LDL-C Screening performed	91.86%	92.13%
LDL-C Control	61.69%	69%
Controlling HTN	56.82%	71.55%

Controlling cholesterol levels and hypertension are in need of improvement . We have programs for both CAD and HTN.

Diabetes:

Source:	American Diabetes Association
Most recent update:	2011
Guidelines URL:	http://care.diabetesjournals.org/content/34/Supplement_1/S11
Measurements	HEDIS-Comprehensive Diabetes Care; eye care, HbA1c screening and control, LDL-C screening and control, nephropathy screening, blood pressure control
Review:	05/03/2011
Diabetes Tools

Guidelines

Diets and Exercise

Goals

Analysis:

Comprehensive Diabetes Care	AHS Score	QC 90th
HbA1c testing	92.10%	92.70%
Eye Exam	45.63%	69.84%
LDL-C screen	89.18%	88.34%
LDL-C control	50.50%	52.60%
Blood Pressure Control (140/90)	64.85%	73.24%

Eye Exam and blood pressure control stand out as areas in need of improvement. Interventions are in place per the QI work plan.

Hypertension:

Source:	Joint National Committee on the Prevention, Detection and Evaluation of the Treatment of Hypertension (JNC 7)
Most recent update:	2003 (new update in development - scheduled for release in Spring 2012) Guidelines for children 2005
Guidelines URL:	http://www.nhlbi.nih.gov/guidelines/hypertension/express.pdf
And	http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.pdf (update for pediatric in development)
Measurements	HEDIS – Control of High Blood Pressure
Review:	05/03/2011
HTN Tools

Guidelines

Additional Guidelines

Action Plan

Analysis:

Controlling HTN	AHS Score	QC 90th
	56.82%	71.55%

Controlling blood pressure is an area in need of improvement. AHS has a mailing program for HTN in place for two years with these CPG’s online for two years.

Migraine:

Source:	American Academy of Neurology
Most recent update:	2000, was reviewed and approved 2008, current of 05/03/2011
Guidelines URL:	http://www.neurology.org/cgi/reprint/55/6/754.pdf
Measurements	Control of Migraine exacerbations (by reduction in ER use for Migraine)
Review:	05/03/2011
Migraine Tools

Guidelines

Additional Care

Pharmacy

Analysis:

No Migraine ER w/I past 12 months	active	inactive
(CPT:05312010)	94%	94%

Pregnancy:

Source:	Institute for Clinical Systems Improvement
Most recent update:	2010
Guidelines URL:	http://www.icsi.org/prenatal_care_4/prenatal_care_routine_full...
Measurements	HEDIS – Timeliness of Pre Natal Care, Post Partum Care
Review:	05/03/2011
Pregnancy Tools

Guidelines

Analysis:

Prenatal and Postpartum Care	AHS Score	QC 90th
Timeliness of prenatal care	81.40%	97.10%
Postpartum care	77.75%	89.04%

AHS is far behind the 90th percentile on these measures. There is an intervention in place for post partum visit (per QI work plan). There is a case management program for pregnancy.

COPD:

Source:	Institute for Clinical Systems Improvement
Most recent update:	2011
Guidelines URL:	http://www.icsi.org/chronic_obstructive_pulmonary_disease/chronic...
Measurements	HEDIS – Use of spirometry testing in the assessment & diagnosis of COPD, Pharmacotherapy management of COPD exacerbation
Review:	05/03/2011
COPD Tools

Guidelines

Quick Guidelines

How Spirometry Tests Work

Action Plan

Analysis:

COPD measures	AHS Score	QC 90th
Use of spirometry	40.27%	46.01%
Exacerbation corticosteroids	74.23%	75%
Bronchodilators	74.23%	83.78%

AHS is close to 90th percentile on these measures but the scores are in real need of improvement. AHS has a COPD program.

Osteoporosis:

Source:	Institute for Clinical Systems Improvement
Most recent update:	2008
Guidelines URL:	http://www.icsi.org/guidelines_and_more/gl_os_prot/womens_health/...
Measurements	HOS (Health Outcomes Survey) Osteoporosis testing in older women
Review:	05/03/2011
Osteoporosis Tools

Guidelines

Analysis:

Measure	AHS Score 2008	AHS Score 2009
Osteoporosis management in women who had a fracture	26.86%	32.56%

Management refers to Bone density testing and medical management. Interventions are in place for this measure on the Medicare QI work plan.

Chronic Renal Failure:

Source:	National Kidney Foundation
Most recent update:	2000-2002
Guidelines URL:	http://www.kidney.org/professionals/kdoqi/guidelines_ckd/toc.htm
Measurements	Percentage of members with either diabetes or hypertension who had a GFR test.
Review:	05/03/2011
CRF Tools

Calculator

Guidelines

Behavioral Health Clinical Practice Guidelines:

Major Depression:

Source:	American Psychiatric Association
Most recent update:	2010
Guidelines URL:	http://www.psychiatryonline.com/pracGuide/pracGuideChapToc_7.aspx
Measurements	HEDIS Antidepressant Medication Management
Review:	05/03/2011

Guidelines

Screening PHQ-9

Analysis:

Anti depression Medication Management	AHS Score	QC 90th
Effective acute phase	72.76%	70.26%
Effective Continuation phase	57.39%	54.31%

Children and Adolescence with Depression Disorders:

Source:	American Academy of Child and Adolescent Psychiatry
Most recent update:	2007
Guidelines URL:	http://www.aacap.org/cs/root/member_information/practice_information/...
Measurements	HEDIS Antidepressant Medication Management
Review:	05/03/2011

Guidelines

Guideline for the Treatment of Bipolar Disorder:

Source:	American Psychiatric Association
Most recent update:
Guidelines URL:	http://psychiatryonline.com/content.aspx?aID=50136
Measurements
Review:	05/03/2011

Treatment of Alcohol and other Drug Dependence:

Source:	National Institute on Alcohol Abuse and Alcoholism
Most recent update:	2005
Guidelines URL:	http://pubs.niaaa.nih.gov/publications/Practitioner/...
Measurements
Review:	05/03/2011

Guidelines

ADHD:

Follow up Care for Children Prescribed ADHD Medications	AHS Score	QC 90th
Initiation phase	42.72%	44.6%
Continuation and Management	39.62%	50.9%

Source:	American Academy of Child and Adolescent Psychiatry
Most recent update:	2007
Guidelines URL:	http://www.aacap.org/galleries/PracticeParameters/JAACAP_ADHD_2007.pdf
Measurements	HEDIS Follow up Care for Children Prescribed ADHD Medication
Review:	05/03/2011

Guidelines