Carlo Ciotoli MD and Cheryl Flynn MD MS MA CoChairs May 30 2018 Agenda Background Board Charge Approach Why Benchmark Benchmarking surveys Clinical Prevention and Safety Acute Care Future action areas ID: 908100
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Slide1
ACHA Benchmarking Committee
Carlo Ciotoli, MD and Cheryl Flynn, MD, MS, MA
Co-Chairs
May 30, 2018
Slide2Agenda
Background
Board Charge
Approach
Why Benchmark
Benchmarking surveys
Clinical
Prevention and Safety
Acute Care
Future action areas
Research Committee
Data Warehouse
Q and A
Slide3Disclosures
Cheryl Flynn:
I have no financial interests to disclose
Carlo Ciotoli:
Grant funding from Pfizer (Men B vaccine)
Slide4ACHA Board Charge
On behalf of ACHA President Mike Huey, here is your committee charge for the 2017-2018 program year:
Continue to implement the Clinical Benchmarking program.
Select the modules & determine yearly schedule for the modules
Consult with staff to recommend participation pricing
Determine the need for any additional modules to be developed
Advance the Utilization Survey further
Work with CEO and Executive Committee to consider a new structure for ACHA research and benchmarking via a new Research Organizing Committee
Slide5Why Benchmark ?
It is a way of using data to compare key performance measures with those of similar organizations and/or against nationally recognized best practices, targets, or goals.
Benchmarking is a critical component of meeting accreditation standards
Ultimately, however, the goal of benchmarking is to use the data derived from benchmarking to initiate and sustain performance improvement over time.
Slide6AAAHC Standards
The organization participates in external
benchmarking
activities that compare key performance measures with other similar organizations, with recognized best practices, and/or with national or professional targets or goals.
The quality improvement program includes the use of Medical Home-focused:
a. Clinical performance measures.
b. Quality improvement studies.
c. Data trending.
d. Benchmarking.
Documentation demonstrates that the results of
benchmarking
activities are reported to the governing body
Slide7Co-Chairs’ Goals for the Committee
Improving data integrity
Facilitating data collection/survey completion
Increasing participation in surveys
Greater participation/involvement of the committee members over the course of the year
Coordination with other groups within ACHA
Slide8Clinical BenchmarkingSurveys
Slide9Selecting Clinical Benchmarks
Conditions commonly seen and/or relevant in college health
Breadth of topics that span the spectrum of college health clinical services
Outside quality measures exist to allow for the potential to benchmark outside of college health
Produces actionable information
Slide10Clinical Benchmarks
Safety, Screening & Prevention
Allergy documentation
Flu vaccine
Tobacco use
Depression screening
Chlamydia testing
Cervical Cancer screening
Acute Care
Pharyngitis
Ankle injury
Acute bronchitis
Chronic Care
Asthma
Depression
Slide11Clinical Benchmarks
Sexual Health
Chlamydia testing
Cervical Cancer screening
Additional items TBD
Acute Care
Pharyngitis
Ankle injury
Acute bronchitis
Chronic Care
Asthma
Depression
Screening & Prevention
Allergy documentation
Flu vaccine
Tobacco use
Depression screening
Slide12Clinical Benchmarking Survey
Acute Care
Pharyngitis
Ankle injury
Acute bronchitis
Screening & Prevention
Allergy documentation
Flu vaccine
Tobacco use
Depression screening
Administered Spring 2018
Slide13Slide14Screening/Prevention
N=86
ACHA Region N %
Southwest 8 9.3
Southern 15 17.4
North Central 3 3.5
Central 3 3.5
Rocky Mountain 5 5.8
Mid-America 9 10.5
Ohio 0 0.0
Mid-Atlantic 17 19.8
New York 12 14.0
New England 4 4.7
Pacific 10 11.6
Control N %
Public 57 66.3
Private 4-Year 29 33.7
Carnegie N %
Associates 3 3.5
Assoc/Bac 2 2.3
Baccalaureate 8 9.3
Masters 16 18.6
Doctoral 57 66.3
Slide15Screening/Prevention
N=86
Undergrad N %
1K-4,999 14 16.3
5K-9,999 20 23.3
10K-14,999 17 19.8
15K-19,999 12 14.0
20K-24,999 8 9.3
25K-51K 15 17.4
Graduate N %
31-4,999 42 54.5
5K-9,999 21 27.3
10K-26K 14 18.2
Location N %
Urban > 1 Mil 25 29.1
Urban 100K- 1 Mil 17 19.8
Urban < 100K 13 15.1
Suburban 28 32.6
Rural 3 3.5
Slide16Prevention and Safety
The
USPSTF
recommends screening for depression in the general adult population, including pregnant and postpartum women. Screening should be implemented with adequate systems in place to ensure accurate diagnosis, effective treatment, and appropriate follow-up. (B recommendation)
Everyone 6 months and older should get a flu vaccine every year, by the end of October, if possible. (
CDC
)
The
AAAHC
Standard requires that allergies and untoward reactions are recorded clearly and consistently in patient clinical records. While EMRs have largely solved the problem of a consistent location for this information, verification at each encounter is frequently missed.
The
USPSTF
recommends that clinicians ask all adults about tobacco use, advise them to stop using tobacco, and provide behavioral interventions and U.S. Food and Drug Administration (FDA)–approved pharmacotherapy for cessation to adults who use tobacco. (A recommendation)
Slide17Slide18Slide19Slide20Slide21Screening & Prevention: 2014 vs 2018
2014
2018
Allergy
documentation
92%
99%
Tobacco
use screening
52%
86%
Depression screening
53%
44%
Influenza vaccination administration
38%
40%
Slide22Clinical Benchmarking Survey
Acute Care
Pharyngitis
Ankle injury
Acute bronchitis
Screening & Prevention
Allergy documentation
Flu vaccine
Tobacco use
Depression screening
Administered Spring 2018
Slide23Clinical Benchmarking: Acute Care
Slide24Acute Care Module
Previously piloted as part of clinical benchmarking
Last done 2014
Topics/criteria unchanged
Updates to support ease of data collection
Worksheets
Updated, clarified criteria
Launched late spring 2018
50 schools
participated prior to ACHA annual meeting
*****
OPPORTUNITY
*****
Plan to keep open through end of June
ACHA member institution, can participate for free
Slide25Institutional Demographics: N=50
ACHA Region
N %
Southwest 7 14.0
Southern 3 6.0
North Central 2 4.0
Central 2 4.0
Rocky Mountain 2 4.0
Mid-America 6 12.0
Ohio 0 0.0
Mid-Atlantic 12 24.0
New York
9 18.0
New England 3 6.0
Pacific 4 8.0
Location
N %
Urban > 1 Mil
14 28.0
Urban 100K- 1 Mil 9 18.0
Urban < 100K 6 12.0
Suburban
20 40.0
Rural 1 2.0
Slide26More demographics
Undergrad
N %
size
1K-4,999 5 10.0
5K-9,999 16 32.0
10K-14,999 7 14.0
15K-19,999 5 10.0
20K-24,999 7 14.0
25K-51K
10 20.0
Graduate
N %
31-4,999 26 54.2
5K-9,999 12 25.0
10K-26K 10 20.8
Control
N %
Public
35 70.0
Private 4-Year 15 30.0
Slide27Acute Care: Ankle Injury
Compliance with Ottawa Ankle Rules
Slide28Slide29Slide30Acute Care: Mngt
Acute Pharyngitis
Compliance with the
Centor
criteria
Clinical criteria to help id when to collect rapid strep test
4
centor
criteria
Fever
(temp >100.5F)
Absence
of a cough
Inflamed tonsils with
exudate
Tender
cervical lymphadenopathy
1 point for each
Slide31Application of clinical criteria
In practice
0-1: no test, no
abx
2-3: collect rapid strep test and treat only if positive
4: OK to empirically treat
In clinical benchmarking
Included only visits where student’s
centor
score 0-1
Consistency with this recommendation across guidelines
Compliance = no testing AND no antibiotics prescribed
Slide32Slide33Acute Care: Mngt
Acute Bronchitis
avoidance of antibiotics
Acute bronchitis is an acute respiratory illness, mostly cough, w/ or w/o sputum
Mostly caused by viruses
When bacterial, usually self-limited too
No useful criteria to distinguish viral vs. bacterial
Avg
duration of cough 18 days!
Antibiotics NOT recommended
NNT 4400 to prevent 1 case pneumonia
Smoking status, asthma status not indications for
abx
Exception: suspect pertussis
Slide34Clinical benchmark: acute bronchitis
Eligible patients have dx of acute cough or acute bronchitis
Review for exclusion:
High risk concurrent conditions: HIV, CF, immune d/o, COPD
No competing dx for which
abx
maybe prescribed: AOM, sinusitis, pneumonia, UTI, Lyme disease
etc
No evidence of pneumonia, and low suspicion for pertussis
Compliance based on
not
prescribing
abx
Slide35Slide36Acute Care Benchmarks: 2014 vs 2018
2014
2018
Ankle injury
Ottawa
ankle rules
60%
84%
Sore
throat
Centor
criteria for not
testing, not treating
34%
35%
Acute bronchitis
N
ot prescribing antibiotics
57%
63%
Slide37Moving Target?
There’s still time to participate in acute care clinical benchmarking, 2018!!!
YOU can help create the most recent benchmark
Slide38Benchmarking & other ACHA initiatives
Slide39Data Warehouse
Slide40DW Goals: Improve the Health & Wellness of College Students
Information ACHA needs to achieve our organizational goals in Advocacy, Education, and Research
Information college health professionals need to advance the health of college students at their institution
Information policy makers need to make informed decisions about college student health
Slide41Benchmarking/data warehouse overlap…
Collecting data on clinical adherence to evidence-based guidelines
Utilization survey likely subsumed by “institutional profile” for data warehouse
Administrative data collection on services, structure, school size
Interest in collecting clinical outcomes of students
Process outcomes
clinical outcomes academic outcomes & success
Slide42ACHA Research Steering Committee
Devin
Jopp
held conference calls with representation from various ACHA groups, coalitions
Charge of benchmarking to offer proposal on research steering committee
Priority of Jan 2018 meeting
Slide43Our conceptualization
Slide44Questions/comments
For us?
Of you?
Timing of Survey Administration?
Additional chronic disease topic?
Input re: sexual health addition
HIV screening?
Appropriateness of STI screening (
ie
NOT screening!)
Ideas re: interface of Benchmarking with
DataWarehouse
? Research Committee?
Slide45Additional Feedback
Carlo Ciotoli
cc47@nyu.edu
Cheryl Flynn
cheryl.flynn@uvm.edu
cfflynnetti@gmail.com
Slide46American College Health Association
Clinical Benchmarks
Screening & Prevention
Acute Care 2018
Slide47Acute Care Chart Documentation: Ottawa, Pharyngitis, Bronchitis N=50
ACHA Region N %
Southwest 7 14.0
Southern 3 6.0
North Central 2 4.0
Central 2 4.0
Rocky Mountain 2 4.0
Mid-America 6 12.0
Ohio 0 0.0
Mid-Atlantic 12 24.0
New York 9 18.0
New England 3 6.0
Pacific 4 8.0
Control N %
Public 35 70.0
Private 4-Year 15 30.0
Carnegie N %
Associates 1 2.0
Assoc/Bac 0 0
Baccalaureate 2 4.0
Masters 13 26.0
Doctoral 34 68.0
Slide48Acute Care
Ottawa Ankle Rules:
Acute Pharyngitis
Acute bronchitis
Slide49Acute Care Chart Documentation: Ottawa, Pharyngitis, Bronchitis N=50
Undergrad N %
1K-4,999 5 10.0
5K-9,999 16 32.0
10K-14,999 7 14.0
15K-19,999 5 10.0
20K-24,999 7 14.0
25K-51K 10 20.0
Graduate N %
31-4,999 26 54.2
5K-9,999 12 25.0
10K-26K 10 20.8
Location N %
Urban > 1 Mil 14 28.0
Urban 100K- 1 Mil 9 18.0
Urban < 100K 6 12.0
Suburban 20 40.0
Rural 1 2.0
Slide50Slide51Slide52Slide53Future Action Areas
Key Performance Indicators
Data Warehouse
Slide54What the heck is a KPI?
A
quantifiable
measure used to evaluate the success of an organization, employee, etc., in meeting objectives for
performance
.
An evaluation of the success of an organization in achieving some operational goal or making progress towards a strategic goal as measured by a particular activity in which it engages
A type of performance
metric
that helps you understand how your organization or department is performing. A good KPI should act as a compass, helping you and your team understand whether you’re taking the right path toward your strategic
goals
.
Slide55Slide56Characteristics of a “good” KPI
Relevant to the organization and its stakeholders
Considers the mission; useful in QI & decision-making
Understandable to all, communicates a clear message of quality
Scientifically sound, Evidence-based
Focus on student outcomes, not service volume; final outcomes over intermediate outcomes
Choose process measures that have proven link with outcome measures
Metric is clearly defined; implementation will produce consistent (reliable) and accurate (valid) across sites
Feasible
Data exists, is readily available (or can be made so) without undue burden
Slide57An example of a KPI’s evolution: depression
Reverse Evolution
Revolution
Slide58KPI example: depression screening
Relevance
Goal health, wellbeing and success of students
Prevalence of depression in college age students ~15%
Negatively impacts academic functioning (NCHA) and retention (Healthy Minds)
Evidence-based
Pre-validated tools (
ie
PHQ9)
measure symptoms and functioning
Screening and surveillance
USPSTF supports screening when intervention possible
Feasible
NCDP project helped create infrastructure
“electronic” surveys in EHRs, run reports to measure screening rates and clinical outcomes
Potential to link clinical outcomes to GPA, retention measures
Slide59KPIs and ACHA Benchmarking
Clinical services, quality of care
Medical services
Mental health services
Public health
Ancillary services
Administrative services
Facilities
Staffing
Funding, insurance
Compliance
https://www.acha.org/ACHA/Resources/Framework_for_College_Health.aspx
Slide60ACHA Data Warehouse Project
Slide61Project Goals: Improve the Health & Wellness of College Students
Information ACHA needs to achieve our organizational goals in Advocacy, Education, and Research
Information college health professionals need to advance the health of college students at their institution
Information policy makers need to make informed decisions about college student health
“The recognized voice of expertise in college health”
Slide62CCHN Value Proposition: 6 Primary Benefits
www.acha.org
1
2
3
4
5
6
Foster
Inter-University
Collaboration
Foster
Academic
Success
Reduce
Health
Inequity
Improve
Quality
Outcomes
Improve
Operational
Efficiency
Better Inform
Policy Makers
Build a greater understanding of health inequity nationwide on college campuses and define strategies to improve
1
Enhance understanding of health factors and their correlation to student achievement (e.g. GPA and retention rates)
2
Develop a series of data-driven interventions that can be shared with universities in order to improve outcomes
3
Enhance and tailor college health and wellness benchmarking
4
Develop a composite view of cross-campus health delivery and utilization. Improve colleges and universities ability to inform and influence national healthcare policy. Build a national health and wellness surveillance network across universities
5
Enhance student health outcomes through peer learning
6
Slide63Slide64Questions or Comments
Slide65Additional Feedback
Carlo Ciotoli
cc47@nyu.edu
Cheryl Flynn
cheryl.flynn@uvm.edu
Slide66Committee Members*
Vanessa
Stoloff
Linda Cook,
Neal Connolly
Sharon McMullen
Allison J Smith
Mary Hoban
Victor
Leino
Judd Moody
Alyssa
Lederer
Amelita
Maslach
Marcy
Ferdschneider
Allison Smith
Joanne Brown
Martha
Dannebaum
Chris
WeraLook at last two years plus attendance at calls
Slide67Clinical Benchmarking Survey
Acute Care
Pharyngitis
Ankle injury
Acute bronchitis
Screening & Prevention
Allergy documentation
Flu vaccine
Tobacco use
Depression screening
Administered Spring 2018
Slide68American College Health Association
Clinical Benchmarks
Screening & Prevention
Acute Care 2018
Slide69Slide70