East Cluster Meeting Minutes, December 31, 2008

Flowstaff Support

• Flow has been going well. No concerns.
• Barb circulating a list of injection room supplies for comment.
• Vaccinations: Becky has a preliminary version of a chart breaking out what clusters and CORE roles are. Basically, only children under 4 yrs MUST go to CORE for injections. The flow question is harder, as only Barb can now do the injections in East cluster. To be worked out. Temporary solution is to route patient to flowstaff after visit, flowstaff to determine cluster vs. CORE for shots.
• We all think MAs should be able to give immunizations. This request is in process.

Quality

• AVS rate clinc-wide last week was 93%, bested only by Factoria and Downtown.
• Excellent discussion around various ways to approach our patients with recommendations for labs, studies, or other types of care. Cheryl makes calls, and learns a lot from patients about what's good and challenging for them in managing chronic diseases. Barb sends letters, which might give patients the chance to feel less pressured.
• Last week we created a concise table of HEDIS measures we will prioritize, including Children's Health, Diabetes, Heart Care, and Cancer Screening. The very nice table is inelegantly translated into text here:

Children's Health

Immunizations: Child Combo 2*
Children 2 years of age who have had the following immunizations:
Diphtheria, tetanus, pertussis (DTaP) (4 doses)
Inactivated polio virus (IPV) (3 doses)
Measles, mumps, rubella (MMR) (1 dose)
H. influenzae type B (Hib) (3 doses)
Hepatitis B (HepB) (3 doses)
Chickenpox (varicella) (1 dose)

Vaccination is not required for children with a documented history of the illness or who are seropositive. For example, children who have a documented history of chickenpox are not required to receive this vaccination.

Diabetes
DM: HbA1c Test*
Individuals 18-75 years of age with type 1 or type 2 diabetes who have had an HbA1c test in the past year.
DM: HbA1c >9.0%*
Individuals 18-75 years of age with type 1 or type 2 diabetes whose most recent HbA1c was >9%. (A lower rate is desired.)
DM: LDL Screen*
Individuals 18-75 years of age with type 1 or type 2 diabetes who have had their LDL cholesterol measured within the past year.
DM: LDL <100*
Individuals 18-75 years of age with type 1 or type 2 diabetes whose most recent LDL cholesterol level within the past year was < 100 mg/dL.
DM: Nephropathy Monitoring*
For individuals 18-75 years of age with type 1 or type 2 diabetes without evidence of known renal disease, monitoring includes:
• Screening test for microalbuminuria in the past year or
• Taking an ACE inhibitor or an angiotensin receptor blocker (ARB)

For individuals 18-75 years of age with type 1 or type 2 diabetes with known renal disease, monitoring includes
• Laboratory evidence of macroalbuminuria
• Diagnosis of end stage renal disease, diabetic nephropathy, chronic renal failure, renal insufficiency, etc.
• Visit to a nephrologist
• Dialysis
(Group Health recommends annual microalbuminuria screening for all diabetic individuals without known renal disease, including those who are taking an ACE inhibitor or an ARB.)

Heart Care
CAD: Persistence of Beta Blocker Treatment
Individuals 35 years of age and older with the diagnosis of myocardial infarction (MI) who continued to take a beta-blocker for at least 6 months following their MI.
CAD: Cholesterol Management – LDL Screen*
Individuals 18-75 years of age who were diagnosed with atherosclerotic cardiovascular disease (ASCVD) one to two years ago who had an LDL-cholesterol screening performed within the past year.
CAD: Cholesterol Management – LDL<100*
Individuals 18-75 years of age who were diagnosed with atherosclerotic cardiovascular disease (ASCVD) one to two years ago whose most recent LDL-cholesterol result was <100>

Controlling High Blood Pressure*
Individuals 18-85 years of age ago whose most recent blood pressure reading at an office visit during the past year was <140/90.>

Screening

Breast Cancer
Women 40–69 years of age (excluding women who have had bilateral mastectomies) who have had a mammogram within the last two years.

Cervical Cancer*
Women 21–64 years of age (excluding women who have undergone hysterectomy with removal of the cervix) who have had a Pap test within the last three years.

Colorectal Cancer*
Individuals 50-80 years of age who have had one of the following:
• Fecal occult blood testing in the past year.
• Colonoscopy in the past 10 years.
• Flexible sigmoidoscopy in the past 5 years.
• Double contrast barium enema in the past 5 years. (Group Health does not recommend double contrast barium enemas for colon cancer screening.)