Posts Tagged ‘mammograms’

Using Registries to Improve Population Health

March 5th, 2013 by Jessica Fornarotto

Patient registries help to provide a bigger picture view of a specific patient population, making it easier to identify patients at high-risk and those who need certain tests, states Dr. Gregory Spencer, chief medical officer of Crystal Run Healthcare. Crystal Run’s use of registries has helped patients to maintain their health, including those with poorly controled diabetes, and to identify gaps in care. However, meaningful use does pose some challenges for Crystal Run registries.

Question: What results have you achieved from your registry data?

Response: Early on, we used registries for routine health maintenance issues, specifically for women that were due for a mammogram. We went from about 60 or 65 percent of women getting mammograms early on to the high 80 percent range. Similarly, prostate specific antigens increased to above 90 percent. Registries do work when there is a concerted effort of everybody thinking about these groups of patients, reporting on it on a regular basis and then sharing results with people.

Through our dashboard, we can show people where they stand. We are incorporating more of these registry data into dashboards. People that are due for prostate specific antigens, for instance, are incorporated onto the dashboard. The other more dramatic use has been a list of patients who have diabetes with an A1C greater than 9; very poorly controlled. We use that registry for our quarterly calls. We have a primary care physician who is on a conference call once a quarter with a dietician and an endocrinologist, and we go over the registry of patients who have poorly controlled diabetes. We talk about the patient, look at them in detail and have the dietician reach out to them. We could also have the patient schedule an appointment or have them make a change to their behavior to help them better manage their diabetes. We have had a dramatic improvement in the A1C’s, where currently, poorly controlled is below 9 percent at this point.

Question: Besides mammograms and diabetes, what other measures do you use to identify gaps in care?

Response: We use most of the common quality measures such as mammograms, prostate specific antigens, colonoscopies, and most of the shots specifically for adults such as Pneumovax®, tetanus and flu shot. For kids, we have all the childhood immunizations. We have a program that tracks immunizations as well as high-risk patients with diabetes with A1C’s greater than 9.

And we have good registries. For patients with well-controlled diabetes or hypertension, there are positive and negative lists. If you are going to gather the information, you know where the blood pressure field is kept. You know that there are good quality measures and bad quality measures, and you can leverage that. Then, you have two items to look at rather than just one. We are developing a library of these, and we are going from meaningful use that has many measures in registries that are required and we are working toward that as well.

Question: What lessons have you learned in terms of meaningful use?

Response: We try to keep the measures and the list standard to the quality measures that already exist. We do many of the NCQA clinical quality measures already. The difficult areas that we have are the same that many other companies have. We are having a difficult time getting an extensive clinical summary out to a patient within three days of a visit. Then, there is e-prescribing rates. Depending on the patient population that is served, patients insist on a printed prescription. We told the staff that if they want it printed, they get it sent electronically as well. You need the threshold there.