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Tobacco and Fall Screening: Aligning Practice Tools and Processes for Quality Improvement
Adam Christensen, DPT, MBA; Scot B. Sternberg, MS; Jeff Heriot, MS; Nisha Basu, MD;
Healthcare Associates and Department of Medicine, Beth Israel Deaconess Medical Center
APPROACH TO ASSESS PERFORMANCE AND SUCCESS
STATEMENT OF PROBLEM
Screening is important for appropriate clinical care, including initiating conversations about
tobacco cessation and fall avoidance.
Tobacco and fall screening data had not been consistently documented in structured fields
in the electronic medical record.
These two measures are also quality metrics for our Pioneer Accountable Care Organization
(ACO) contract.
A baseline measure was taken for patients who had HCA visits in January and February. This
data revealed a 32.3% screening rate for tobacco use and a 15.7% screening rate for falls.
Assessment will include:
The percentage of all patients over the age of 18 screened at time of visit for tobacco use
The percentage of patients over the age of 65 (as of Jan 1) screened at time of visit for falls
The percentage of all patients seen in HCA in the last 24 months screened for tobacco and
falls, as appropriate within 24 months
FINDINGS TO DATE
AIM
AIM: To ensure consistent screening and documentation with a goal of:
100% of all patients for tobacco assessment and if a smoker, provide information on smoking
cessation, and
100% of all patients aged 65 or older for recent falls.
INTERVENTION INCLUDING CONTEXT AND MEASUREMENT
Healthcare Associates is a large academic primary care practice at Beth Israel Deaconess
Medical Center.
Baseline data for tobacco and fall screening rates was obtained via reports generated from
the online medical record.
Physicians and medical assistants identified perceived barriers to consistent screening,
including adequate structure on the check-in sheet, lack of standardization for data transfer
to the electronic medical record, and lack of training and auditing processes.
Tobacco screening and fall screening questions were added to the check-in sheet.
Audits were performed to ensure completeness in the entire check-in sheet, and
documentation of the information into the electronic medical record. Performance rate on
screening is continually monitored and reported.
Tobacco Screening Rates
24 Month Lookback and Monthly Capture Rate
Screened within 24 months
Screened on Date of visit that month
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
April
May
June
July
August
September
October
November
December
Since revising the check-in sheet and engaging MA staff, the percentage of patients seen in HCA
in the last 24 months and screened for tobacco use has increased from 72.3% to 86.5%.
In May, 2684 tobacco screens were completed. Each month from June through the end of the
calendar year saw HCA complete more than 5,000 tobacco screens, averaging 5681 over this
period
�Tobacco and Fall Screening: Aligning Practice Tools and Processes for Quality
Improvement
Adam Christensen, DPT, MBA; Scot B. Sternberg, MS; Jeff Heriot, MS; Nisha Basu, MD; Roderick Ibe , BS
Healthcare Associates and Department of Medicine, Beth Israel Deaconess Medical Center
FINDINGS TO DATE (CONTINUED)
LESSONS LEARNED
Non-physician and non-nursing clinic staff can be engaged and facilitate patient care
such as screening.
Initial incidents in which screening was identified as incomplete were found to be
attributable to misinformation and errors in documentation. For example, on a number
of occasions, smoking cessation materials were offered, but when the patient declined
those materials, it was mistakenly documented that counseling was not offered.
Ongoing staff education on the importance of the screening questions reduced
information gaps and helped to improve performance.
Fall Screening Rates
24 Month Lookback and Monthly Capture Rate
Screened @ visit that month
Screened in 24 months
100.0%
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
April
May
June
July
August
September
October
November
December
Since revising the check-in sheet and engaging MA staff, the percentage of patients seen in
HCA in the last 24 months and screened for falls has increased from 55.2% to 80.8%.
In April and May, 347 and 423 fall screens were completed in HCA, and in November alone,
1258 total fall screens were completed.
NEXT STEPS
Continue tracking screening rates and identify high and low performing teams within HCA from
which lessons can be learned.
Identify ways to streamline the check-in sheet and minimize inefficiencies such as Medical
Assistants writing down screening results twice as well as entering them into the EHR
Identify additional opportunities to engage non-physician and non-nursing staff in population
health efforts
�
Dublin Core
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Title
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Silverman Symposium
Description
An account of the resource
Each year the Silverman Symposium poster session offers BIDMC staff and affiliates the opportunity to share experiences and learn about efforts to improve Quality and Safety.
Date
A point or period of time associated with an event in the lifecycle of the resource
2021
Silverman Poster
Primary Contact
If you would like more information about this project, contact this person. Make email address clickable.
Adam Christensen (<a href="mailto:achriste@bidmc.harvard.edu">achriste@bidmc.harvard.edu</a>)
Department
Any departments listed on the poster or identified in the spreadsheet.
Healthcare Associates
Medicine
BIDMC Location
The BIDMC location where the poster team resides if identified in spreadsheet. If not identified, choose BIDMC.
BIDMC
Project Team
Adam Christensen
Scot B. Sternberg
Jeff Heriot
Nisha Basu
Roderick Ibe
Dublin Core
The Dublin Core metadata element set is common to all Omeka records, including items, files, and collections. For more information see, http://dublincore.org/documents/dces/.
Title
A name given to the resource
Tobacco and Fall Screening Aligning Practice Tools and Processes for Quality Improvement
Date
A point or period of time associated with an event in the lifecycle of the resource
2016
Format
The file format, physical medium, or dimensions of the resource
pdf
Compliance
Effectiveness
Equality