The Utah Beacon Experience: Integrating Quality Improvement, Health Information Technology, and Practice Facilitation to Improve Diabetes Outcomes in Small Healthcare Facilities

Abstract

Purpose:The Utah Improving Care through Connectivity and Collaboration (IC3) Beacon community (2010–2013) was spearheaded by HealthInsight, a nonprofit, community-based organization. One of the main objectives of IC3 was to improve health care provided to patients with diabetes in three Utah counties, collaborating with 21 independent smaller clinics and two large health care enterprises. This paper will focus on the use of health information technology (HIT) and practice facilitation to develop and implement new care processes to improve clinic workflow and ultimately improve patients’ diabetes outcomes at 21 participating smaller, independent clinics.Innovation:Early in the project, we learned that most of the 21 clinics did not have the resources needed to successfully implement quality improvement (QI) initiatives. IC3 helped clinics effectively use data generated from their electronic health records (EHRs) to design and implement interventions to improve patients’ diabetes outcomes. This close coupling of HIT, expert practice facilitation, and Learning Collaboratives was found to be especially valuable in clinics with limited resources.Findings:Through this process we learned that (1) an extensive readiness assessment improved clinic retention, (2) clinic champions were important for a successful collaboration, and (3) current EHR systems have limited functionality to assist in QI initiatives. In general, smaller, independent clinics lack knowledge and experience with QI and have limited HIT experience to improve patient care using electronic clinical data. Additionally, future projects like IC3 Beacon will be instrumental in changing clinic culture so that QI is integrated into routine workflow.Conclusion and Discussion:Our efforts led to significant changes in how practice staff optimized their EHRs to manage and improve diabetes care, while establishing the framework for sustainability. Some of the IC3 Beacon practices are currently smoothly transitioning to new models of care such as Patient-Centered Medical Homes. Thus, IC3 Beacon has been instrumental in creating a strong community partnership among various organizations to meet the shared vision of better health and lower costs, and the experience over the last few years has helped the community prepare for the changing health care landscape.

Using Electronic Health Records to Measure Quality Improvement Efforts: Findings from a Large Practice Facilitation Initiative

“…For example, in a prior federally funded practice facilitation initiative, stakeholders determined that reliable and useful measures of diabetes performance were not available in practices' EHRs, which led them to develop a customized software system to promote QI work. 6 In addition, the quantitative results observed here reflect published qualitative findings from the national EvidenceNOW Initiative, 11 in which members of seven regional EvidenceNOW cooperatives (including the H3 trial conducted by our study team) reported challenges obtaining clinical quality reports from EHRs with time lines that aligned with QI project time lines. 14 Including one EHR vendor that created customized reports with rolling 12-month reporting periods only upon request, the majority of practices under study here (58/107; 54.2%) used an EHR without built-in features to produce quality measures with rolling 12-month reporting periods ( Table 2 ; rows H-K).…”

IT-enabled Community Health Interventions: Challenges, Opportunities, and Future Directions

“… Deployment and Intervention: Three of the submissions discuss the implementation challenges of HIT interventions within a community, such as incorporating HIE notifications in care coordination. 14 , 15 , 16 These papers have faced both technical and policy challenges in increasing the diversity of their stake-holders. Evaluation: A third of the articles focus on the evaluation of HIT-enabled, community-based transformations.…”

Practice Facilitator Strategies for Addressing Electronic Health Record Data Challenges for Quality Improvement: EvidenceNOW

“…25–35 Little is known about how Facilitators respond to practice-level EHR data challenges that create barriers to performing data-driven QI. 18, 35, 36…”