PPRNet Tips for Providers

The PPRNet A-TRIP Basics:

• Read practice reports and use them to guide your quality improvement efforts and monitor your progress.  Select areas of weak performance and formulate a realistic plan for improvement.
• Be a champion! Educate your staff about chronic disease care, and delegate quality improvement activities amongst your staff.   Improvement activities are not limited to providers.  Empowering and motivating your staff are essential for success. For example, make entire staff aware of blood pressure goals for hypertensive and diabetic patients to achieve better follow-up care.  Staff members can then conduct BP checks and educate patients about goals.
• Make quality improvement a goal for your entire practice, and use positive reinforcement and incentives to motivate your staff.  For example, hang posters detailing office performance, progress.
• Use visit note templates containing practice guidelines at the point of care.  For example, a visit note template for Diabetes Mellitus should remind you of the recommended blood pressure, A1C, and cholesterol goals for diabetic patients.

Templates for each visit can also be prepared ahead of time by either yourself or nursing/staff members, with data such as labs added in advance. Items needing attention can be flagged; labs can be printed ahead of time.

• Use flags, internal emailing, and delayed messages for self-reminders regarding follow-up care. For example, use a flag as a reminder to measure LFTs q 3 months for patients on Actos.
• Use inquiries to provide outreach to patients who may be in need of follow-up care. For example, identify patients with coronary artery disease and LDL not at goal, and contact for better management. Conduct billing query to find patients (i.e. diabetics with no visit in one year), create mail merge file to contact patients.
• Activate your patients.  Provide copies of lab reports to patients, use letter templates to generate letters reporting lab results to patients.  Provide A-TRIP Patient Education handout to patient to explain guidelines and health care goals.
• Aim for low staff turnover in order to facilitate adherence to new policies and procedures.

Please send your tips to the PPRNet ListServ and we will update this list accordingly.

Specific Tips from successful PPRNet-TRIP Practices:

• Establish standing protocols for diagnosing HTN, hyperlipidemia, etc. Also establish standard protocols for chronic care follow-up.  For example, some practices see all hypertensive or diabetic patients q3 months. Others see patients with uncontrolled DM q3 months, and once controlled, see DM patients q6 months. Be consistent, and make entire staff aware of standing protocols to achieve tighter follow-up care. 
• Formulate a “plan” for chronic care follow-up, including all labs that should be ordered, what will be done with the results, subsequent follow-up, etc.  These protocols for chronic care f/u can be built into visit note templates.
• Implement standing orders for labs (i.e. cholesterol screening for all patients) and empower nursing staff to determine if patients need screening labs.
• Use flow sheets to guide decision-making.
• Use “insert previous note” to speed up note writing.
• Use limited refills to promote regular visits.  For example, see hypertensive, diabetic patients more frequently by scheduling patients for visits when they call for refills. Plan more frequent visits for patients not at goal.
• Create algorithms for medication refills (lipid lowering meds for hyperlipidemia).
• Some practices have achieved better success by scheduling shorter, more frequent appointments. For example, rather than annual physical, schedule patients for nursing BP f/u, foot clinic, etc.
• Schedule lab visits before office visits for patients with chronic diseases, such as DM.
• Obtain blood pressures as patients come in for A1Cs to reach goal of BP every 3 months for diabetic patients.
• Some practices are using point-of -care HgbA1C and cholesterol testing devices regularly at time of scheduled follow-up visits.
• Establish Chronic Disease clinics certain half days per week, such as DM, diabetes foot care, lipids, anticoagulation. A nurse or NP may run these, where nurse provides direct patient care while MD is available for consultation. Visits may also be classified as nursing visits, doctor visits, or nurse/doctor visits.  Nurse/doctor visits can encompass more in-depth chronic disease state management with regular changes in therapy.
• Group visits/classes can also be established for patients with chronic diseases such as DM.
• Laptops can be used to save space and money for site licenses.
• Copy/paste electronic hospital d/c summaries into D/C summary section of Patient Records, use Pb/Dx function to add diagnoses to problem list.
• Insert Pb/Dx codes into templates, on problem list, or on T line of visit note. Adding diagnoses will heighten awareness and prompt subsequent treatment.

Please send your tips to the PPRNet ListServ and we will update this list accordingly.

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