Sometimes, it’s the simplest systems that have the most impact. Debra Bislip, MD (pictured on right), and Lone Tree Primary Care Clinic are taking a swipe at chronic health conditions using nothing more than the swipe of highlighter.
According to Colleen Conry, MD, professor and vice-chair of the department of family medicine, Dr. Bislip is helping to lead her practice to identify processes that improve patient care. Together with her staff, Dr. Bislip developed a simple color-coded system that allows everyone in the practice to quickly identify patients living with chronic health conditions.
“The color-coding system is an easy method for staff to help remind providers of things that need to be done, without needing face to face contact or complicated messaging systems,” said Dr. Conry.
As the clinic worked toward becoming a patient centered medical home, they created registries for certain chronic conditions. But it wasn’t until they discovered the need for quick identification of Medicare patients that their latest system improvement was born.
The practice no longer used paper patient medical records, but they did keep a paper visit log with printed labels for each patient being seen. Because Medicare coverage can vary, medical assistants have to run an “advanced beneficiary notice” (ABN), prior to performing any tests or other services to ensure coverage by Medicare. They began marking the label with a yellow highlighter as a reminder to run an ABN.
The system worked so well, Dr. Bislip and her team decided to use it to identify patients with chronic health conditions: A green highlighter identifies patients with hypertension, blue identifies depression and pink identifies diabetes. It has resulted in everyone in the practice being able to see quickly the chronic conditions a patient faces.
“It’s really simple. Say a patient has come in because of rash. I will treat the rash accordingly, but because I’ve seen the blue stripe on his label, I’ll also ask about the last time we saw him for his depression. If it’s indicated, I’ll administer a PHQ-9 (a depression test questionnaire),” Dr. Bislip said.
The color-coding system allows the entire clinic to become involved without needing to dig into the electronic health record to review the conditions being monitored.
Since the practice became a patient centered medical home, Dr. Bislip says patients are much more involved in their own care. Providers and patients work together as a team—setting goals, tracking and monitoring at home and seeing each other regularly. Patients are held accountable and can see their own progress, which Dr. Bislip believes is key to improving their health.
“When you’re sick, there’s a lot of distress over not having control. Patients might ask, ‘why me?’. Being involved in the management of your care gives you control over something. And when you routinely see where your labs are or how diet impacts your A1C, the patients feel empowered to take charge at home and improve their conditions.”
The focus on patient centered medical care also keeps providers accountable. A recent check of practice dashboards revealed that 94% of their patients with diabetes have had their AIC checked in the last 13 months, with 96% of Dr. Bislip’s patients having their AIC checked.
“It’s not a huge difference in how we care for the individual patient, but by documenting everything, we see how we’re doing as a practice and as individual practitioners. This at-a-glance identification is a visual reminder to start a conversation no matter what the patient is being seen for.”
Dr. Conry says Dr. Bislip’s system is a win for patients and providers alike.
“Patients get what they need, staff are engaged in improving patient care and providers have an easy reminder—they don't need to rely on memory to look in multiple places for the gaps.”
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