Disease Management Functional Requirements by 2Upv1d

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									l and external customers are aware, knowledgeable, and know how to access
the program. Role of the individual staff member is clarified.
Continuous process improvement methods (e.g., FOCUS-PDCA) used throughout
the program to monitor performance.

Education: Focuses on staff and provider education regarding new disease
management business processes. Timely feedback on performance is
provided to the primary care team and the MTF staff. Providers who are
not meeting standards are reviewed. Includes education to patients and
family members regarding clinical processes as well as self-management
skills.

Marketing: Specific initial and ongoing marketing plans to entire
healthcare team, patients, and families about the disease management
program exists.
MTF Road Map Functional Area Requirements

Leadership

Appropriate and meaningful diseases/conditions are selected and supported
by leadership at all levels: Disease/condition state is meaningful to
the command and is in alignment with required clinical metrics on the
current BUMED Business Plan. May include other disease and condition
states that the command notes needs improvement based on current clinical
evidence and national benchmarks.
Senior leadership support for targeted disease management reengineering:
Command support exists at the highest level (e.g., part of the annual
plan).
Leadership has made it clear that success of the program is high priority
and will provide available support and resources. Moreover, leaders will
hold staff accountable for compliance and performance.
MTF Clinical Champions (primary care and specialists) and Program
Coordinators identified as directed in BUMEDNOTE 6310 “Disease State and
Condition Management Program”. Both persons should be intimately
involved in the program. Some smaller commands, however, may not have
specialists. Outside consultants (civilian or military) may be used.
Multidisciplinary teams have been formally appointed to assist in
deployment, implementation, monitoring, evaluation, and sustainment.
Multidisciplinary team formally appointed: Physicians, other providers
(e.g., NPs & Pas), RNs, pharmacists, case managers, Population Health and
Health Promotion. Have also involved performance improvement
specialists, nurse researchers, clinical epidemiologists, and others as
available at command.

Plan exists for program evaluation by command leadership: Command has a
plan to periodically examine clinical indicators, return on investment,
cost avoidance, and other relevant business outcomes such as continuity,
primary care access and utilization and decreased use of inappropriate
portals such as the ED for primary care issues.

Clinical Practice Guidelines and Metrics

Cohort identified and defined: The cohort with the disease being managed
is identified by some mechanism. How did the command do this? Is the
information accurate?
Guideline for use in targeted condition(s) established: A clinical
practice guideline (CPG) for each disease state is selected and accepted
by the facility as standard of care. The mechanism by which this
guideline was selected is evident. Stakeholders embrace the guideline.
Healthcare team members have access to CPG.
Facility is aware of metrics measured Navy wide by BUMED: MTF is focused
on, at a minimum, the enterprise-wide BUMED clinical metrics. Additional
relevant disease states and conditions have been chosen and/or are being
considered for implementation.
Metrics for interventions are defined and baseline measurements are
taken: MTF has clearly defined and publishes metrics they are monitoring
on a periodic basis. Baseline metrics prior to implementation of the
program are published for facility staff. Metrics are evidenced based
and focus on a reasonable number that are clinically relevant.
Process for data collection and analysis of metrics, including frequency,
is defined by Clinical champion and Program Coordinator, and
multidisciplinary team: How metrics will be gathered is clearly defined.
Source of data is evident (e.g., Population Health Navigator or local
clinical registries). Person(s) responsible for gathering and
disseminating information are aware and frequency of data collection is
well defined. Metrics are monitored by multidisciplinary disease
management team.
Metrics are gathered and reviewed regularly with feedback to providers:
Evidence exists that metrics are gathered regularly and distributed to
providers and their healthcare delivery teams to show progress on
improving process. Providers who fail to demonstrate improvement over
time receive specific feedback on ways to improve their performance.

Disease and Condition Management Reengineering

Project management plan is developed: An implementation plan, including
a timeline for the program is evident. Goals, objectives (using “SMART”
criteria: Specific; Measurable; Achievable; Realistic; Time bound). Who
oversees the program? Are there points of contact / action officers at
command (i.e., Clinical Champion & Program Coordinator) and at clinic
levels? How will continuity be maintained over time despite PCS moves
and turn over of personnel? There is evidence of a sustainment plan.
Multidisciplinary team meets regularly to examine program and how to
improve: Documentation (e.g., meeting records) available to track this
ongoing process. Evidence of progress by team evident in available
documentation.
Clinical and business processes are mapped: How and where patients enter
and move through the program is clearly defined. A schedule of
requirements and services is clearly defined as is a timeline for how
they are delivered most efficiently. Innovative approaches such as
nurse-pharmacist-dietitian-managed clinics and group visits are
implemented.
Roles of staff members in targeted disease management are clear: MTF
staff have standing orders to perform specific tasks in the program.
Roles are clear. Who is responsible for deliverables? Use of staff is
optimized. Multidisciplinary involvement in the program is evident.
Formal process exists for contacting patients not meeting established
benchmarks: There is evidence of a coordinated healthcare delivery team
approach, including timeframes for contacting “out of standards”
patients. It is NOT the expectation that credentialed providers are
contacting patients on lists.
Standing orders for non-providers providing authority to carry out
responsibilities: Evidence that clear guidance is in place regarding
team member roles. Team members have checklists or other mechanisms to
remind them of their duties in the program.
Process defined to monitor patient response to standing orders protocols:
Cohorts of patients addressed using standing orders are periodically
evaluated in order to monitor effectiveness of developed protocols.

Program Deployment and Evaluation

Deployment plan developed: A timeline with milestones is evident. The
process of how the program will be developed and deployed is specific.
Includes, but is not limited to: training on guideline, supply
chain/process for educational tools integration with PCM or specialty
care, PI (evaluation) program, physician feedback reports.
Resource analysis for deployment and sustainment: Evidence that the MTF
analyzed the amount of resources including personnel that are necessary
to manage the cohort defined in the program they have implemented. MTF
leadership is supportive of the program and has provided resources
necessary for success of the program as designed by the stakeholders.
Tools for use in clinical business processes are developed, available,
and being used: Use of standard forms and tools, such as those found in
the BUMED Disease Management toolboxes available:   HYPERLINK
"https://dataquality.med.navy.mil/community/Disease+Management/default.as
px" \t "_parent"
 https://dataquality.med.navy.mil/community/Disease+Management/default.as
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is evident. Evidence the patient care tools and education materials are
standardized throughout the facility to increase consistency, improve
quality, and reduce variation in care. If a chart from one of the
patients in the cohort is pulled, standard forms/templates have been used
during visits for the disease in question.
Process in place to monitor compliance with assigned responsibilities:
How does the MTF ensure that team members are performing the tasks they
have been assigned? Who is responsible for ensuring compliance and what
mechanism is in place to correct deficiencies? Noteworthy performance is
reflected in formal evaluations (e.g., performance appraisal reports,
military evaluations).
Multidisciplinary team meets regularly and uses formal continuous process
improvement methods (e.g., FOCUS-PDCA) to evaluate and modify processes
to improve delta between benchmarks and performance: Address clinical
quality, cost avoidance (e.g., decreased disengagement, increased
continuity, access to primary care portals, decreases in ED visits &
admissions) and quality of life indicators. Includes feedback from
health care team members, patients and families.

Education

Baseline education of providers/ staff: MTF is aware of the knowledge
base of providers and their ancillary staff and any deficits.
Baseline knowledge assessment of patients and families: Process exists
for identifying knowledge related to disease process and self-management
skills of patients (and families) regarding their disease at baseline.
Evidence exists that this information is then used to create their
education and treatment plan.
Regular continuing education and training is provided to healthcare
delivery team on disease process: Education is based on approved current
CPG. CME/CEUs are awarded.
Staff education on clinical business processes and feedback on
performance: Evidence of formal initial “kick-off” and ongoing (e.g., new
staff; updates) education plan.
Patient self-management education implemented and periodically evaluated:
Patient cohort and their family members are periodically assessed to
determine level of knowledge of evidence-based self-management
strategies. Evidence exists that healthcare team education and outreach
efforts are revised to meet these identified needs.
Marketing

Baseline marketing plan exists for entire health care team: Goals,
“SMART” objectives (using “SMART” criteria: Specific; Measurable;
Achievable; Realistic; Time bound), milestones and deliverables are
delineated. How is the program marketed to hospital staff and providers
so that everyone is aware of the program?
Specific (ongoing) marketing plan exists for patients and families: How
is the program marketed to the enrolled patient population to encourage
their participation?
How does the MTF determine whether patients in the cohort of interest are
aware of the program?
Ongoing marketing plan exists for entire health care team: Consistently
implemented across departments within the command (e.g., asthma
management in Family Medicine and Pediatrics).




 PAGE   5
Disease Management Road Map

Meyers, J. & Padden, M. O. (2001).   Revised: C. J. Gantt   (January 2005)




Meyers, J. & Padden, M. O. (2001).   Revised: C. J. Gantt   (January 2005)




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