DSRIP - Cal plans - Contra Costa

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					                                                       DSRIP Plan: Contra Costa Health Services
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                                                       CATEGORY 1: Infrastructure Development

         Project                              Description                                                          5-Year Goals
Increase Primary Care       Establish more primary care clinics              Y1:    (1) Increase number of evening clinics at two health centers; (2)
Capacity                    Expand primary care clinic space                        Increase number of primary care hours; (3) Develop plan and
                            Expand primary care clinic hours                        monitoring system to assess patient access to primary care using an
                            Develop system for primary care provider                industry standard of patient’s access to care, e.g. 3rd Next-Available
                             recruitment and retention                               Appointment
                                                                              Y2:    (1) Increase primary care clinic volume by expanding the number of
                                                                                     primary care continuity clinic appointments by 600 additional clinic
                                                                                     visits; (2) Begin new construction on 53,000 sq ft replacement health
                                                                                     center; (3) Expand one clinic to add nine additional exam rooms; (4)
                                                                                     Collect baseline data for 3rd Next-Available Appointment and establish
                                                                                     improvement targets for years 3, 4 and 5
                                                                              Y3:    (1) Increase primary care clinic volume by expanding the number of
                                                                                     primary care continuity clinic appointments by 1,2000 additional clinic
                                                                                     visits; (2) Increase access to primary care by reducing 3rd Next-Available
                                                                                     Appointment by X% or X number of days over baseline in at least one
                                                                                     primary care clinic. Baseline to be determined in year 2; (3) Begin new
                                                                                     construction of 7,000 sq ft Family Medicine Clinic
                                                                              Y4:    (1) Increase primary care volume by expanding the number of primary
                                                                                     care continuity clinic appointments by 1,800 additional clinic visits; (2)
                                                                                     Increase Access to Primary Care by reducing 3rd Next-Available
                                                                                     Appointment by X% or X number of days over baseline in at least one
                                                                                     additional primary care clinic (2 total). Baseline to be determined in year
                                                                                     2
                                                                              Y5:    (1) Increase primary care clinic volume by expanding the number of
                                                                                     primary care continuity clinic appointments by 2,400 additional clinic
                                                                                     visits (2) Increase Access to Primary Care by reducing “3rd Next-Available
                                                                                     Appointment by X% or X number of days over baseline in at least two
                                                                                     additional primary care clinics (4 total). Baseline to be determined in
                                                                                     year 2
Increase Training of        Increase number of primary care training          Y1:   (1) Increase primary care training in Continuity Clinics in diverse / low-
Primary Care Workforce       faculty/staff                                           income community-based settings by 120 scheduled clinic visits; (2)
                            Establish / expand primary care training programs       Assess the Ambulatory Care Lead Preceptor Program and assess
                            Update primary care training programs                   supervision standards for resident training in the ambulatory setting
                            Expand number of resident continuity clinics and Y2:    (1) Increase primary care training in Continuity Clinics in diverse / low-
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                              panel size                                               income community-based settings by 750 additional scheduled clinic
                             Include primary care trainees in primary care            visits (870 total); (2) Hire additional Ambulatory Care Lead Preceptors
                              quality improvement projects                             for Family Medicine Clinics
                                                                                   Y3: (1) Increase primary care training in Continuity Clinics in diverse / low-
                                                                                       income community-based settings by 300 additional scheduled clinic
                                                                                       visits (1,170 total); (2) Include 100% of 1st year residents in quality
                                                                                       improvement projects
                                                                                   Y4: (1) Increase primary care training in Continuity Clinics in diverse / low-
                                                                                       income community-based settings by 500 additional scheduled clinic
                                                                                       visits (1,670 total); (2) Include 100% of 1st and 2nd year resident(s) in
                                                                                       primary care quality improvement projects
                                                                                   Y5: (1) Increase primary care training in Continuity Clinics in diverse / low-
                                                                                       income community-based settings by 1,850 additional scheduled clinic
                                                                                       visits (3,520 total); (2) Include 100% of 1st, 2nd and 3rd year resident(s) in
                                                                                       primary care quality improvement projects
Enhanced Interpretation      Train & certify additional medical interpreters      Y1: Designate team to enhance interpretation services
Services and Culturally      Upgrade Health Care Interpreter Network (HCIN) Y2: (1) Develop plan to expand the use of HCIN hardware to accommodate
Competent Care                units.                                                   wireless network technologies; (2) Conduct a gap analysis to determine
                             Expand health care interpretation so that                HCIN hardware and training needs for wireless network technologies;
                              patients can receive instantaneous interpretation        (3) Provide at least 3,2000 qualified health care interpreter encounters
                              from a qualified health are interpreter, as              per month; (4) Train / certify additional medical interpreters
                              evidenced by at least 3,500 qualified health care    Y3: (1) Provide at least 3,300 qualified health care interpreter encounters
                              interpreter encounters per month.                        per month; (2) Expand qualified health care interpretation technology
                                                                                       by upgrading HCIN Audio / Video Units to function on a wireless
                                                                                       network
                                                                                   Y4: Provide at least 3,400 qualified health care interpreter encounters per
                                                                                       month
                                                                                   Y5: Provide at least 3,500 qualified health care interpreter encounters per
                                                                                       month
Collection of Accurate       Collect patient demographic data in a way that       Y1: (1) Develop REAL data template for the hospitals and health centers and
Race, Ethnicity and           can be compared to quality and health outcomes           integrate it into the data warehouse; (2) Train at least 100 hospital and
Language (REAL) Data to       data                                                     health centers registration staff on the collection of consistent, valid
Reduce Disparities           Stratify patient demographic data by outcomes to         and reliable data; (3) Collect accurate REAL data fields as structured
                              identify disparities                                     data for at least 20% of patients registered at the hospital and health
                             Engage in quality improvement projects to                centers
                              reduce health care disparities that have been        Y2: Collect accurate REAL data fields as structured data for at least 40% of
                              identified                                               patient registered at the hospital and health centers
                             Through the current efforts of REAL, have the        Y3: Collect accurate REAL data fields as structured data for at least 60% of
                                                                                       patient registered at the hospital and health centers
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                            patient’s preferred spoken language within the     Y4: Collect accurate REAL data fields as structured data for at least 70% of
                            EPIC EHR                                               patient registered at the hospital and health centers
                                                                               Y5: (1) Collect accurate REAL data fields as structured data for at least 80%
                                                                                   of patient registered at the hospital and health centers; (2) Perform
                                                                                   REAL data analysis for at least 2 specific health care disparities
                                                      CATEGORY 2: INNOVATION AND REDESIGN

Expand Medical Homes       Pilot a primary care medical home model in at        Y1: (1) Develop a plan, in conjunction with the Contra Costa Health Plan, to
                            least 3 health centers                                   assign patients to primary care teams serving as medical homes to
                           At least 95% of Full Scope Medi-Cal and Low              coordinate patients’ health care needs; (2) Implement a system where
                            Income Health Plan individuals enrolled or               at least 80% of FullScope Medi-Cal and Low Income Health Plan
                            managed by the County’s Knox-Keen Health Plans           individuals are assigned to a primary care provider within a medical
                            will be assigned to a primary care provider              home
                           New patients assigned to medical homes will          Y2: Implement a system where at least 85% of FullScope Medi-Cal and Low
                            receive their first appointment in a timely              Income Health Plan individuals are assigned to a primary care provider
                            manner                                                   within a medical home
                           Care teams will actively manage their patient        Y3: Implement a system where at least 90% of FullScope Medi-Cal and Low
                            panel so that patients are reminded of services          Income Health Plan individuals are assigned to a primary care provider
                            needed and receive coordinated care rooted in a          within a medical home
                            primary care setting                                 Y4: Implement a system where at least 95% of FullScope Medi-Cal and Low
                           Patients will know the professionals on their care       Income Health Plan individuals are assigned to a primary care provider
                            team and establish trusting, ongoing                     within a medical home
                            relationships to reinforce a continuity of care      Y5: (1) Implement a system where at least 95% of FullScope Medi-Cal and
                                                                                     Low Income Health Plan individuals are assigned to a primary care
                                                                                     provider within a medical home; (2) Report shared learning of the
                                                                                     medical home model and any findings related to impact on improved
                                                                                     health, experience and cost
Patient Experience of      NRC PCKER CG-CAHPS survey tools will be spread       Y1: Develop a plan to regularly display patient experience data and provide
Care                        to the Emergency Department and outpatient               updates to staff on the efforts underway to improve the experience of
                            clinics                                                  patients and their families
                           Baseline performance will be measured in the         Y2: (1) Expand use of NRC PICKER Patient Experience of Care surveys into
                            emergency department and at least 3 adult                ambulatory and emergency department Settings; (2) Display quarterly
                            primary care clinics and 3 pediatric clinics             patient experience data for inpatient medical / surgical and perinatal
                           Performance data from the medical/surgical               units
                            ward, perinatal, emergency department and 4          Y3: (1) Establish baseline performance in emergency department (2)
                            outpatient clinics will be internally displayed in       Establish baseline performance in at least 1 adult outpatient clinic and 1
                            order to promote performance improvement                 pediatric clinic; (3) Display quarterly patient experience data for the
                                                                                     emergency department
                                                                                 Y4: (1) Establish baseline performance in at least 2 adult outpatient clinics
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                                                                                      and 2 pediatric clinics (total of 4 clinics); (2) Display quarterly patient
                                                                                      experience data for at least 1 adult outpatient clinic and 1 pediatric
                                                                                      clinic
                                                                                  Y5: (1) Establish baseline performance in at least 3 adult outpatient clinics
                                                                                      and 3 pediatric clinics (total of 6 clinics); (2) Display quarterly patient
                                                                                      experience data for at least 2 adult outpatient clinics and 2 pediatric
                                                                                      clinics (total of 4 clinics)
Integrate Physical and      Better integration between primary and               Y1: Develop models that bring behavioral health services into primary care
Behavioral Health Care       behavioral health care will help more                    and bring primary care to the seriously mentally ill population
                             appropriately address patient’s needs                Y2: (1) Pilot integrating physical and behavioral health at one health center;
                            Behavioral health conditions better diagnosed in         (2) Being construction on the co-located Concord Adult Mental Health-
                             primary care settings, reducing medication               Integrated Primary Care Building
                             errors, improving patient’s health outcomes          Y3: (1) Screen 15% of Pilot PCP Panels seen using depression and substance
                            Utilization of avoidable emergency department            abuse screens; (2)being construction on new 3,000 sq ft co-located
                             and hospital services reduced                            primary care / mental health clinic
                                                                                  Y4: Screen 30% of Pilot PCP Panels using depression and substance abuse
                                                                                      screens
                                                                                  Y5: Screen 60% of Pilot PCP Panels using depression and substance abuse
                                                                                      screens
Conduct Medication          Implement a medication refill process in the         Y1: Assess patient need for implementation of medication refill process in
Management                   ambulatory care setting                                  the ambulatory care setting
                            Better clinical outcomes due to improved disease Y2: Select a primary disease target state and pilot a Medication Refill
                             state management for selected at-risk                    Process in one ambulatory care health center
                             populations (e.g. hypertension, heart disease,       Y3: Measure baseline for the number of patients enrolled / referred to the
                             diabetes, etc)                                           Medication Refill Clinic who adheres to the medication refill process
                            Increase adherence to the medical refill process     Y4: (1) Expand pilot program to one additional health center; (2) Increase by
                             in the ambulatory care setting by enrolled               X% over baseline for adherence to the medication refill process by
                             patients who have selected conditions / diagnose         enrolled patients in the medication refill clinic (X% increase determined
                                                                                      in year 3)
                                                                                  Y5: (1) Assess need for expansion of Medication Refill Process to cover
                                                                                      additional disease states and/or health centers; (2) Increase by X% over
                                                                                      baseline for adherence to the medication refill process by enrolled
                                                                                      patients in the medication refill clinic (% increase determined in Year 3)
                                                       CATEGORY 4: URGENT IMPROVEMENT IN CARE

Improve Severe Sepsis       implement Sepsis Management and Resuscitation        Y1: Designate a multidisciplinary team
Detection and                Bundle                                               Y2: (1) Implement the Sepsis Resuscitation Bundle: (2) Report at least 6
Management                  Reduce avoidable harm or deaths due to severe            months of data to SNI for baseline / benchmarks; (3) Report the results
                                                                                      to the state.
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                              sepsis to patients receiving inpatient services       Y3: (1) achieve TBD% compliance with sepsis resuscitation bundle; (2) share
                                                                                        data and practices with SNI for benchmarking across public hospitals; (3)
                                                                                        Report results to the state
                                                                                    Y4: (1) achieve TBD% compliance with sepsis resuscitation bundle; (2) share
                                                                                        data and practices with SNI for benchmarking across public hospitals; (3)
                                                                                        Report results to the state
                                                                                    Y5: (1) achieve TBD% compliance with sepsis resuscitation bundle; (2) share
                                                                                        data and practices with SNI for benchmarking across public hospitals; (3)
                                                                                        Report results to the state
Central Line Associated      improve compliance with central line insertion        Y1: Designate a multidisciplinary Central Line-Associated Bloodstream
Blood Stream Infection        bundle                                                    Infection (CLABSI) Infection Prevention Team
(CLABSI) Prevention          Reduce avoidable harm or deaths and costs of          Y2: (1) Implement the Central Line Insertion Practices (CLIP; (2) Report at
                              care due to central-line associated blood stream          least 6 months of data collection on CLIP to SNI for baseline /
                              infections                                                benchmarks; (3) Report at least 6 months of data collection on CLABSI
                                                                                        to SNI baseline / benchmarks; (4) Report CLIP results to the state
                                                                                    Y3: (1)achieve TBD% compliance with CLIP; (2) share data and practices
                                                                                        with SNI; (3) report CLIP and CLABSI results to State
                                                                                    Y4: (1) achieve TBD% compliance with CLIP; (2) reduce central line
                                                                                        bloodstream infections by TBD%; (3) share data and practices with SNI;
                                                                                        (4) report CLIP and CLABSI results to State
                                                                                    Y5: (1) achieve TBD% compliance with CLIP; (2) reduce central line
                                                                                        bloodstream infections by TBD%; (3) share data and practices with SNI;
                                                                                        (4) report CLIP and CLABSI results to State
Surgical Site Infection      improve surgical site infection prevention            Not a selected intervention by Contra Costa Regional Medical Center and
                                                                                            Health Centers
Hospital-acquired            Use a multi-disciplinary team approach to the         Y1: Designate a multidisciplinary Hospital-Acquired Pressure Ulcer
Pressure Ulcer (HAPU)         prevention of pressure ulcers using evidence-             Prevention Team
Prevention                    based recommendations from the national               Y2: (1) Share data, promising practices and findings with SNI to foster
                              Pressure Ulcer Advisory Panel                             shared learning and benchmarking across the California public hospitals;
                                                                                        (2) Report hospital-acquired pressure ulcer prevalence results to the
                                                                                        state.
                                                                                    Y3: (1) Achieve hospital-acquired pressure ulcer prevalence of less than
                                                                                        3.6%; (2) Share data, promising practices and findings with SNI to foster
                                                                                        shared learning and benchmarking across the California public hospitals;
                                                                                        (3) Report hospital-acquired pressure ulcer prevalence results to the
                                                                                        state
                                                                                    Y4: (1) Achieve hospital-acquired pressure ulcer prevalence of less than
                                                                                        2.6%; (2) Share data, promising practices and findings with SNI to foster
                                                                                        shared learning and benchmarking across the California public hospitals;
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                                                                                      (3) Report hospital-acquired pressure ulcer prevalence results to the
                                                                                      state
                                                                                  Y5: (1) Achieve hospital-acquired pressure ulcer prevalence of less than
                                                                                      1.1%; (2) Share data, promising practices and findings with SNI to foster
                                                                                      shared learning and benchmarking across the California public hospitals;
                                                                                      (3) Report hospital-acquired pressure ulcer prevalence results to the
                                                                                      state
Stroke Management                                                                Not a selected intervention by Contra Costa Regional Medical Center and
                                                                                          Health Centers
Venous                      Prevent VTE by checking patients for risk of blood Y1: Designate a multidisciplinary Venous Thromboembolism (VTE)
Thromboembolism (VTE)        clots and taking appropriate steps to prevent            Prevention & Treatment
Prevention & Treatment       them                                                 Y2: (1) Report at least 6 months of data collection on the VTE management
                                                                                      process measures to SNI for baseline / benchmarks; (2) Report the 5 VTE
                                                                                      process measures data to the state
                                                                                  Y3: (1) increase by TBD rate the rate of patients who received VTE
                                                                                      prophylaxis or documentation why no VTE prophylaxis given the day of
                                                                                      or day after hospital admission or surgery end date; (2) increase by TBD
                                                                                      rate the rate of patients who received VTE prophylaxis or
                                                                                      documentation why no VTE prophylaxis given the day of or the daty
                                                                                      after initial admission to ICU or surgery end date; (3) increase by TBD
                                                                                      rate the rate of patients diagnosed with confirmed VTE who received
                                                                                      and overlap of parenteral IV or subcu anticoagulation and warfarin
                                                                                      therapy; (4) increase by TBD rate the rate of patients diagnosed with
                                                                                      confirmed VTE who received IV UFH therapy dosages AND had platelet
                                                                                      counts monitored using defined parameters; (5) increase by TBD rate
                                                                                      the rate of patients diagnosed with confirmed VTE that are discharged
                                                                                      to home, home care, court/law enforcement or home on hospital care
                                                                                      on warfarin with written discharge instructions that address all criteria;
                                                                                      (6) share data and findings with SNI; (7) report 5 VTE process measures
                                                                                      to State
                                                                                  Y4: Same as Y3 with adjusted rates
                                                                                  Y5: Same as Y4 with adjusted rates
Falls with Injury                                                                 Contra Costa Regional Medical Center and Health Centers is precluded from
Prevention                                                                                selecting this intervention due to current top performance

				
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