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FCHP's commitment to patient safety

Fallon Community Health Plan (FCHP) is committed to the quality improvement principles of the three Leapfrog Group initiatives (Computer Physician Order Entry, Evidence-based Hospital Referral, and ICU Physician Staffing). These initiatives have the potential to save lives by reducing preventable mistakes in hospitals.

Our collaboration with the Massachusetts Leapfrog Coalition allows us to enhance patient safety through member and provider education and by supporting compliance with the Leapfrog interventions at all our contracted hospitals.

As part of our proactive approach and commitment to patient safety, FCHP has performed the following:

• FCHP, in conjunction with the Massachusetts Hospital Association, was successful in its request to secure a place for the Leapfrog project on the agenda of the Massachusetts Health Quality Partnership (MHQP).

• FCHP directly contacted chief administrators at network hospitals that had not reported data to the Leapfrog Web site. As a result of this action, more than 75% of our contracted hospitals have now voluntarily reported data for the calendar year 2002.

• To give our members and providers the proper tools needed for an effective and educated dialogue about our contracted hospitals' progress in compliance with the Leapfrog initiatives, we've published resource information and articles in our member magazine and provider newsletters. The FCHP Web site, www.fchp.org, is being updated to include member and provider educational materials. 

Leapfrog compliance data

The following shows the actual levels of compliance among FCHP's contracted hospitals for 2001 and 2002, as well as our projected levels for 2002.

 For the surgical volume standards, the Leapfrog Group recently indicated that risk adjusted outcome data may be substituted for CABG volume data, using the databases available from the Northern New England Surgery Collaborative, the American College of Thoracic Surgery, or the state of New York, with a risk adjusted 30-day mortality rate as the threshold for compliance.

Outpatient safety programs

In addition to our implementation plan for the Leapfrog initiatives, FCHP is furthering its commitment to patient safety through the following programs.

High-risk drugs

In a collaborative effort with Fallon Clinic, FCHP identified approximately 60 high-risk drug interactions, which are now flagged real-time at our contracted pharmacies. By creating a distilled list of truly high-risk drugs, FCHP was able to achieve a much higher compliance rate, with pharmacists documenting calls in more than 90% of the targeted cases.

Anticoagulation management

Through FCHP's peer review process, oral anticoagulation was identified as a high-risk prescribing activity. With the help of an expert panel, FCHP developed and distributed guidelines for the appropriate management of patients on warfarin. Monitored compliance of this guideline has shown progressive improvement in four cycles of measurements at Fallon Clinic, our highest volume provider. In addition, FCHP created an online tool to assist clinicians at our high volume primary care provider sites in the complex management of this patient population.

Premature refills

Through our asthma management program, FCHP identified a sizable number of patients who were requesting premature refills of their beta-agonist rescue inhaler. We created a monthly pharmacy report to identify patients receiving more than two beta-agonist canisters per month, highlighting those who are not on concomitant anti-inflammatory therapy. We were able to use this tracking system to notify prescribing doctors who may not be aware of multiple premature refills if they are signed off by multiple prescribers. Additionally, targeted recommendations for anti-inflammatory therapy are offered along with referrals to our disease management program.

Fall and fracture prevention

FCHP has created and distributed practice guidelines to help our practitioners identify and manage patients at high risk for falls and fractures, including those with multiple medications contributing to their risk status. FCHP also has promoted the distribution of hip pads to members with the highest risk, as a means of preventing the most disabling fractures, and distributed several editions of our guidelines for the prevention and management of osteoporosis. Last fall, FCHP obtained grant funding to provide site-based screening at our high-volume primary care sites, using heel ultrasound technology. This funding allowed us to screen approximately 400 members.

Improving the quality of life

Fallon Community Health Plan anticipates our communities' evolving health care needs and creates innovative solutions so our services, and the services of our providers, improve the quality of life. We strive to give our communities tools, through education, communication and technology, to achieve good health. FCHP will continue to support the Leapfrog Group, as it will strengthen the link between patient, provider and health plan.