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    Healthcare Plan Information

    MVP Health Plan Patient Safety Initiatives

    Facilitating the delivery of appropriate care in the best setting and at the right time is a key objective of MVP's medical management programs. As care grows increasingly more complex, errors may be inevitable. Support of processes and programs that minimize such errors will increase the likelihood that our members achieve an optimal health outcome. MVP's Quality Management Program includes progressive elements aimed at maximizing appropriate care and reduction of medical errors. Interventions address both ambulatory and inpatient opportunities for improvement. Interventions such as the development of the Hospital Quality Profile allow MVP to analyze key quality indicators (satisfaction, safety and continuity of care) at our high volume hospitals in order to establish current performance levels and identify opportunities for improvement.

    Primary Care Physicians (PCPs) are also evaluated on several safety issues in areas that have proved to reduce errors in practitioners' offices. These issues focus on systems the practice has in place regarding abnormal tests, missed appointments and reminder systems to ensure consultant reports are returned to the PCP.

    The following describes the results of MVP's Patient Safety efforts in 2003.

    Hospital Quality
    In the second quarter of 2003, the MVP Hospital Quality Profile for acute inpatient facilities was distributed to the twenty -four hospitals that serve the largest number of members. The reports summarized level of compliance with LeapFrog standards, member satisfaction information and compliance with evidenced based referral standards. Results were compared to similar type facilities (academic, rural, urban) and to plan wide results.

    Prior to distribution of the Hospital Quality Profile, a Request for Information (RFI) was sent to each of the hospitals and 54% (13) were returned. MVP's RFI focused on the same issues identified by the LeapFrog Group. Credit was given to nine hospitals that submitted data to LeapFrog. The major RFI findings are highlighted below:

    • 44% of the hospitals reported having a physician order entry system in place or a plan to implement by 2004.
    • 72% of the hospitals have physicians who are certified in critical care medicine staffing the ICU or a plan to implement by 2004.

    In the first quarter of 2003 MVP worked with Fact Finders, an independent research firm, to conduct a survey of member satisfaction with hospital services. Members admitted during 2002 to one of the 24 high volume hospitals were randomly selected to be interviewed. The survey focused on service, communication, quality of care, safety and continuity of care. Results were reported to the QIC in June 2003. Overall findings of the 2003 survey include:

    • Overall satisfaction and quality of hospitals     78.4%
    • Satisfaction with nursing staff     80.4%
    • Safety     91.8%
    • Continuity of Care     96.2%

    As a result of the findings from the RFI, The Senior Medical Director of QI met with several of the hospitals regarding initiatives and collaborations focusing on continuity of care.

    Continuity and Coordination of Care

    Hospital/ER care

    On an annual basis, MVP assesses continuity of care for hospitals by looking for evidence of feedback received by PCPs for their patients who had an inpatient stay or ER visit. Medical record review results for 2002 and 2003 are shown below:

    Continuity of Care Medical Record Review Results
      2002 2003
    Inpatient 48.50% 49.4%
    Emergency Room 39.20% 43.6%

    To assess barriers to continuity of care, MVP added a section to the 2004 hospital RFI containing seven questions on the hospitals' process for sending discharge summaries and ER reports. In addition, a list of the members seen in the hospital whose charts did not contain evidence of feedback according to the 2002 medical record review was provided with the mailing. Hospitals were given the opportunity to audit their records and submit evidence that they sent the records. MVP plans to take these findings into consideration and give the hospitals credit on the next edition of the Hospital Quality Profile due to be released in the Spring of 2004. Analysis of the continuity of care section of the RFI will allow MVP to identify further opportunities for improvement.

    Vermont ER/PCP Study
    MVP monitors the communication between the ER physicians and primary care physicians in Vermont on an annual basis. Efforts in VT focus on those hospitals within the state that are not included in the plan wide efforts described above. In 2003 hospitals with fifteen or more claims for emergency room visits between September 2002 and March 2003 were included in the study.

    For these facilities, up to 40 claims were selected at random and a survey was sent to the PCP on record to determine if an ER discharge summary was received. Feedback was received from 100% of all PCPs surveyed for this project. Reported hospital compliance rates ranged from 32-85%.

    As another part of the study, MVP requested verification from each facility that ER records were sent as recommended. Results from this survey were then compared to the PCP survey results to assess medical record filing procedures within PCP offices. These results did not reveal any trends as feedback was only received from four of the eight eligible hospitals.

    Following the study, MVP called each hospital to determine their process for sending ER records to the PCP. Feedback from the hospitals with a compliance rate of 80% or higher indicated that they have processes in place to verify an individual's PCP during the ER registration process and to ensure that a copy of the ER note is sent to the PCP by the Medical Records department.

    Processes reported by hospitals with lower rates included:

    • Requesting that the dictation company fax the notes to the PCP
    • Not sending records unless requested by the patient due to HIPAA
    • Requiring that the ER physician request that the notes be forwarded to the PCP
    • Sending copies of records to PCPs for MVP patients based on a formal report
    • Sending ER notes only to the physician the member will see for follow-up care
    • Sending notification electronically that the ER notes are available

    Information received to date from these hospitals indicates that they are not able to confirm 100% of records are sent to PCPs. For those hospitals with electronic notification processes in place, MVP is not able to confirm notification of the PCP.

    Ambulatory Medical Record Review

    In 2003, the continuity and coordination of care component of the ambulatory medical record review was expanded. Medical records were reviewed for feedback from cardiologists, gastroenterologists, and orthopedics as well as hospital discharge summaries, ER reports, and Behavioral Health specialists. To measure the feedback received by the PCP, each provider's chart review list contained members identified through claims to have utilized one or more of these services. The results below indicate the percentage of medical records that had feedback from the provider or the facility. Where available the 2003 rates are compared to the 2002 results.

      2002 2003
    Hospital discharge summary 48.5% 49.4%
    Emergency Room report 39.2% 43.6%
    Behavioral health specialist 16.5% 22.1%
    Cardiologist NA 65.9%
    Gastroenterologist NA 72.8%
    Orthopedist NA 58.8%

    In 2003, QI staff interviewed office staff at high volume PCP offices to assess the processes in place to ensure effective communication and continuity of care. As evidenced below, most office staff reported that procedures were in place to ensure communication and continuity of care.

    Reminder or Follow-up Process Result
    Sending all vital information on to consultants 99.0%
    Ensuring timely feedback from consultations 76.5%
    Following up on patients who missed appointment 96.0%
    Following up with patient who have abnormal test results 99.9%
    Following up on patients requiring re-checks or periodic testing 99.3%

    During their site visit, the reviewers educated the practice sites on the importance of sending relevant patient information and following up to obtain timely feedback. To aid the practice sites, the reviewers distributed communication forms to send to specialists with relevant patient information and a feedback form for specialists to send back to the PCP.

    During 2004 in addition to interviewing the office staff, the QI reviewers will be looking for evidence of these systems as part of the on site review. MVP's communication and coordination of care forms will again be promoted at the practice sites. The purpose of these forms is to improve the quality of care by: preventing duplication of tests, promoting follow-up of important clinical findings, and preventing harm caused by the dispension of a medication that is a known allergen for an individual.

    PCP Experience with Continuity of Care
    The medical record reviewers also conducted a survey on PCP experience with feedback from different types of providers and facilities. PCPs were asked to rate each provider type on a scale of one to five. (1=poor, 5=excellent)

    Provider Type PCP Rating
    Hospital inpatient 3.58
    Emergency Room 3.29
    Behavioral health 2.33
    Specialists 3.61
    Ambulatory surgery 3.16
    Home health agencies 3.89

    Within the specialist physician category, PCPs ranked their experience with specific specialties. The PCP's surveyed ranked cardiologists, gastroenterologists and orthopedists the highest for communicating back to them. Behavioral health specialists, psychiatrists and OB/GYN providers were ranked the lowest. Other survey responses indicate that 99% of the PCP's preferred written feedback over verbal/telephonic reports; 79% of PCPs schedule appointments with the specialists for their patients at the time of referral and 96% of PCPs reported sending appropriate clinical information to the specialist.

    Improving Dilated Eye Exams for Diabetes Patients Initiative
    An initiative was undertaken in late 2003 to increase the rate of dilated eye exams performed on diabetic members and the coordination of care between PCPs and eye care providers. Letters were sent to over 80 eye care providers along with coding information and lists of diabetics. A continuity of care form that the eye care provider could fill out and send back to the member's PCP was also included. A survey was included with the mailing to assess usefulness of the initiative. 73.3% of the respondents indicated the continuity of care form was useful.

    Future Plans
    Current plans call for MVP to make the hospital quality profile available to providers and members via the MVP website during 2004. Patient safety information will also be shared with members via MVP's quarterly newsletter, Healthy News. In an effort to help physicians educate their patients about improving patient safety the 2004 edition of the Physician QI Manual and Tool Kit will contain a patient brochure and an exam room poster that highlight steps individuals can take to decrease the likelihood of an adverse event happening to them during a hospital stay.

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