Quality Matters at Community Health By Jill Jesso-White on January 8, 2020 in Community Health News HPV Vaccination Rate Improves with Quality Assessment Rutland – Tracy Upton is a registered nurse, a career caregiver and skilled provider who has worked in primary care and pediatrics for 23 years. She cares about quality. Upton’s 17 years of direct patient care experience is being applied more strategically now in her role as the quality improvement manager. Upton works closely with Community Health’s medical director and clinical director to prioritize ways to make the delivery of health care at Community Health more effective, more efficient, and more geared toward addressing patient’s health needs before issues arise. Upton was a nurse at Community Health Pediatrics when the practice transitioned to electronic medical records (EMR) in 2010 and saw how data from the EMR could improve patient care and help providers really understand their patient population. “We use data to drive our work clinically in the organization,” she said. “Our current EMR was implemented less than two years ago. The EMR has the ability capture discrete data and to do a lot of great reporting.” For the reporting to be reliable, the data needs to be documented accurately and consistently. “It’s been a slow process in terms of making sure people document in the right place every time they add data to the chart. That’s one of our challenges,” she said. Upton took the lead in a nine-month nationwide study of HPV vaccination rates that started in November 2018 and wrapped up in July 2019. The National Immunization Partnership and the Academic Pediatric Association (NIPA) sponsored the initiative to improve HPV vaccine rates for adolescents 11-17 years of age. The Centers for Disease Control recommends the human papillomavirus (HPV) vaccine for 11- and 12-year-old boys and girls as the best way to protect them against certain types of cancer later in life. The required monthly webinars, data collection and reporting in the NIPA study were a big time commitment and Upton credits Dr. Carl Beckler and Practice Leader Betty Ellingsen at Community Health Mettowee for championing the project at the practice level. “Monthly chart reviews and online data submission were requirements of the project. Every month I would review charts, identify 16 patients who were eligible to receive the HPV during an office visit and submit data online.” Every eligible patient who did not receive the vaccine was counted as a missed opportunity. “Our missed opportunity rate was over 80% at the beginning of the project. By the end of the project, our missed opportunities rate was below 50%” Upton said. “The HPV project highlights how we can use our data to move quality forward and improve the level of care we give to our patients.” Upton said the HPV study not only showed improvement in vaccination rates, it also revealed that presenting data directly to providers can make a difference in the way they practice. “We started to change the way they thought about all opportunities to address any gap in care.” As an FQHC (Federally Qualified Health Center), Upton says Community Health has several external quality data requirements that must be reported on a regular basis. “We are always creating reports to evaluate data,” she said. As an organization we need to be sure data is collected correctly, to accurately reflect the level of care our providers are giving to our patients. Collecting data and sharing data demonstrated an improvement in HPV vaccination rates, supporting Upton’s goal of increased overall quality. As a nurse, Upton says her clinical background has been invaluable to her role as a quality improvement manager. Upton’s next challenge is to develop and expand the role of improving care through quality projects in all of Community Health’s seven primary care and Express Care practices. To assist her in achieving this goal Upton has recently hired a clinical data coordinator who works closely with her on data sharing and data integrity, and a population health coordinator to outreach to patients who have identified gaps in care. Upton (right) and her manager, Community Health Clinical Director Claudia Courselle (left), were selected to produce a multimedia version of the presentation they made at the 2019 American Academy of Ambulatory Care Nursing conference. Their presentation of Community Health’s Care Management Program can be viewed on the organization’s online library of care management programs from around the country or watch the presentation here: https://library.aaacn.org/aaacn/sessions/2367/view Community Health is the largest network of primary care, pediatric and dental services in Rutland and southern Addison counties with offices in Rutland, Brandon, Castleton, West Pawlet and Shoreham. Community Dental offices are located in Rutland and Shoreham, Community Health Pediatrics is in Rutland and Community Health’s Express Care centers, open seven days a week, are located at the Rutland and Castleton Community Health Centers. Behavioral health providers are available at all Community Health locations. The mission of the Community Health (Community Health Centers of the Rutland Region) is to improve the health and wellness of all people in the communities we serve by providing access to excellent medical and dental primary care regardless of any financial consideration.