Metrics Definition - Patient Communication and Education
Metrics Definition - Patient Communication and Education
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Patient Communication Meaningful Use Norm
Patient Communication Meaningful Use Norm
Connect Care communication norms relate to meaningful use expectations respecting the provision of information, education and communication supports to patients. Key clinical information system workflows include timely and effective use of:
After Visit Summary (AVS) is printed at the end of emergency, outpatient and inpatient encounters. It is presented directly to the patient and/or designated decision-maker, with details about the encounter purpose, interventions, medication changes, diet and activity instructions, links to a post-encounter satisfaction survey and other clinically important details.
Educational handouts about conditions, interventions or medications can be incorporated into the AVS if selected (and optionally edited) by a provider.
Green Sleeve plastic pocket containing advance care planning documents printed at discharge and presented together with the AVS.
MyAHS Connect patient portal provides enduring access to discharge documents, educational materials, visit scheduling, communications and a wide range of other patient-centred information services.
Further details of the relevant meaningful use norms are summarized in the Connect Care Clinician Manual:
Patient Communication and Education Metrics
Patient Communication and Education Metrics
Evaluation the quantity (consistency) of use of patient education and communication supports at the end of visits or hospitalizations is difficult because AVS printing is built-in (and automated) as part of discharge workflows and is a required operating procedure. Whether printed materials are actually received by patients and families is better assessed through in-person quality assurance spot-checks. Rates of patient invitation, successful sign-up, and active use of the MyAHS Connect patient portal are readily available.
Evaluating the quality of content of patient encounter communication is currently limited to detecting the presence of structured data elements within an AVS that reflect provider interaction with sections focused on education and post-encounter care coordination.
Whether inpatient providers succeed in promoting MyAHS Connect uptake is reflected in the proportion of patients at discharge whose patient portal status (including in standardized discharge summaries) is "Active" or "Pending" or "Declined".
After Visit Summary Quantitative Metric
Proportion of discharged patients where nursing discharge checklist records indicate that instructional materials (AVS) are provided to the patient or designated decision-maker.
After Visit Summary Qualitative Metric
Proportion of discharged patients where the patient's AVS contains evidence of use of patient education, transition plan or follow-up instructions.
AHS Connect Status
Proportion of discharged patients where the patient's MyAHS Connect status is "Active", "Pending" or "Declined".
Workflow
Workflow
Encounter Documentation Norms and related Workflows are described in the Connect Care Clinician Manual.
After Visit Summary Quantitative
After Visit Summary Quantitative
AVS documents are automatically generated and printed at completion of emergency, outpatient or inpatient encounters. The summary is also automatically exposed in MyAHS Connect. Accordingly, measuring whether the AVS is generated or printed does not reflect whether the information is provided to patients or families.
Nursing discharge checklists include an entry for whether instructional information (AVS), together with patient belongings, are explicitly provided to patients at discharge from inpatient encounters. This flowsheet information can be used as a proxy for whether patients actually receive their AVS.
After Visit Summary Qualitative
After Visit Summary Qualitative
Minimum use activities, like medication and problem reconciliation, determine the content of parts of the AVS.
In addition, completing all steps of the Discharge Navigator will ensure prescriber awareness of tools for adding to, or revising, AVS content.
Follow-up Providers
Facilitates rapid selection of healthcare providers who will participate in post-discharge follow-up care, with the ability to add comments about how appointments will be made (e.g., "clinic will call to arrange").
Additional Appointment Instructions
Free-text field for adding any additional narrative about follow-up arrangements.
Education and Handouts
One or more patient handouts can be selected from an Alberta-optimized library (same as MyHealth and HealthLink resources, to provide high quality information about medications, interventions or health conditions.
Stock handouts can be edited by the provider for customized inclusion in the AVS.
A free text field can be used to provide overarching guidance in addition or instead of handouts.
AVS Preview
This final step in the Discharge Navigator allows the discharging prescriber to preview how all information (including medication reconciliation instructions) will appear to the patient.
MyAHS Connect Status
MyAHS Connect Status
Hospitalization provides an important opportunity to promote patient sign-up for MyAHS Connect patient portal services, particularly since the portal provides a "Day at a Glance" feature that helps patients and families anticipate important inpatient events.
Posters and flashcards are prominent in most inpatient units. In addition, inpatient charts provide visual indicators of patient portal activity at the top of the (left column) Storyboard. Clicking on the MyAHS Connect icon opens a tool for inviting or re-inviting sign-up with email or printed prompts.
Data
Data
After Visit Summary Quantitative
After Visit Summary Quantitative
Nursing safe discharge checklists include an entry for whether instructional information (AVS), together with patient belongings, are explicitly provided to patients at discharge from inpatient encounters. This flowsheet information can be used as a proxy for whether patients actually receive their AVS.
FLO 3040200081 R ASH IP STC BELONGINGS AND INFO GIVEN TO THE PATIENT - CATEGORY
User prompt: "It is important to ensure patients/families receive all of their belongings and information (ie. education materials, goals of care documentation, After Visit Summary) before leaving"
Response options:
Patient [1]
Family [2]
Support Person [3]
EMS [4]
Comment [5]
After Visit Summary Qualitative
After Visit Summary Qualitative
These AVS sections are associated with specific note type identifiers, which can be assessed for presence or absence in encounter-linked notes (EPT 20330):
"Additional Instructions" (HNO 34033 = 68)
"What's Next" (HNO 34033 = 65)
"Instructions" (HNO 34033 = 3041568)
"Patient Instructions" (HNO 34033 = 37)
"Attached Information" (HNO 34033 = 59)
Note types used by AHS are documented in the Builder Handbook:
MyAHS Connect Status
MyAHS Connect Status
MyAHS activation status is displayed in most provincially standardized summative document templates, including discharge summaries. This reflects values in a single data element, which should be the basis for metrics.
EPT 28006 MYCHART ACTIVATION STATUS - CATEGORY with values (Title):
Activated [1]
Inactivated [2]
Pending Activation [3]
Non-Standard MyChart Status [4]
Patient Declined [5]
Activation Code Generated, but Disabled [6]
Of the above, values [1] OR [3] OR [5] would constituted compliance with the Norm.
Many other data elements are available, giving additional information about how a patient was invited, when they signed up, whether there is proxy access, etc.
Metrics
Metrics
After Visit Summary Quantitative Metric
After Visit Summary Quantitative Metric
Description
Proportion of discharged patients where nursing discharge checklist records indicate that instructional materials (AVS) are provided to the patient or designated decision-maker.
Denominator
Number of Patient Encounters where:
Inpatient (EPT 10110 = Inpatient) AND
Discharged (EPT 10115 = Discharged) AND
Discharge disposition (EPT 1888) IS NOT EQUAL TO
Died in Facility OR Transfer to LTC / Mental Health / Addiction Treatment / Hospice OR ED Transfer to stand alone rehab/AMH OR * Transfer to another acute care facility OR Transfer to acute care facility with planned repatriation OR Client Self-Discharged OR Left Against Medical Advice OR Transferred to another ED OR AWOL
AND
Specified time of discharge (I EPT 18855 Hospital Discharge Date and I EPT 18856 Hospital Discharge Time)
Numerator
Number of Patient Encounters from denominator where:
Discharge Checklist response (FLO 3040200081) is NON-NULL
Calculation
Numerator DIVIDED INTO Denominator expressed as PERCENTAGE rounded up to nearest integer percentage point
Filters
Hospital Speciality Service: EPT 18886 - CATEGORY - (e.g., General Internal Medicine [106])
Hospital Unit: EPT 18880 - CATEGORY - inpatient unit/ward (e.g., EDM UAH WMC 5D4 GIM [101094229])
Hospital Facility: EPT 18883 - CATEGORY - (e.g., EDM WMC University of Alberta Hospital [101094])
Analytics Definition
After Visit Summary Qualitative Metric
After Visit Summary Qualitative Metric
Description
Proportion of discharged patients where the patient's AVS contains evidence of use of patient education, transition plan or follow-up instructions.
Denominator
Number of Patient Encounters where:
Inpatient (EPT 10110 = Inpatient) AND
Discharged (EPT 10115 = Discharged) AND
Discharge disposition (EPT 1888) IS NOT EQUAL TO
Died in Facility OR Transfer to LTC / Mental Health / Addiction Treatment / Hospice OR ED Transfer to stand alone rehab/AMH OR * Transfer to another acute care facility OR Transfer to acute care facility with planned repatriation OR Client Self-Discharged OR Left Against Medical Advice OR Transferred to another ED OR AWOL
AND
Specified time of discharge (I EPT 18855 Hospital Discharge Date and I EPT 18856 Hospital Discharge Time)
Numerator
Number of patient encounters from denominator where encounter-linked notes list (EPT 20330) INCLUDES
"Additional Instructions" (HNO 34033 = 68) OR
"What's Next" (HNO 34033 = 65) OR
"Instructions" (HNO 34033 = 3041568) OR
"Patient Instructions" (HNO 34033 = 37) OR
"Attached Information" (HNO 34033 = 59)
Calculation
Numerator DIVIDED INTO Denominator expressed as PERCENTAGE rounded up to nearest integer percentage point
Filters
Hospital Speciality Service: EPT 18886 - CATEGORY - (e.g., General Internal Medicine [106])
Hospital Unit: EPT 18880 - CATEGORY - inpatient unit/ward (e.g., EDM UAH WMC 5D4 GIM [101094229])
Hospital Facility: EPT 18883 - CATEGORY - (e.g., EDM WMC University of Alberta Hospital [101094])
MyAHS Connect Status Metric
MyAHS Connect Status Metric
Description
Proportion of discharged patients where the patient's MyAHS Connect status is "Active", "Pending" or "Declined".
Denominator
Number of Patient Encounters where:
Inpatient (EPT 10110 = Inpatient) AND
Discharged (EPT 10115 = Discharged) AND
Discharge disposition (EPT 1888) IS NOT EQUAL TO
Died – Died in Facility [41] OR
Transfer to Another Facility [214] OR
AMH – Client Self-Discharged [236] OR
Left – Against Medical Advice (AMA signed) [7] OR
ED – Transfer to another ED [216] OR
Left – Absent Without Leave (AWOL) (AMA not signed) [206] OR
Transfer to acute care facility with planned repatriation [215]* OR
ED Transfer to stand alone rehab/AMH [217]* OR
Transfer to LTC / Mental Health / Addiction Treatment / Hospice [218]*
AND
Specified time of discharge (I EPT 18855 Hospital Discharge Date and I EPT 18856 Hospital Discharge Time)
*These discharge dispositions were deactivated as of October 29, 2024. However they are still included in the metric to ensure correct data before they were deactivated.
Numerator
Number of Patient Encounters from denominator where:
EPT 28006 MYCHART ACTIVATION STATUS EQUALS (Activated [1] OR Pending Activation [3] OR Patient Declined [5])
Calculation
Numerator DIVIDED INTO Denominator expressed as PERCENTAGE rounded up to nearest integer percentage point
Filters
Hospital Speciality Service: EPT 18886 - CATEGORY - (e.g., General Internal Medicine [106])
Hospital Unit: EPT 18880 - CATEGORY - inpatient unit/ward (e.g., EDM UAH WMC 5D4 GIM [101094229])
Hospital Facility: EPT 18883 - CATEGORY - (e.g., EDM WMC University of Alberta Hospital [101094])
Limitations
Limitations
After Visit Summary Quantitative Metric
After Visit Summary Quantitative Metric
The current proxy for provision of an AVS to a patient at discharge is a discharge checklist flowsheet row that should be completed as a standard operating procedure. However, the data entry is not associated with a Hard Stop and so this metric depends upon data entry behaviors and compliance with procedural norms. Moreover, the flowsheet row does not explicitly call out the AVS as the patient instruction material that should be provided.
After Visit Summary Quality Metric
After Visit Summary Quality Metric
There is more than one way to enter follow-up provider information in Connect Care. Some discharge order sets have provisions for entering follow-up referral requests or triggering requests for other types of post-op encounters. Occasionally, information may not make it into the AVS.
If providers do not follow sequential steps in discharge management, then it may be possible for an AVS to be generated before all follow-up and patient education information is entered; and the AVS content provided to the patient may not reflect the AVS content recorded in the system (MyAHS Connect AVS will still be complete).
MyAHS Connect Status Metric
MyAHS Connect Status Metric
Barriers to access to MyAHS Connect include complex Alberta Health sign-up constraints that force patients to apply for, and maintain in active state, a MyAlberta Digital Identity. Obtaining this incurs delays. More importantly, the MyAlberta identity is only available to Albertans who can produce a (physical) Alberta Identity Card or Alberta Driver's License. Marginalized groups (lacking these documents or easy access to processes for getting them) will not be able to maintain patient portal access. Newcomers to Alberta and all patients from other provinces or countries will not be able to complete the sign-up process and will remain in a "Pending" status until their activation code expires, at which point they disappear from the numerator.
Reports
Reports
Radar Dashboards
Radar Dashboards
Reporting Workbench
Reporting Workbench
Slicer-Dicer
Slicer-Dicer
Components
Components
Summative documentation content is supported in Connect Care (Epic) with standardized templates that make use of AHS-validated standardized components, many further described in the Builder Handbook.
SmartLinks (HHS)
101757 MYAHS CONNECT COVID ACTIVATION (MACCOVIDACT)
CERMSGREFRESH(304716414,1,0,1) - MyAHS Connect Status
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