How Physicians Are Embracing Preventative Care

On the face of it, it almost sounds like some CIA operation: "The Proactive Office Encounter Approach."

But it's not clandestine, and there's the rub. The Southern California Permanente Medical Group's patient care system, dubbed POE, appears to reflect what healthcare reform is all about, with designs on improving quality and establishing data to back up what they do, working toward a clean slate of transparency.

The POE system allows physicians to begin focusing on preventative and chronic care needs of patients almost as soon the patients step inside the door of their offices, whether the conditions were reasons behind the visit or not. The system uses, in the medical world parlance, "standardized workflows" and "sophisticated information technology" to achieve its outcomes. Whatever The Southern California Permanente Medical Group calls it, the system is about carrying out preventative care.

Since its inception, POE has contributed to sharp improvement in the group's clinical quality performance, in areas ranging from colorectal screening to blood pressure control, says Michael Kanter, MD, regional medical director of quality and clinical analysis for The Southern California Permanente Medical Group. It is the physician's group for Kaiser Permanente members in Southern California.

Clinicians, labor partners, and health care professionals and administrators work collaboratively to develop the process, in which electronic medical records are important components. Even before a patient's visit to the physician's office, staff works to identify "gaps in care" for particular patients as their histories become better known.

"One thing to keep in mind is every time a patient with high blood pressure comes in for a visit, even if they are not coming in for a blood pressure check, it is another opportunity to monitor and speak with them about their blood pressure no matter what department they are going to since every department is documenting patient care gaps," Kanter says. "This is also a demonstration of what we refer to as complete care, which is providing every aspect of care to our patients throughout their life cycle."

In instances where patients have high blood pressure, they may be placed on medication and begin an ongoing monitoring process. Also, they may referred to a hypertension clinic, and also begin health education classes and instruction. Proper nutrition and exercise programs are also established. The idea is to get the blood pressure to an appropriate level.

"Since we've implemented this new way of practicing, we've seen many cancers detected earlier and found cases of undiagnosed hypertension, and we have some of the best blood pressure control rates in the country," Kanter says.

The conclusions drawn from an analysis of data compiled by POE show an improvement in clinical strategic goals and in "closing care gaps" at every opportunity. Some of the improvements from 2006 to the second quarter of 2009 include:

• An 18.5% increase in patients screened for colorectal cancer, from 52.5% to 71%
• A 17% increase in the number of patients counseled to quit smoking from 53% to 68%.
• A 12.2% increase, from 70.5% to 79.6% in controlling high blood pressure for patients aged 18 to 85.
• A 9.3% increase in the percentage of patients given a retinal screening test from 61.6% to 70.9%

While individual physicians, departments and medical centers have previously implemented various programs to address patient care needs, of course, Kanter sees a difference in his staff does by, again, closing those "preventative and chronic care gaps."

Closing the "care gaps" – isn't that what every physician wants to do? Kanter agrees. In "most physician offices, they do not have complete access to all the relevant information about a patient," he says

In many instances, a primary care doctor would refer a patient to a dermatologist, but that dermatologist would not know, for instance, she needed a mammogram, Kanter says. Under the proactive encounter, "each patient contact presents an opportunity to remind the patient that she needs a mammogram," Kanter says.

"The idea is to get patients the tests and/or other preventative measures they need regardless of where they enter the Kaiser Permanente health system," Kanter adds.

Overall, patients have been receptive and have not felt the added information would be intrusive, he says. 

"Patients are particularly impressed when they visit a physician or other provider who is not their primary care physician and are offered a flu shot, or a mammogram" Kanter says. "They might expect their primary care physician to have that information, but are particularly grateful when they get reminders from receptionists and others in specialists' offices. They are impressed to see how much information their primary care doctor or specialist has at his or her fingertips."

Kanter is excited about the possibilities. I keep thinking about the quality initiatives being launched under healthcare reform, and many of the plans are wrapped around the idea of detecting health issues involving patients before they become full-blown problems. And that's what the POE is all about. Kanter says the POE is working for physicians, too.

"Physicians like POE because it allows them to do what they were trained to do: talk with patients, diagnose issues and treat them," Kanter says.