Sharp Rees-Stealy Medical Group

Sharp Rees-Stealy Medical Group, the region’s oldest multi-specialty medical group, is committed to providing the finest in personalized healthcare. We provide care at 19 locations with 1,600 employees and more than 340 physicians representing virtually every medical specialty. In 2007, we had over one million patient visits, with nearly 70 percent of the population covered by one of several managed-care arrangements.

Since our medical group’s founding more than eight decades ago, the philosophy has always been to place the well-being of the patient first, followed by what is best for the medical group, and then the individual physician. This is one of the cornerstones of our mission, and it is deeply embedded in our organizational culture. It drives our desire to provide an optimal healthcare experience for patients in terms of quality, service, and access.

The aim is to offer quality services that set community standards and exceed expectations. We have designed a quality improvement program to optimize preventive, acute, and chronic care in addition to providing an outstanding patient experience. The initiatives have included

• Implementing a comprehensive electronic health record (EHR) system
• Building the IT infrastructure to produce the data needed to determine our outcomes
• Creating multidisciplinary teams to engage physicians and staff to design and implement quality and service

initiatives

• Implementing point-of-care alerts to notify physicians when patients require additional services
• Building a diabetes registry to track diabetic patients
• Improving scheduling to increase patients’ ability to see their primary care physician on the same day they call for an appointment

Appointment

• Implementing outbound phone calls to reach out to patients due for services
• Implementing physician report cards for quality and service measures
• Establishing a physician incentive program based on quality and service
• Developing, reviewing, and setting performance targets
• Tying manager performance reviews to achievement of strategic targets

We apply quality improvement resources towards projects that will clearly create better health for patients and community. Two projects illustrate our ability to achieve dramatic improvements in patient outcomes: blood sugar control in high-risk patients with diabetes and breast cancer screening.

The blood sugar control program (called “DM-9”) focuses on patients whose last HbA1c was nine or above. We initiated the “planned visits” model in which patients follow a pathway that includes physician or staff interventions prior to, during, and after the office visit. Lists of qualifying patients are provided to individual physicians who pro-actively schedule a visit dedicated to helping the patient attain better diabetes control. Staff then calls the patient one week prior to the visit to remind them of their appointments and their need to bring their medications, the blood sugar log book, and to have their laboratory tests done. Physicians developed an evidence-based algorithm that guides treatment, and on-site nurses have been trained to provide insulin teaching for new starts, when necessary. Finally, diabetes case managers follow-up telephonically with each patient after the visit. Since the inception of the program in January 2007, DM-9 has resulted in a 15 percent reduction in the number of patients with HbA1c level nine or above.

Breast cancer screening was a focus of an extensive, multidisciplinary team review. The goal was to increase mammography screening rates by improving access, customer service, and physician office efficiency. The team instituted centralized radiology scheduling, with a single number to call. A system of standing orders and self-referrals allows women to call the central scheduling office directly to schedule their mammograms. To improve compliance, a computerized automated reminder system notifies women when they are due for a mammogram and offers the option of scheduling a Pap smear and mammogram on same day for convenience and dramatically reduced wait times. Most sites at Sharp Rees-Stealy now offer same day mammograms and breast cancer screening rates have improved from 73 percent to 85 percent in the past four years.

These and other quality improvement projects have fostered the creation of a flexible, learning organization. We set high expectations for our physicians and staff, knowing that our patients and community will benefit from the improvements. Transparent goals and feedback drive accountability throughout the medical group. Multidisciplinary teams facilitate open communication and reduce barriers based on tradition or hierarchy. Rounding by top leadership (sites visits and problem-solving at the local level) creates trust and helps maintain momentum. Incentives, both financial and non-financial, create alignment between strategic quality and service goals and performance.

We are proud of the recognition our quality efforts have received, both within California and nationally. For the second year in a row, Sharp Rees-Stealy Medical Group has earned the title of top performing physician organization in Blue Cross of California’s Quality Scorecard. Also in 2007, Sharp Rees-Stealy was selected as the American Medical Group Association’s Acclaim Award honoree, an award recognizing organizations that embrace the Institute of Medicine’s aims for an ideal healthcare system. We achieved another milestone in 2007, when Sharp HealthCare was awarded the Malcolm Baldrige National Quality Award, the nation’s highest Presidential honor for quality and organizational performance excellence.

With patients/consumers and employer groups demanding transparency in healthcare costs, quality and service, Sharp Rees-Stealy began to strategize early to align the structure, culture, and processes to support the effort and achieve success. We learned data is the key for successful quality improvement efforts. Accurate, high-quality data is critical because without it, it is impossible to create feedback reports and point-of-care tools and to understand if changes result in true improvement outcomes. The adoption of an electronic health records system will allow us to continue our efforts towards providing efficient, high-quality care. Above all, it is our physicians who make the difference. Their skill, dedication, and commitment to excellence position Sharp Rees-Stealy Medical Group well for ongoing quality and service improvement.