Automated Tracking and Reporting of Resident Experiences in

Automated Tracking and Reporting of Resident Experiences in Continuity Clinic Using Clinical Classification Software Greg Garrison, MD Vicki Jacobsen, MD Bob Bonacci, MD

An Alternate Title: Capturing a Resident’s Continuity Clinic Experience

Goals • Learn how Clinical Classification Software (CSS) available through Agency for Healthcare Research and Quality (AHRQ) can be used to summarize resident experience in clinic • Evaluate the utility of using a radar graph • Discuss how the tool can be used to tailor individual resident educational plans 3

Disclosures • Greg Garrison, MD – None • Vicki Jacobsen, MD – None • Robert Bonacci, MD – None

New FM-RC Requirements • Numbers, numbers and more numbers • Highlight the importance of tracking the number of encounters – Pediatric encounters – Women’s health encounters – Geriatric encounters

Resident Patient Panel • Over last several years panels have been streamlined – Total panel number – Gender mix – Pediatric patients – Geriatric patients 6

Goal • Develop a snapshot of each resident’s patient experience at clinic. 7

Data • Residents – Busy, self-logging not a sustainable option • Electronic Medical record is not FM-RC friendly • Billing data is separate from clinical data

Initial Questions • How many patients seen in FMC? – Count notes per resident • How many pediatric patients seen in FMC? – Count notes where patient’s age < 18 • What proportion of patients seen are continuity patients? – Combine with panel data and count visits where physician = PCP

The Residency Clinic • A nagging sense that female resident experience was different from a male resident experience – Continuity OB – Women’s health – Musculoskeletal – Procedures – Complex medical encounters

But how to capture experience? • Counts are great, but. . . • We want to know experience • Can we develop a tool….

Attributes of the Tool • Create a visual depiction of the resident experience that is easy to interpret • Ability to compare individual experience with peer group experience • Identify potential educational gaps

Possible Solution • Create a database to merge – Primary physician panel demographics – Clinical note information – Billing data • ICD 9 codes record diagnoses • Can ICD 9 codes reflect resident experience?

ICD 9 -CM Codes are Messy • Over 14, 000 diagnosis codes, 3, 900 procedure codes • COPD can be coded many ways ICD 9 Code Description 496 Chronic airway obstruction 490 Bronchitis, not specified as acute or chronic 491. x Chronic bronchitis 492 Emphysema 492. 0 Emphysematous bleb 492. 8 Other emphysema 494 Bronchiectasis 494. 0 Bronchiectasis without acute exacerbation 494. 1 Bronchiectasis with acute exacerbation 493. 2 Chronic obstructive asthma

Clinical Classification Software • Available free of charge from AHRQ • Groups the ICD 9 -CM codes into – 18 Major Categories (Infectious, Circulatory, etc. ) – Up to 3 more levels of minor categories (Circulatory->Heart Disease->Acute MI) ICD 9 Code CCS Level 1 CCS Level 2 CCS Level 3 CCS Level 4 491. 21 8: Diseases of the respiratory system 8. 2: Chronic obstructive pulmonary disease 8. 2. 4: Obstructive chronic bronchitis -

Resident Dashboard • Reports Clinical Classification Software aggregation of billing information • Presented in a radar graph, with average and max by PGY year • Report is discussed at semiannual review • Also includes visit counts and panel demographic data 16

The Result

Comparing Three PGY-3’s

So What About that Nagging Sense? • Female resident experience is different from a male resident experience… 19

Male vs. Female Resident

Capturing a Resident’s Clinic Experience • Is it important? • Confounders? • How can this tool be enhanced? 21

Thank You! • • Be sure to complete the session evaluation Bonacci. robert@mayo. edu Garrison. gregory@mayo. edu (technical) Jacobsen. vicki@mayo. edu 22