Safety net innovations often undergo continuous refinement after implementation. Our lessons and these tips can help others  incorporate impressions to refine these types of improvement projects after launching.

This is the seventh blog in a series highlighting how the Los Angeles County Department of Health Services helps patients better navigate their care. Catch up on part 1, part 2, part 3, part 4, part 5, and part 6.

We learned several lessons looking at first impressions of primary end users for Olive View-UCLA Medical Center’s Prospective Action in Care Transitions (ProACT) initiative, which aims to improve care transitions with emails to patient-centered medical home (PCMH) care managers automatically-triggered when a patient visits the emergency department (ED) or urgent care clinic.

Success Story: Re-Directing Patients to Their Patient-Centered Medical Home

A female patient had visited Olive View-UCLA Medical Center’s ED five times in the last year for low-acuity visits such as medication renewals. ProACT automated email alerts enabled our care manager to identify her latest ED arrival. We contacted the patient and advised her to call the clinic or nurse advice line in the future for low-acuity needs instead of turning to unscheduled rescue care visits.

ProACT has now been operational for 2 months. In that time, we gathered feedback from care managers regarding strengths of the system and how it could be improved.

Identifying Strengths

ProACT is:

  • Instant
  • Automatic
  • Passive
  • Limited to Olive View-UCLA Medical Center patients

Opportunities for Improvement 

  • Efficiency in identifying PCMH patients: OVMC has two PCMHs (one faculty-run, one house staff-run), each with a different care manager. Because Olive View’s final empanelment was incomplete until mid-June, ProACT was able to identify a patient was empaneled to Olive View, but not their PCMH or PCP. Consequently, care managers continued to spend valuable time checking non-ProACT sources identifying, based on visit history, the patient’s PCMH and PCP. Since mid-June, the relationship between patients and their PCP has been finalized through Olive View’s empanelment table. We now will soon route the email alert to the proper care manager and include the PCP’s name in the email.
  • Obtaining timely follow-up appointments. The house staff-run clinic recently began an Urgent Follow-up Clinic accommodating 12 patients per week. However, more patients than this require short-term follow-up. Olive View is preparing to begin provider telephone visits to fill this gap.
  • Achieving full coverage: ProACT captures only 90 percent of patients captured by the previously-used query report printed from the electronic health record (on the flip side, the previous method didn’t capture some patients ProACT does). This means 10 percent of PCMH patients presenting to the ED are not captured by ProACT. We will refine the system to capture these remaining 10 percent.

In practice, upon receiving a ProACT alert, care managers review the ED record and apply their judgment to determine if a patient requires a post-ED follow-up appointment and in what timeframe.

In the event that no short-term, face-to-face follow-up appointments are available at the Urgent Follow-up Clinic, care managers reach out and call patients to assess their well-being. They send letters to patients they are unable to contact, encouraging them to call the clinic. More refinements like this will continue, as we learn from longer implementation.

Innovations such as ProACT also require evaluation to connect outcome measures to original intended goals. In the next installment, we’ll describe the performance of mixed-method evaluations in health care settings.