According to the NCQA, a Primary Care Medical Home (PCMH) inspires quality in care, cultivates more engaging patient relationships, and captures savings through expanded access and delivery options that align patient preferences with payer and provider capabilities.
Located in Statesville, North Carolina, Piedmont HealthCare Family Medicine offers complete primary care services for all ages. As a part of the PCMH transformation process, Tara Frankhouser, DO, and the entire staff at Piedmont HealthCare Family Medicine identified and implemented several quality improvement projects throughout 2015 and 2016. The practice worked to improve in the following areas:
- Decrease in number of patients with a diagnosis of Chronic Kidney Disease or Diabetes who have high blood pressure – improved scores by 19%. The practice is now 100% compliant with this measure.
- Decrease in number of patients who need a Tdap immunization – improved scores by 18%.
- Focus on ensuring that all diabetic patients have an A1C < 8. The practice is well below the national benchmark at 12% compliance – well below goal of 30% compliance.
- Implemented a campaign for patients who need a DEXA scan
- Focus on getting patients in for pneumonia vaccines – reducing Prevnar 13 from 61% – 41% compliance from Q1 – Q2 2016 and reducing Pneumovax from 71% – 68% compliance from Q1 – Q2 2016
- Focus on decreasing hypertension in patients 60+.
- Focus on getting patients in for their Medicare Annual Wellness Visit with a goal of 85% receiving the service by end of year.
- Provide education and intervention for patients around smoking cessation.
- Focused on cost reduction, by making generic medications available to patients
- Opened up daily same day appointment slots, to allow patients to get appointments in a timely manner, as well as extended office hours.
- Worked to reduce hospital admissions and re-admissions. Decreasing less than 30 day readmission rate from 17% to 7%
- Implemented a Care Coordination department staffed with nurses and a clinical team. Their role is to reach out to patients by phone in-between their visits to the office, working with patients to help them meet their health goals (lowering blood pressure, lowering blood sugar, increasing exercise, weight loss, etc.).
- Conducted patient satisfaction survey to learn best what patients would like to see improved within the practice. The practice worked to meet patient expectations and saw improvement in most every measure within the survey.
PHC – PHC Family Medicine
Tara Frankhouser, DO
208 Old Mocksville Road
Statesville, NC 28625
704-838-8237 Phone
704-924-5358 Fax
