Using Pre-Visit Planning to Close Care Gaps

Background: The Healthcare Effectiveness Data and Information Set is a standardized set of performance measures maintained by the National Committee on Quality Assurance (NCQA) that relates to many significant population health issues. HEDIS data can be used to identify opportunities for gap closures and track annual performance (Centers for Medicare & Medicaid Services, n.d). The system-wide goal for this health care facility is to achieve four-star rating across quality metrics to include diabetic health screenings and testing, mammography, colorectal cancer screening, and preventative immunizations across the population health spectrum. The purpose of this initiative was to develop a pre-visit planning process as a standard way to identify care gaps for individual patients prior to their visits so that gaps in care could be addressed during the visit.
Methods: In late 2019, a multidisciplinary team was formed to implement pre-visit planning. Two primary care clinics were selected as pilot sites, which included leader input from the nursing, physician, and operational perspectives. However, the dissemination efforts to all practices were halted due to COVID-19 pandemic in April 2020. In April 2021, an analysis was conducted to determine which practices were utilizing pre-visit planning. In the summer of 2021, nursing, physician, quality improvement specialists, the primary care nurse educator, operational leaders, and clinical support staff created a standard workflow. Medical assistants and licensed practical nursing staff provided input on key tasks to shape the workflow for patient visits and rooming. They assisted with peer-to-peer training and collaboration with schedulers to include steps on obtaining medical records and the state’s immunization registry access. Tests of change included creating a standard pre-visit clinic workflow based on Gemba walks and a standard pre-visit planning document. In October 2022, the hospital system transitioned to a new electronic medical record platform allowing pre-visit planning and gap closure to be more readily operationalized.
Results/outcomes: By September 2021, seven practices began to roll out the process and evaluation of the processes occurred. In December 2021, nine additional practices were conducting pre-visit planning. As of February 2022, all 54 primary care practices have pre-visit planning as their standard workflow. The pre-visit planning process continues to be utilized even upon transition to a new EMR. A rooming checklist process was developed by the front-line staff with mentorship and guidance by the nurse leaders. The RN educator and nurse manager leaders continue to provide training updates for current and new staff members. Nurse leaders and front-line staff collaborated with physician partners and operational leaders during the EMR transition to ensure the incorporation of the pre-visit planning process.
Implications for practice: Pre-visit planning has implications for patient partnerships, chart review, rooming practices, and office staff communications to provide comprehensive, quality care.