ing squeezed out of the hotel beds not having places to throw people metric number had the finance measure and we met our target in terms of the expenses and number 5 is our workforce experience we implemented our first ever network wide will take 4 to 6 weeks that will serve our baseline and number 6 is civil service retirement there was several a process over purchase it is imagining efficient we know that we're looking at it very concretely and specifically at san francisco board of appeals and anticipate that the learning we have there and the process improvement will be applicable to the rest of the

dpw i'll get back to 7 in a second number 8 this a house do i have in mind this is trying to measure a urban if i had organizational culture that measures 6 hundred a 5 staff at san francisco board of appeals we took a web-based module this is something that needs to be looked at some more all right. so number 7 is around patient experience i'm going to talk about this in the quality metric session i wanted to let you know original we have two questions per division one right of vendors c.j. caps changed divisions so for both

substance abuse they manually administer there is not love changes it is fairly flat same tool and methodology important substance abuse and pretty flat health at home they've used we have approved a tool for health at home agrees what i'll say awhile a 20 percent dollars decrease this last database there are 39 patients and in general you need one hundred to say something robustly jailhouse we have homegrown survey administered every six months a flash in the bar there is a change in methodology we

changed the question question and scale the change is not comparable laguna also has a homegrown survey they've met their target primary care additional speciality care use another cms tool they met their target this one has expand if 236 clinics and expand to the speciality clinics and san francisco board of appeals uses another tool and the whole task force is working on the task scores number 9 our clinical measure we're proud of achieving 70 percent mammogram rate

comparable to commercially insured patient and the last measure is around care coordination the primary care coordination and while the methodology changed over the baseline they've met their target i realize it's a rolling overview you have a lot of documents i'm happy to answer any questions or clarify any part of this i want to talk about quality measures and answer questions altogether >> right? >> okay. >> when we talk about health care measurement but talk about 3 big budget operational and financial and clinical i mean experience when you think of a way forward metric we say one financial and one clinical that

doesn't mean we're not tracking a mri idea of measures scott wiener we have so many that is difficult to boil it down in the dashboard i want to give a 50 thousand feet overview of the quality metric one with two take home merge clipal measures are important we're a clinical facility and two they're complex and we face a number of challenges okay. so all you remember for the next few minutes all right. so the first to know there are a lot of cooks in the kitchen there are a number of different regulatory agencies and payers that mandate a variety of metric for different part of division for different programs bless you. >> let's change with health

reform it is no longer just pay for reporting it is pay for performance so if you want to get away interest fray fee service payments for providing service and moving targeted getting paid for the quality of the service we all agree i think everyone in health care agrees with that we face challenges we have fragment systems just because something that measurableable it didn't mean it's meaningful in terms of the way forward staff understanding the key for looking for your keys under the lamp post you probably revolt them on the pathway so something

straightforward comparing across the division is apples and oranges when i try to conveyer the clinical measures those are different and then we talk about availability external benchmarks the internal validity and the sheer proliferation of sheer numbers of measures we have to have thoughtful analysis i want to touch on one the first one on data systems people talk about there's a gap between data and information information and knowledge and knowledge and other fields this is a schematic by one of our it staff that shows all the databases to

distract from let alone knowledge we've been working on that and with the b i u when you get this data how do you push it out in a rational way this is the apples and oranges issue i want to walk you through the metric number 7 in the first column i see the tool that is announced the second column who is used that this is - the sample question on the scale and the scoring for example if you're in behavorial health you're asked i would recommend this agency to a friend or family member rate us on a scale one to 54.3 are 5 if you're health at home you get a question would i recommend this

to a family or friend definitely no probably yes or definitely yes. you don't get an average your score is the percentage of people that answered definitely yes, if no one answered probably yes and 50 percent probably yes you'll get a 50 percent rate so alright so the next slide i want to give you a sense of the scope clinical measurement sieve seen that we track one hundred and 96 miles an hour for both reporting and pay for performance laguna holland there is 17 benchmark 11 are pubically recorded i wanted to our

scores are are pretty darn good and 7 were better than the state average etc. for health at home we use the c mc called the 0 was the numbers are small we'll be fair and reasonable compared to the national average primary care tracks a number of measures and again we have done pretty well over the years the orange bar is fitting the green bar and the gray bar a comparable population green a medicaid and glare is the community health centers the grair is the community population most of us so as you can see we actually do almost as well or better in the

commercial population for most groups and in the last metric lower is better and then in behavorial health an unanimous audit their 20 clinical measures and then there will be an additional 7 clinical manufacture in the last four slides from the 50 to the one thousand foot measures with you have one hundred and 12 measures on a grid what actually going goes into that >> so sf hs this is the harder thing to push so for example they standardized you'll hear standardization so across the clinics they've embedded it into the eir and gave realtime feedback to people how they're

doing similarly on the section around c sections they standard device their way of doing thing interesting decrease the number of people walking in and out of o r and actually moved from staples to sutures and reduced by half their surgeon section i think you've seen some of our successes around the mammogram but this is a great use of data actually, i'm jumping to the data again standardization or they have emmy's at the time of care without having a bottleneck and outreach for people coming in clinics and urging scrips and

working with radiology and getting weekend mammograms and lastly this is the emancipation proclamation pit of timely relevant action data that is given out to we believing or mostly how many ma'am gramdz you need to have to get pier goals in chinatown if you get 5 more mammograms you'll be at geography and in behavorial health focuses on reducing the prescriptions with methamphetamine treatments that's a high-risk group for over dozen in the- risk group the gray line during an all staff meeting we're reviewing this registering all the staff

to see where the patients are getting their controlled substance and sixth amendment guidelines and done a huge push in getting kids care the black is primary blue is permanent teeth and the other is the black line we're looking at so i hope that gives us a sense of the kind of things you see these data measures why is it changeing from quarter to quarter there is a lot going on i want to fwif a shout out i think virginia is here one the quality people those are the people doing the work and deborah and marlene and others

from primary care regina at laguna honda and i'll be remiss in not giving a shout out to kilogram all the background materials she was responsibly for putting together so thank you. >> questions? >> question for any of the represented. >> i have a question. >> you mentioned the challenges dr. chin in meeting the quality standards because there's so many source of data how do you get here. >> a consumer of health care there's a difference between patient care and quality care well, i think we've talked about that repeating but what's

necessary but not sufficient is an enterprise e m r it collects data in one place you need data warehouse to extract and analysis the gap between data and information. >> so the patient surveyed our most used tool for quality care. >> that aspect the quality care that survey is what we used to determine patient experience. >> i maybe missing part of our question. >> i'm not sure i got the are answer i was looking for i'm trying to determine you talked about all those manufacture and sort of indicated start it is compleshthd but quality you have to have manufacture given all

the sources of data you collect including the patient survey how do i get to determine your meeting the goals of clinical care. >> the last 4 slides is representative of the kind of measures we're trying to track and move the needle so if fewer people die from an infection or an infection from their wound after surgery or more people are getting mammograms or vaccinations we feel those represent the quality of care and dr. chin i was going to ask you commissioner that it sound like when i looked at the patient status you have to standard device those because

they're asking a question in so many was bad data in and out you have to look at how to standard device those questions as well. >> i think i i'll if i wasn't clear the patient satisfaction survey we have stuck with those it is complicated ways we have regulatory agencies saying you must use h a cap and the mental health survey. >> a followup question. >> yes. >> i don't know which slide you had the number and the clinics and the names for example mammograms how to get from 25 to 75 percent in meeting those goals what are you doing

to get them there. >> i personally am trying to support of the teem that's doing it between the quality of the team and the medical directors their again trying or implementing a sweep of intreefrn to train their staff who ask and call people and are go language specialists giving them scrips you're over due for our gambling mammogram but engage them their fears and issues they having may have and cross training and sharing best practices sunshine they have staff who is a low perform shadowing staff that is a high performer. >> before we go on can i ask a

followup what then one clinic or people in the clinic to do what you just described. >> i think i'll speak for puc primary care i think one provider of nature are competitive so when i see the information compared to someone else that is an incentive and the health plan i don't know if? a metric but the health plan as a number of clinical networks to meet certain targeted golden's. >> when we get back to the individual provider even in the sense of coming back to the department because they did well, are there individual incentives you're using. >> i have to say i think so to

speak for myself who works in one of the clinics those are tried and true quality measures it is an issue of supporting when the systems and the teams actually can enjoy. >> commissioner pating. >> thank you very much i want to thank dr. chin for the wonderful presentation and the opportunity to observe high colleagues and meet with dr. chin to learn about our system of care i'm happy to announce dr. chin you two are two of the smart it people in san francisco knowing how our system works but murray's that their level comprehensive and the divisions and charging outsources of the jail so i'd like to direct this

to our commissioner i'm pleased doctor chinning if this is not the consecutive par falsifying we're producing a lot of tremendous amount of data but you're seeing an abundance that of data but trying to figure out how to boil this to a level to clinical managers and division leaders even us as the commission what we need one of the things to been what do we need to be able to see as a commission we've done a great job job of providing oversight i'd like to recommend this duo to be into a comet for framework it coming nationally we want a

health system has has budget and certify use of resources and improvement of patient experience as commissioner taylor-mcghee mentioned and good overview health come this is the federal mandate and good for us as a commission to make sure our system is doing this when you're looking at the data how the question is how dr. chin and her staff to help us prepare the reports so when we look at it we're in budgeted yep patient experience look right it's not one thing but access to care and ability to want to reenroll in services this is a complex number of services they'll combine help us to answer the questions one of the things in terms of oversight to know what

questions are ours and more at the department at a clinic level how sfrls /* san francisco board of appeals we want to know looking at the top from the big picture and the major categories? where i think there would have roles for us as part of commission to help to frame that usually questions we might have and when dr. chin presents to us we can also be able to come away with a sense of yep i came away with when i wanted to hear i hope we'll consider this

i look at the data item 7 you're in budget and item 3, 5 and access and no item 4 we will rebuttal and access and member patient services look great and the quality you've got mammograms and call center and behavorial call systems we're looking great i could say we're meeting the goal but has to be presented we need to as a community gun to digest this there is a role for us i'll ask dr. chin to comment on this i know hearing from us what we need and hear from the commissions if this is a reasonable thought otherwise we'll look at a lot of grass and thickets and not getting what we

want out of it. >> commissioner pating we've discussed this even if you call that our planning session and i think you've helped to continue to articulate some of the items we'll want to say are within the report i think commissioner taylor-mcghee has hit on the same questions that is a you know not that we expect any answers immediately but what is it we're going to be following we're asking during this phase we've asked our committees breaking down the topics into finance planning and quality and all that are two committees that of his opinion planning and our

public health we'll start hewlett-packard in what is essentially a scorecard or report card as autopsy report pointing out we'll use whether we've made budget or whether theaters has it or there's sufficient numbers of sign questions to the population what the timely access within the committees we can formulate from the suggestion from staff what would be those items we would like to see and continue over i think i gave ourselves a 6 month period of time i believe we'll have to work out scheduling to get that this is a preliminary opportunity to where they've come similar to who was presented at the finance committee two weeks ago in terms of some of the detail there we

needed to fiore fin it i'll be happy to hear what the other commissioners along with other questions so and then we'll take that and continue to work on it i ask also the director to comment how we can be helpful this is that interim process coming six months of our pilot programming much of the detail report at the committee levels. >> i don't how to frame this i'll say it is great to have a lot of indicators open paper to see what we're measuring what i person would be interested to know though liquor

preventive medication like the mammograms and the rates of patient educating mammograms but the rates of early detection we do we have ways to track that the reason why i ask that coming from the hiv field like we have a lot of quality assurance and indicators for hiv services and doctors like cv 4 adherent and retention getting appoint so i'm curious how can we really take a step back and look at it what's in terms of measuring i think that having all those physical screening for

everyone would be one because this is what d c a is for early detection and looking at because one of the priority when i first started here was health equality what can we do to reduce disparities amongst the population that to me is the right track not so much about how many appointment and what they're doing it is great to know but as public health agency what are we doing to help disparities for the ininsured and for those who are more vulnerable. >> i'll start i think there is a lot we can do particularly in primary care and the other parts of network we use