One of the best ways to engage physicians and other clinicians in health system initiatives is to ask for their help and insight, says Zoe Tenney, a family nurse practitioner and clinical quality supervisor at Blue Hill Memorial Hospital, which is part of Brewer, Maine-based Beacon Health, the accountable care organization (ACO) arm of Eastern Maine Healthcare Systems.
Equally important is the language used when interacting with physicians, adds Tenney. “Don’t talk in terms of insured lives or other executive-level terms,” she says. Instead, point out a real clinical problem that needs to be solved—and ask for their ideas on ways the health system can solve it.
That approach is what Tenney says led to more effective STD screening at Beacon Health, more specifically, chlamydia screenings for women between the ages of 16 and 24. Chlamydia is a growing problem in Maine. The Portland Press Herald reports that cases in the state increased 76% between 2010 and 2017, according to the Maine Centers for Disease Control and Prevention.
To help address this problem, Blue Hill has revamped the wellness visit for young women in this age range, which starts with a letter that is sent to the patient’s home—most likely, this letter is read by the patient’s parents. Included in that letter, which orients the patient regarding what the annual visit will cover, is a statement that all women between the ages of 16 and 24 will take part in an STD test during the visit.
Normalizing the STD test is important, says Tenney, because then the young woman and her parents won’t be alarmed when it shows up on the explanation of benefits from their payer. Screening as many young women as possible is helpful as well, because many won’t be honest about their sexual activity, she adds. When the patient arrives for her annual wellness visit, a medical assistant then takes a urine sample as a standard protocol.
Blue Hill has a goal to screen at least 35% of current patients in this age range annually. One of the challenges Tenney and her team face is convincing college students to come in for screenings; it’s also difficult because many of these patients are self-pay and decline because of the cost associated with the test. (She adds that some patients are tested anonymously outside the clinic, which means those numbers aren’t available.)
A health system spokesperson says that Blue Hill has a monthly meeting that involves all staff members—including clinicians—where quality improvement plans, such as this revamp of the young women’s annual wellness visit, are developed. At these clinician-led meetings, performance improvement plans are finalized. “Without the [clinician] commitment to quality improvement and engagement, the goal couldn’t be met,” the spokesperson says.
Currently, Blue Hill screens 28% of young women for chlamydia, says Tenney, who notes that in January 2017, clinicians were screening just 17%.