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Lake Health Mission and Vision Our mission is to provide comprehensive health care services to the residents of Lake County and neighboring communities in partnership with those who share a commitment to local access, healing with compassion and superior quality. LHS, in partnership with its medical staff, will be the first choice for superior care close to home. Together, we will coordinate a lifetime of health which patients and families experience as warm, responsive and state ‑ of ‑ the ‑ art. Our organization and culture will produce the best opportunities to practice and work.

Lake Health System Values RESPECT: We believe in treating everyone in a dignified and caring manner. INNOVATION: We believe that the pursuit of creative ideas leads to improvements that build a better future. TEAMWORK: We believe that working together and communicating effectively help us achieve shared goals. STEWARDSHIP: We believe that the wise use of our resources today assures our ability to continue our mission tomorrow. INTEGRITY: We believe that our words and actions need to be in harmony to build trusting relationships.

Commitment to Excellence Lake Health prides itself in our commitment to excellence through the services we provide and the leadership we offer:  A Gold Seal of Approval by The Joint Commission  Community Awards: 2008 American Heart Association Gold Fit Friendly award 2009 State of Ohio: Silver Healthy Ohio-Healthy Worksite Award Certified Urgent Care Designation – Urgent Care Association of America 2011 AHA Worksite Innovation Award AHA Gold Fit-Friendly Award Bronze Healthy Ohioans Award 2012 Bronze healthy Ohioans Award Northcoast 99” Best Places to Work in Northeast Ohio” – 11 years in a row

Heart Failure Program at Lake Health Our Early Heart Failure beginnings: –2007 joined the AHA Get With the Guidelines –Heart Failure –Focused on compliance to using Heart Failure ordersets –Strides were made yet Core Measure compliance was not in control Improvement Journey Today –Nov 2009 formalized the Heart Failure Leadership Committee –Focused on process improvements and standardized care methods –Focused on processes in Heart Failure management –Significantly improved our Core Measures and standard care methods –2012 Implementation of High Risk Case Management program focusing on Heart Failure and COPD populations Achieved the Heart Failure Performance Award: 2010 Bronze Level Performance Achievement Award from the AHA Get With the Guidelines Performance Achievement Program 2011 Silver Award 2012 Gold Award

Heart Failure Program Vision A model of Heart Failure Care in Lake County. Dedicated to the continued education of the community in symptoms and management of Heart Failure. Enhance the Quality of Life for those affected by Heart Failure Disease.

Heart Failure Program Goals To improve Heart Failure core measure outcomes. To educate team members and the community on Heart Failure and supportive measures. To decrease Heart Failure length of stay. To decrease 30 day re-admission rate for Heart Failure

Heart Failure Program Leadership Clinical Support –Chetan Patel MD- Cardiologist, Program Medical Director –Dawn Demarest RN, MSN, Director Patient Care West Medical Center –Nursing Managers –Cardiopulmonary Services –Patient Education –Cardiac Rehab Services –Care Coordination Administrative Support –Joyce Taylor RN, MBA, CPHQ-Chief Quality Officer/Vice President, Quality –Mary Ogrinc RN, MS,MBA- Senior Vice President Patient Care Services/ Chief Nursing Officer –Andrea Wasdovich- Duffner RN, BA,BSN, MSHA- Vice President Perioperative Services/Critical Care Services and Emergency Care –Janie Racer MBA, RRT-Vice President Clinical Services

Heart Failure Program Services Multidisciplinary, family-centered approach to care. 24/7 visiting hours for all of our patients Integrated Medicine program available such as healing touch, music therapy, pet therapy, therapeutic message Community services including, HHC, Cardiac Rehab, community referrals Comprehensive Care Coordination services Comprehensive Cardiac Rehabilitation services Phase 1 and 2 rehab, Inpatient Heart Failure education On-site Acute Rehab Unit for post discharge needs. Integrated care through the use of evidenced based practice guidelines.

Clinical Practice Guidelines 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report form the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. (Circulation. 2013;128: )

Heart Failure Gender Mix

Heart Failure Age Distribution

HF Discharge Disposition Distribution

Heart Failure PI Goals Increase the use of ACE-I or ARB at discharge to 95% –Revised pre-printed guidelines to the 2013 ACCF/AHA recommendations. –Revised orderset to include section for documentation of contraindications to prescribing. –Created and education physicians on Heart Failure progress note for documentation of contraindications. –Core measure coordinators monitor concurrent documentation and dialogue with MD for possible contraindications –Implemented electronic workflow in EMR including ACE/ARB as a guideline recommendation for discharge medication.

Heart Failure PI Goals Increase documentation of heart failure discharge instructions to 95% –Created and implemented electronic workflow for HF to include heart failure specific discharge instructions as a handout. –Conducted focused nursing education on units on new documentation tools. –Revised electronic medical record documentation of HF education. –Created Heart Failure Patient Education manual for each HF patient.

Heart Failure PI Goals Increase smoking cessation education to 95% –Respiratory and Nursing staff educated on smoking cessation instruction as a HF core measure. –Home going instructions revised to include smoking cessation as a teaching point. –Respiratory section of the EMR revised to include documentation of cessation discussion Increase LV assessment to 95% –Revise pre-printed order set to include LV function assessment documentation. –Included LV assessment on Physician HF progress note –Included NYHA class Types – In-services provided to physicians and nurses on core measure requirements of LV assessment documentation. –Core Measure case managers obtain recent documentation of LV assessment and place on chart

Clinical Outcomes ACE-I

Clinical Outcomes LV Assessment

Clinical Outcomes Smoking Cessation

Clinical Outcomes Discharge Instructions

30-Day Mortality Lake Health Overall rate per time period = 2.62% Ohio Overall rate per time period = 3.33%

30-Day All Cause CHF Readmission Source = Crimson Lake Health Overall rate per time period = 22.39% Ohio Overall rate per time period = %

CHF 30 Day SAME CAUSE Readmission Rates Source = Crimson Lake Health Overall rate per time period = 5.61% Ohio Overall rate per time period = 5.53%

Community Education  Active Community Wellness Department  Nutrition Potpourri- discussion on Dietary recommendations for Heart Disease  Wellness screenings  Be Strong- family centered weight management and healthy living program for 6-14 yr olds  Best of Health Spotlights on Heart Failure  Know Your Numbers- Preventative Medicine Symposium including Heart Failure lecture, Atrial Fibrillation, Nutrition for a healthy heart  Cardiology guest speakers at Lifestyles Seminars  On Demand topics for local Employers

Program Enhancement Acute Care High Risk Case Management Pilot Patient and Family Centric, Care coordination 3-4 months post discharge Focus on High Risk for readmit populations: –HF, COPD, DM Intensive Disease Management program focusing on: –Transitions of Care –Medication adherence –Self management education –Provider follow-up/linkage

Pilot Project Results May May patients treated (closed cases) Pre-Program Patient Statistics: –ED visits: 159 episodes –Inpatient admissions: 333 episodes –Total ED and IP episodes for this population: 492 episodes. –Average visits per month: 82 visits Post Program Results 84% improvement in patient visits –ED visits post program 24 –Inpatient admissions post program: 56 –Total Visits post program: 80

Pilot Readmission Statistics 30 Day readmission episodes pre- program:  28 patients since project enrollment compared to 96 pre-program 90 day readmission episodes post program :  65 patients experienced a readmission within a 90 days period of enrollment in the High Risk Program

Cost Avoidance of Acute Care High Risk Case Management Pre program costs: ED visits $43,089 Inpatient visits $ 1.3 Mill Total costs preprogram: $1.4 Mill Post Program cost ED Visits $3,816 Inpatient visits $ 228K Total costs post program: $232 K High Risk Case Management program reflects a total cost savings of $1.16 Million in 1 year of operation

Patient Centered Medical Home Coordination of Care Across the Continuum Aims: –Better Health Care: improve individual patient experience of care based on IOM domains of Quality –Better Health: focus on overall health outcomes of populations by addressing underlying causes of poor health, i.e; self management behaviors, lack of preventative care, poor nutrition, etc. –Reduce cost: reduce unnecessary readmissions, improve quality of care and patient experience, promote lifetime of health

Patient Centered Medical Home –Team-based Care focus –Transitions of Care across the continuum: Hospital to Primary Care Community Agencies Home Care Skilled Care –Focus Case Management of High Risk Chronic Illness CHF, Diabetes, COPD, Depression

Heart Failure Management in the PCMH Heart Failure practice guidelines Heart Failure self-management tools PCMH Care Manager focus on high risk heart failure patients Performance Metric Annual Cardiology visit

Our Goals for the Future Become a best practice model of Heart Failure Care focusing on strategies to: – reduce Heart Failure-readmissions through a Transitional Care Model of Case Management. Expand Care Management of the Heart Failure patient in physician Practices through a Patient- Centered Medical Home Implementation Increase Heart Failure Perfect Care Scores at 100% Continue pursuit of excellence by maintaining the American Heart Association Awards. Improve utilization of the Lake Health Heart Failure Clinic.