Objective To develop and implement a quality improvement program composed of a discharge summary curriculum and an objective discharge summary scoring.

Slides:

Advertisements

Similar presentations

Care Transitions – Critical to Quality and Patient Safety Society of Hospital Medicine Lakshmi K. Halasyamani, MD.

Advertisements

PLANNING A CARE TRANSITIONS CURRICULUM 2011 Annual Reynolds Meeting.

Connie N. Hess, MD, Bimal R. Shah, MD, MBA, S. Andrew Peng, MS, Laine Thomas, PhD, Matthew T. Roe, MD, MHS, Eric D. Peterson, MD, MPH Relationship of Early.

Transitions of Care: From Hospital to SNF Steven Tam, MD Assistant Clinical Professor UCI Program in Geriatrics, Internal Medicine.

Advance Directives Residency Curriculum Authors: Ashley E. Wofford Leong, MD, MPH, Carol Becerra, MD, Judith Gordon, PhD, Anne Ryan, JD Department of Family.

Why are we involved? Transitions of Care: What We Need to Know

Advanced Curriculum Development: Creating Education Models in Practice Based Learning and Improvement and Systems Based Practice to “Geriatricize” Your.

Improving care transitions at Harborview Medical Center Frederick M. Chen, MD, MPH Chief of Family Medicine Associate Professor, University of Washington.

Risk Assessment - What are we Learning? Stephanie Mudd RN MSM CCM Supervisor, Care Management TG/AH/MBCH 1 Presented by Washington State Hospital Association.

Connecting the Dots Creating a learning health system linking clinical quality improvement, Maintenance of Certification, and research Maureen Smith, MD,

Safe Transitions for the Elderly Patient (STEP). The Discharge Conundrum Do you worry about your patient’s after they are discharged from the hospital?

Transitional Care for Post-Acute Care Patients in Nursing Homes Mark Toles, MSN, RN.

Aging Q3: Hospital Care and Transitions

DataBrief: Did you know… DataBrief Series ● March 2012 ● No. 28 Chronic Conditions and Rehospitalizations In 2009, Medicare beneficiaries with 5 or more.

Using Teen Actors to Teach How to Communicate with Adolescents Anisha Abraham, MD, MPH Associate Professor, Department of Pediatrics Chief, Section of.

Leadership and Management Training for physicians Maria V. Gibson, MD, PhD Trident / MUSC Family Medicine Residency Program Background Practice Problem.

Quality Improvement HIT Design to Support Teamwork and Communication Lecture a This material (Comp12_Unit7a) was developed by Johns Hopkins University,

Agency for Healthcare Research and Quality Advancing Excellence in Health Care HCAHPS: Update for Trustees Mary Therriault RN MS Senior Director,

Addressing the Problem of Hospital Readmissions Arya Sedehi HS 8803.

Kazakhstan Health Technology Transfer and Institutional Reform Project Clinical Teaching Post Graduate Medicine A Workshop Drs. Henry Averns and Lewis.

SUSAN ALTFELD, PHD 1, ANTHONY PERRY, MD 2, VANESSA FABBRE, MSW 3, GAYLE SHIER, MSW 2, ANNE BUFFINGTON, MPH 1 AND ROBYN GOLDEN, AM, LCSW 2 1 UNIVERSITY.

Hospitalizations and the Patient Discharge: Has Society Overlooked Quality in Favor of Efficiency? (and what if anything can we, as individuals do about.

Reduction Of Hospital Readmissions Hany Salama, MD Diplomat ABIM IM Hospice and Palliative Care Sleep Medicine.

Learn more about ways to Bend the Curve in health care costs at: Made possible through support from: Preventing Hospital Readmissions:

Transitional care management (TCM): A team approach to facilitating transitions of care in a Gerontology Clinic Carol O’Leary, Jeffrey Kochka, Virginia.

Health Literacy Interest Group Academic Value of Health Literacy April 6, 2009 Health Literacy Symposium Leadership Dinner.

Reaching Out to Reduce Readmissions William C Crowe, Jr, DNP, APN, ACNP-BC, FNP-BC; Paul M Smith, RN; Jodi Whitted, MSSW, LCSW Erlanger Health System,

Geriatric Emergency Medicine: Research Update - Tried and True to Somewhat new Jacques Lee MD, MSc, FRCPC.

Essential Interventions for Improving Transitions of Care Presented By:Cheri Lattimer, RN, BSN - Executive Director, NTOCC & CMSA NTOCC is a 501(c)(4)

Do Heart Failure Disease Management Programs Make Financial Sense Under a Bundled Payment System? Zubin J. Eapen, Shelby D. Reed, Lesley H. Curtis, Adrian.

The Health Roundtable Early detection of patient deteriopration Presenter: (delegate name) Innovation Poster Session HRT1215 – Innovation Awards Sydney.

Hospital Care of the Elderly

Unit 5a: Care Coordination HIT Design for Teamwork and Communication This material was developed by Johns Hopkins University, funded by the Department.

MA STAAR Fall Learning Session Early Assessment of Post-Hospital Needs 1:15-2:30PM Breakout Massachusetts General Hospital and Sturdy Memorial Hospital.

1 Module 7 Discharge Planning Managing the Transition from Inpatient to Outpatient Care Diabetes Special Interest Group Georgia Hospital Association.

Readmissions: Process Improvement using the INTERACT II Tools Linda Denison Bub MSN, RN, GCNS-BC Director of Senior Health Services.

What REALLY Happens to YOUR Medical Records? A series of unsettling truths January 8, 2014.

From Knowledge to Practice Translation A Multidisciplinary Intervention to Reduce 30 day Heart Failure Readmissions.

Continuity of Care Components of a Meaningful Primary Care Visit Pre-VisitVisitPost-VisitInter-Visit Review notes – your last note, any notes by other.

MA STAAR Fall Learning Session Ensuring Post-Hospital Care Follow-up 2:45-4:00PM Breakout St. Anne’s Hospital, MetroWest Medical Center Peg Bradke and.

Transitions of Care: EP Perspective Post Acute and Long Term Care Update Mid-Atlantic Medical Directors Association Annual Meeting November 6, 2015 Sheraton.

Improving Transitions of Care from Hospital to Home: A Health Care Reform Priority Gina Gill Glass, MD, FAAFP Barbara J. Roehl, MD, MBA, CAQ Geriatrics.

Integration of Geriatrics Specialty Care in Family Medicine Ian M Deutchki, MD Assistant Professor of Family Medicine and.

` ASystematic review of the effectiveness of nurse coordinated transitioning of care on readmission rates for patients with heart failure Jason T. Slyer.

Michela C.C. Fiori, Pharm.D. PGY1 Pharmacy Resident, Penobscot Community Health Care Outcomes of a Pharmacist-Driven Education Program For Residents Discharged.

“STAR (Safe Transitions Across CaRe): A resident and faculty initiative to improve patient care across the healthcare continuum Nancy M. Denizard-Thompson,

Transitions In Care: Why They Are Important, And How To Improve Them Senior Medicine Rotation Emory University School of Medicine.

EVALUATING THE EFFECTIVENESS OF THE AGS UPDATED 2012 BEERS CRITERIA AS AN EDUCATIONAL TOOL IN A FAMILY MEDICINE RESIDENCY TRAINING PROGRAM Eseoghene Abokede.

Reducing Readmissions: A Review of the Relevance, Causes, and Evidence Regarding Rehospitalizations Niladri Das, MD Mary Pat Friedlander, MD Gretchen Shelesky,

From Hospital to Home: Medical Students Observe Patients in Transition Martha S. Terry, MD Assistant Professor of Clinical Family and Community Medicine.

Introduction References Objectives Conclusions Results Faculty provision of performance feedback is critical for residents to improve their clinical skills.

Experience in Implementing New Expanded Curriculum in Geriatrics for a Family Medicine Residency Program O Pishchalenko, MD, PhD, N Palafox, MD, MPH, P.

1. Forming Care Partnerships Lessons Learned 2 Our Call to Action Virtually all of our residents experience transitions in care Care coordination between.

Faculty Development for an New Family Medicine Residency in Chogoria, Kenya Roger K. Gerstle, MD, FAAFP David K. Klee, MD, FAAFP Munson Family Medicine.

A Multidisciplinary Transitions in Care Workshop for Medical Students

DECREASING READMISSION THROUGH TRANSITIONAL CARE FROM SNF TO HOME

Eddie Needham, MD, FAAFP Assistant Professor/Program Director

Aging Q3: Hospital Care and Transitions

Medical Students as Teachers in Extended Care (MedTEC): Development of an interdisciplinary teaching program for medical students Amanda Lathia, MD, MPhil.

Continuity of Care Components of a Meaningful Primary Care Visit

By: Marie-Josée Pagé, DO

Courtney selby, Pharm.d. arcare pgy1 Community pharmacy resident

Polypharmacy In Adults: Small Test of Change

Engaging a Microsystem to Reduce 30-Day Readmissions on an Acute Care Unit Erin Johnson, MSN, RN, Sara Stetz, MSN, RN.

Peg Bradke and Rebecca Steinfield

QUALITY: COORDINATED CARE

Planning a care transitions curriculum

Medication Reconciliation Steps

Quality Improvement Programs and Critical Pathways

MA STAAR Fall Learning Session Real-Time Handover Communication

Presentation transcript:

Objective To develop and implement a quality improvement program composed of a discharge summary curriculum and an objective discharge summary scoring tool for feedback purposes with the goal of improving discharge summary quality and timeliness. Hospitalized older adults are at particularly high risk for new/worsening symptoms, medication related problems, and other adverse events after hospital discharge.(1) Nationally, 19.6% of hospitalized Medicare patients are readmitted within 30 days, with even higher rates for nursing home residents. Excess costs for readmissions are estimated at $17.4 billion/year.(2-3) Communication between inpatient and outpatient care providers is poor with direct communication occurring only 3-20% of the time. Discharge summaries are often late with only % available at the time of first follow up appointment.(4) Prior clinical trials have reported the effectiveness of individual feedback to improve discharge summary quality, but there are few reports of successful QI programs in this area.(5) However, little is known regarding the value of team-based feedback in teaching settings for improving discharge summary quality. Background As part of our Aging Q 3 Program funded by the D.W. Reynolds Foundation, our multidisciplinary team adapted and extensively refined an objective discharge summary scoring instrument that featured a weighted list of 13 elements deemed critical for high quality discharge summaries.(6) (Figure 1) Internal Medicine residents were presented a coordinated discharge summary curriculum that included didactic lectures, academic detailing, morning report presentations, and distribution of discharge summary template pocket cards. (Figure 2) ALL interns reviewed at least 3 of their own previously dictated discharge summaries with Aging Q 3 faculty. Feedback was provided, and faculty/intern agreed on a “Prescription for Improvement.” In addition, general medicine teams rotating on the general medicine inpatient service received team- based feedback on summaries of patients recently discharged from their service (~1/week). Methods Preliminary Results Conclusions An integrated discharge summary curriculum combined with individualized team-based feedback can improve objective discharge summary scores. Team-based feedback provided on a weekly basis to inpatient teams is feasible. Ongoing analysis in progress regarding the effect of team-based feedback on discharge summaries produced by upper-level resident physicians. Individual and Team-based Feedback to Improve Discharge Summary Quality for Hospitalized Elders R. Neal Axon, MD, MSCR 1.2 ; Fletcher T. Penney, MD 2 ; Justin E. Marsden 2 ; Patty J. Iverson, MA 2 ; Jane Zapka, ScD 2 ; Patrick D. Mauldin, PhD 2 ; Kimberly S. Davis, MD 2 ; Yumin Zhao, PhD 2 ; Lauren Angotti, MD 2 ; William P. Moran, MD 2 1. Ralph H. Johnson VAMC 2. The Medical University of South Carolina References 1. Snow V, Beck D, Budnitz T, Miller DC, Potter J, Wears RL, et al. Transitions of Care Consensus policy statement: American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College Of Emergency Physicians, and Society for Academic Emergency Medicine. Journal of Hospital Medicine. 2009;4(6): Jencks SF, Williams MV, Coleman EA. Rehospitalizations among Patients in the Medicare Fee-for-Service Program. N Engl J Med. 2009;360(14): Mor V, Intrator O, Feng Z, Grabowski DC. The revolving door of rehospitalization from skilled nursing facilities. Health Aff (Millwood). 2010;29(1): Kripalani S, LeFevre F, Phillips CO, Williams MV, Basaviah P, Baker DW. Deficits in Communication and Information Transfer Between Hospital- Based and Primary Care Physicians: Implications for Patient Safety and Continuity of Care. JAMA. 2007;297(8): Myers JS, Jaipaul CK, Kogan JR, Krekun S, Bellini LM, Shea JA. Are Discharge Summaries Teachable? The Effects of a Discharge Summary Curriculum on the Quality of Discharge Summaries in an Internal Medicine Residency Program. Academic Medicine. 2006;81(10):S5-S /01.ACM b. 6. Coit MH, Katz JT, McMahon GT. The Effect of Workload Reduction on the Quality of Residents' Discharge Summaries. J Gen Intern Med Over the 3 month QI project, 100% of Interns received discharge summary feedback 12 of 12 inpatient teams received team-based feedback during the intervention period. Overall, 77.2% of residents received individualized feedback, team-based feedback, or academic detailing exercise to practice evaluating discharge summaries. For Interns- paired means for discharge summary grades (out of 100 points) improved from 75.3% ± 8.1 or with 95% confidence interval 75.3 (72.6, 78.1) to 83.0% ± 6.1 or with 95% confidence interval 83.0 (80.9, 85.0) (p =.0001) (Letter grade increase from C to B). Post test results showed an overall Resident confidence increase in ability to construct a discharge summary which meets standard quality criteria (p =.0006). Post test results also showed an overall Resident confidence increase in ability to critique a discharge summary according to standard quality criteria (p = <.0001). Figure 1: Figure 2: