The Impact of Pneumonia Core Measure Scores on Value Based Purchasing Financial Outcomes Presented by Brenda Lee, MSN,RN.

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Presentation transcript:

The Impact of Pneumonia Core Measure Scores on Value Based Purchasing Financial Outcomes Presented by Brenda Lee, MSN,RN

Why are we focused on Pneumonia? In FY 2010, UTHSCT compliance with the all-or-none bundle pneumonia core measure set was 85% - 20th percentile ranking (July 9, 2009 – June 30, 2010). Value Based Purchasing Score decreasing from 83 to 23 for all core measures. Pneumonia measures are being dropped in the areas we are 100%.

Pneumonia: Setting a Goal Performance Required for 95th Percentile National Ranking Vaccinations (P & I) Antibiotic within 6 hrs Initial Antibiotic Selection Compliance Rate 92.25 20th Pneumonia 96.82 20th Influenza 87.69 5th 97.21 20th Total 88.28 5th ICU 66.69 5th Non-ICU 91.73 20th Goal Success Rate 100 Average Metric Failures/Month 1.0 (.33/.66) .33 .66 (.50/.41) Permitted Metric Failures /Month

AIM Statement Improve compliance to 100% for all Pneumonia evidenced based performance measures by June 2011.

Pneumonia: Building the Team Physicians/Inpatient Nurses ED Medical Director/ED Physicians/ED Nurses Internal Medicine Physicians Pharmacists Quality Staff

Pneumonia: Measuring the Problem 34 RFI’s Total

Pneumonia: Interventions Revise Pulmonary Order Set (prior separate) Revise Physician Discharge Instruction Set Design Concurrent Review Checklist for nursing Present core measure compliance data to staff and physicians (committee/dept level) Printed off booklets for medical staff and made download available Nursing/MD staff educational program/in-services

Pneumonia: Interventions Address physician concerns per CDC Guidelines regarding administration of immunizations Revise immunization protocol to align with CDC; dropping physician order to not administer as an option Administer immunizations prior to discharge for all patients as appropriate – JUST GIVE IT!

Pneumonia: Barriers Current form approval process hindered “pilot” of forms and created delay in changes Physicians outside of team wanted a separate order set for Pneumonia patients Nursing did not want to perform concurrent review documentation – additional work

Pneumonia: Interventions Create Pneumonia Order Set Adjust admission initial nursing assessment form to incorporate core measure requirements Create a “pilot” plan utilizing next 5 patients with hospitalist admissions only Post laminated Pneumonia Core Measure Antibiotic selection sheet as reference

Results

REVENUE ENHANCEMENT

Pneumonia: Conclusions and Next Steps An order set and forms revisions “pilot” process is instrumental for rapid cycle change Continue to provide feedback as cases “fall out” as soon as identified (trending) Implement aggressive campaign with medical and nursing staff for Influenza Vaccination Continue study to determine if order set contributes to decrease LOS and cost of care

Questions?