INTERACT Quality Improvement Program & INTERACT Online eCurriculum Tyler Altman – Medline Industries

Agenda INTERACT Program Overview INTERACT eCurriculum Overview

INTERACT Program Overview

Interact Program Overview Hospitals penalized 3% for readmissions above national average1 Hospitals seek to partner with post-acute providers who can exhibit care transition strategies Protecting Access to Medicare Act requires public reporting of readmission rates for SNFs - October 1, 2017. Medicare reimbursement rates for SNFs based partially on performance scores - October 1, 2018. Data is King, Outcomes are currency Marketability 1. The Advisory Board Company, Healthcare Industry Committee. Hospital Readmissions Reduction Program. C-Suite Cheat Sheet Series. August 2013

Interact Program Overview INTErventions to Reduce Acute Care Transfers Is a quality improvement program designed to improve the care of residents with acute changes in condition. The byproduct? Reduce potentially avoidable hospital transfers and readmissions

Interact Program Overview INTERACT is an evidence based quality improvement program Shown to reduce hospital readmissions by up to 24%1 in long term care2 CMS recognized National Institute of Health Grant3 2. Ouslander et al, J Am Geriatr Soc 59:745–753, 2011 3. Grantome. Implementing Interventions to Reduce Hospitalizations of Nursing Home Residents. Available at: http://grantome.com/grant/NIH/R01-NR012936-02. Accessed November 22, 2015.

INTERACT Program Overview The Commonwealth Fund study showed Dr. Ouslander that in order for facilities to receive the full benefit of the program, it needs to be implemented with all of the tools and training on how to properly utilize them. Here are the findings of the Commonwealth fund study I referred to earlier, which supports my reference to the evidence of INTERACT reducing hospital readmissions by up to 24%. This study was published in the Journal of the American Geriatrics Society. In the study, INTERACT was evaluated by 25 nursing homes across three states over the course of 6 months. The initiative was comprised of the following 3 components: 1. Dedicated champions at the facility acting as project coordinators, 2. on-site education for all staff with training on all 37 INTERACT tools, 3. and biweekly teleconferences facilitated by an experienced INTERACT expert. Of the 25 participating nursing homes, 17 were characterized as "moderately or highly engaged" in the initiative. This group had a 24 percent reduction in hospitalizations, compared with a 6 percent reduction in the group of eight facilities rated as "minimally or not engaged" and a 3 percent reduction in a comparison group of 11 nursing homes. The average cost of the 6-month implementation was $7,700 per nursing home. The authors of the study estimate that the projected Medicare savings in a 100-bed nursing home could be about $125,000 per year. The findings from the Commonwealth Study emphasized the importance of facility engagement and showed Dr. Ouslander that in order for facilities to receive the full benefit of the program, it needs to be implemented with all of the INTERACT tools supported by comprehensive training to specific staff audiences on how to properly use them. This finding serves as the genesis of our partnership with Dr. Ouslander and the development of the INTERACT eCurriculum.

INTERACT Program Overview The take away? Using some of the tools does not constitute INTERACT use. Referral sources need to see more than SBAR and STOP and WATCH. Using all 37 tools combined with instruction on how to properly use them promotes the best results. Targeted education can drastically impact the success and standardization of a single or multi-facility INTERACT initiative. Here are the findings of the Commonwealth fund study I referred to earlier, which supports my reference to the evidence of INTERACT reducing hospital readmissions by up to 24%. This study was published in the Journal of the American Geriatrics Society. In the study, INTERACT was evaluated by 25 nursing homes across three states over the course of 6 months. The initiative was comprised of the following 3 components: 1. Dedicated champions at the facility acting as project coordinators, 2. on-site education for all staff with training on all 37 INTERACT tools, 3. and biweekly teleconferences facilitated by an experienced INTERACT expert. Of the 25 participating nursing homes, 17 were characterized as "moderately or highly engaged" in the initiative. This group had a 24 percent reduction in hospitalizations, compared with a 6 percent reduction in the group of eight facilities rated as "minimally or not engaged" and a 3 percent reduction in a comparison group of 11 nursing homes. The average cost of the 6-month implementation was $7,700 per nursing home. The authors of the study estimate that the projected Medicare savings in a 100-bed nursing home could be about $125,000 per year. The findings from the Commonwealth Study emphasized the importance of facility engagement and showed Dr. Ouslander that in order for facilities to receive the full benefit of the program, it needs to be implemented with all of the INTERACT tools supported by comprehensive training to specific staff audiences on how to properly use them. This finding serves as the genesis of our partnership with Dr. Ouslander and the development of the INTERACT eCurriculum.

Interact Tool Categories Advance Care Planning Tools Communication Tools From 30,000 feet, the INTERACT tools fall into 4 distinct categories – Communication Tools, Decision Support Tools, Advance Care Planning Tools and Quality Improvement Tools. Decision Support Tools Quality Improvement Tools

Interact Program Overview INTERACT targets three key strategies: Improving advance care planning for residents for whom a palliative or comfort care plan is appropriate. Preventing conditions from becoming severe enough to require acute hospital care When you are fully implementing INTERACT in your facility, three distinct strategies will develop: One: You will be better at preventing conditions from becoming severe enough to require acute hospital care. This is, of course, imperative to managing your facility’s readmission rates. Two: You will better manage selected acute conditions in your facility. The implications of improvement in this area are many. Chiefly, the resident will remain in a setting where they are familiar and comfortable and the family will remain trusting that their loved one is adequately cared for. Additionally, there are also financial implications. When we safely keep our residents in our facility, we avoid “empty bed” scenarios. According to our long term care advisory board, it is estimated that a facility loses between $300 and $500 dollars per day per resident when he or she leaves the building for a hospital transfer. If a facility were able to mitigate unnecessary transfers, then it would most certainly find increased retention of its reimbursement dollars resulting in improved financial outcomes. Lastly, number Three, improving advance care planning for residents for whom a palliative or comfort care plan may be appropriate. This area allows facilities and families an opportunity to tactfully navigate those delicate episodes - ensuring the resident is receiving care that promotes the best quality of life or falls within their advanced directives. Managing selected acute conditions in your facility

. ECurriculum overview

ECurriculum overview Developed by the experts Covers every aspect of INTERACT Content specific to staff roles Available 24-7

ECurriculum overview Interactive online training to improve early detection, evaluation, documentation and communication of changes in condition Practice with care paths designed to guide staff during changes in condition such as congestive heart failure (CHF), lower respiratory infection, etc. Instruction on quality improvement tools for logging, reviewing and calculating transfer rates, and performing root cause analyses

ECurriculum overview 11 total modules in the eCurriculum Basic Overview Module (1 a, b, c, d) 10 intensive modules Provide depth Interactive training on all 37 tools Targeted syllabi for specific job titles

ECurriculum overview Don’t reinvent the wheel, we’ve mapped it out for you Prioritize training where you need it most Standardize staff comprehension

ECurriculum overview In addition to education, you receive an INTERACT Resource Starter Kit including: Implementation Guide Communication tools – Stop & Watch, SBAR and more

ECurriculum overview INTERACT Resource Starter Kit continued: Care paths for dehydration, fever, mental status change, and symptoms of CHF, lower respiratory infection and UTI Quality improvement tools, including the Quality Improvement Tool for Review of Acute Transfers Advanced care planning tools

ECurriculum overview

TAltman@medline.com, 812-219-7061 JLumsden@medline.com, 847-643-3905 Questions? Tyler Altman TAltman@medline.com, 812-219-7061 James Lumsden JLumsden@medline.com, 847-643-3905 Thank you!

Acknowledgement Use of the Program https://interact.fau.edu/index.aspx The INTERACT Program and Tools were initially developed by Joseph G. Ouslander, MD and Mary Perloe, MS, GNP at the Georgia Medical Care Foundation with the support of a contract from the Centers for Medicare & Medicaid Services (CMS). The current versions of the INTERACT Program were developed by an interdisciplinary team under the leadership of Dr. Joseph G. Ouslander, M.D. with input from many direct care providers and national experts in projects based at Florida Atlantic University (FAU). Support for the further development, refinement, evaluation, and dissemination of the INTERACT Program for nursing homes has been provided by The Commonwealth Fund, the National Institutes of Health's National Institute for Nursing Research, CMS, the Retirement Research Foundation, PointClickCare (Westcom), and Medline Industries. Support for the development and testing of the INTERACT Program for assisted living and home health has been provided by a CMS Innovation Award. Use of the Program The INTERACT™ trademark is registered with the US Patent and Trademark Office by FAU and the INTERACT Program materials are copyrighted by FAU. These materials are provided for free and we welcome their use in clinical care. There is growing interest in INTERACT materials within academic, clinical, and commercial organizations which we welcome. However, we want to ensure that these materials are utilized consistently and in an optimal fashion. As a result there is now a "Click through" agreement on the INTERACT Tool pages. We do not want inhibit use, but we request that INTERACT materials not be incorporated in software or electronic health records or in other forms of health information technology, without specific permission from FAU. We also request that you not use these materials and/or the trademark INTERACT® trademark in any form in products for sale, without specific permission from FAU. If you have any questions about the use of the INTERACT Program and Tools, please send them to us through the "Contact Us" section of this website. Thank you.