What is It and Why Does It Matter?

Slides:



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

Mary D. Naylor, Ph.D., R.N. Marian S. Ware Professor in Gerontology University of Pennsylvania School of Nursing.
MEDICAL HOME 1/2009 Mary Goldman, D.O., President of MAOFP.
The Evolving Role of Nursing in ACOs and Medical Homes Carol A. Conroy DNPc RN CNOR Chief Nursing Officer/VP Operations VONL SUMMIT: April 19, 2013.
Paying for Primary Care: Robert Graham Center Primary Care Forum Washington, DC Two CMS/CMMI payment experiments Jay Crosson March 25, 2014.
The Evercare Model: Using Nurse Practitioners to Achieve Positive Outcomes Pat Kappas-Larson, MPH APRN-BC Professional Relations/Development April 24,
1 Wisconsin Partnership Program Steven J. Landkamer Program Manager Wisconsin Dept. of Health & Family Services July 14, 2004.
Advancing Excellence in America’s Nursing Homes A Review of 2 Clinical Tools: Pressure Ulcer and Restraints.
Keeping it Simple: Using IVR to Enhance Wellness Janelle Howe Sr. Director, Health Enhancement HealthCare Partners Medical Group Co-Investigator, HealthCare.
INTERACT II: Interventions to Reduce Acute Care Transfers Joseph G. Ouslander, M.D. Professor of Clinical Biomedical Science Associate Dean for Geriatric.
Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) Source: Centers for Medicare and.
A Model to Reduce Acute Care Readmissions Susan Weber, RN Chief Nursing Officer Angela Venditte, LPN, CMCO Assurance HealthCare.
Transitional Care for Post-Acute Care Patients in Nursing Homes Mark Toles, MSN, RN.
Deploying Care Coordination and Care Transitions - Illinois
QIO Program Overview December 6, About VHQC Private, non-profit healthcare consulting and quality improvement organization More than 60 experienced.
Joseph G. Ouslander, MD Professor and Associate Dean for Geriatric Programs Charles E. Schmidt College of Medicine Professor (Courtesy), Christine E.
Joseph G. Ouslander, MD Professor and Associate Dean for Geriatric Programs Charles E. Schmidt College of Medicine Professor (Courtesy), Christine E.
On the Horizon for Affordable Housing: What the Research Says Alisha Sanders LeadingAge Center for Housing Plus Services LeadingAge Maryland Annual Conference.
MaineHealth ACO in Context W 5 Who? What? Why? When? HoW? 1.
1 The San Diego Readmissions Summit February 5, 2015.
Laurie Herndon, MSN, GNP Director of Clinical Quality Massachusetts Senior Care Foundation SBAR Communication Form and Progress Note The development and.
Community Care and Wellness for Seniors
Memorial Hermann Healthcare System Clinical Integration & Disease Management Dan Wolterman April 15, 2010.
Using the INTERACT Early Warning Tool:
Alice Bonner, PhD, RN Executive Director Massachusetts Senior Care Foundation.
Reduction Of Hospital Readmissions Hany Salama, MD Diplomat ABIM IM Hospice and Palliative Care Sleep Medicine.
Addressing the Critical Shortage of Geriatric Health Care Leaders Eric A. Coleman, MD, MPH, AGSF, FACP Professor of Medicine Executive Director, Practice.
Session 1c Overview of the INTERACT Program This session is designed for: Certified Nursing Assistants (CNAs) All non-nursing staff with direct resident.
Community Partnerships to Reduce Readmissions Part 1 May 2, 2012.
© Joint Commission Resources Reducing Hospital Readmissions Deborah Morris Nadzam, PhD, BB, FAAN Project Director AHRQ and CMS Contracts Joint Commission.
Developing a Patient Centric Geriatric Home Based Care Management Model Presented by: Gail Silver, MS, APRN, GNP, BC.
© Florida Atlantic University 2011 Joseph Ouslander, MD Florida Atlantic University Gerri Lamb, PhD, RN, FAAN Arizona State University Laurie Herndon,
Mary D. Naylor, PhD, RN Marian S. Ware Professor in Gerontology Director, NewCourtland Center for Transitions and Health University of Pennsylvania, School.
CMS as a Public Health Agency: Effective Health Care Research Barry M. Straube, M.D. Centers for Medicare & Medicaid Services January 11, 2006.
Putting the Tools to Work in
INTERACT COLLABORATIVE ORIENTATION SESSION NYSHFA/IPRO PARTNERSHIP Sara Butterfield, RN, BSN, CPHQ, CCM Christine Stegel, RN, MS, CPHQ NYSHFA/IPRO INTERACT.
Hospital State Division Kristi Martinsen Hospital State Division Director HSD Overview September 2014 Department of Health and Human Services Health Resources.
© Florida Atlantic University 2011 Joseph Ouslander, MD Florida Atlantic University Gerri Lamb, PhD, RN, FAAN Arizona State University Laurie Herndon,
Session 1d Overview of the INTERACT Program This session is designed for: Administrators Social Workers Therapists (PT, OT, RT) Other Direct Care Staff.
SUMMARY Emergency Departments (EDs) are an essential service for the care of injuries and trauma for everyone. They provide a safety net when the system.
Collaborating with FADONA to Improve Care Coordination FHA Readmission Collaborative June 4, 2010.
On-Time Prevention Program for Long Term Care: Clinical Decision Support On-Time Prevention Program for Long Term Care: Clinical Decision Support William.
22670 Haggerty Road, Suite 100, Farmington Hills, MI l Save Your Census: Strategies to Prevent Re-hospitalization March 30, 2010 Joint.
Readmissions: Process Improvement using the INTERACT II Tools Linda Denison Bub MSN, RN, GCNS-BC Director of Senior Health Services.
July 2012 Your hosts: Jody Rothe, MetaStar Stephanie Sobczak, WHA.
Module 4 Overview of INTERACT Clinical Practice Tools This module is designed for: RNs and LPNs Medical directors Primary care MDs, and NPs/PAs The development.
Anna Rahman, PhD, MSW ADVANCE CARE PLANNING Part 2: The Individual Perspective The development and evaluation of the INTERACT quality improvement program.
Improving Geriatric Care by Reducing Potentially Avoidable Hospitalizations Laurie Herndon, MSN, GNP-BC, ANP-BC Director of Clinical Quality Massachusetts.
Improving Patient-Centered Care in Maryland—Hospital Global Budgets
Community Paramedic Payment Reform December 2 nd,2015 Terrace Mall- North Memorial.
+ Overview of INTERACT Alexis Roam, RN, MSN Certified INTERACT Educator
Quality Improvement and Care Transitions in a Medical Home Maryland Learning Collaborative May 21, 2014 Stephanie Garrity, M.S., Cecil County Health Officer.
Transition to Reform in Wisconsin Donna McDowell, Director Bureau of Aging & Disability Resources Department of Health Services D. McDowell1.
Developing Our Service Package(s) Florida Neighborhood Networks Shirley, Sandra, Gabriel, Maria and Anna.
Joseph G. Ouslander, MD Professor and Senior Associate Dean for Geriatric Programs Charles E. Schmidt College of Medicine Professor (Courtesy), Christine.
© Florida Atlantic University 2011 Joseph Ouslander, MD Florida Atlantic University Gerri Lamb, PhD, RN, FAAN Arizona State University Laurie Herndon,
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.
Practice Transformation for Physicians and Health Care Teams
Quality in Post Acute Care: Using Data to Differentiate Cheryl Phillips, M.D., Senior VP Advocacy and Health Services.
All-Payer Model Update
A Practical Approach To Safely Reducing Rehospitalizations
Development and feasibility testing of a complex intervention
INTERACT Quality Improvement Program & INTERACT Online eCurriculum
Peg Bradke and Rebecca Steinfield
Transitions of Care Project 2C.
All-Payer Model Update
Kathy Clodfelter, MSN, MBA, RN, NE-BC
HOSPITAL READMISSION REDUCTION’S IMPACT ON ASSISTED LIVING
Optum’s Role in Mycare Ohio
Presentation transcript:

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? Joseph Ouslander, MD Florida Atlantic University Ruth Tappen, EdD, RN, FAAN Jill Shutes, GNP Nancy Henry, PhD, GNP Michelle Duhaney, DO Laurie Herndon, MSN, GNP-BC Mass Senior Care Foundation Gerri Lamb, PhD, RN, FAAN Arizona State University Jo Taylor, RN, MPH The Carolinas Center for Medical Excellence

The INTERACT Program: What is It and Why Does It Matter? The INTERACT Interdisciplinary Team Joseph Ouslander, MD Florida Atlantic University Ruth Tappen, EdD, RN, FAAN Florida Atlantic University Jill Shutes, GNP Florida Atlantic University Nancy Henry, PhD, GNP Florida Atlantic University Michelle Duhaney, DO Florida Atlantic University Maria Rojido, MD Florida Atlantic University Sanya Diaz, MD Florida Atlantic University Laurie Herndon, MSN, GNP-BC Mass Senior Care Foundation Jo Taylor, RN, MPH The Carolinas Center for Medical Excellence Gerri Lamb, PhD, RN, FAAN Arizona State University Annie Rahman, PhD, MSW USC Davis School of Gerontology Dan Osterweil, MD California Association of Long Term Care Medicine Amy E. Boutwell, MD, MPP Collaborative Healthcare Strategies Mary Perloe, GNP Georgia Medical Care Foundation John Schnelle, PhD Vanderbilt University Sandra Simmons, PhD Vanderbilt University Alice Bonner, PhD, GNP Center for Medicare and Medicaid Services In collaboration with participating nursing homes

Background and Why it Matters The INTERACT Program: Background and Why it Matters College of Medicine College of Nursing New Dorms New FOOTBALL STADIUM

What is It and Why Does It Matter? Objectives of this Presentation The INTERACT Program: What is It and Why Does It Matter? Objectives of this Presentation Discuss key health policy issues related to the future of nursing home care Provide a broad overview of the INTERACT quality improvement program and how it fits with health care reform initiatives Highlight future directions for INTERACT Discuss key concepts for eINTERACT

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? Health Care Reform The Affordable Care Act is focused on a “triple aim”: Improving care Improving health Making care affordable This presents major opportunities to improve geriatric care in the U.S.

The INTERACT Program: Background and Why it Matters Medicare Fee-for-Service Financial incentives in the Medicare fee-for-service program incentivize overuse of diagnostic tests and procedures that do not benefit many elderly people, and can result in morbidity and costs By far, the most costly example in the geriatric population is potentially preventable hospitalizations Willie Sutton FBI Ten Most Wanted Fugitives Born/Died 1901 -1980 Charges Bank robbery Caught February 1952 During his forty year criminal career he stole an estimated $2 million, and eventually spent more than half his adult life in prison.

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? The U.S. Department of Health and Human Services “Partnership for Patients” Accelerate Reduction in Harm to Patients in Hospitals Achieve a 40% reduction in preventable harm by 2013 ~ 1.8 million fewer injuries to patients; ~ 60 000 lives saved; ~ $20 billion in health care costs avoided Decrease Preventable Hospital Readmissions Within 30 Days of Discharge Reduce readmissions by 20% by 2013 ~1.6 million hospital readmissions prevented and ~ $15 billion in health care costs avoided   http://www.healthcare.gov/center/programs/partnership

What is It and Why Does It Matter? Changes in Medicare Financing The INTERACT Program: What is It and Why Does It Matter? Changes in Medicare Financing Pay-for-Performance (“P4P”) No payment for certain complications; disincentives for avoidable hospitalizations Bundling of payments for episodes of care Accountable Care Organizations that include hospitals, physicians, home health agencies, and SNFs that are responsible for the care of a defined group of patients

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? Why Does This Matter? Hospital transfers are common and often result in complications in older NH residents Some hospital transfers are preventable Care can be improved, resulting in fewer complications and reduced cost Cost savings to Medicare can be shared with NHs to further improve care Financial and regulatory incentives are changing

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? 1 in 4 patients admitted to a SNF are re-admitted to the hospital within 30 days at a cost of $4.3 billion Mor et al. Health Affairs 29: 57-64, 2010

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? Why Does This Matter? At risk for complications Delirium Polypharmacy Falls Incontinence and catheter use Hospital acquired infections Immobility, de-conditioning, pressure ulcers At the beauty salon Hospitalization

The INTERACT Program: Background and Why it Matters Some Hospitalizations of NH Residents are Avoidable As many as 45% of admissions of nursing home residents to acute hospitals may be inappropriate Saliba et al, J Amer Geriatr Soc 48:154-163, 2000 In 2004 in NY, Medicare spent close to $200 million on hospitalization of long-stay NH residents for “ambulatory care sensitive diagnoses” Grabowski et al, Health Affairs 26: 1753-1761, 2007

The INTERACT Program: What is It and Why Does It Matter? CMS Special Study in Georgia – Expert Ratings of Potentially Avoidable Hospitalizations Based review of 200 hospitalizations from 20 NHs Was the Hospitalization Avoidable? Definitely/Probably YES NO Medicare A 69% 31% Other 65% 35% HIGH Hospitalization Rate Homes 75% 25% LOW 59% 41% TOTAL 68% 32% Ouslander et al: J Amer Ger Soc 58: 627-635, 2010

The INTERACT Program: Background and Why it Matters CMS Study of Dually Eligible Medicare/Medicaid Beneficiaries

Quality $ Costs The INTERACT Program: What is It and Why Does It Matter? Opportunities for You and Your Facility HIGH Improved Quality, Reduced Costs Reduced Avoidable Hospitalizations Quality $ Incentives for Providers Costs Avoided LOW $ $ Costs LOW HIGH

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? Maslow, K and , Ouslander, JG: Measurement of Potentially Preventable Hospitalizations. White Paper prepared for the Long Term Quality Alliance, 2012. (Available at: http://www.ltqa.org/wp-content/themes/ltqaMain/custom/images//PreventableHospitalizations_021512_2.pdf

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? Defining “Preventable”, “Avoidable”, “Unnecessary” hospitalizations is challenging because numerous factors and incentives influence the decision to hospitalize Risk adjustment is very complicated Maslow, K and , Ouslander, JG: Measurement of Potentially Preventable Hospitalizations. White Paper prepared for the Long Term Quality Alliance, 2012. (Available at: http://www.ltqa.org/wp-content/themes/ltqaMain/custom/images//PreventableHospitalizations_021512_2.pdf

The INTERACT Program: What is It and Why Does It Matter? Opportunities for You and Your Facility The Affordable Care Act mandates that each facility have a Quality Assurance and Performance Improvement program (“QAPI”) The regulation and related surveyor guidance are being written Improving management of acute change in condition and reducing unnecessary hospital transfers is one potential focus of your QAPI

What is It and Why Does It Matter? Safe Reduction in Unnecessary The INTERACT Program: What is It and Why Does It Matter? What Do You and Your Facility Need to Take Advantage of These Opportunities? QI Programs Tools Infrastructure Incentives Safe Reduction in Unnecessary Acute Care Transfers Morbidity Costs Quality

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? (“Interventions to Reduce Acute Care Transfers”) Is a quality improvement program designed to improve the care of nursing home residents with acute changes in condition

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? Includes evidence and expert-recommended clinical practice tools, strategies to implement them, and related educational resources The basic program is located on the internet: http://interact2.net

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? Acknowledgement 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 Center for Medicare and Medicaid Services. The current version of the INTERACT Program, including the INTERACT II Tools, educational materials, and implementation strategies were developed by Drs. Ouslander, Gerri Lamb, Alice Bonner, and Ruth Tappen, and Ms. Laurie Herndon with input from many direct care providers and national experts in a project based at Florida Atlantic University supported by The Commonwealth Fund. The Commonwealth Fund is a private foundation supporting independent research on health policy reform and a high performance health system. Some materials herein are © Florida Atlantic University 2011. Such materials and the trademark INTERACTTM may be used with the permission of Florida Atlantic University. Permission can be granted by Dr. Ouslander (jousland@fau.edu)

The INTERACT Program: What is It and Why Does It Matter? INTERACT is One of Several Evidence-Based Care Transitions Interventions “BOOST” (Better Outcomes for Older Adults Through Safe Transitions) http://www.hospitalmedicine.org “Project RED” (Re-Engineered Discharge) https://www.bu.edu/fammed/projectred Enhanced hospital discharge planning “Care Transition Program” http://www.caretransitions.org Transition coach Trained volunteers Empowered patients and caregivers “POLST” (or “MOLST”) (Physician (or Medical) Orders For life Sustaining Treatment) http://www.ohsu.edu/polst Advance care planning “Bridge Model” http://www.transitionalcare.org/the-bridge-model Social Worker coordinating Aging Resource Center Services at hospital discharge “Transitional Care Model” http://www.transitionalcare.info/index.html APN coordinates care during and after discharge Home, SNF, and clinic visits “INTERACT” (Interventions to Reduce Acute Care Transfers) http://interact2.net Communication Tools, Care Paths, Advance Care Planning Tools, and QI tools for nursing homes and SNFs High Quality Care Transitions for Older Adults & Caregivers

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? HALT Unnecessary Hospital Stays The goal of INTERACT is to improve care, not to prevent all hospital transfers In fact, INTERACT can help with more rapid transfer of residents who need hospital care

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? Can help your facility safely reduce hospital transfers by: Preventing conditions from becoming severe enough to require hospitalization through early identification and assessment of changes in resident condition Managing some conditions in the NH without transfer when this is feasible and safe Improving advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization for some residents

What is It and Why Does It Matter? A Tale of Three Siblings The INTERACT Program: What is It and Why Does It Matter? A Tale of Three Siblings Sadie Sara Sam

What is It and Why Does It Matter? A 96 year old long-stay NH resident The INTERACT Program: What is It and Why Does It Matter? Sadie A 96 year old long-stay NH resident Hospitalized for UTI and dehydration Discharged back to the NH after 4 days Re-hospitalized 7 days later for dehydration and recurrent UTI Avoidable? INTERACT strategy: Prevent conditions from becoming severe enough to require hospitalization through early detection and evaluation

What is It and Why Does It Matter? A 92 year old long-stay NH resident The INTERACT Program: What is It and Why Does It Matter? Sara (Sadie’s younger sister) A 92 year old long-stay NH resident Hospitalized for a lower respiratory infection, but had normal vital signs and oxygen saturation Developed delirium in the hospital, fell, fractured her pubis, and developed a pressure ulcer Avoidable? INTERACT strategy: Manage some conditions in the NH without transfer

The INTERACT Program: What is It and Why Does It Matter? Sam (Sara and Sadie’s older brother) A 101 year old long-stay NH resident Hospitalized for the 4th time in 2 months for aspiration pneumonia related to end-stage Alzheimer’s disease Transferred to hospice on the day of admission Avoidable? INTERACT strategy: Improve advance care planning and the use of palliative care plans when appropriate as an alternative to hospitalization

What is It and Why Does It Matter? CMS Pilot Study Results The INTERACT Program: What is It and Why Does It Matter? CMS Pilot Study Results Tools and implementation strategies were pilot tested in 3 Georgia NHs with relatively high hospitalization rates Tools were acceptable to staff Significant reduction in hospitalizations Significant reduction in transfers rated as avoidable by an expert panel Ouslander et al: J Amer Med Dir Assoc 9: 644-652, 2009

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? The program and tools were revised based on CMS pilot study, and input from front-line NH staff and national experts The revised program and INTERACT II Tools are available at: http://interact2.net Supported by a grant from the Commonwealth Fund

The INTERACT Program: What is It and Why Does It Matter? Implementation Model in the Commonwealth Fund Grant Collaborative On site training (part of one day) Facility-based champion Collaborative phone calls with up to 10 facility champions twice monthly facilitated by an experienced nurse practitioner Availability for telephone and email consults Completion and faxing of QI Review Tools

The INTERACT Program: What is It and Why Does It Matter? Commonwealth Fund Project Results Facilities Mean Hospitalization Rate per 1000 resident days Mean Change p value Relative Reduction in All-Cause Hospitalizations Pre intervention During Intervention All INTERACT facilities (N = 25) 3.99 3.32 - 0.69 0.02 17% Engaged facilities (N = 17) 4.01 3.13 - 0.90 0.01 24% Not engaged facilities (N = 8) 3.96 3.71 - 0.26 0.69 6% [This slide should build as it does on this slide] This slide illustrates the findings. We obtained baseline hospitalization rates for July-December 2008 from each facility, and they reported hospitalization rates for the months of July-December 2009 while implementing the INTERACT program. The numbers on this slide represent all-cause hospitalizations for all residents. They are calculated as a rate per 1000 resident days to adjust for census – so, in a typical 100-bed nursing home, this would represent the number of hospitalizations in 10 days. So, for all 25 facilities on this slide, the baseline hospitalization rate was 3.99 [highlight]. This would mean in a 100 bed facility, there were 4 hospitalizations every 10 days, which is a high rate of hospitalization. 25 of the 30 facilities completed the project and were able to provide baseline and current hospitalization rates. The hospitalization rate decreased by 17% in these 25 facilities. [highlight] We also rated the participating nursing homes on their level of engagement in the project independent of knowing their hospitalization rates. Engagement was rated using data from how many telephone calls the champions participated on, how many quality improvement review tools were submitted, and level of interest and participation on the collaborative calls. There were 17 facilities rated as engaged [highlight] . In these 17 facilities the hospitalization rate dropped a dramatic 24% [highlight] In the 8 facilities that were rated as less engaged [highlight], the hospitalization rate decreased, but by only 6% [highlight]. Although this project was not conducted as a true randomized controlled trial, which offers the best evidence of effectiveness, the findings suggest that INTERACT has a strong effect in the participating nursing homes, especially those that were more engaged in INTERACT implementation. Ouslander et al, J Am Geriatr Soc 59:745–753, 2011

The INTERACT Program: What is It and Why Does It Matter? Commonwealth Fund Project Results - Implications For a 100-bed NH, a reduction of 0.69 hospitalizations/1000 resident days would result in: 25 fewer hospitalizations in a year (~2 per month) $125,000 in savings to Medicare Part A (using a conservative DRG payment of $5,000) The intervention as implemented in this project cost of ~ $7,700 per facility Net savings ~ $117,000 per facility per year Medicare could share these savings to support NHs to further improve care Ouslander et al, J Am Geriatr Soc 59:745–753, 2011

Putting the Tools to Work in Everyday Practice Communication Tools Decision Support Tools Advance Care Planning Tools Quality Improvement Tools

Putting the Tools to Work in Everyday Practice Note The program and tools are currently being updated “INTERACT III tools” and an updated INTERACT website should be available by the end of 2012 © Florida Atlantic University 2011

Putting the Tools to Work in Everyday Practice The INTERACT tools are meant to be used together in your daily work in the nursing home http://interact2.net

Getting Started: Keys to a QI Program Getting Started: Tracking Hospital Transfers and The Quality Improvement Review Tool Getting Started: Keys to a QI Program Tracking, trending, and benchmarking well-defined measures Root cause analysis to learn and guide care improvement and educational activities © Florida Atlantic University 2011

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? Maslow, K and , Ouslander, JG: Measurement of Potentially Preventable Hospitalizations. White Paper prepared for the Long Term Quality Alliance, 2012. (Available at: http://www.ltqa.org/wp-content/themes/ltqaMain/custom/images//PreventableHospitalizations_021512_2.pdf)

Getting Started: Tracking Hospital Transfers and The Quality Improvement Review Tool

Getting Started: Tracking Hospital Transfers and The Quality Improvement Review Tool Highlighting identifies residents at risk for 30-day readmission and those who returned to hospital within 30 days Flyover boxes provide instructions for data entry This is a screen shot of one of the data entry screens for the tracking tool available on the INTERACT website, modified from the one developed for the Advancing Excellence Campaign. The original tool can be located on the Advancing Excellence website at the address shown on this slide. The tool allows for easy and efficient entry of data and automatically calculates the four measures we discussed on a monthly basis. Advancing Excellence tool will be located at: http://www.nhqualitycampaign.org © Florida Atlantic University 2011

Getting Started: Tracking Hospital Transfers and The Quality Improvement Review Tool Dropdown lists for easy data entry Transfers that occur within 30 days of admission from the hospital are highlighted In addition to calculating hospitalization measures on a monthly basis, the tool can help you trend your facility’s data over time and benchmark it against your previous performance, as well as that of other facilities [This should be accompanied by a moving arrow that illustrates trends, and also shows “your facility’s trend” and “other facilities” trend] In the full implementation training curriculum, you can learn more about how to use this tool. Advancing Excellence tool will be located at: http://www.nhqualitycampaign.org © Florida Atlantic University 2011

Getting Started: Tracking Hospital Transfers and The Quality Improvement Review Tool Rates trended by month – in this graph 30-day readmissions from PAC, LTC, and total In addition to calculating hospitalization measures on a monthly basis, the tool can help you trend your facility’s data over time and benchmark it against your previous performance, as well as that of other facilities [This should be accompanied by a moving arrow that illustrates trends, and also shows “your facility’s trend” and “other facilities” trend] In the full implementation training curriculum, you can learn more about how to use this tool. Advancing Excellence tool will be located at: http://www.nhqualitycampaign.org © Florida Atlantic University 2011

Getting Started: Tracking Hospital Transfers and The Quality Improvement Review Tool

Getting Started: Tracking Hospital Transfers and The Quality Improvement Review Tool

Getting Started: Tracking Hospital Transfers and The Quality Improvement Review Tool

Getting Started: Tracking Hospital Transfers and The Quality Improvement Review Tool

Getting Started: Tracking Hospital Transfers and The Quality Improvement Review Tool

Getting Started: Tracking Hospital Transfers and The Quality Improvement Review Tool

Getting Started: Tracking Hospital Transfers and The Quality Improvement Review Tool Unplanned Transfer Assessment Data Collection Tool   Facility Name: Name Date Completed: Date Time Period Being Reviewed: Using information from the Unplanned Transfer Assessments reviewed during the timeframe you have identified in Row #5, enter item totals in the following sections. Day of Hospital Transfer: # % Sunday 4 11% Monday 2 6% Tuesday Wednesday 5 14% Thursday 6 17% Friday 7 19% Saturday 8 22% Total 36 100% How many transfers occurred on the following shifts: 1st Shift: 7AM-3PM 2nd Shift: 3PM-11PM 33% 3rd Shift: 11PM-7AM 50% 12 Notes: Summary

Putting the Tools to Work in Everyday Practice

Putting the Tools to Work in Everyday Practice

Putting the Tools to Work in Everyday Practice

Putting the Tools to Work in Everyday Practice

Putting the Tools to Work in Everyday Practice The INTERACT Change in Condition File Cards: The case of Mrs. S: a classic case that illustrates their purpose

Putting the Tools to Work in Everyday Practice

Putting the Tools to Work in Everyday Practice

Putting the Tools to Work in Everyday Practice

Putting the Tools to Work in Everyday Practice INTERACT Care Paths 9 conditions All structured the same way Provide guidance on when to notify the MD/NP/PA consistent with File Cards Suggest evaluation strategies Provide recommendations for management and monitoring in the facility

Interacting with Your Hospitals The new INTERACT III NH to Hospital Data List will contain recommended data elements consistent with national standards for CCDs The sample Resident Transfer Form has two pages: The first page has information that ED physicians and nurses identified as essential to make decisions about the resident.

Interacting with Your Hospitals This Transfer Checklist can be printed or taped onto an envelope, and is meant to compliment the Transfer Form by indicating which documents are included with the Form

Interacting with Your Hospitals Information Transfer From the Hospital The new INTERACT III Hospital to PAC Data List will contain recommended data elements consistent with national standards for CCDs, and data that is critical for safe care in the first 24-72 hours The sample Hospital to PAC sample Transfer Form will provide an example of how to put the data in easy to read format for the receiving clinician.

ADVANCE CARE PLANNING TOOLS When? ACP should occur at some time shortly after admission Decisions should be reviewed regularly and at times of acute changes in condition

ADVANCE CARE PLANNING TOOLS Adapted from Tulsky, JA. Beyond Advance Directives – Importance of Communication Skills at the End of Life. JAMA 2005; 294:359-365 .

ADVANCE CARE PLANNING TOOLS Comfort or palliative care, whether or not the resident is enrolled in a hospice program, should include standard orders that address: Nutrition and hydration Activity Monitoring in the least disruptive way Hygiene Comfort and safety This material was adapted from the Birmingham VA Safe Harbor Project in 2007

Future Directions for INTERACT Test INTERACT in clinical trials to improve the evidence-base NIH grant (funded) VA grant (scheduled for funding later in 2012) Refine the program and the implementation training curriculum (Medline Industries grant) Further spread the INTERACT program in conjunction with the QAPI roll-out (Commonwealth Fund grant) Develop ethnically and culturally sensitive person-centered decision tools about hospital transfer (Patient-Centered Outcomes Research Institute grant)

Future Directions for INTERACT Further spread the INTERACT program in other settings ALFs, home care (CMS Innovations Grant) Other countries (e.g. England, Canada, Singapore) Combine INTERACT with other interventions Care transition interventions (CMS Innovations Grant) Telemedicine and others Work with regulators and payers to incentivize INTERACT implementation (underway with CMS) Embed INTERACT into HIT (PointClickCare) EMRs (LTC software) Inter-facility transfer platforms

Examples of HIT Applications Using INTERACT Tools HIT

Examples of HIT Applications Using INTERACT Tools HIT Facility QI Reports Information for hospital transfer Quality Measures

Examples of HIT Applications Using INTERACT Tools HIT Nursing assistant notes Automated alerts to licensed nurses

Examples of HIT Applications Using INTERACT Tools HIT

Examples of HIT Applications Using INTERACT Tools HIT

Examples of HIT Applications Using INTERACT Tools HIT Secure information transfer to emergency room or acute care unit CCD that meets national standards

What is It and Why Does It Matter? The INTERACT Program: What is It and Why Does It Matter? Questions? Comments? Suggestions? jousland@fau.edu