1. Move to Improve Program Process and Results Gina Mazza RN, BSN Partner, Fazzi Associates Jim Culhane. MSW, MBA Director of Homecare and Personal Services VNA of Manchester and S NH February 2013 1

2. To identify best practice strategies for reducing avoidable hospitalizations of the home care patient. Objective 2

3. 76 Agencies Size of agencies by Average Daily Census: Mean: 230 Median: 157 # agencies less than 100: 19 # between 100 and 300: 39 # agencies greater that 300: 20 Move To Improve Project Statistics 3

4. For comparative analysis, agencies were divided into three categories: Move To Improve Project Statistics Home Health Compare Rate Number of Agencies Low Hospitalization Rate (Best) 16% - 27%23 Moderate Rate Hospitalization 28% - 32%28 High Hospitalization Rate (Poorest) 33% or greater25 4

5. The Program… Initiated collection of baseline OASIS data Agency practice survey Focus Group Developed Tracker and Hospitalization Management Dashboard Training 5

6. Revised Structure Audit tool revised Dashboard revised Monthly Accountability/Planning Meeting 6

7. SafeSide ™ Structure Activity Real Time Tracking Real Time Audits Monthly Targeted Trend Improvement Effort SafeSide Components Hosp. Dashboard 48-Hour SafeSide Audit SafeSide Monthly Accountability Meetings (MAP) No More Than 1 New Improvement per Quarter LeadQI/PI Clinical Director/ Supervisor SafeSide Lead Clinical Director 7

8. InputProcess Outcomes: Improvement Efforts Zealous Accountability ● Data-Driven ● Goal-Oriented Measurable Targets and Outcomes Project Leader Planning and Improvement Meeting Fazzi’s SafeSide Outcomes Model The Outcome Oriented Change Model Process Improvements Practice Refinements New Strategies Education and Competency Data Monitoring and Tracking Data Monitoring and Tracking Real-Time Audits 8

9. Leadership of Program Lead CEOSenior Clinical Dir. Mid Level Quality Average Overall Reduction -6.0%-5.0%-2.2%0.2%-4.2% 9

10. Frequency of Monitoring Hospitalization Rates How often monitor scores Often Somewhat more In- Frequent Have not monitored Average Overall Reduction -6.7%-3.2%0.8%0.0% 10

11. Results of Agencies Performing Audits Hospitalization Grouping at Initiation Change in HHC Hospitalization Rate % Reduction of the HHC Rate High Rate -11 percentage points 21.5% Moderate Rate -5.3 percentage points 15.6% Low Rate -2.8 percentage points 10.1% Total -6.6 percentage points 15.7% 11

12. Overall Results Hospitalization Grouping at Initiation Change in HHC Hospitalization Rate: First 6 Months vs. Last 6 Months % Reduction of their HHC Rate High Rate-11 percentage points19.9% Moderate Rate-4percentage points13.9% Low Rate-3 percentage points8.2% Total Average-6 percentage points14.8% 12

13. Recommendations 1.Audit charts of hospitalized patients ●Critical to identifying core issues related to hospitalization ●Create teachable moments 2.Set clear and measureable goals and share with team ●Set stretch goals and publicize and celebrate wins 13

14. Recommendations 3. Accountability ●Have a leader that has authority, accountability and respect of clinicians. 4. Develop a plan for change and operationalize ●Plan, Do, Check, Act ●Don’t let daily fires distract from the focus. 14

15. SafeSide Hospitalization Study 2012: Key Findings 1. This patient was identified as high risk for ACH. 2. Interventions were implemented for the ACH risks identified. 15

16. Final Thoughts Act with purpose Make decisions based on data Set clear goals Have clear outcomes 16

17. Gina L. Mazza RN, BSN 413- 584-5300 17