1. INTERACT COLLABORATIVE ORIENTATION SESSION NYSHFA/IPRO PARTNERSHIP Sara Butterfield, RN, BSN, CPHQ, CCM Christine Stegel, RN, MS, CPHQ NYSHFA/IPRO INTERACT Collaborative Orientation Webinar June 11, 2013

2. Objectives Provide an overview of the collaborative guidelines Review how to calculate your facilities baseline hospitalization rate Discuss resident hospitalization reviews completed to date Establish monthly teleconference schedule - Timeline

3. 3 The INTERACT version 3.0 tools are meant to be used together in your daily work in the nursing facility http://interact2.net

4. Collaborative Mission Statement Each skilled nursing facility that has agreed to participate in the collaborative will implement all components of the INTERACT Program by July 31, 2014

5. Collaborative Vision Statement Through regular learning and action teleconferences, the facility’s INTERACT team will: Implement the INTERACT Program, Share their experiences and strategies, Trend their hospitalization rate over time, Reduce resident acute care transfers by 10% by 07/31/2014

6. First Steps Select a team (include direct care staff) and establish a meeting schedule Calculate your hospitalization baseline rate Begin using the Interact Quality Improvement Review tool (with the next resident transfer) Establish implementation plan (how has the facility implemented new programs in the past - one unit versus whole facility) Establish a plan to participate in Collaborative monthly teleconference

8. INTERACT Website http://interact2.net Always access for most up to date version of tool Download the Hospitalization tracking tool Print: The Implementation Guide Print: The Implementation Checklist complete and fax back to Christine Stegel at 518-426-3418 by June 30, 2013

9. Website Tools Currently In Use QI Tool for Review of Acute care Transfers QI Summary Worksheet Acute Care Transfer Log Worksheet

10. © Florida Atlantic University 2011

13. CALCULATING HOSPITALIZATION RATES

14. Calculating Hospitalization Rates INTERACT tools designed to provide clear definitions related to rates of hospital transfers, hospitalizations and hospital readmissions consistent with evolving definitions used by CMS and other national organizations. 1.Acute Care transfer Log- paper & pencil tool 2.Hospitalization Rate Tracking Tool-excel workbook

16. INTERACT Hospitalization Rate Tracking Tool

19. 19 Basic Hospitalization Rates Four Basic Hospitalization Rates can be calculated: 1.Unplanned Hospitalization rate 2.30 day readmission rate 3.Emergency Room Visits Only 4. Transfers Resulting in Observation Stays

20. 20 Basic Hospitalization Rates 1. Unplanned Hospitalization Rate-excludes observation stays and planned admissions Adjusted for census and # of days in month for comparison purposes among facilities. (expressed in terms of 1,000 resident days) Each day a resident spends in the nursing home contributes one resident day for the month. Total resident days= Aver daily census (ADC) by days in month

21. 21 Let’s Practice A nursing facility with an ADC of 100 will have 3000 resident days in a 30-day month. If that nursing facility had 9 hospitalizations for the month, the hospitalization rate would be 3 per 1000 days. 9/3000= 3/1000

22. 22 Basic Hospitalization Rates 2. 30-Day Readmission Rate : Calculated by identifying individual residents admitted after an inpatient stay during a given month and following them for 30 days. Numerator: # of inpatient hospitalizations among those residents in denominator that occur within 30 days of admission to your facility after an inpatient hospital stay. Denominator: # of residents admitted to the facility who had an inpatient hospital stay during the month. Residents with 2 or more 30 day readmissions in a 30 day period counts into the N and D. Therefore 1 resident could contribute 2 or more times to the 30 day readmission count.

23. 23 30 Day Readmission Rate Cont’d Includes residents who were admitted to NF within 30 days from inpatient stay at Acute Care Hospital (ACH), Critical Access Hospital (CAH) or Acute Psychiatric Hospital (APH). Only includes those discharged to ACH or CAH within 30 days not those discharged to APH or acute rehab hospital. (only record these in transfer log) Planned admissions not counted. Admitted- inpatient or Admission- uncertain in data log counted not observation status.

24. 24 Let’s Practice Your census in January was 110, February 112, March 108. During these 3 months you had 66 admissions after an inpatient stay at your local hospital. During the same 3 months you transferred a total of 30 of these 66 residents back to the hospital within 30 days of their recent hospital discharge. Of these 30, 1 was a planned admission for colostomy revision, a 2 nd was scheduled hip replacement, and one for monthly chemo. 5 residents were admitted under observation status. What was your 30-day readmission rate for the Quarter?

25. 25 Let’s Practice Answer: 33%. The denominator is 66. The numerator is 22 (30 minus 3 residents with planned admissions and then 5 admitted into observation status) 22/66=33%

26. Basic Hospitalization Rates cont’d 3. Emergency Room Visits Only:  Adjusted by ADC as in unplanned hospitalization rate.  Residents who die in ambulance or ER are counted in numerator. 4.Transfers Resulting in Observation Stays  Adjusted by ADC as in unplanned hospitalization rate.  Count observation stays that do get changed to inpatient status only.

27. Each of the 4 rates can be tracked and trended in different ways: Entire facility Post-acute unit Long stay residents When combined with data from the QI tool, variety of additional measures can be tracked-time, day of the week, clinician ordering the transfer etc. Basic Hospitalization Rates cont’d

28. ROOT CAUSE ANALYSIS

29. Review Resident Transfers – Root Cause Analysis Use the INTERACT Quality Improvement Tool for review of acute care transfers Quality Improvement Summary Worksheet IPRO Excel tool

30. Identify Improvement Opportunities Two ways to look for opportunities to improve care and decrease potentially avoidable transfers Population level-proactively look at trends and patterns in order to improve performance Individual case level-more reactive and aimed at identifying specific system/process breakdowns in order to improve performanc e 30

31. 31 The QI Summary Worksheet is designed to: 1.Walk the QI team through analysis of transfers 2. Call out common reasons for transfers Section 1: Resident Characteristics Section 2: Acute Change in Condition & Factors Contributing to the Transfer Section 3: Actions taken to evaluate & manage Change in Condition Prior to transfer Section 4: Characteristics of the Transfer 3.Choose interventions/Focus educational and improvement activities Section 5: Identify opportunity for improvement

32. Review Resident Transfers Discussion of resident review findings

33. Next Steps Download the Hospitalization tracking tool Calculate Baseline Hospitalization Rate Print: The Implementation Guide Print: The Implementation Checklist Complete both tools and fax back to Christine Stegel at 518-426-3418 by June 30, 2013

34. QUESTIONS

35. For more information Sara Butterfield, RN, BSN, CPHQ, CCM Senior Director (518)426-3300 x104 sbutterfield@nyqio.sdps.org IPRO REGIONAL OFFICE 20 Corporate Woods Boulevard Albany, NY 12211-2370 IPRO CORPORATE HEADQUARTERS 1979 Marcus Avenue Lake Success, NY 11042-1002 www.ipro.org Template 1/13/2012 Christine Stegel, RN,MS,CPHQ Sr. Quality Improvement Specialist (518) 320-3513 cstegel@nyqio.sdps.org This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents do not necessarily reflect CMS policy. 10SOW-NY-AIM8-13-42.