1. 1 Home Health Agencies Quarterly Sharing Call: Cardiac Data Registry and Quality Assurance and Performance Improvement (QAPI) November 10, 2015 Cindy Sun and Misty Kevech

2. Initiating Cardiovascular QAPI Development HHQI RN Project Coordinators: Cindy Sun, MSN, RN, COS-C Misty Kevech, MS, RN, COS-C This material was prepared by Quality Insights, the Medicare Quality Innovation Network- Quality Improvement Organization supporting the Home Health Quality Improvement National Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The views presented do not necessarily reflect CMS policy. Publication number 11SOW-WV-HH-MMD-110415

3. Objectives  Describe the purpose of HHQI’s cardiovascular health initiative and how it aligns with own agency's quality priorities  Access and navigate the HHCDR  Use the HHCDR data to develop and evaluate quality priorities  Develop a QAPI Cardiovascular Performance Improvement Project (PIP) using key tools from the Cardiovascular Health Best Practice Intervention Packages (BPIPs)

4. What is HHQI? Goal: Improve the quality of care home health patients receive Special Project funded by Centers for Medicare & Medicaid Services Free evidence-based tools and resource Many networking opportunities with about 14,000 participants

5. On the Horizon & Connection to QualityQuality HH Star CoP VBP

6. 3-Step QI Process Step 1: Assess agency data / overview of quality Step 2: Decide where to focus efforts Step 3: Create PIP including strategies & resources

7. Home Health Cardiovascular Data Registry

8. Home Health Cardiovascular Improvement Initiative  Aligns with national Million Hearts® initiative ABCS  Focuses on the ABCS of preventive cardiovascular care: – Aspirin when appropriate – Blood pressure control – Cholesterol management – Smoking cessation

9. ABCS Measures ASPIRIN % of patients with IVD using ASA or other antithrombotic BLOOD PRESSURE % of patients with HTN with controlled BP % of patients with HTN with a recommended follow-up plan CHOLESTEROL % of patients with DM or IVD with adequately controlled LDL-C SMOKING % of patients screened for tobacco and received cessation counseling / intervention if identified as a tobacco user

10. HHCDR Details  HHCDR accessible through Data Access portal  Episodes from July 2014 to current  Each month, HHA will select which topic areas (A, B, C, and/or S)  Pre-populated with episode demographic data  12 or less episodes per topic area with option to enter additional data if desired

11. Patient Qualifications  Must have been under the care of the HHA for 2 weeks or more  Individual measure age requirements  Aspirin: IVD diagnosis  Blood Pressure: HTN diagnosis without renal failure and/or pregnancy  Cholesterol: IVD and/or diabetes  Smoking: All patients qualify

12. www.HomeHealthQuality.org

13. Data Access

14. Accessing the HHCDR

15. Selecting month to abstract

16. Making monthly selection

17. 1 st page in monthly registry

18. Top portion of Registry

19. Aspirin

20. Blood Pressure

21. Cholesterol

24. Tobacco

25. Dual-Eligibility

26. Accessing the HHCDR

27. HTN: Controlling High Blood Pressure Hypertension: Controlling High Blood Pressure Percentage of patients aged 18-85 years who had a diagnosis of hypertension (HTN) documented within the most recent 12 months while under the care of the agency and whose blood pressure (BP) was adequately controlled (<140/90 mm Hg) while under the care of the home health agency Jul 2014 Aug 2014 Sep 2014 Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 Apr 2015 Total # of Episodes with Controlled BP 2524 21 152326 23228 Total Eligible Episodes Abstracted-Agency 30273026282526303127280 Agency Measure Compliance % 83.3388.8980.0080.7775.0060.0088.4686.6783.8785.1981.43 Total Data Registry Measure Compliance % 78.9880.5378.0179.4677.2174.0874.6976.4678.5078.2477.57

28. Controlling Blood Pressure: Follow-Up Documented Controlling High Blood Pressure: Follow-Up Documented Percentage of patients aged 18-85 years who had a diagnosis of hypertension (HTN) documented within the most recent 12 months while under the care of the home health agency and a recommended follow-up plan is documented while under the care of the home health agency Jul 2014 Aug 2014 Sep 2014 Oct 2014 Nov 2014 Dec 2014 Jan 2015 Feb 2015 Mar 2015 Apr 2015 Total # of Episodes with a Follow-Up Plan 2618 121511141722 175 Total Eligible Episodes Abstracted-Agency 30273026282526303127280 Agency Measure Compliance % 86.6766.6760.0046.1553.5744.0053.8556.6770.9781.4862.50 Total Data Registry Measure Compliance % 83.6084.4973.6376.2876.1487.0484.4781.3179.1476.6280.04

29. Cardiovascular Health Performance Improvement Plan (PIP) Resources

30. Blood Pressure Control Aspirin as Appropriate Blood Pressure Control Smoking Cessation Cholesterol Management

31. PIP Tool: Blood Pressure

32. So What is QAPI? Quality Assurance Measure quality compliance standards Assure care reaches acceptable levels Focus on provider Required and reactive Performance Improvement Improve processes to meet standards continuously Decrease problems by identifying opportunity for improvement Focus on patient Chosen and proactive

33. 5 Standards of Home Health QAPI

34. QAPI Standards 1.Executive Responsibility – Require the HHA’s governing body to assume responsibility for your agency’s QAPI program – Define, implement, and maintain an ongoing agency-wide program for quality improvement and patient safety developed from evidence- based practices – Ensure that performance improvement efforts are prioritized and evaluated for effectiveness to promote your agency’s integrity and quality

35. QAPI Standards 2.Program Scope – Show measurable improvement in indicators for which there is evidence for improvement of health outcomes Examples: Reduction of hospitalizations and readmissions, safety, and quality of care for patients – Measure, analyze, and track quality indicators, including adverse patient events and other performance indicators

36. QAPI Standards 3.Program Data – Use quality indicator data, including measures derived from OASIS or other relevant data See the worksheet for more specifics – Utilize data to: Assess quality of patient care Identify and prioritize opportunities for improvement – Focus quality assessment efforts, including data collection on high priority safety, and health conditions and other goals identified by your agency – Monitor the effectiveness and safety of your agency’s services and quality of care

37. QAPI Standards 4.Program Activities – Focus on high-risk, high-volume, or problem- prone areas of service, and consider the incidence, prevalence, and severity of problems in those areas – Correct any immediate problems that directly or potentially threaten the health and safety of patients – Continue to monitor the area(s) to assure that improvements are sustained over time

38. QAPI Standards 5.Performance Improvement Projects (PIPs) – Conduct PIPs at least annually, reflecting the scope, complexity, and past performance of your agency’s services and operations – Utilize data collection and analysis to select focus areas: Previous problematic performance issues Clear evidence of poor patient outcomes High-risk and high-volume – Document QAPI project and progress

39. QAPI Performance Improvement Project (PIP) HHA’s QAPI Plan PIP PIP (e.g., CVH) Other PIPs Infection Control PIP

40. PIP Tool: Blood Pressure ACTIONSRESOURCES

41. Blood Pressure Staff Education  Cardiovascular Health Part 1 BPIP Cardiovascular Health Part 1 BPIP – Blood Pressure Accuracy & Accurately Assessing Orthostatic Hypotension

42. Blood Pressure Staff Education  HHQI University Courses HHQI University – Master the Maze of Blood Pressure Medications – Blood Pressure Control & Smoking Cessation

43. Blood Pressure Patient Education  Cardiovascular Blood Pressure Control Video BPIP Cardiovascular Blood Pressure Control Video BPIP – How to Check My Own Blood Pressure (7 min) – AHA Blood Pressure Tracker tool – Blood Pressure Medication Management (7 min)

44. My Healthy Heart Workbook Available in: English Spanish Chinese Russian Vietnamese

45. Additional QAPI Tools & Resources

46. HHQI University Pave Your Path Series  Pave Your Path: Designing a Systematic Approach to Quality Improvement – 4-course series in HHQI University Focuses on IHI’s Model for Improvement Includes PDSA (Rapid Cycle Improvement) Collaboration with Institute of Healthcare Improvement Includes free nursing CEs

47. HHQI University QAPI Series  Home Health QAPI Foundation course  Subsequent specialized individual courses – Hospitalizations – Medication Management – Cardiovascular Health

48. HHQI CardioLAN Sharing of cardiovascular knowledge & application of resources Networking Identifying opportunities for improvement Direct access to the HHQI Team CardioLA N

49. Next Steps Download and read the CVH BPIPs Parts 1 and 2, if you select CVH as a PIP. Have you joined HHCDR already? If not join now! Are you working with your QIN/QIO? If not contact them! Which of the ABCS will you abstract and develop a PIP? Decide on an area for a Performance Improvement Plan (PIP). What does your data say? What area is high risk, high volume, or will impact your populations? What key tools and resources will you consider implementing? Download and review the QAPI materials from HHQI. How does your current quality improvement align with QAPI? What do you need to work on to strengthen your overall QAPI Plan?

50. Questions?

51. Networking & Assistance

52. Connect with HHQI Facebook www.facebook.com/myHHQI www.facebook.com/myHHQI Twitter www.twitter.com/HHQI www.twitter.com/HHQI Pinterest www.pinterest.com/myHHQI www.pinterest.com/myHHQI LinkedIn www.linkedin.com/company/hhqi-national-campaign www.linkedin.com/company/hhqi-national-campaign MyHHQI Blog http://hhqi.wordpress.com http://hhqi.wordpress.com LiveChats under Network tab on HHQI website under Network tab on HHQI website

53. Thank You! Contact Info: General Mailbox – HHQI@wvmi.orgHHQI@wvmi.org Cindy Sun – csun@wvmi.orgcsun@wvmi.org Misty Kevech – mkevech@wvmi.orgmkevech@wvmi.org This material was prepared by Quality Insights, the Medicare Quality Innovation Network-Quality Improvement Organization supporting the Home Health Quality Improvement National Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The views presented do not necessarily reflect CMS policy. Publication number 11SOW-WV-HH-MMD-110415

54. 54 Who to Call for Help? QINQIO Colorado Contact: Devin Detwiler 303-875-9131 Devin.detwiler@area-d.hcqis.org QINQIO Illinois Contact: Anna Astalas 630-928-5832 Anna.astalas@area-d.hcqis.org QINQIO Iowa Contact: Frann Otte 515-273-8807 Frann.otte@area-d.hcqis.org

55. 55 Thank you for joining! This material was prepared by Telligen, the Medicare Quality Innovation Network Quality Improvement Organization, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 11SOW-QIN-B4-10/2015-11282