Genesis Health System PromiseCare Research Summit June 8, 2016 1 - - PowerPoint PPT Presentation

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Genesis Health System PromiseCare Research Summit June 8, 2016 1 - - PowerPoint PPT Presentation

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Genesis Health System PromiseCare Research Summit June 8, 2016 1 PromiseCare - Concepts The PromiseCare process is known by many titles, and in summary is focused on: Re-designing clinical care to achieve these goals Reducing

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Genesis Health System PromiseCare

Research Summit – June 8, 2016

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PromiseCare - Concepts

The PromiseCare process is known by many titles, and in summary is focused on:

  • Re-designing clinical care to achieve these

goals

  • Reducing variation in care
  • Increasing reliability of outcomes
  • Increasing efficiencies in the use of

resources

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Almost all studies that investigate the reliability of the application of clinical science in healthcare conclude that there are significant opportunities for improvement.

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  • lume 348(26) 26 June 2003 pp 2635-2645

The Quality of Health Care Delivered To Adults In the United States

McGlynn, Elizabeth A.: Asch, Steven M.: Adams, John: Jeesey, Joan: Hicks, Jennifer: DeCristofaro, Alison: Kerr, Eve A.

BACKGROUND We have little systematic information about the extent to which standard processes involved in healthcare—a key element of quality—are delivered in the United States. METHODS We telephoned a random sample of adults living in 12 metropolitan areas in the United States and…received written consent to copy their medical records…to evaluate performance on 439 indicators of quality of care for 30 acute and chronic conditions as well as preventative care… RESULTS Participants received 54.9 percent of recommended care. CONCLUSIONS The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public. Strategies to reduce these deficits are warranted.

Reliability in HealthCare

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PromiseCare - Origins

The concept of decreasing variation in care is not new. It has been successfully implemented by

  • rganizations such as Geisinger Health

System and Intermountain Health Care. They have documented success in achieving the desired results.

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Geisinger Model – Proven Care

Developed a process one procedure / DRG at a time. About 10 years in the making so far Originally started with CABG Led by a Cardiac Surgeon to start with Currently about 17 projects in place CABG Ave. LOS fell 0.5 days (6.2 vs. 5.7) CABG 30-day readmission rate fell 44%

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GHS - Performance Excellence as Strategy

Physician Led - Professionally Managed

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The Promise in PromiseCare

Right Patient

Equitable Care

Every time Every patient

Right Time Right Setting Right Resources Right Care

Safe Patient-Centered

Timely

Effective/Efficient

Crossing the Quality Chasm 2001 – Institute of Medicine 9

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PromiseCare - Objectives

Differentiate Genesis based on quality outcomes Reduce the overall cost to treat

  • Research current best evidence
  • Hardwire care delivery processes
  • Reduce unwanted variation to deliver high clinical

reliability

  • Reduce operational inefficiencies
  • Provide effective and efficient clinical care

Develop the internal infrastructure (people, process and

technology) that will ensure sustained improvements, maintain consistency and provide ongoing cost-effective care

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PromiseCare - Operational Structure

GHS Performance Excellence Leadership Committee PromiseCare Steering Committee

Chair: CMO

Medical, Clinical & Administrative Leadership

PromiseCare Project Support Team: IT, BIC, Finance, Quality, Nursing Education, Pharmacy, and others PromiseCare Coordinator and Specialist

GMC-Davenport MOC GMC – Illini MOC CAH MEC

Sepsis Leadership Team and Workgroups HF Leadership (Phase I & II)Teams and Workgroups Stroke Rehab Leadership Team and Workgroups

Condition Specific Leadership Committee

Physician, Nurse & Administrative Champions

11 Total Knee Procedure (Sleep Apnea ) Diabetes (Phase I & II)Teams and Workgroups

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PromiseCare - Steering Committee

Essential governance to make the process consistent Reports to the MOC and MEC on progress and state of the program Needs multidisciplinary input

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PromiseCare - Steering Committee Differentiate Genesis based on quality outcomes

  • Receive and review ongoing requests for PromiseCare

initiatives

  • Approve selection criteria
  • Select DRG / Diagnosis for Promise Care
  • Charter DRG & Clinical Redesign Teams
  • Monitor progress of PromiseCare projects
  • Monitor attainment of metrics for Promise Care

initiatives (process and outcomes)

  • Oversee communication plan

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Criteria Rank (1 – 5 high) Percentage Weighting Total Availability of Evidence Base Medicine 25% Physician Leadership in Area/Condition 20% Quality Opportunity 20% Sufficient Volume for Change 15% Availability of Data 10% Financial Opportunity 10%

PromiseCare - Selection Criteria for Care Redesign

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PromiseCare – What are We Doing? Agreeing on what the right care is (Best Practice Elements) Designing the processes to ensure the right care happens every time Measuring compliance to the process measures Measuring the outcomes Expecting improved outcomes with less cost

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PromiseCare - Structure & Relationships

 A methodology to bring the optimal coordination of resources to a clinical situation in a consistent, quality

  • riented, cost effective manner

 Requires the utmost collaboration between all components of patient care  Needs extensive resources

  • Medical Oversight
  • Nursing
  • Pharmacy and other Disciplines
  • Education
  • IT
  • BIC / Finance review
  • Quality

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Stroke Rehab

 Physician led - Dr. Chin

 Professionally managed – Suzanne Schalber  Stroke Rehab process is fully implemented and the model for the rest of the System to follow  Will promise future Stroke Rehab patients they will deliver specific best practice elements

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Condition:

GMC - Daven

Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample

n = 14 n = 17 n = 9 n = 18 n = 12 n = 15 n = 9 n = 12 n = n = n = n =

Compliance to Process Measures

Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 YTD Avg.

PromiseCare Admit Stroke Rehab Power Plan Percentage 100.0% 100.0% 81.8% 100.0% 100.0% 93.8% 88.9% 92.3%

1 % of Patients Assessed by Therapies within 24 Hours

  • f Receipt of Initial Rehab Order

100% 100% 100% 100% 100% 100% 100% 100% 100% 2 % of Patients Who Received a Dietary Consult within 24 hours of Receipt of Initial Rehab Order 100% 100% 100% 100% 100% 93% 100% 100% 99% 3 % of Patients Who received Bowel and Bladder Training 100% 100% 100% 100% 100% 100% 100% 100% 100% 4 % of Patients Who Completed Depression Screening within 48 Hours of Receipt of Initial Rehab Order 86% 100% 100% 100% 100% 100% 89% 100% 97% 5 % of Patients Who Had Swallowing Assessment Completed 100% 100% 100% 100% 100% 100% 100% 100% 100% 6 % of Patients With Communication Disorder Who Received Training by SLP 100% 100% 100% 100% 100% 100% 100% 100% 100% 7 % of Patients With Cognitive Deficit Who Received Training 100% 100% 100% 100% 100% 100% 100% 100% 100% 8 % of Patients Who Have Neurofeedback Assessment Completed 100% 100% 100% 100% 100% 100% 100% 100% 100% 9 % of Patients Who Have Daily Monitoring for Skin Integrity 100% 100% 100% 100% 100% 100% 100% 100% 100% 10 % of Patients Who Receive 3 Hours of Therapy Daily 93% 100% 89% 100% 100% 100% 100% 100% 98% 11 % of Patients Who Have Mobility Issues AND Received PT Training 100% 100% 100% 100% 100% 100% 100% 100% 100% 12 % of Patients Who Have Self Care Issues AND Received OT Training 100% 100% 100% 100% 100% 100% 100% 100% 100% 13 % of Patients Who Were Discharged by Estimated Discharge Date 100% 100% 78% 100% 100% 93% 100% 85% 94%

PromiseCare Stroke Rehab Bundle 98.1% 100.0% 97.2% 100.0% 100.0% 98.9% 99.1% 99.3% 99.2% PromiseCare All or Non Bundle 78.6% 100.0% 66.7% 100.0% 100.0% 86.7% 88.9% 92.3% 90.7%

n = 12 n = 16 n = 11 n = 18 n = 11 n = 16 n = 9 n = n = n = n = n =

Clinical Outcome Measures

Baseline Target

Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 YTD Avg. 1 % of Patients Discharged to Acute Care 6.3% 10.2% 0.0% 6.3% 27.3% 11.1% 0.0% 12.5% 11.1% 7.7% 2 Case Mix Index 1.31 1.54 1.5751 1.3291 1.1231 1.4732 1.1707 1.5338 1.2057 1.3456 3 FIM Change Admission to Discharge 21.97 22.07 28.58 21.06 16.91 22.56 25.18 23.69 22.00 23.46 4 % of Discharges to home 66% 67.96% 42% 56% 64% 61% 73% 63% 44% 77% 5 % of Discharges to a Skilled Nursing Facility 21.17% 58.3% 37.5% 9.1% 27.8% 27.3% 25% 33% 15% 6 ALOS 19.86 14.25 15.33 15.88 11.45 12.73 15.36 15.06 15.89 15.15 7 ALOS O/E Index N/A 0.85 1.03 0.86 0.74 1.10 0.85 1.01 0.96 8 Rehab Unit Patient Satisfaction Percentile 38 80

Financial Outcome Measures

Baseline Target

Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 YTD Avg. 1 Variable Cost per Case 10,592 $ 8,911 $ 9,996 $ 7,086 $ 8,562 $ 9,845 $ 8,880 $ 3 Contribution Margin 78,917 $ 75,499 $ 25,119 $ 109,141 $ 94,101 $ 76,555 $

Stroke Rehab GMC - Davenport

Goal is 98.5%

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Goal is 98.5%

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Sepsis

 Physician led – Dr. Dierks

 Professionally managed – Lynn Colberg  CMS intervention

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60 64 60 53 33 94 70 74 100 90 10 20 30 40 50 60 70 80 90 100

Jul-2015 Aug Sep Oct Nov Dec Jan-2016 Feb Mar Apr May

PERCENT POWER PLAN USAGE MONTH

GMC-DAVENPORT - CMS INPATIENT SEPSIS POWER PLAN USAGE

Goal 45%

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GMC - Silvis Sepsis GMC - Silvis Seps GMC - Silvis Sepsi

Disch in sample Disch in sample Disch in sample Disch in sample Disch in sample Disch in sample Disch in sample Disch in sample Disch in sample

6 6 3 4 6 5 8 5 5

Compliance to Process Measures

Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 All SIRS, potential Sepsis patients 1 % Was SIRS Alert fired 2 % Was suspected Adult Sepsis protocol initiated All Sepsis patients 3 % Lactate ordered < 3 hrs 100% 86% 100% 100% 17% 100% 100% 100% 100% 4 % Remeasure lactate if initial lactate was elevated < 6 hrs 66% 43% 67% 100% 50% 33% 60% 60% 5 % Patients in which Sepsis Order Set was utilized 83% 67% 86% 50% 50% 60% 50% 60% 100% % Patients in which Sepsis Order Set was utilized < 3 hrs 6 % Sepsis Patients in which 2 Blood cultures are drawn prior to administration of antibiotics < 3 hrs 100% 86% 67% 100% 17% 80% 100% 100% 80% 7 % Sepsis Patients in which broad spectrum antibiotics were administered < 3 hrs of admit time 83% 71% 100% 75% 33% 100% 88% 100% 100% 10 % Patients receiving appropriate fluid resuscitation < 3 hrs (Only Septic Shock patients) 50% 100% 50% 25% 0% 0% 12 % Patients with Focused Exam and/or Hemodynamic Monitoring < 6 hrs (Only Septic Shock patients) 100% 50% 0% 0% 0% 0% 15 % Patients given Vasopressor (or other inotrope) < 6 hrs (only Septic Shock patients) 100% 100% 0% 0% 0% 0% Overall Compliance All or None Bundle (CMS) 17% 14% 33% 67% 0% 0% 0% 20% 20%

Clinical Outcome Measures (rolling 12 mon.)

Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 1 Mortality O/E - Total Sepsis now 0.71 0.70 0.62 0.63 0.65 0.57 0.64 3 LOS O/E - Total Sepsis now 0.78 0.80 0.74 0.74 0.73 0.75 0.74 5 Readmission O/E - Total Sepsis now 0.76 0.78 0.85 0.86 0.82 0.77 7 Complication O/E - Total Sepsis now 0.83 0.91 0.56 0.58 0.57 0.54 0.56

Financial Outcome Measures

Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 1 Variable Cost per Case - Total Sepsis now 3,798 $ 4,559 $ 3,677 $ 5,340 $ 4,580 $ 5 Contribution Margin - Total Sepsis now 65,277 $ 57,202 $ 54,661 $ 174,122 $ 53,324 $

Generated 05/16/2016

Indicates data not available Indicates data not yet available but will be later

Sepsis

GMC - Silvis

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Heart Failure (HF)

 Physician led - Dr. Rajendran  Professionally managed – Karen Doy / Jacque Oelerich

 Acute Setting - Phase 1 Completed with

some needed improvements

  • Will pilot PromiseCare Promise to Heart

Failure Patients

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Condition: Heart Failure

Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample Discharges in sample

n = 12 n = 14 n = 18 n = 11 n = 6 n = 20 n = 6 n = 11 n = 20 n = 22

Compliance to Primary Process Measures

Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 1

% of ED Patients Who Had a Primary Diagnosis of Heart Failure who received a Loop Diuretic

0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 2

% of ED Heart Failure Patients Admitted to Observation/Outpatient

16.7% 18.2% 5.0% 0.0% 3

% of Heart Failure Patients for which the HF Admission PowerPlan was utilized

75.0% 78.6% 50.0% 100.0% 85.0% 80.0% 83.3% 90.9% 80.0% 81.8% 4

% of Heart Failure Patients for whom the PromiseCare Heart Failure Checklist was utilized

91.7% 92.9% 83.3% 100.0% 100.0% 95.0% 100.0% 100.0% 95.0% 100.0% 5

% of Heart Failure Patients for which LVEF was charted

91.7% 85.7% 83.3% 100.0% 100.0% 95.0% 83.3% 90.9% 95.0% 100.0% 6

% of Heart Failure Patients who had a bodyweight measurement taken each day

83.3% 85.7% 83.3% 100.0% 100.0% 95.0% 100.0% 100.0% 90.0% 100.0% 7

% of Heart Failure Patients placed on strict daily Intake & Output.

91.7% 92.9% 83.3% 100.0% 95.0% 95.0% 100.0% 100.0% 90.0% 100.0% 8

% of Heart Failure Patients who received Heart Failure Education.

91.7% 92.9% 77.8% 100.0% 95.0% 95.0% 100.0% 100.0% 95.0% 95.5% 9

% of Heart Failure Patients with a 3-5 days post-discharge follow-up appointment scheduled.

83.3% 57.1% 55.6% 63.6% 75.0% 85.0% 66.7% 72.7% 75.0% 77.3% 10

% of Heart Failure Patients on which Medication Reconciliation was completed prior to discharge

58.3% 50.0% 44.4% 90.9% 70.0% 60.0% 83.3% 72.7% 75.0% 68.2% 11

% of Heart Failure Patients with a copy of their Discharge Medication List on their chart

83.3% 64.3% 50.0% 63.6% 80.0% 90.0% 83.3% 72.7% 85.0% 95.5% 12

% of Heart Failure Patients who had their Discharge Medication List provided/faxed to their physician

83.3% 64.3% 44.4% 63.6% 80.0% 90.0% 83.3% 72.7% 80.0% 86.4% 13

% of Heart Failure Patients with LVEF < 40 who had ACEI or ARB prescribed at discharge

91.7% 78.6% 72.2% 100.0% 90.0% 90.0% 100.0% 90.9% 95.0% 100.0% 14

% of Heart Failure Patients for whom the Heart Failure Discharge PowerPlan was utilized

0.0% 0.0% 0.0% 0.0% 5.0% 5.0% 0.0% 9.1% 0.0% 0.0%

Clinical Outcome Measures

Baseline Target

Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 1 Mortality O/E - Heart Failure 0.83 0.57 0.55 0.76 0.59 0.51 0.37 0.25 0.26 0.33 2 LOS O/E - Heart Failure 0.90 0.68 0.69 0.70 0.72 0.73 0.74 0.74 0.74 0.74 3 Readmission O/E - Heart Failure (30 Day PPR) 1.08 0.74 0.71 0.60 0.64 0.65 0.69 0.62 0.60 0.62 4 Complications - Heart Failure (30 Day PPC) 0.69 0.82 0.76 0.99 0.97 1.11 1.08 1.05 0.97 1.00 5 ALOS

GMC - Silvis

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Diabetes Team

Physician Led – Dr. Figaro Professionally Managed – Dianna Shie Expertly Facilitated by Nicole Palmer and Beth Fox

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Total Knee

Physician Led – Drs. Martin and Connolly Professionally managed – Julie VanDusen Expertly facilitated by Nicole Palmer and Beth Fox

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Heart Failure Phase II

Physician Leader to be determined Professionally managed – Jacque Oelerich Expertly Facilitated by Nicole Palmer

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PromiseCare Teams in Process

Developing

  • PowerPlans / Protocols
  • Checklists / Visual Cues
  • Diabetes Screening and A1C Results
  • Sleep Disorder Screening
  • Education for the Patients, Families, Staff and

Medical Staff

  • Transitions of Care
  • IT Deliverables
  • Scorecards

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PromiseCare

Integration with HRO, Lean and Baldrige

  • Research Best Evidence and Hardwire
  • Use of Algorithms, A3’s, Visual Cues, Standard

Work, Value Stream Mapping, Lean the PromiseCare Process

  • Project Management and IT Deliverables
  • Education of New Leadership
  • Education of New Providers
  • Move from Checklists to Care Plans
  • Healthcare Team Building

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PromiseCare

Questions?

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PromiseCare

Not The End Only the Beginning

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