HOME I S T HE HUB An I nitia tive to Ac c e le ra te Pro g - - PowerPoint PPT Presentation

HOME I S T HE HUB

An I nitia tive to Ac c e le ra te Pro g re ss to Re duc e Re a dmissio ns in Virg inia We b ina r # 6 De e p Dive Se rie s: E D-b a se d Stra te g ie s Ja nua ry 25, 2017

HOUSE K E E PI NG

• Slide s we re se nt this mo rning
• We b ina r is b e ing re c o rde d
• Ple a se use the “te le pho ne ” o ptio n
• Audio pin pro mpt
• All pa rtic ipa nts a re mute d
• Ra ise yo ur ha nd
• Ask a q ue stio n
• Wa rm up

WE L COME AND OVE RVI E W

Abraham Segres VHHA

Vic e Pre side nt, Qua lity & Pa tie nt Sa fe ty

a se g re s@ vhha .c o m (804) 965-1214

VI RGI NI A HOSPI T AL & HE AL T HCARE ASSOCI AT I ON

An a sso c ia tio n o f 30 me mb e r he a lth syste ms re pre se nting 107 c o mmunity, psyc hia tric , re ha b ilita tio n a nd spe c ia lty ho spita ls thro ug ho ut Virg inia .

Visio n

T hro ug h the po we r o f c o lla b o ra tio n, the a sso c ia tio n will b e the re c o g nize d driving fo rc e b e hind ma king Virg inia the he a lthie st sta te in the na tio n b y 2020.

Missio n

Wo rking with o ur me mb e rs a nd o the r sta ke ho lde rs, the a sso c ia tio n will tra nsfo rm Virg inia ’ s he a lth c a re syste m to a c hie ve to p-tie r pe rfo rma nc e in sa fe ty, q ua lity, va lue , se rvic e a nd po pula tio n he a lth. T he a sso c ia tio n’ s le a de rship is fo c use d o n: princ iple d, inno va tive a nd e ffe c tive a dvo c a c y; pro mo ting initia tive s tha t impro ve he a lth c a re sa fe ty, q ua lity, va lue a nd se rvic e ; a nd a lig ning fo rc e s a mo ng he a lth c a re a nd b usine ss e ntitie s to a dva nc e he a lth a nd e c o no mic o ppo rtunity fo r a ll Virg inia ns.

VHHA 2015-2020 I MPROVE ME NT PRI ORI T I E S

• 1. Ho spita l re a dmissio ns

1a . Ho spita l-wide 1b . Po st-a c ute tra nsfe rs 1c . T

• ta l hip/ T
• ta l kne e Re pla c e me nt 30-da y re a dmissio ns
• 2. Clo stridium diffic ile – He althc are -ac q uire d I

nfe c tio ns

• 3. Pa tie nt E

xpe rie nc e – HCAHPS

• 4. Se rio us Sa fe ty E

ve nts

HOME I S T HE HUB: 2016

Ac tivitie s E ve nts

• I

de ntify “Hig h-L e ve ra g e Stra te g ie s”

• Pre se nta tio n to VHHA Bo a rd
• Pa rtne rship with Virg inia QI

O

• We b ina r Se rie s: “Hig h L

e ve ra g e Stra te g ie s”

• I

n-Pe rso n L e a rning E ve nt

• Me e ting with SNF

Asso c ia tio n le a de rhsip

• Ma y

VHHA Bo a rd Pre se nta tio n

• June

“Hig h L e ve ra g e Stra te g ie s”

• Aug ust

Da ta / Me a sure me nt

• Se pte mb e r

Po st-Ac ute Ca re

• Oc to b e r

Multi-Visit Pa tie nts (hig h utilize rs)

• No ve mb e r

I n-pe rso n L e a rning E ve nt

• De c e mb e r

Artic ula te yo ur Stra te g y

HOME I S T HE HUB: 2017

Ac tivitie s Pla nne d E ve nts

• De e p Dive we b ina rs
• Spe c ia l T
• pic we b ina rs
• Offic e Ho urs fo r individua l c o a c hing
• Sta te -wide ”Sprint”
• Ho me is the Hub “Pla yb o o k”
• I

n-Pe rso n Me e ting : Suc c e sse s

*All we b inars will b e o ffe re d at 10am

• Ja nua ry 25

De e p Dive : E D-b a se d Stra te g ie s

• F

e b rua ry 22 Spe c ia l T

• pic : Pa ye r-Ba se d E

ffo rts

• Ma rc h 15

Offic e Ho urs with Dr. Bo utwe ll

• April 19

Spe c ia l T

• pic : CHWs
• Ma y 17

Offic e Ho urs with Dr. Bo utwe ll

• June 14

De e p Dive : Po st-Ac ute Ca re

• July 12

Ho me is the Hub Pla yb o o k

• Aug ust 16

Offic e Ho urs with Dr. Bo utwe ll

• Oc to b e r 18

I n-Pe rso n Me e ting

DE E P DI VE : E D-BASE D ST RAT E GI E S

Amy Boutwell, MD, MPP Collaborative Healthcare Strategies

Pre side nt

a my@ c o lla b o ra tive he a lthc a re stra te g ie s.c o m

(617) 710-5785

AGE NDA

• Co nc e pt: T

he E D is a n impo rta nt se tting fo r re a dmissio n re duc tio n e ffo rts

• E

xa mple : Oppo rtunitie s to tre a t-a nd-re turn to skille d nursing fa c ilitie s

• E

xa mple : Ca re te a ms tha t “re a c h in” to E D to sa fe ly a vo id re a dmissio n

• E

xa mple : Using E D Ca re Pla ns to b ring b e tte r info rma tio n to the po int o f c a re

• Re c o mme nda tio ns: T

a king a c tio n

OBJE CT I VE S

1. De sc rib e why the E me rg e nc y De pa rtme nt is a n impo rta nt se tting in whic h to de plo y re a dmissio n re duc tio n e ffo rts 2. De sc rib e ho w to ide ntify the “drive r o f utiliza tio n” 3. De sc rib e “E D Ca re Ale rts” a nd ho w te a ms a re using the m to re duc e re a dmissio ns a nd impro ve c a re

T HE E D I S AN I MPORT ANT SE T T I NG F OR RE ADMI SSI ON RE DUCT I ON

ST ART RE ADMI SSI ON RE DUCT I ON I N T HE E D

• We ha ve b e e n ta ug ht tha t the b e st wa y to re duc e re a dmissio ns wa s to

impro ve the tr

ansitio n o ut o f the ho spita l

• So me inno va tive te a ms ha ve ide ntifie d o ppo rtunitie s to re duc e re a dmissio ns

whe n a pa tie nt pre se nts to the E D, pr

io r to the de c isio n to (r e )admit:

• Ma ssa c huse tts Ge ne ra l Ho spita l Hig h Co st Be ne fic ia ry De mo nstra tio n
• CMS Pio ne e r ACO Pro g ra m (3-da y wa ive r)
• CMS MSSP ACO Pro g ra m
• CMS Bundle d Ca re Pro g ra m
• Ma ryla nd ”CMS wa ive r”
• I

NT E RACT (I nte rve ntio ns to Re duc e Ac ute Ca re T ra nsfe rs)

I NCRE ASE OPPORT UNI T I E S T O T RE AT AND RE T URN

I NCRE ASE T RE AT AND RE T URN

• Ask: do a hig h pe rc e nt o f pa tie nts se nt to yo ur E

D fro m SNF g e t a dmitte d?

• Ask: I

s the re a hig h re a dmissio n ra te a mo ng yo ur pa tie nts disc ha rg e d to SNF ?

• Ask yo ur E

D sta ff “Why? ”

• Ask “why” 5 time s – e lic it the a ssumptio ns, no rms, pa tte rns
• Co nside r – is (re )a dmitting the pa tie nt the fa ste r, e a sie r, “sa fe r” thing to do ?
• Co nside r – ho w c a n sa fe ly re turning the pa tie nt to SNF

b e ”e a sie r? ”

• Why the pa tie nt wa s

se nt in

• Na me , numb e r o f a

pe rso n to c a ll a t the SNF

• Wha t the SNF

c a n do

https:/ / inte ra c t2.ne t/ to o ls_v4.html

“RE ACH I N – T RANSI T I ON OUT ”

Re a l-time no tific a tio n o f c o mmunity b a se d c a re te a ms

”E D CARE AL E RT S”

A ne w to o l to b ring b e tte r info rma tio n to the po int o f c a re

T YPE S OF CARE PL ANS

• L
• ngitudinal Car

e Plan

• A c o mpre he nsive pla n to a c hie ve he a lth-pro mo ting g o a ls a nd o b je c tive s. Spe c ific g o a ls re g a rding

c linic a l, b e ha vio ra l, a nd/ o r func tio na l sta tus a re o fte n inc lude d, a nd a re me a sure d via se ria l a sse ssme nts o ve r time . L

• ng e r te rm; c a re ma na g e me nt o ve r time .
• T

r ansitional Car e Plan

• I

de ntifie s po st-ho spita l ne e ds, pa tie nt prio ritie s, a nd re a dmissio n risks a nd the pla n to a ddre ss tho se ne e ds, prio ritie s a nd mitig a te risks in the 30 da ys po st disc ha rg e . F

• c us o n e nsure linka g e to pro vide rs

a nd se rvic e s within the 30 da y tra nsitio na l pe rio d.

• E

D Car e Plan

• Summa ry info rma tio n fo r the E

D pro vide r to info rm sa fe , e ffe c tive , a nd c o nsiste nt c a re in the E D a nd fa c ilita te disc ha rg e with te a m-b a se d fo llo w up, a s a ppro pria te .

E D CARE PL AN: E ME RGI NG T OOL I N T HE F I E L D

• Purpo se : I

mpro ve the ma na g e me nt o f the hig h-risk pa tie nt - the ne xt

time the y c o me to the E D

• Audie nc e : E

D c linic a l sta ff

• Co nte nt:
• E

xe c utive summa ry o f pr

io r utilizatio n a nd te sting ;

• I

de ntific a tio n o f the dr

ive r

• f ho spital utilizatio n;
• Re c o mme ndatio ns fo r c o nside ra tio n
• I

de ntific a tio n o f a c a re ma na g e r/ pro vide r c o ntac t

E D CARE PL ANS: L E SSONS F ROM T HE F I E L D

• Br

e vity: No mo re tha n 1 pa g e ; the e sse ntia l summa ry info rma tio n in a wa y tha t

sa ve s time a nd pro mo te s q ua lity, info rme d de c isio n ma king .

• Audie nc e : Who is yo ur inte nde d a udie nc e ? E

D do c ? De ve lo p the “c linic a l sna psho t” a nd re c o mme nde d inte rve ntio ns with the e nd-use r in mind.

• Summar

ize the “utilization” par t of “high utilize r :” T

his summa ry is no t just a c linic a l summa ry, b ut a utiliza tio n pro file . Qua ntify prio r visits, a dmissio ns, te sts, c o nsults to c o nve y wha t ha s b e e n do ne in the pa st.

• De le gate the synthe sis, c ollabor

ate on the plan: De le g a te the dra fting o f the c a re

pla n summa ry to a me mb e r o f the hig h-risk c a re te a m. Me e t a s a te a m to de ve lo p re c o mme nda tio ns a nd ne xt ste ps.

E D CARE PL AN E XAMPL E

• Summa rize utiliza tio n
• I

de ntify “why” - the drive r o f utiliza tio n

• Re c o mme nda tio ns fo r E

D to c o nside r

• Who to c a ll re : de c isio n to a dmit
• Da te c re a te d/ c a re pla n te a m sig no ff

Bo utwe ll e t a l: De sig ning a nd De live ring Who le -Pe rso n T ra nsitio na l Ca re , 2016. Se e Cha pte r 6 a nd T

• o l 13: https:/ / www.a hrq .g o v/ pro fe ssio na ls/ syste ms/ ho spita l/ me d ic a id re a d mitg uid e / ind e x.html

ACUT E CARE PL AN I USE D AT MGH

Clinic al:

T ypic a lly pre se nts with c yc lic vo miting syndro me , o fte n pre c ipita te d b y psyc ho so c ia l stre sso rs a nd a nxie ty. Pe r GI , [na me o f GI NP] NP, pa tie nt sho uld b e tre a te d with I VAtiva n 4-6 mg a nd I V Zo fra n 8mg q 6 hrs until vo miting ha s sub side d, with re spira to ry mo nito ring in pla c e . He sho uld c o ntinue o n a mitriptyline 100 mg QHS.

Disposition Conside r ations:

I f pa tie nt is to b e disc ha rg e d ho me fro m E D: e nsure fo llo w up with GI ([na me o f NP], NP fo r Dr. [na me o f GI MD]). I f pa tie nt is to b e a dmitte d to Ho spita l: T e a m 4 [this is the no n-ho use staff ho spitalist se rvic e ]

Advanc e Car e Planning: HC Pro xy: [na me ], fa the r Ke y Psyc hiatr ic and Psyc hosoc ial Conside r ations: Histo ry o f de pre ssio n a nd a nxie ty, se e n b y MGH psyc hia try Pr

• vide r

Managing Pain/ Psyc h Me ds: Dr. [na me ], psyc hia try Ambulator y Car e T e am:

[na me ], NP - GI

• Dr. [na me ]- GI
• Dr. [na me ], psyc hia try

[signe d by PCP with page r #]

Utilization prior 12 months: 1. 12/15/14 - ED, inpatient 2. 2/3/15 ED, inpatient 3. 6/14/15 - ED inpatient 4. 6/25/15 - ED , inpatient 5. 6/28/15 - ED, inpatient 6. 8/5/15 - ED, inpatient 7. 9/25/15 – ED, inpatient

I DE NT I F YI NG ”DRI VE R OF UT I L I ZAT I ON”

L

• o king b e yo nd the c hie f c o mpla int to unde rsta nd “why”

• Ask “why”
• I

de ntify the drive rs o f utiliza tio n

• L

iste n fo r a ll the fa c to rs tha t le a d to a c ute c a re utiliza tio n

• Asse ss fo r c linic a l – b e ha vio ra l – so c ia l ne e ds
• Do n’ t o ve r-me dic a lize re c urre nt utiliza tio n

I DE NT I F Y ROOT CAUSE S; T HE “DRI VE R OF UT I L I ZAT I ON”

DE SI GN SE RVI CE S T O ADDRE SS T HE “DRI VE RS OF UT I L I ZAT I ON”

• Ma ryla nd “T
• ta l Pa tie nt Re ve nue ” Ho spita l
• Ac c e pte d g lo b a l b udg e t fo r a ll pa tie nts se e n in the ho spita l
• 1st stra te g y to a ddre ss po te ntia lly a vo ida b le utilza tio n:
• “we put the mo st e xpe rie nc e so c ia l wo rke r we ha d in the E

D”

• “she kne w the c o mmunity, she kne w the pa tie nts”
• I

f the “drive rs o f utiliza tio n” a re so c ia l a nd b e ha vio ra l, the n use yo ur so c ia l wo rke rs whe re the y a re mo st ne e de d to ha ve g re a te st impa c t

“In pr e vio us time s, the path wo uld’ve be e n to simply admit the patie nt, and we ’ll so r t it o ut 5 days late r . We ’r e be c o ming mo r e ac c usto me d to having r e so ur c e s in the E R to he lp us disc har ge patie nts fr

• m the E

D. T hat’s a c ultur e c hange .”

RE COMME NDAT I ONS

RE DUCI NG RE ADMI SSI ONS F ROM T HE E D

1. Cre a te a 30-da y r

e tur n flag o n the E

D T ra c ke r Bo a rd

• Be sure to c o mmunic a te wha t the ir de sire d re spo nse to the fla g is

2. Use the 30-da y re turn fla g to notify the hig h risk c a re te a m

• Re a l-time no tific a tio n to a llo w te a m to wo rk with E

D o n sa fe disc ha rg e 3. Use c ar

e plans a nd c a re te a ms’ invo lve me nt in the E

D

• Co mmunic a te b a se line c linic a l sta tus, drive r o f utiliza tio n, re c o mme nda tio ns

4. Co nside r de ve lo ping “tr

e at and r e tur n” pathways

• I

nve nto ry the c a pa b ilitie s o f po st a c ute pro vide rs a nd po st in E D

• De plo y so c ia l wo rk in the E

D to link to se rvic e s a nd suppo rts

RE SOURCE S

Bo utwe ll e t a l. Ava ila b le a t: http:/ / www.a hrq .g o v/ pro fe ssio na ls/ syste ms/ ho spita l/ me dic a idre a dmitg uide / inde x.html

Re duc e Re admissions

Ac tion Analysis

A

• Analyze Your

Data

S

• Sur

ve y Your Cur r e nt Re admission Re duc tion E ffor ts

P

• Plan a Multi- fac e te d, Data- Infor

me d Por tfolio of Str ate gie s

I

• Imple me nt Whole - Pe r

son T r ansitional Car e for All

R

• Re ac h Out and Collabor

ate with Cr

• ss- Continuum Pr
• vide r

s

E

• E

nhanc e Se r vic e s for High- Risk Patie nts

1. Data Analysis 2. Readmission Review 3. Hospital Inventory 4. Community Inventory 5. Portfolio Design 6. Operational Dashboard 7. Portfolio Presentation 8. Conditions of Participation Handout 9. Whole-Person Transitional Care Planning 10. Discharge Process Checklist 11. Community Resource Guide 12. Cross Continuum Collaboration 13. ED Care Plan Examples

The guide comes with 13 customizable tools to be used in hospital teams’ day-to-day

• perations.

Bo utwe ll e t a l. Ava ila b le a t: http:/ / www.a hrq .g o v/ pro fe ssio na ls/ syste ms/ ho spita l/ me dic a idre a dmitg uide / inde x.html

Bo utwe ll e t a l ASPI RE Guide p 77-79

Bo utwe ll e t a l. Ava ila b le a t: http:/ / www.a hrq .g o v/ pro fe ssio na ls/ syste ms/ ho spita l/ me dic a idre a dmitg uide / inde x.html

QUE ST I ONS?

T HANK YOU F OR YOUR COMMI T ME NT T O RE DUCI NG RE ADMI SSI ONS

Amy E . Bo utwe ll, MD, MPP Adviso r, VHHA Ce nte r fo r He althc are E xc e lle nc e Pre side nt, Co llab o rative He althc are Strate g ie s amy@ c o llab o rative he althc are strate g ie s.c o m