Learning Session 2 June 26, 2019 Qualis Health & HealthInsight - - PowerPoint PPT Presentation

Department of Health Care Finance (DHCF) and Comagine Health

Nursing Facility Quality Improvement Collaborative

Learning Session 2

June 26, 2019

Qualis Health & HealthInsight have joined forces to do great things. Together, we’re reimagining health care.

• Comagine Health, formerly Qualis Health and HealthInsight, is a national,

nonprofit, health care consulting firm. We work collaboratively with patients, providers, payers and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system.

• As a trusted, neutral party, we work in our communities to address key,

complex health and health care delivery problems.

• Serving as the Medicare Quality Improvement Organization (QIO) for Idaho,

Nevada, New Mexico, Oregon, Utah and Washington.

Comagine Health

Agenda

8:00-8:30am Registration and Sign-in 8:30-9:15am Collaborative Overview 9:15-10:00am Peer-to-Peer Sharing: Stories from the Field 10:00-10:15am Break & Visit Story Boards 10:15-10:45am The Go Wish ™ Game 10:45-11:45am Evidenced-based and Resident Centered End of Life Care 11:45am-12:15pm Team Time 12:15-12:30pm Evaluation & Wrap Up

Collaborative Overview

Collaborative Aims

• Partner with DHCF staff to create “all, teach, all learn” Learning and Action

Networks

• Assess nursing facility readiness to participate in pay-for-performance and

develop a plan of action on areas of improvement

• Provide individual and group technical assistance (e.g. training, education and

quality improvement consultation services) to 17 DC nursing facilities to instill high-quality, person-centered care

• Engage nursing facilities in rapid-cycle improvements in areas at the system

level

• Ensure nursing facility staff are adequately trained to conduct MDS

assessments

• Conduct Consumer Assessment of Healthcare Providers and Systems (CAHPS)

survey to measure resident/family experience and identify areas for improvement

Roles and Responsibilities

Nursing Home Team Comagine Health

Provide staff time to devote to the Collaborative effort Provide expertise on clinical & systems content and process improvement Perform pre-work activities to prepare for the Learning Sessions Provide quality improvement coaching & training to individual NFs Participate in each Learning Session and Outcomes Congress Assess gaps in care with the NF Team with improvement action planning Implement small-scale, rapid Plan-Do-Study- Act (PDSA) improvement cycles and submit monthly reports and data Provide venues for peer sharing via in person meetings, conference calls and email groups Share learnings on a regular basis with Collaborative faculty and peer participants Make resources readily available, including guidelines, clinical tools and in-service materials

Collaborative Model for Improvement

Act Plan Study Do

Nursing Facility Quality Improvement Collaborative Model

WE ARE HERE!

Project Start Date: 11/1/18 | Project End Date: 10/31/2023

Collaborative 1: 11/1/18 - 10/31/19

Nursing Facility Collaborative 1 Schedule of Events

• Pre-work – January – March 2019
• Face –to-Face Orientation Meeting – January 28, 2019
• Collaborative Handbook & Change Package Distributed to NFs – February 2019
• Individual Initial Assessment Site Visits #1 - February-March 2019
• NFs complete pre-work – February-March 2019
• Learning Session 1 – March 28, 2019 (1:00 – 4:00 pm) – Host: DHCF
• Action Period 1 - March – May 2019
• In-person Training at DC Health Care Association – April 19, 2019
• Webinar #1 – National Nursing Home Quality Improvement Campaign (NNHQIC) Part 1: Overview - May 14, 2019 (1:00 – 2:00 pm)
• Senior Leader Reports
• Individual Technical Assistance Site Visits #2 - March–June 2019
• Learning Session 2 - June 26, 2019 (8:00 am – 12:30 pm) Host: Bridgepoint Sub-Acute Capitol Hill
• Action Period 2 - June - September 2019
• Webinar #2 - National Nursing Home Quality Improvement Campaign (NNHQIC) Part 2: Staff Stability - July 9, 2019 (1:00 – 2:00 pm) -

Cancelled

• Webinar #3 – MDS Coding Part 1 - August 26, 2019 (10:00 am – 12:00 pm)
• Webinar #4 - MDS Coding Part 2 – September 23, 2019 (10:00 am – 12:00 pm)
• Senior Leader Reports
• Individual Technical Assistance Site Visits #3- July– September 2019
• Outcomes Congress – October 22, 2019 (8:00 am – 12:30 pm) Host: Carroll Manor Nursing and

Rehabilitation

Site Visit #2 Feedback

• 15/17 Nursing Homes – Total of 124 Participants
• Areas of focus/goals:
• Establishing a comprehensive End of Life Program
• Reducing falls
• Reducing/healing pressure injuries
• Decreasing the use of antipsychotics
• Reducing urinary tract infections (UTIs)
• Improving bowel and bladder incontinence
• Improving resident dining experience
• Reducing avoidable hospitalizations

Site Visit #2 Feedback (cont.)

• Challenges
• Time and labor intensive nature of the Prompted Voiding Program
• Inconsistent implementation of Prompted Voiding Program
• Documentation discrepancies
• Gaining staff buy-in
• Staffing and staff stability (e.g., recruiting and retaining quality staff)
• Providing time in the QAPI meeting for discussion of root causes, progress towards barriers and

actions to take to reach the goal(s)

• Establishing a comprehensive End of Life Program
• Preparing for and successfully implementing the Patient-Driven-Payment Model (PDPM)
• Preventing avoidable hospitalizations
• Admitting high number of residents with Stage 3 & 4 pressure injuries
• Lack of communication/documentation from hospitals regarding residents admitted with pressure

injuries

• Identifying and healing pressure injuries on admission
• MDS coding
• Lack of consistent follow through on Care Plans
• Dealing with major restructuring, renovations, and/or moves
• Juggling multiple priorities

Site Visit #2 Feedback (cont.)

• Best practices
• Examples: LS2 Peer to peer sharing of four nursing homes quality improvement projects
• Topics for technical assistance
• Root cause analysis
• MDS coding tips
• QAPI
• Nursing documentation
• Critical thinking
• Urinary Tract Infections
• Antipsychotic medication reduction (e.g., gradual dose reduction)
• Preventing/healing Stage 3 & 4 pressure injuries
• Person-centered dementia care and managing challenging behaviors
• Training on the National Nursing Home Quality Improvement Campaign (NNHQIC) website and

resources

• Culture change
• Customer service
• Staff burnout
• How to integrate the Chesapeake Regional Information Systems for Patients (CRISP) into day-to-day

practice/systems

DHCF Nursing Facility Quality Improvement Domains and Measures

Quality of Care Quality of Life Utilization Infrastructure

Percent of high risk, long-stay residents with pressure ulcers Resident/ Family Experience Low-acuity Non-emergent Emergency Department (ED) visits Staff Continuing Education in Minimum Data Set (MDS) Training Percentage of long-stay residents who received an antipsychotic medication End of Life Program All-cause 30-day Readmissions RN Hours per Resident Day Percent of long-stay residents with a urinary tract infection Potentially Preventable Hospital Admissions Quality Assurance and Performance Improvement (QAPI) Plan Percent of low risk long-stay residents who lose control of their bowel or bladder Staff Turnover Percent of long-stay residents experiencing

• ne or more falls with major injury

Certified Electronic Health Record (EHR) Adoption Enrollment and Integration in the Chesapeake Regional Information System for our Patients (CRISP) to share health information among doctor’s offices, hospitals, nursing facilities, and other healthcare organizations

Quality of Care Domain – Baseline Data

Source: DHCF

Lose Control of Bowel or Bladder

Quality of Life Domain

• There are two measures under the Quality of Life domain:
• Resident and Family Satisfaction
• Use the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to measure

resident/family experience

• Discharged Resident Survey
• Response data is being assessed; initial report preparation underway
• Long Stay Resident Survey
• Data analysis and report preparation continues
• Family Member Survey
• Anticipate first survey questionnaire to be mailed June 18-19, 2019
• Next Steps
• Ongoing report preparation for Discharged and Long Stay Resident surveys. Reports are on track for

delivery by the DHCF requested timeframe of mid-July

• Administration of Family Member Survey
• DHCF should send reports to nursing facilities after the beginning of the fiscal year (October 1, 2019)

Quality of Life Domain (cont.)

• End of Life Program
• Develop a program that serves the staff, residents, and family members in

preparation for the time of passing

• Provide supporting documentation for the program containing details

and evidence of compliance

• DHCF completed all annual nursing facility site visits to evaluate compliance.

Facilities should expect to receive their results no later than the first week of July.

DC MOST Program

• The District of Columbia Medical Orders for Scope of Treatment (MOST)

program was established by DC Council by the Health-Care Decisions Amendment Act of 2015, and replaces the Emergency Medical Services (EMS) Comfort Care Order-Do Not Resuscitate (CCO-DNR) program.

• The program is administered by the DC Department of Health (DC Health)

Health Emergency Preparedness and Response Administration’s (HEPRA) EMS Division

• The MOST program provides a more comprehensive approach, empowering

terminally-ill patients the right to make decisions on their end-of-life care

• ptions, in consultation with their DC-licensed authorized healthcare provider

(Physician (MD/DO) or Advanced Practice Registered Nurse (APRN) only).

• Details of the program and the form can be found at:

https://dchealth.dc.gov/most

Utilization Domain

• There are three measures under the Utilization domain:
• Low-acuity Non-emergent ED visits
• All-cause 30-day Readmissions
• Potentially Preventable Hospital Admissions
• All facilities will get full credit for all of these measures due to very low

denominators

• DHCF will continue to run these measures but they will be removed from

the program at the next redesign

Infrastructure Domain

There are six measures under the Infrastructure domain:

• MDS Training
• Documentation that staff is trained to document MDS assessment in a uniform and

consistent manner.

• DHCF completed all re-measurement site visits to review elements of this measure.

Facilities should expect to receive their results no later that the first week of July.

• RN Hours Per Resident Day
• This data is retrieved from Nursing Home Compare data and will be reviewed at the

close of the fiscal year

• Quality Improvement Plan
• DHCF reviewed all QAPIs that were submitted at the close of the previous fiscal year
• The measure is met when NHs have a completed QAPI plan in place
• DHCF is requesting all QAPI Plans be submitted by September 1, 2019, along with

minutes from three meetings

Infrastructure Domain (cont.)

• Staff Turnover
• Percentage of direct care staff who have been terminated during the measurement

period

• DHCF will send templates to facilities no later than September 1, 2019 and submission is

expected back to DHCF by October 5, 2019 for staffing as of September 30, 2019

• Electronic Health Record (EHR)
• Adopt EHR technology to support the creation and execution of person-centered plan of

care

• After FY19, NFs will need to provide a narrative of how EHR has been integrated into the

workflow

• Chesapeake Regional Information Systems for Patients (CRISP)
• Enroll in CRISP to receive hospital and emergency department alerts for enrolled

beneficiaries

• After FY19, NFs will need to provide narrative of how CRISP has been integrated into the

workflow

How Are We Doing?

*Source: CASPER **Source: Nursing Home Compare Q42018

Peer to Peer Sharing: Stories from the Field

Peer to Peer Sharing: Stories from the Field

• Jeanne Jugan Residence: Prompted

Voiding Program

• Bridgepoint Sub-Acute and

Rehabilitation Capitol Hill: Pressure Injuries Reduction/Healing

• Bridgepoint Sub-Acute and

Rehabilitation National Harbor: Pressure Injuries Reduction/Healing

• Carroll Manor Nursing and

Rehabilitation Center: Return to Continence Program

“Success is 99% failure.” - Sochiro Honda, Honda’s founder

Talking Points

What was the problem you were confronting? What is your aim/goal? What departments are involved in your quality improvement project? What data is being tracked to show improvement? What change(s) did you test? What were your barriers, failures or mistakes? What were your successes?

Break & Visit Story Boards

The Go Wish™ Game

http://www.gowish.org/gowish/gowish.html

The Go Wish™ Game

Total Time: 30 Minutes

• Objective: To better understand what is most important to you and what

you really want at the end of your life

• Goal: Have 10 cards in the Very Important category
• Tools: Online Go Wish game cards, pencil and paper to record responses

15 Minutes

• As the presenter draws each card, on your own, write each card’s

statement in the Very Important, Somewhat Important, or Not Important category in the open space in any of those categories on your sheet of paper

• You may rearrange your choices by erasing/moving a statement to

another category

5 Minutes

• Share your Very Important category responses with your table members
• Select one person to share your table’s Very Important category

responses with the larger group

10 Minutes

• Share your table’s Very Important category responses with the larger

group

Source: Go Wish™ was developed by Coda Alliance: http://codaallliance.org

Evidenced-based and Resident Centered End of Life Care

DHCF Nursing Facility Quality Improvement Collaborative Member Website

DHCF’s Nursing Facility Quality Improvement Collaborative

• website. Here, you will find

resources for the Collaborative, including the Collaborative Handbook, PowerPoint presentations, webinar audios, and Learning Session 1 & 2 handouts.

https://dhcf.dc.gov/node/1390591

Thank you!

Reminders:

• Please sign up for individual Site Visit #3 (July –

September)

• One member from each Team please complete

Senior Leader Report

• Please complete your post-event evaluation

Contact:

Gazelle Zeya, MBA, MS, RAC-CT Quality Improvement Advisor Lead Comagine Health GZeya@Comagine.org | 800.949.7536 Ext. 292 Derdire “De” Coleman, RN Quality Improvement Advisor Lead Department of Health Care Finance Derdire.Coleman@dc.gov | 202.724.8831