NURSE CASE MANAGEMENT REDESIGN PROJECT: LOS ANGELES COUNTY - - PowerPoint PPT Presentation

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NURSE CASE MANAGEMENT REDESIGN PROJECT: LOS ANGELES COUNTY - - PowerPoint PPT Presentation

Jan 09, 2024 92 likes •246 views

NURSE CASE MANAGEMENT REDESIGN PROJECT: LOS ANGELES COUNTY CALIFORNIA CHILDRENS SERVICES (CCS) P RESEN TER: M A RY D O YLE, M D , FA A P SEP TEM BER 1 0 , 2 0 1 4 FA M ILY V O IC ES W EBIN A R: N UTS A N D BO LTS O F C C S 1

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SLIDE 1

NURSE CASE MANAGEMENT REDESIGN PROJECT: LOS ANGELES COUNTY CALIFORNIA CHILDREN’S SERVICES (CCS)

P RESEN TER: M A RY D O YLE, M D , FA A P SEP TEM BER 1 0 , 2 0 1 4 FA M ILY V O IC ES W EBIN A R: N UTS A N D BO LTS O F C C S 1

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SLIDE 2

BACKGROUND

CCS Pr

  • gr

am:

Co ve rs a dive rse se t o f me dic a l c o nditio ns

CCS Patie nts/ F amilie s:

Ne e d c a re c o o rdina tio n o n a c a re c o ntinuum spe c trum

CCS Car e Coor dination Mode l:

T ra ditio na lly, the sa me fo r e ve ryo ne

Pr

  • ble m:

T he mo st ne e dy a re unde rse rve d

2

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SLIDE 3

LA COUNTY CCS EXPERIENCE

  • Se r

ving: 45,000 c lie nts in the g e ne ra l pro g ra m; 5,000 in the MT

P

  • Pr
  • c e ssing: 2500 ne w re fe rra ls a mo nth
  • Case load/ mix: a ve ra g e o f 650 c a se s/ nurse ; ra ndo m a sso rtme nt
  • Analysis of a sample of 2000 patie nts in Apr

il 2013:

~60% - a c ute a nd like ly to re so lve in 1 ye a r o r le ss

  • r c hro nic b ut stra ig htfo rwa rd to ma na g e

~40% - c hro nic a nd c o mplic a te d

  • Conc lusion: o ne c a se ma na g e me nt mo de l do e s NOT

fit a ll!

3

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SLIDE 4

THE IDEA

  • Sort by c omple xity of the CCS c ondition
  • Assign c omple x c ase s to one group of nurse s and non-c omple x
  • ne s to anothe r
  • Adjust the c ase loads: nurse s with the c o mple x c a se s wo uld c a rry

le ss; nurse s with the no n-c o mple x c a se s wo uld c a rry mo re

  • Assign e ac h c ase a he alth status group: ta ke s into a c c o unt a ll o f

ne e ds o f the pa tie nt a nd his o r he r fa mily

  • Matc h le ve l of c are c oordination to c omple xity of ne e d
  • T

rac k me aningful data

4

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SLIDE 5

EXPECTED OUTCOMES

Ove r all and In Ge ne r al:

I mpro ve d c a se ma na g e me nt fo r a ll pa tie nts in the CCS pro g ra m

L

  • ng te r

m and Spe c ific ally:

Answe rs to the se q ue stio ns

  • 1. Whic h inte rve ntio ns he lp? Whic h do n’ t?
  • 2. Whe re a re the ine ffic ie nc ie s in o ur syste ms?
  • 3. I

s CCS me e ting the ne e ds o f o ur pa tie nts, fa milie s, pro vide rs a nd sta ff?

5

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SLIDE 6

THE PILOT

  • L

aunc he d: F

e b rua ry 10, 2014

  • T

ar ge t gr

  • up: 4000 CCS pa tie nts – mix o f ne w & e xisting c a se s
  • Sor

te d by c omple xity: no n-c o mple x ve rsus c o mple x

  • Assigne d to one of 8 nur

se s:

4 nurse s with 250 c o mple x c a se s e a c h 4 nurse s with 750 no n-c o mple x c a se s

  • Assigne d a he alth status gr
  • up: ra ng e s fro m 2 to 9
  • Inte r

ve ne d: c a se ma na g e me nt a c tivitie s diffe re d de pe nding

  • n c o mple xity a nd he a lth sta tus g ro up

6

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SLIDE 7

THE PILOT ACTIVITIES

  • Case Manage me nt Ac tivitie s: Non- c omple x Case s
  • 1. I

ntro duc to ry le tte r

  • 2. Autho riza tio ns
  • 3. Re spo nse s to inq uirie s
  • 4. Ca se c lo sure a fte r o ne ye a r if the c o nditio n re so lve s

7

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SLIDE 8

THE PILOT ACTIVITIES

  • Case Manage me nt Ac tivitie s: Comple x Case s
  • 1. I

ntro duc to ry c a ll with a de ta ile d ne e ds a sse ssme nt

  • 2. Autho riza tio ns a nd re fe rra ls, inc luding c a re o f the

who le c hild

  • 3. Ong o ing inte rve ntio ns a c c o rding to ne e d
  • 4. Qua rte rly re vie w
  • 5. Annua l re vie w with a n o b je c tive a na lysis o f the

suc c e ss o f the inte rve ntio ns a nd o ve ra ll he a lth o f the pa tie nt

8

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SLIDE 9

SO FAR, HERE’S WHAT WE’VE FOUND

  • Pr

e - pilot satisfac tion sur ve ys of familie s: N=331

►Ove ra ll: 89-97% ne e d to c o nne c t with a t le a st 1 pe rso n a t CCS

56-60% re po rte d e ithe r ne ve r o r ra re ly spe a king with the ir nurse

►Ove ra ll g re a te st se rvic e ne e ds fro m CCS:

me dic a tio ns; tra nspo rta tio n; me dic a l a ppo intme nts

►F

  • r fa milie s with c o mple x c a se s: ne e ds
  • Mo re e duc a tio n o n se rvic e s fo r the m/ the ir c hild
  • Unde rsta nding the ir/ the ir c hild’ s insura nc e
  • Unde rsta nding the ir/ the ir c hild’ s me dic a l c o nditio n
  • Autho rizing CCS spe c ia lty do c to rs to c a re fo r the m/ the ir c hild

9

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SLIDE 10

SO FAR, HERE’S WHAT WE’VE FOUND

  • Pr

e - pilot satisfac tion sur ve ys of staff: N=67

►75% we re no t sa tisfie d with the ir c a se lo a ds

►T

he mo st sa tisfie d o ve ra ll we re o n spe c ia lty te a ms

  • Pr

e - pilot he alth status of our c omple x patie nts:

Pa re nta l re po rt in the ye a r prio r to the pilo t fo r c o mple x c a se s 1. Da ys o f sc ho o l misse d: 1248 2. Da ys o f ho spita liza tio n: 154 3. E R visits: 208 4. I llne ss visits: 183

10

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SLIDE 11

SO FAR, HERE’S WHAT WE’VE FOUND

  • Dur

ing the pilot: initial data thr

  • ugh June

►T

  • ta l c a se s ha ndle d: 1060 – c o mple x; 2247 – no n-c o mple x

►Ca se lo a ds: 205 – c o mple x; 472 – no n-c o mple x ►T

  • ta l numb e r o f c o mpla ints/ inq uirie s:

6 - no n-c o mple x 0 – c o mple x

11

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SLIDE 12

SO FAR, HERE’S WHAT WE’VE FOUND

  • Dur

ing the pilot: initial data thr

  • ugh June

►Pilo t te a m nurse s:

  • Spe nding 60% o f the ir da y c o lle c ting a nd e nte ring da ta
  • All ve ry sa tisfie d with the mo de l
  • Qua lity o f c a re c o o rdina tio n is impro ving

12

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SLIDE 13

SO FAR, HERE’S WHAT WE’VE FOUND

  • Dur

ing the pilot: initial data thr

  • ugh June

“I L

  • ve the Pilo t Case Manag e me nt Mo de l b e c ause it allo ws

me to b e mo re c o mfo rtab le , mo re satisfie d b e c ause I have mo re time with my patie nts.” “A po sitive e ffe c t o f the mo de l is that e ve ry thre e mo nths the familie s are e xpe c ting a pho ne c all, whic h e nab le s the familie s to fe e l mo re c o mfo rtab le g e tting a ho ld o f us to pre ve nt mino r issue s fro m e sc alating .” “I am satisfie d b e c ause I am ab le to spe nd mo re time with the m, I am ab le to le arn mo re ab o ut the m and the ir ne e ds and the y c o ntac t me whe n the y have a c halle ng e .”

13

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SLIDE 14

A LOT MORE TO DO!

  • Now: study the c a re c o o rdina tio n inte rve ntio ns
  • Who ne e ds the m
  • Ho w o fte n
  • Whic h o ne s wo rk
  • F

e br uar y 2015: da ta c o lle c tio n a nd a na lysis

  • Surve ys: pa tie nts, fa milie s a nd sta ff
  • He a lth sta tus
  • E

ffe c tive ne ss o f c a re c o o rdina tio n inte rve ntio ns

  • Ongoing: sha re da ta a nd o ur e xpe rie nc e
  • With who : a ll wo rking to wa rd impro ving the CCS pro g ra m
  • Why: to b e tte r se rve all c hildre n a nd fa milie s with spe c ia l

he a lth c a re ne e ds

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