Pressure Ulcer Prevention Dissemination Program Clare Davidson, - - PowerPoint PPT Presentation

Evaluation of the On-Time Pressure Ulcer Prevention Dissemination Program

Clare Davidson, Lauren Bishop, Sai Loganathan, Laurie Imhof, Linda Bergofsky, William Spector, Tamara Konetzka

AcademyHealth Annual Research Meeting June 27th, 2017 New Orleans

Pressure Ulcers (PrUs) and Health Information Technology (HIT)

►PrUs increase patient morbidity and

mortality and are costly to patients and the health care system.

►Opportunities exist for using HIT to help

alert staff of PrU risk and inform clinical decision-making.

Right Data Right People Right Time Effective Support

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The Nursing Home Context

Slow to Adopt Electronic Health Records (EHR) Low Margins- Shrinking Finances, Increasing Demands Bulk of Direct Care by Nurses and Aides Lengthy Patient Stays Patients with High Number

• f PrU

Risk Factors

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On-Time Program

►The Patient Safety Program for Nursing

Homes: On-Time was developed by the Agency for Healthcare Research and Quality (AHRQ).

Website: https://www.ahrq.gov/professionals/systems/long-term- care/resources/ontime/index.html

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Right Data Right People Right Time Effective and Safe Care

On-Time Program

►The Patient Safety Program for Nursing

Homes: On-Time was developed by the Agency for Healthcare Research and Quality (AHRQ).

Website: https://www.ahrq.gov/professionals/systems/long-term- care/resources/ontime/index.html

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Data on Risk Factors Frontline Staff Weekly and Early Adverse Event Decrease

Facilitation

On-Time PrU Prevention Reports

►Based on multiple sources of data from

the medical record, particularly certified nursing assistant (CNA) charting.

►Include: Nutrition Risk, Weight Summary,

PrU Trigger Summary, and Risk Change

►Provide a weekly snapshot at the resident,

unit, or facility level to identify risk for PrU development.

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On-Time PrU Prevention Facilitation

►A trained facilitator is utilized to help

staff understand the reports and to guide integration of reports into day-to-day clinical decision-making.

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The Current Study

AHRQ Funder NORC at the University

• f Chicago

Evaluator Disseminate and Evaluate Stratis Health Facilitators

Core Research Questions:

1.

What is the effect of On- Time on pressure ulcer incidence?

2.

What factors were associated with facilities’ ability to successfully implement On-Time?

3.

What are the barriers and expediters to disseminating On-Time?

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Mixed Methods Approach

Quantitative: Core Research Questions 1&2

► Longitudinal pre-post analysis. Treatment facilities only. ► Pre-post difference-in-differences analysis. Treatment

and matched control facilities.

Qualitative: Core Research Questions 2&3

► Content analysis of facilitator-collected encounter notes. ► Content analysis of nursing home and facilitator

discussions.

Mixed Methods: Core Research Questions 2&3

► Examination of factors associated with success.

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Mixed Methods Approach

Quantitative: Core Research Questions 1&2

► Longitudinal pre-post analysis. Treatment facilities only. ► Pre-post difference-in-differences analysis. Treatment

and matched control facilities.

Qualitative: Core Research Questions 2&3

► Content analysis of facilitator-collected encounter notes. ► Content analysis of nursing home and facilitator

discussions.

Mixed Methods: Core Research Questions 2&3

► Examination of factors associated with success.

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Participating Facilities (n=41)

2 3 4 5

FIVE-STAR RATING

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For-profit Non-profit Gov't

PROFIT STATUS

0-100 101-200 >201

BED COUNT

West South Midwest Northeast

LOCATION

The PrU Measure of Interest

►Captures percentages of long-stay, high-

risk residents with Stage II-IV PrUs.

• Long Stay = More than 100 cumulative days

in the facility.

• High-Risk = Impaired bed mobility or transfer;

Comatose; Malnutrition.

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Preliminary Study Results

5.01% 3.94% 3.90% 3.72% 2.87%

0% 1% 2% 3% 4% 5% 6% Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017

Overall High-risk Pressure Ulcer Rate

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017

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Qualitative Methods

►‘Encounter Notes’ collected over a 12

month period.

►Homes categorized according to time to

implementation.

►NVivo 11 used to analyze the percentage

coverage for success- and challenge- related codes by time to implementation.

• Percentage coverage = Percentage of each

code for which a group is ‘responsible’; has limitations.

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Challenge and Success-Related Coding by Time to Implementation

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0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Challenge Codes

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Success Codes

<6mo 6-12mo Did Not Complete <6mo: n=19; 6-12mo: n=12; Did Not Complete: n=21

Time Required to Implement

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Challenges: Limited staff time EHR functionality Having the right data Expeditors: Figuring out workflow Team communication Understanding how to use the EHR

Conclusions

►Associated with reduced rates of pressure ulcer

incidence on average.

►Timely implementation was contingent upon

nursing home organizational capacity to adapt workflow and utilize EHR.

►Potential for real impact in the right setting.

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Limitations

►Initial pre-post PrU measure findings may

actually reflect a secular trend.

►Analysis of qualitative data continues and

different patterns may emerge.

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Next Steps

►Incorporating Minimum Data Set (MDS)

data from CMS.

►Difference-in-differences analysis. ►Further qualitative analysis of encounter

notes as well as nursing home and facilitator discussions.

►Mixed-methods analysis to determine

factors associated with success.

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Questions?

Contact: Davidson-Clare@norc.org