RI Antipsychotic Med Reduction Challenges to the QIN-QIO 11 th - - PowerPoint PPT Presentation

RI Antipsychotic Med Reduction Challenges to the QIN-QIO 11th Statement of Work Contract

Briefing Presented to the Healthcentric Advisors Board of Directors & Governance Advisory Council June 21, 2017

Task Requirements (63 engaged

nursing homes)

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• Reduce antipsychotic medications in long stay residents to

achieve a 9% relative improvement rate (statewide)

• Baseline rate – 18.2%
• Rate required to pass the evaluation in July 2017 – 16.6%
• Current “official” rate – 17.7% (3.2% RIR)
• Current “unofficial” rate - 16.7% (for Q 4 2016 & Q 1 2017)

(8.4% RIR)

Multi-faceted Approach

• Educational webinar series – 12/2015 – 8/2016

– Subject Matter Experts – Peer Mentors/Sharing of Best Practices

• Affinity Group for the homes with the highest rates
• Quarterly DON group – education & sharing
• MDS Coordinator Group – supporting the homes in

accurate coding

• Onsite technical support

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In-Depth Root Cause Analysis

• A younger behavioral health population, including the most disparate

residents (homeless, PTSD, high incidence of mental illness, former incarcerated)

• Insufficient group home housing
• Turnover has been high among quality improvement champions,

leadership, and staff

• RI nursing homes initially amongst the highest performers with a rate

better than 33 states

• Further analyses show that after removing 10 nursing homes with highest

percentages of psychiatric diagnoses and younger residents we see the 2017 Q1 antipsychotic rate decrease to 15.14% and RIR increase to 17.0%

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What Did We Learn?

Positively Associated with Antipsychotic Prevalence (Adjusted Findings) Negatively Associated with Antipsychotic Prevalence (Adjusted Findings)

• Antianxiety medication
• Antidepressant medication
• Psychiatric diagnoses
• Behavioral symptoms
• For-profit institutions
• Dementia
• Behavior care plans
• Middle income community
• High income community

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Additional Interventions

• Outreach to high performing QIOs
• Discussion at the behavioral health

coalition

• Behavioral health statewide taskforce

(coming late June)

• Physician education (RIMs article, Medical

Directors dinner)

6/15/2017 6

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