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Using the RAI 2.0 to Promote Continual Quality Improvement Across - - PowerPoint PPT Presentation

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Using the RAI 2.0 to Promote Continual Quality Improvement Across the Winnipeg LTC Region Joe Puchniak & Cynthia Sinclair 1 1 Winnipeg Health Region One of 5 health regions in Manitoba Largest with 28,000 staff Operating

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Using the RAI 2.0 to Promote Continual Quality Improvement Across the Winnipeg LTC Region

Joe Puchniak & Cynthia Sinclair

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  • One of 5 health regions in Manitoba
  • Largest with 28,000 staff
  • Operating budget of $2.1 billion
  • Administer and support 200 health service

facilities and programs

Winnipeg Health Region

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WRHA PCH Program

  • 39 Personal Care Homes (nursing homes)

in Winnipeg

  • Support >5,600 people
  • Variety of ownership models
  • Regional
  • Not for Profit
  • Corporate – For Profit
  • Operating budget approx. 348 million

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RAI/MDS – Winnipeg

  • RAI/MDS = clinical decision support system for

monitoring QI’s, outcome measures and population case-mix

  • Implemented across all 39 nursing home sites in

Winnipeg since 2008

  • Detailed picture of > 5600 residents living in the

Winnipeg nursing homes, all data submitted to CIHI since 2009

  • Potential to guide continual quality improvement and

assist with evidence-informed decision making at all levels

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RAI Assessments sent to CIHI(CCRS) from WRHA

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International use of RAI/MDS

North America

Canada US Mexico

Nordic Countries

Iceland, Norway, Sweden, Denmark, Finland

Europe

Netherlands, Germany, Switzerland, France, UK Italy, Spain, Czech Republic Russia

Pacific Rim

Japan, South Korea, Taiwan, China, Hong Kong, Australia, New Zealand

Middle East

Israel

South America

Chile, Argentina, Brazil, Peru

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RAI LTC Adoption in Canada

RAI is a well researched tool used across Canada and the world

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Multiple Possible Uses for RAI/MDS Data Collected

e.g. How do resident populations at different facilities compare? How does

  • ur region compare with
  • ther regions across Canada?

e.g. Are we getting the best outcomes for our health care dollars? How effective are our services? What are the priorities for quality improvement? e.g. Are we developing effective Care Plans? What are the outcomes of care? Do our residents achieve their health goals? What resources were used?

MDS Assessment

Operational Management & Strategic Planning

Public Accountability & Engagement Clinical Decision Making/ Clinical & Utilization Research

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WHAT IS THE PROBLEM/CHALLENGE?

  • RAI has not been used to inform decision

making at nursing home sites and regional levels

  • Value of the RAI data not seen by staff &

management

  • Reports not consistently being used to identify

areas for improved resident care or to inform

  • perational or policy changes

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CAUSES OF THE PROBLEM

  • RAI generates lots of information – Sites
  • verwhelmed
  • RAI not tied to standards or accreditation
  • No strategy or mandate to use the RAI data
  • Data does not equate to knowledge

translation

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GOAL OF THE PROJECT

  • To use the RAI data to identify areas for

quality improvement and then use the RAI data to gauge the effectiveness of our intervention.

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What Evidence did we use to Inform our Project?

  • 1. Participatory Education and Leadership are key to

effective and sustained knowledge translation

(Stolee et. al, 2009; Barba & Fay, 2009; Marzlin, 2010; Morgan et al., 2007)

  • 2. Antipsychotic Lit.: “In patient populations for

whom the evidence of the efficacy of antipsychotic medications is limited and the risk of a fatal side effect is clear, prudence would suggest that the use

  • f these drugs should be reduced sharply.”

(Schneeweiss S, Avorn J., N Engl J Med, 2009 Jan 15; 360 (3):225-35)

  • 3. RAI data

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How Does our IP Affect the Problem?

  • Choosing one RAI quality indicator, high

antipsychotic usage, to focus on –Provides for a focused approach –Allows for a quick measurable success –Prove success with one indicator and then move to the other quality indicators –Potential to link indicator with clinical initiative

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How Does our IP Affect the Problem?

  • Choose one site: complete an intervention at

the site

  • Intervention Objectives

– Reduction of antipsychotic usage – Site and region to understand value of RAI data – Apply this understanding to work with other RAI QI’s

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How we Reduced Antipsychotics?

  • To reduce antipsychotic usage = intensive

implementation of P.I.E.C.E.S™ which is a dementia care model

  • Physical, Intellectual, Emotional, Capabilities,

Environment and Social

  • P.I.E.C.E.S promotes the use of medications as

a last resort to manage challenging resident behaviors

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Challenges and Change Management Strategies

  • 1. Effectively communicate the project to all

relevant stakeholders

  • Face to face meetings at various tables
  • 2. Spread change throughout the region
  • Decision for pilot site

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Challenges and Change Management Strategies

  • 3. Effectively educate entire site
  • Intensive education

– Classroom education for all staff – ‘Huddles’ – Posting RAI Data – Online learning module

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Online Learning Module

http://www.aissystems.com/wrhaeLearn/pieces

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Challenges and Change Management Strategies

4. Management and MD “buy-in” and support

  • Management and MD meetings

5. Enthusiasm of staff

  • Kick off party, regular postings of data and progress, staff

forums, regular unit feedback 6. Project Human Resources

  • We are the resources  No additional resources

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Project Results

  • Quantitative:
  • 10% reduction in antipsychotics overall at site
  • > 25% reduction in antipyschotic medication

prevalence within cohort

  • No ↑ physical restraints or behaviors
  • Qualitative:
  • Improved teamwork
  • Growing leaders
  • Evidence based practice

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Antipsychotics Middlechurch Pilot Site

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Lessons Learned

  • RAI can identify areas for improvement and

evaluate the effectiveness of clinical interventions.

  • ↓ antipsychotics = ↑quality of life while ↓cost
  • Participatory learning is an effective method for

promoting best practice & sustaining knowledge transfer

  • Site management needs to play a visible and

active role

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Lessons Learned

  • P.I.E.C.E.S™ is effective
  • “Lead from where you stand”
  • Keep messaging simple and repeat often
  • Do fewer ‘projects’ - more targeted approach to

assist PCHs with quality improvement

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Spread and Sustainability

  • A regional guide as a blueprint
  • Online learning for P.I.E.C.E.S.™
  • Benchmarking through Quality Team
  • Dedicated human resources - business

plan in development

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Conclusion

  • CIHI video presentation:

The story of our project – the difference data can make

http://www.cihi.ca/land/Article/Data+In+Action/cihi011336

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  • CIHI Video – “The Difference Data Makes”:

http://www.cihi.ca/land/Article/Data+In+Action/cihi011336

  • Wave Magazine Article – “Formula for Success”:

http://www.aissystems.com/wrhaeLearn/pieces/www/swf/pdf/ EXTRA.fWAVE_JAN12_final2.pdf

  • CTV New Story – “Memories Before Medications”:

http://winnipeg.ctv.ca/servlet/an/local/CTVNews/20120315/wp g_dementia_treatment_120315/20120315/?

  • CIHI Publication – “From Clinician to Cabinet”:

http://www.cihi.ca/CIHI-ext- portal/pdf/internet/hsu_clinic_cab_pdf_en

Project Publicity/Media Stories:

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