L19: Improving Transitions from the Hospital to Post Acute Care Settings

Size: px
Start display at page:

Download "L19: Improving Transitions from the Hospital to Post Acute Care Settings"

Transcription

1 This presenter has nothing to disclose L19: Improving Transitions from the Hospital to Post Acute Care Settings Gail A. Nielsen December 8, th Annual National Forum on Quality Improvement in Health Care Orlando, Florida 1

2 We can t solve problems by using the same kind of thinking we used when we created them. Albert Einstein Changing Paradigms Traditional Focus Immediate clinical needs Patients are the recipients of care and the focus of the care team GPS location team (teams in each clinical setting) Transformational Focus Comprehensiveneeds of the whole person Patient and family members are essential and active members of the care team Cross Continuum Team with a focus on the patient s experience over time 2

3 Changing Paradigms Traditional Focus Length of stay in the hospital and timely discharges of patients Handoffs Clinician teaching Transformational Focus Initiating a post-acute care plan to meet the comprehensive needs of patients Senders & receivers co-design handover communications What are the patient and family caregivers learning? STAAR Initiative: Two-Levels Concurrent Strategies 1.Provide technical assistance to front-line teams of providers working to improve the transition out of the hospital and into the next care setting 2.Create and support state-based, multistakeholder initiatives to concurrently examine and address the systemic barriers to improving care transitions, care coordination over time 3

4 Process Changes to Improve Transitions from Hospital (or SNF) to Home Skilled Nursing Care Centers Hospital Primary & Specialty Care Home (Patient & Family Caregivers) Home Health Care Supplemental Care for High-Risk Patients Transition to Community Care Settings and Better Models of Care The Transitional Care Model (TCM) Transition from Hospital to Home or other Care Setting Patient and Family Engagement Cross-Continuum Team Collaboration Health Information Exchange and Shared Care Plans 4

5 4 Guides on Transitions Senders: From Hospital to SNF or Home Receivers: Office Practice Home Care Skilled Nursing Care Facilities Key Changes to Achieve an Ideal Transition from Hospital (or SNF) to Home: HOW CAN WE. 1. Gain a deeper understanding of the comprehensive postdischarge needs of the patient through an ongoing dialogue with the patient, family caregivers and community providers? 2. Gain a deeper understanding of patient and family caregiver understanding and comprehension of the clinical condition and self-care needs after discharge? 3. Develop a post-acute care plan based on the assessed needs and capabilities of the patient and family caregivers? 4. Effectively communicate post-acute care plans to patients and community-based providers of care? 5

6 What have we learned to date in the STAAR Initiative? What are we learning about Reducing Avoidable Readmissions? Local learning about the failures and problems that exist is core to success Knowledge of patients home-going needs emerges throughout hospitalization Family and community caregivers are important sources of information about patients home-going needs Though Teach Back we learn what patients may be able to remember and do 6

7 Diagnostics 360 review Chart reviews Interviews with patients and families Interviews with community providers Observations Assessment Discharge processes for senders and receivers Patient teaching and learning Patient and family experiences of transitions Data analyses Outcome measures Process measures Diagnostic Case Reviews Reveal opportunities for learning from a small sampling of patients experiences Engage the hearts and minds of clinicians and catalyzes action toward problem-solving Formal chart reviews and interviews Cross-continuum team hears first-hand about the transitional care problems through the patients eyes 7

8 What are we learning about Reducing Avoidable Readmissions? Cross-continuum partnerships design transformational changes together Senders and receivers agree upon and co-design the needed local changes Vital few critical elements of patient information can be available at the time of discharge to community providers Written handover communication for high risk patients is insufficient; direct verbal communication allows for inquiry and clarification What have we learned about Reducing Avoidable Readmissions? Appropriate and timely follow-up care is dependent on availability and payment for services There are no universally agreed-upon risk assessment tools We need a much deeper understanding of how best to meet the needs of high-risk patients Use practical methods to identify modifiable risks 8

9 What Are We Learning about Reducing Avoidable Readmissions? Strategies to promote patient and family caregiver engagement are critical Appropriate and timely follow-up care is dependent on availability and payment for services Achieving Desired Results Results 9

10 Analysis of Results-to-Date Reducing readmissions is dependent on highly functional cross-continuum teams and a focus on the patient s journey over time Improving transitions in care requires co-design of transitional care processes among senders and receivers Providing intensive care management services for targeted high risk patients is critical Reliable implementation of changes in pilot units or pilot populations require 18 to 24 months An Early Look at a Four-State Initiative to Reduce Avoidable Readmissions. Boutwell, A,, Bihrle Johnson, M, Rutherford, P, et. al. Health Affairs, July 7,

11 Ohio Hospital Association Work Results in Hospital Readmission Reductions AUGUST 2, 2012 OHA s Quality Institute worked to decrease hospital readmissions through the Ohio State Action on Avoidable Rehospitalizations (STAAR) Initiative. Eighteen hospitals participated, and results showed an eight percent greater reduction in STAAR hospitals readmissions than other Ohio hospitals. The Columbus Dispatch reported that hospital readmissions in Ohio dropped six percent in 18 months and accredited the STAAR program as a factor in the decrease. 11

12 12

13 Heart Failure Readmissions (for Any Cause) within 30 Days 45% 40% 35% Percent 30% 25% 20% 15% 10% 5% 0% 2006 Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q Q2 %HF to Any Reason Median prepared at the request of the Center for Medicare and Medicaid Innovation (CMMI) 13

14 30 Day All-Cause Readmissions 40% 35% 30 Day Readmissions for HF Pilot Nursing Units: Any Dx of HF 2009 Average = 24% 2010 Average = 18 % 2011 Average = 13% % of Patients Readmitted within 30 days 30% 25% 20% 15% 10% 5% Goal Line: 16% (30% reduction) 0% Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10 Jul-10 Time Period Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 Sep Day All Cause Readmissions % of Patients Readmitted within 90 days 50% 45% 40% 35% 30% 25% 20% Jan-Mar 09 Feb-Apr 09 Mar-May 09 Apr-Jun 09 May-Jul Day Readmissions for Heart Failure Patients Goal Line: 31% (30% reduction) Jun-Aug 09 Jul-Sep 09 Aug-Oct 09 Sep-Nov 09 Oct-Dec 09 Average for 2009 = 40.2% Average for 2010= 31% Average for 2011 = 26% 30% Reduction from 2006 (45.2%) to San-Francisco.aspx?omnicid=20 Nov-Jan 10 Dec-Feb 10 Jan-Mar 10 Feb-Apr 10 Mar-May 10 Apr-Jun 10 May-Jul 10 Time Period Jun-Aug 10 Jul-Sep 10 Aug-Oct 10 Sep-Nov 10 Oct-Dec 10 Nov-Jan 11 Dec-Feb 11 Jan-Mar 11 Feb-Apr 11 Mar-May 11 April - June 11 May - July 11 June - Aug 11 14

15 UCSF Heart Failure Program Studies/2012/Nov/University-of-California-San-Francisco.aspx It s About Systems of Care The quality of patients experience is the north star for systems of care. Donald Berwick, MD 15

16 Donald Goldmann, MD Pat Rutherford, RN, MS Co-Principal Investigators, STAAR Initiative Institute for Healthcare Improvement Azeem Mallick, MBA Project Manger, STAAR and Care Transitions Programs oidablerehospitalizationsstaar.htm 16

Faculty Presenters. The Care Transitions Program. STAAR Initiative

Faculty Presenters. The Care Transitions Program. STAAR Initiative Session M13 These presenters have nothing to disclose 26th Annual National Forum on Quality Improvement in Health Care Minicourse: Reducing Avoidable Readmissions by Creating a More Patient-Centered Transition

More information

Developing Post- Hospital Follow-Up Care Plans and Real-time Handover Communications Peg Bradke

Developing Post- Hospital Follow-Up Care Plans and Real-time Handover Communications Peg Bradke These presenters have nothing to disclose Developing Post- Hospital Follow-Up Care Plans and Real-time Handover Communications Peg Bradke September 28, 2015 Session Objectives Participants will be able

More information

The STAAR Initiative

The STAAR Initiative The STAAR Initiative A quality effort at the heart of system redesign Amy E. Boutwell, MD, MPP The Center for Innovative Healthcare Strategies amy@innovativehealthcarestrategies.org Please note: Dr Boutwell

More information

Quality Management Report 2017 Q2

Quality Management Report 2017 Q2 Quality Management Report 2017 Q2 Quality Management Program CMS STAR Ratings Member Satisfaction (CAHPS & HOS) HEDIS Risk Adjustment DHS Member Incident Reporting Member Satisfaction Surveys Pay for Performance

More information

Community Care Coordination Cross Continuum Care IHC Medical Home Conference September 5, 2012 Des Moines IA

Community Care Coordination Cross Continuum Care IHC Medical Home Conference September 5, 2012 Des Moines IA Community Care Coordination Cross Continuum Care IHC Medical Home Conference September 5, 2012 Des Moines IA Peg Bradke, RN, MA Director of Heart Care Services St. Luke s Hospital, Cedar Rapids, IA Session

More information

Readmission Reduction: Patient Interviews. KHA Quality Conference March, 2018

Readmission Reduction: Patient Interviews. KHA Quality Conference March, 2018 Readmission Reduction: Patient Interviews KHA Quality Conference March, 2018 Initial Driver Diagram Use Data and Root Cause Analysis to drive Continuous Improvement Analyze data to inform targeting approach

More information

IHI Expedition Reducing Readmissions by Improving Care Transitions Session 4

IHI Expedition Reducing Readmissions by Improving Care Transitions Session 4 Thursday, July 25, 2013 These presenters have nothing to disclose IHI Expedition Reducing Readmissions by Improving Care Transitions Session 4 Peg Bradke, RN, MA Saranya Loehrer, MD, MPH Expedition Coordinator

More information

Corporate Services Employment Report: January Employment by Staff Group. Jan 2018 (Jan 2017 figure: 1,462) Overall 1,

Corporate Services Employment Report: January Employment by Staff Group. Jan 2018 (Jan 2017 figure: 1,462) Overall 1, Corporate Services Employment Report: January Employment by Staff Group Jan (Jan 20 figure: 1,462) Jan % Overall 1,520 +58 +4.0% 8 Management (VIII+) 403 +52 4.8% Clerical & Supervisory (III to VII) 907

More information

Discharge and Follow-Up Planning. Presented by the Clinical and Quality Team

Discharge and Follow-Up Planning. Presented by the Clinical and Quality Team Discharge and Follow-Up Planning Presented by the Clinical and Quality Team After today s training you will be able to: Identify and summarize important information about discharge planning Have adequate

More information

Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver JULY 18, 2016

Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver JULY 18, 2016 Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver HEALTH FORUM AND AHA LEADERSHIP SUMMIT JULY 18, 2016 SAN DIEGO, CALIFORNIA Please note that the views expressed are those of the conference

More information

Executive Summary MEDICARE FEE-FOR-SERVICE (FFS) HOSPITAL READMISSIONS: QUARTER 4 (Q4) 2012 Q STATE OF CALIFORNIA

Executive Summary MEDICARE FEE-FOR-SERVICE (FFS) HOSPITAL READMISSIONS: QUARTER 4 (Q4) 2012 Q STATE OF CALIFORNIA MEDICARE FEE-FOR-SERVICE (FFS) HOSPITAL READMISSIONS: QUARTER 4 (Q4) 2012 Q3 2013 Executive Summary STATE OF CALIFORNIA The Centers for Medicare & Medicaid Services (CMS) has tasked Health Services Advisory

More information

Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver JULY 18, 2016

Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver JULY 18, 2016 Post-Acute Care Networks: How to Succeed and Why Many Fail to Deliver HEALTH FORUM AND AHA LEADERSHIP SUMMIT JULY 18, 2016 SAN DIEGO, CALIFORNIA Please note that the views expressed are those of the conference

More information

Winning at Care Coordination Using Data-Driven Partnerships

Winning at Care Coordination Using Data-Driven Partnerships Idriz Limaj, LNHA, RN Chief Operating Officer Winning at Care Coordination Using Data-Driven Partnerships Session #166, February 22, 2017 1 Steven Littlehale, MS, GCNS-BC EVP & Chief Clinical Officer Speaker

More information

IHI Expedition. Reducing Readmissions by Improving Care Transitions Session 2. Expedition Coordinator

IHI Expedition. Reducing Readmissions by Improving Care Transitions Session 2. Expedition Coordinator Thursday, June 20, 2013 These presenters have nothing to disclose IHI Expedition Reducing Readmissions by Improving Care Transitions Session 2 Peg Bradke, RN, MA Saranya Loehrer, MD, MPH Expedition Coordinator

More information

Reducing Medicaid Readmissions

Reducing Medicaid Readmissions Reducing Medicaid Readmissions Webinar 1: Medicaid Readmissions 101 Amy E. Boutwell, MD MPP Co-Principal Investigator AHRQ Reducing Medicaid Readmissions Project February 25 2015 Agenda Introduction to

More information

Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability

Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability Leveraging the Accountable Care Unit Model to create a culture of Shared Accountability How we improved Patient Safety and Quality Outcomes at Northwest Hospital Our Journey to Shared Accountability Implementation

More information

JANUARY 2018 (21 work days) FEBRUARY 2018 (19 work days)

JANUARY 2018 (21 work days) FEBRUARY 2018 (19 work days) AND CORRESPONDING DATES FOR JANUARY AND FEBRUARY 2018 JANUARY 2018 ( work days) Deadline* 12-27 12-28 12-29 1-2 1-3 1-4 1-5 1-8 1-9 1-10 Benefit Hold ** 12-28 12-29 1-2 1-3 1-4 1-5 1-8 1-9 1-10 1-11 Mailing

More information

Enlisted Professional Military Education FY 18 Academic Calendar. Table of Contents COLLEGE OF DISTANCE EDUCATION AND TRAINING (CDET):

Enlisted Professional Military Education FY 18 Academic Calendar. Table of Contents COLLEGE OF DISTANCE EDUCATION AND TRAINING (CDET): Enlisted Professional Military Education FY 18 Academic Calendar Table of Contents STAFF NON-COMMISSIONED OFFICER ACADEMIES: SNCO Academy Quantico SNCO Academy Camp Pendleton SNCO Academy Camp Lejeune

More information

Overview of a new study to assess the impact of hospice led interventions on acute use. Jonathan Ellis, Director of Policy & Advocacy

Overview of a new study to assess the impact of hospice led interventions on acute use. Jonathan Ellis, Director of Policy & Advocacy Overview of a new study to assess the impact of hospice led interventions on acute use Jonathan Ellis, Director of Policy & Advocacy The problem Almost 600,000 people die each year Half will die in a hospital

More information

Compliance Division Staff Report

Compliance Division Staff Report Compliance Division Staff Report Polygraph Advisory Board Meeting Tuesday, September 26, 2017 Public Outreach Compliance Division routinely attends annual industry meetings held by TALEPI (Texas Association

More information

HPV Vaccination Quality Improvement: Physician Perspective

HPV Vaccination Quality Improvement: Physician Perspective HPV Vaccination Quality Improvement: Physician Perspective Discussion of efforts to raise HPV vaccine coverage using quality improvement from a physician s perspective Alix Casler, M.D., F.A.A.P. Chief

More information

National Trends Winter 2016

National Trends Winter 2016 National Trends Winter 216 About the National Trends data This report presents a unique and real-time view of trends within temporary nursing including bank and agency usage. The data used has been drawn

More information

PSYCHIATRY SERVICES UPDATE

PSYCHIATRY SERVICES UPDATE PSYCHIATRY SERVICES UPDATE Mark Leary MD, Interim Chief Kathy Ballou RN, Director of Nursing Anton Nigusse Bland MD, PES Medical Director Emily Lee MD, Inpatient Psychiatry Medical Director TRUE NORTH

More information

Change Management at Orbost Regional Health

Change Management at Orbost Regional Health Change Management at Orbost Regional Health Our change management journey 1 Medication Change System Meds at Beds 2 The slightly exaggerated before process 3 Project Goals The purpose of the Meds at Beds

More information

CAUTI Reduction A Clinton Memorial Presentation

CAUTI Reduction A Clinton Memorial Presentation CAUTI Reduction 2016 A Clinton Memorial Presentation Clinton Memorial Statistics Rurally situated in a primarily agricultural community with a population of 42,000 The hospital is licensed for 165 beds

More information

National Readmissions Summit Safe and Reliable Transitions: An Integrated Approach Reducing Heart Failure Readmissions

National Readmissions Summit Safe and Reliable Transitions: An Integrated Approach Reducing Heart Failure Readmissions National Readmissions Summit Safe and Reliable Transitions: An Integrated Approach Reducing Heart Failure Readmissions Michael Kanter, MD, Medical Director Quality and Clinical Analysis Patti Harvey, RN,

More information

Workflow. Optimisation. hereweare.org.uk. hereweare.org.uk

Workflow. Optimisation. hereweare.org.uk. hereweare.org.uk Workflow Optimisation Dr. Paul Deffley & Jaivir Pall Clinical Lead & Commercial Lead About Here Not-for-profit social enterprise Membership organisation (our members are local GPs, Practice Managers, Practice

More information

Aurora will expand its geographic coverage within Wisconsin to achieve its mission to: Aurora Health Care 1991 Strategic Plan

Aurora will expand its geographic coverage within Wisconsin to achieve its mission to: Aurora Health Care 1991 Strategic Plan Objectives To describe the 20-year evolution of Aurora Medical Group within Aurora Health Care To identify the cultural characteristics necessary to improve patient access from the patient s perspective

More information

SPSP Medicines. Prepared by: NHS Ayrshire and Arran

SPSP Medicines. Prepared by: NHS Ayrshire and Arran SPSP Medicines Prepared by: NHS Ayrshire and Arran Medication Reconciliation: Story so far MR happening in primary care, acute adult, paediatrics and mental health Started in acute then mental health,

More information

OhioHealth s Mission: To Improve the Health of Those We Serve

OhioHealth s Mission: To Improve the Health of Those We Serve Enhancing SAFE SKIN Through Computer Utilization OhioHealth s Mission: To Improve the Health of Those We Serve 2 1 3 Grant Medical Center 21,000 patient discharges/year Average daily census of 260 Magnet

More information

PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, August 2016

PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, August 2016 Report Contents: PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, August By: Terry Dentoni, MSN, RN, CNL, SFGH Chief Nursing Officer 1. Professional Nursing..1 2. Emergency Department

More information

Influence of Patient Flow on Quality Care

Influence of Patient Flow on Quality Care Influence of Patient Flow on Quality Care Patients Waiting on Trolleys for an Inpatient Bed Patients who are Medically Fit to be discharged and cared for at Home with Support or in a Nursing Home or District

More information

FHA HIIN Readmissions Peer Sharing Webinar: Improving Care Transitions through a Discharge Lounge. July 24, 2018

FHA HIIN Readmissions Peer Sharing Webinar: Improving Care Transitions through a Discharge Lounge. July 24, 2018 FHA HIIN Readmissions Peer Sharing Webinar: Improving Care Transitions through a Discharge Lounge July 24, 2018 Welcome & Overview How are we doing on Reducing Readmissions? Peer Sharing Presentation:

More information

Kentucky Sepsis Summit. August 2016

Kentucky Sepsis Summit. August 2016 1 Kentucky Sepsis Summit August 2016 St. Elizabeth Healthcare About Us: - 7 facilities & over 1200 licensed beds - Serving the NKY/Cincinnati Region in: - Orthopedic Care - Heart and Vascular Institute

More information

Northern Health - Acute Services. Evidence Based Practice Venous Thromboembolism Prevention

Northern Health - Acute Services. Evidence Based Practice Venous Thromboembolism Prevention Northern Health - Acute Services Evidence Based Practice Venous Thromboembolism Prevention (VTE) Jeannette Kamar Christine Lamotte, Liam Carter Improving Patient Safety Preventing and Managing Venous Thromboembolism

More information

1. November RN VACANCY RATE: Overall 2320 RN vacancy rate for areas reported is 12.5%

1. November RN VACANCY RATE: Overall 2320 RN vacancy rate for areas reported is 12.5% PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, December 2013 Terry Dentoni, RN, MSN, CNL, Interim Chief Nursing Officer 1. November 2013-2320 RN VACANCY RATE: Overall 2320 RN

More information

BOROUGH OF ROSELLE PUBLIC NOTICE ANNUAL NOTICE OF CALENDAR YEAR 2018 WORKSHOP SESSIONS, PRE-AGENDA MEETINGS AND REGULAR MEETINGS

BOROUGH OF ROSELLE PUBLIC NOTICE ANNUAL NOTICE OF CALENDAR YEAR 2018 WORKSHOP SESSIONS, PRE-AGENDA MEETINGS AND REGULAR MEETINGS BOROUGH OF ROSELLE PUBLIC NOTICE ANNUAL NOTICE OF CALENDAR YEAR 2018 WORKSHOP SESSIONS, PRE-AGENDA MEETINGS AND REGULAR MEETINGS BE IT RESOLVED, by the Mayor and Borough Council of the Borough of Roselle,

More information

CareTrek : Nebraska s Journey to Safe Care Transitions

CareTrek : Nebraska s Journey to Safe Care Transitions CareTrek : Nebraska s Journey to Safe Care Transitions Audrey Paulman, MD, MMM Principal Clinical Coordinator CIMRO of Nebraska This material was prepared by CIMRO of Nebraska, the Medicare Quality Improvement

More information

L4: Getting to Always! Using teach-back to Maximize Patient Learning

L4: Getting to Always! Using teach-back to Maximize Patient Learning These presenters have nothing to disclose 15th Annual International Summit on Improving Patient Care in the Office Practice and the Community Sunday March 9 - Tuesday, March 11, 2014 L4: Getting to Always!

More information

QIO Care Transitions Activity: the Good News so far

QIO Care Transitions Activity: the Good News so far QIO Care Transitions Activity: the Good News so far Kim Irby, MPH; kirby@cfmc.org Senior Project Director Colorado Foundation for Medical Care www.cfmc.org/integratingcare This material was prepared by

More information

2017 HIMSS DAVIES APPLICANT

2017 HIMSS DAVIES APPLICANT 2017 HIMSS DAVIES APPLICANT Introduction of NOMS Team Members Melissa Thomas IT Project Director Joshua Frederick, CPA, MT Chief Executive Officer Jennifer Hohman, MD Executive Vice President, NOMS Healthcare

More information

M7: Improving Transitions and Reducing Avoidable Rehospitalizations. St. Luke s Hospital Member, Iowa Health System

M7: Improving Transitions and Reducing Avoidable Rehospitalizations. St. Luke s Hospital Member, Iowa Health System M7: Improving Transitions and Reducing Avoidable Rehospitalizations Peg M. Bradke, RN, MA St. Luke s Hospital, Cedar Rapids, Iowa This presenter has nothing to disclose. St. Luke s Hospital Member, Iowa

More information

Taming Length of Stay Challenges Through Analytics

Taming Length of Stay Challenges Through Analytics Taming Length of Stay Challenges Through Analytics March 3, 2016 Dr. Michelle Pezzani, Medical Director Utilization Management at El Camino Hospital & Palo Alto Medical Foundation (PAMF) Petrina Griesbach

More information

Tina Nelson, MBA, BSN Lisa Stepp, BSN, RN Rebecca Fyffe, BSN, RN Jessica Coughenour, LPN

Tina Nelson, MBA, BSN Lisa Stepp, BSN, RN Rebecca Fyffe, BSN, RN Jessica Coughenour, LPN Establishing a Conservative Approach to the Prevention of Pressure Ulcers with the Utilization of Data Analytics to Monitor Effectiveness of Quality Efforts and Best Practice Models Tina Nelson, MBA, BSN

More information

CAMDEN CLARK MEDICAL CENTER:

CAMDEN CLARK MEDICAL CENTER: INSIGHT DRIVEN HEALTH CAMDEN CLARK MEDICAL CENTER: CARE MANAGEMENT TRANSFORMATION GENERATES SAVINGS AND ENHANCES CARE OVERVIEW Accenture helped Camden Clark Medical Center, (CCMC), a West Virginia-based

More information

Transitions of Care Project BOOST

Transitions of Care Project BOOST Transitions of Care Project BOOST Donald Pocock, MD, FACP, CPE Chief Medical Officer Morton Plant Mease Healthcare Jerry Corsello, MBA Unit Business Manager Med-Surg/Oncology Unit "Medicine used to be

More information

JMOC Update: Behavioral Health Redesign. March 16 th, 2017

JMOC Update: Behavioral Health Redesign. March 16 th, 2017 JMOC Update: Behavioral Health Redesign March 16 th, 2017 Ohio Medicaid Behavioral Health Redesign Initiative The Redesign Initiative is an integral component of Ohio s comprehensive strategy to rebuild

More information

Transitions of Care Innovations in the Medical Practice Setting

Transitions of Care Innovations in the Medical Practice Setting Transitions of Care Innovations in the Medical Practice Setting Linda Wendt, System Director of Quality- UnityPoint Clinic Sheila Tumilty, Senior Project Manager- UnityPoint Clinic Session Objectives After

More information

5/26/2015. January 26, 2015 INCENTIVES AND PENALTIES. Medicare Readmission Penalties. CMS Bundled Payment Providers & ACOs in NE

5/26/2015. January 26, 2015 INCENTIVES AND PENALTIES. Medicare Readmission Penalties. CMS Bundled Payment Providers & ACOs in NE Agenda ESTABLISHING SHARED EXPECTATIONS New tool of ACOs, Bundled Payments & Readmission Reduction Update on current market pressures driving a focus on care across settings & over time at lowest cost

More information

Laguna Honda Lean Transformation. Laguna Honda Strategic Performance Management November 2017

Laguna Honda Lean Transformation. Laguna Honda Strategic Performance Management November 2017 Laguna Honda Lean Transformation Laguna Honda Strategic Performance Management November 2017 Background MAKE IT BETTER 4. 1. Performance Improvement FIX IT Do the work and make it happen 3. Create best

More information

Please place your phone line on mute.

Please place your phone line on mute. We will begin the MaRISS Coordinator Call shortly Please place your phone line on mute. 8/26/2016 2 Overview Missing data Correct dates on Baseline NIHSS Form 24 hour window for consent CRF Forms What

More information

Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario

Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario 4/1/2014 This document is intended to provide health care organizations in Ontario with guidance as to how they can develop

More information

Countywide Emergency Department Ambulance Patient Transfer of Care Report Performance Report

Countywide Emergency Department Ambulance Patient Transfer of Care Report Performance Report Countywide Emergency Department 9-1-1 Ambulance Patient Transfer of Care Report Performance Report Prepared by: Contra Costa Emergency Medical Services Visit us at www.cccems.org 2/28/2017 Patient Transfer

More information

Short-term, Redefined By Managed Care. Welcome Everyone!

Short-term, Redefined By Managed Care. Welcome Everyone! Short-term, Redefined By Managed Care Welcome Everyone! Presenter: Christopher B. Bailey, MHA, NHA President of Premier Healthcare Resources Management/Consulting Company serving PA, NJ, OH, & MD 20 years

More information

IHI S APPROACH TO REDUCING REHOSPITALIZATIONS IN THE STAAR INITIATIVE: OVERVIEW

IHI S APPROACH TO REDUCING REHOSPITALIZATIONS IN THE STAAR INITIATIVE: OVERVIEW Session M1 This presenter has nothing to disclose IHI S APPROACH TO REDUCING REHOSPITALIZATIONS IN THE STAAR INITIATIVE: OVERVIEW Pat Rutherford, RN, MS, Vice President, Institute for Healthcare Improvement,

More information

PRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management

PRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management PRISM Collaborative: Transforming the Future of Pharmacy PeRformance Improvement for Safe Medication Management Mission: To improve the health of the people of Connecticut through safe and effective medication

More information

Harm Across the Board Reporting: How your Hospital Can Get There

Harm Across the Board Reporting: How your Hospital Can Get There Harm Across the Board Reporting: How your Hospital Can Get There Presentation to KHA Annual Quality Conference March 19, 2014 Jackie Conrad RN, BSN, MBA Improvement Advisor Cynosure Health Objectives Upon

More information

Andrew Kirby Director, Healthcare Solutions Microsoft Services

Andrew Kirby Director, Healthcare Solutions Microsoft Services Andrew Kirby Director, Healthcare Solutions Microsoft Services Microsoft in Health Patient Safety Challenges The Patient Safety Principles Driving MSCUI Delivery Roadmap Review Examples of MSCUI in Use

More information

Quality Improvement Program Evaluation

Quality Improvement Program Evaluation Quality Improvement Program Evaluation 2013 Care Wisconsin 2013 Quality Improvement Program Evaluation INTRODUCTION Care Wisconsin s Quality Management Program uses the Home and Community-Based Quality

More information

PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, March 2018

PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, March 2018 Report Contents: PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, March By: Terry Dentoni, MSN, RN, CNL - ZSFG Chief Nursing Officer 1. Professional Nursing......1-2 2. Emergency

More information

PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, February 2009 Sue Currin, RN, MS, Chief Nursing Officer

PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, February 2009 Sue Currin, RN, MS, Chief Nursing Officer PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, February 2009 Sue Currin, RN, MS, Chief Nursing Officer 1. January 2009 2320 RN VACANCY RATE: Overall 2320 RN vacancy rate for

More information

The Triple Aim. Productivity: Digging Deep Enough 11/4/2013. quality and satisfaction); Improving the health of populations; and

The Triple Aim. Productivity: Digging Deep Enough 11/4/2013. quality and satisfaction); Improving the health of populations; and NAHC Annual Conference October, 2013 Cindy Campbell, BSN, RN Associate Director Operational Consulting Fazzi Jeanie Stoker, BSN, RN, MPA, BC Director AnMed Health Home Care Context AnMed Health Home Health

More information

Strategies to Reduce Readmissions, Sepsis, and Health-Care Associated Infections

Strategies to Reduce Readmissions, Sepsis, and Health-Care Associated Infections C10 This presenter has nothing to disclose Strategies to Reduce Readmissions, Sepsis, and Health-Care Associated Infections David Renfro, MS, RN NE BC Kelly Farnam, BSN, RN Gloria Martinez, MS, RN, NEA

More information

Presenter Disclosure

Presenter Disclosure Improving Transitions from the Hospital to Community Settings IHI National Forum Learning Lab Sunday, December 8, 2013 Presenter Disclosure MaryAnne Elma, MPH Quality Implementation and Innovations Director

More information

HIMSS Nicholas E. Davies Award of Excellence Case Study Nebraska Medicine October 10, 2017

HIMSS Nicholas E. Davies Award of Excellence Case Study Nebraska Medicine October 10, 2017 HIMSS Nicholas E. Davies Award of Excellence Case Study Nebraska Medicine October 10, 2017 Nebraska Medicine $1.2 billion academic health system 8,000 employees More than 1,000 affiliated physicians Primary

More information

Quality Measure Indicators +Throughput Metrics + Automated Dashboard = Innovation to Improve Quality Goals

Quality Measure Indicators +Throughput Metrics + Automated Dashboard = Innovation to Improve Quality Goals Quality Measure Indicators +Throughput Metrics + Automated Dashboard = Innovation to Improve Quality Goals DMC Harper- Hutzel Hospital The DMC is an 8 facility academic medical center Harper-Hutzel is

More information

CHF Readmission Initiative. Mary Fischer MSN, CCRN, PCCN, CHFN Cardiology Clinical Nurse Specialist St. Vincent Hospital Indianapolis, Indiana

CHF Readmission Initiative. Mary Fischer MSN, CCRN, PCCN, CHFN Cardiology Clinical Nurse Specialist St. Vincent Hospital Indianapolis, Indiana CHF Readmission Initiative Mary Fischer MSN, CCRN, PCCN, CHFN Cardiology Clinical Nurse Specialist St. Vincent Hospital Indianapolis, Indiana St. Vincent 86 th Street Campus Heart Failure Program History

More information

Advancing Popula/on Health and Consumerism

Advancing Popula/on Health and Consumerism Advancing Popula/on Health and Consumerism 44,954 Senior Enrollees 274,345 Commercial Enrollees 66,070 Commercial ACO Members Popula/on Health Risk Stra/fica/on: Keep Pa/ents Healthy, Happy & at Home Tier

More information

Peraproposal for EWG Task

Peraproposal for EWG Task Peraproposal for EWG Task Attracting Hi Growth SMEs to National Programmes Andy Jones, Pera July 2014 Contents 1. Proposal to Taftie EWG 2. Hypothesis to research 3. Stakeholder benefits 4. Draft project

More information

GRANTS.GOV Updates Federal Demonstration Partnership Meeting. Presented by Grants.gov September 7, 2017

GRANTS.GOV Updates Federal Demonstration Partnership Meeting. Presented by Grants.gov September 7, 2017 GRANTS.GOV Updates Federal Demonstration Partnership Meeting Presented by Grants.gov September 7, 2017 RELEASE UPDATE 09/06/2017 GRANTS.GOV Updates Federal Demonstration Partnership JAD Meeting Slide 2

More information

STAAR Initiative STate Action on Avoidable Rehospitalizations

STAAR Initiative STate Action on Avoidable Rehospitalizations Amy Boutwell, MD MPP Primary Investigator, STAAR Initiative Institute for Healthcare Improvement Commonwealth Fund-supported initiative to reduce avoidable rehospitalizations, taking states as unit of

More information

Improvements & Sustained Change through the Implementation of High Reliability Units

Improvements & Sustained Change through the Implementation of High Reliability Units Improvements & Sustained Change through the Implementation of High Reliability Units Tammy Van Dyk, MSN, RN, CPEN Quality Management & Patient Safety Manager Objective Describe how high reliability principles

More information

CareTrek : Nebraska s Journey to Safe Care Transitions

CareTrek : Nebraska s Journey to Safe Care Transitions CareTrek : Nebraska s Journey to Safe Care Transitions Audrey Paulman, MD, MMM Principal Clinical Coordinator CIMRO of Nebraska This material was prepared by CIMRO of Nebraska, the Medicare Quality Improvement

More information

Standardising Acute and Specialised Care Theme 3 Governance and Approach to Hospital Based Services Strategy Overview 28 th July 2017

Standardising Acute and Specialised Care Theme 3 Governance and Approach to Hospital Based Services Strategy Overview 28 th July 2017 Standardising Acute and Specialised Care Theme 3 Governance and Approach to Hospital Based Services Strategy Overview 28 th July 2017 Background Theme 3 builds upon previous key strategic commissioning

More information

Person and Family Centered Care

Person and Family Centered Care Mountain Pacific Quality Health Foundation August 19, 2015 Person and Family Centered Care Martha Donovan Hayward IHI Lead for Patient and Public Engagement IHI Strategy 2 Person- and Family-Centered Care

More information

PSI-15 Lafayette General Health 2017 Nicholas E. Davies Enterprise Award of Excellence

PSI-15 Lafayette General Health 2017 Nicholas E. Davies Enterprise Award of Excellence PSI-15 Lafayette General Health 2017 Nicholas E. Davies Enterprise Award of Excellence Rachel Brunt, RN, BSN, MBA-HCA, CIC, CPHQ, Director Quality Jessie Hanks, BS, RHIA, Director HIM Lafayette General

More information

PROJECTS. FOR THE MONTHS OF October-November 2017

PROJECTS. FOR THE MONTHS OF October-November 2017 PROJECTS FOR THE MONTHS OF October-November 2017 Foundation Marketing 2017 Foundation Websites - Web Usage Report (Jan - Oct 2017) * ** ** ** Column R Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Total

More information

JMOC Update: Behavioral Health Redesign. December 15 th, 2016

JMOC Update: Behavioral Health Redesign. December 15 th, 2016 JMOC Update: Behavioral Health Redesign December 15 th, 2016 2 Implementation Schedule BH Redesign 7/1/2017: Medicaid requires rendering (NPI) practitioner*, ORP, and/or supervisor on claims Go Live for

More information

Baptist Health System Jacksonville, FL

Baptist Health System Jacksonville, FL Baptist Health System Jacksonville, FL Baptist Health System Community Leader in Healthcare Five (5) Hospital System Serving greater Jacksonville area and SE Georgia Children s Hospital Primary Care Facilities

More information

Transforming Healthcare Delivery, the Challenges for Behavioral Health

Transforming Healthcare Delivery, the Challenges for Behavioral Health Transforming Healthcare Delivery, the Challenges for Behavioral Health Presented by: M.T.M. Services, LLC P. O. Box 1027, Holly Springs, NC 27540 Phone: 919-434-3709 Fax: 919-773-8141 E-mail: mtmserve@aol.com

More information

Countywide Emergency Department Ambulance Patient Transfer of Care Report Performance Report

Countywide Emergency Department Ambulance Patient Transfer of Care Report Performance Report Countywide Emergency Department 9-1-1 Ambulance Patient Transfer of Care Report Performance Report Prepared by: Contra Costa Emergency Medical Services Visit us at www.cccems.org 2/11/2016 Contra Costa

More information

CHC-A Continuity Dashboard. All Sites Continuity - Asthma. 2nd Qtr-03. 2nd Qtr-04. 2nd Qtr-06. 4th Qtr-03. 4th Qtr-06. 3rd Qtr-04.

CHC-A Continuity Dashboard. All Sites Continuity - Asthma. 2nd Qtr-03. 2nd Qtr-04. 2nd Qtr-06. 4th Qtr-03. 4th Qtr-06. 3rd Qtr-04. PPC1: ACCESS AND COMMUNICATION Element B: Access and Communication Results Item 1: Visits with assigned PCP Continuity data is reviewed each month at our Office Redesign Committee (ORDC). The data is collected

More information

TCLHIN Standardized Discharge Summary

TCLHIN Standardized Discharge Summary TCLHIN Standardized Discharge Summary ehealth Conference June 4, 2014 Kara Kitts Quality Improvement Manager St. Michael s Hospital Ontario Healthcare System 14 Local Health Integration Networks (LHINs)

More information

1. March RN VACANCY RATE: Overall 2320 RN vacancy rate for areas reported is 13.8%

1. March RN VACANCY RATE: Overall 2320 RN vacancy rate for areas reported is 13.8% PATIENT CARE SERVICES REPORT Submitted to the Joint Conference Committee, April 2014 Terry Dentoni, RN, MSN, CNL, Interim Chief Nursing Officer 1. March 2014-2320 RN VACANCY RATE: Overall 2320 RN vacancy

More information

Overview of Home Health Star Ratings

Overview of Home Health Star Ratings Overview of Home Health Star Ratings September 23, 2015 Presented by: Liz Silva Deyta Analytics, a division of HEALTHCAREfirst Agenda Home Health Star Ratings Quality of Patient Care Star Rating Patient

More information

What happened before MMC?

What happened before MMC? Modernising Medical Careers: Foundation Programme Application Process Dr (Insert Name) (insert title) What happened before MMC? PRHO (F1) and SHO (F2) Applications all year round Multiple applications

More information

UNIVERSITY OF DAYTON DAYTON OH ACADEMIC CALENDAR FALL Incoming First Year students move into UD Housing

UNIVERSITY OF DAYTON DAYTON OH ACADEMIC CALENDAR FALL Incoming First Year students move into UD Housing UNIVERSITY OF DAYTON DAYTON OH 2018-2019 ACADEMIC CALENDAR FALL 2018 Mon. Aug 6 TBD Thu, Aug 16 Fri, Aug 17 Sat, Aug 18-21 Sun, Aug 19 Tue, Aug 21 Tue, Aug 21 Wed, Aug 22 Tue, Aug 28 Mon, Sep 3 Fri, Sep

More information

Utilization Management in Inpatient Psychiatry

Utilization Management in Inpatient Psychiatry IDEAS AT WORK Utilization Management in Inpatient Psychiatry Mike VandenBroek, F.G. McNestry and Ann Dobby ospitals face a growing challenge of accountability and scrutiny for the services they deliver.

More information

Departments to Improve. February Chad Faiella RN, Terri Martin RN. 1 Process Excellence

Departments to Improve. February Chad Faiella RN, Terri Martin RN. 1 Process Excellence Coordination of Multiple Departments to Improve ED Throughput February 2011 Chad Faiella RN, Terri Martin RN 1 Agenda OhioHealth information Grant Medical Center facts Bed assignment process Key takeaways

More information

Accreditation Support for Ohio Local Health Districts Request for Training or Technical Assistance - Round 1 The Ohio Department of Health

Accreditation Support for Ohio Local Health Districts Request for Training or Technical Assistance - Round 1 The Ohio Department of Health 12-28-2016 Accreditation Support for Ohio Local Health Districts Request for Training or Technical Assistance - Round 1 The Ohio Department of Health OVERVIEW With funding from the Ohio Department of Higher

More information

Hospitals and the Economy. Anne McLeod Vice President, Finance Policy California Hospital Association

Hospitals and the Economy. Anne McLeod Vice President, Finance Policy California Hospital Association Anne McLeod Vice President, Finance Policy California Hospital Association American hospitals are financially challenged and the trends in revenues and expenses will put and even greater burden on the

More information

Influence of Patient Flow on Quality Care

Influence of Patient Flow on Quality Care Influence of Patient Flow on Quality Care Patients Waiting on Trolleys for an Inpatient Bed Patients who are Medically Fit to be discharged and cared for at Home with Support or in a Nursing Home or District

More information

Creating A Niche: Medical-Surgical Nurses Role in Succesful Program Development (Oral)

Creating A Niche: Medical-Surgical Nurses Role in Succesful Program Development (Oral) Lehigh Valley Health Network LVHN Scholarly Works Patient Care Services / Nursing Creating A Niche: Medical-Surgical Nurses Role in Succesful Program Development (Oral) Eileen Sacco MSN, RN, CNRN, ONC

More information

Adapting to changing times.. The challenge & the power of person-centredness

Adapting to changing times.. The challenge & the power of person-centredness Adapting to changing times.. The challenge & the power of person-centredness The healthcare team.. Pharm. Dietician Doctor Chaplains Patient OT Physio Nurse Domestic Staff The healthcare team.. Dietician

More information

Reducing Hospital Readmissions: Home Care as the Solution

Reducing Hospital Readmissions: Home Care as the Solution Reducing Hospital Readmissions: Home Care as the Solution Kathy Duckett RN, BSN Sutter Center for Integrated Care ducketk@sutterhealth.org www.suttercenterforintegratedcare.org Learning Objectives 1 Review

More information

West Valley and Central Valley Care Coordination Coalitions

West Valley and Central Valley Care Coordination Coalitions West Valley and Central Valley Ettie Lande, MS, BSN, ACM-RN February 08, 2018 Thank You! For sponsoring today s breakfast AstraZeneca and Cyndi Black If you can sponsor breakfast at an upcoming community

More information

Improving Transitions to Home & Community- Based Care Settings

Improving Transitions to Home & Community- Based Care Settings This presenter has nothing to disclose. Improving Transitions to Home & Community- Based Care Settings Eric Coleman September 29, 2015 Session Objectives Participants will be able to: Describe the role

More information

Improving Pain Center Processes utilizing a Lean Team Approach

Improving Pain Center Processes utilizing a Lean Team Approach Improving Pain Center Processes utilizing a Lean Team Approach Organization Name: St. Joseph Medical Center Type: Acute Care Hospital Contact Person: Sue Mitchell Title: Nurse Mgr Pain Mgmt Center E-Mail:

More information

AGENDA. Introduction and Executive Leadership Year in Review Environment of Care Report and Policy Approvals

AGENDA. Introduction and Executive Leadership Year in Review Environment of Care Report and Policy Approvals AGENDA Introduction and Executive Leadership Year in Review Environment of Care Report and Policy Approvals San Francisco General Hospital and Trauma Center Executive Leadership Roland Pickens, Interim

More information

Health Care Systems - A National Perspective Erica Preston-Roedder, MSPH PhD

Health Care Systems - A National Perspective Erica Preston-Roedder, MSPH PhD Health Care Systems - A National Perspective Erica Preston-Roedder, MSPH PhD Outline Quality Overview Overview and discussion of CMS programs Increasing transparency Move from P4R to P4P Expanding beyond

More information