NoCVA North Carolina Preventing Avoidable Readmissions Collaborative

Transcription

1 NoCVA North Carolina Preventing Avoidable Readmissions Collaborative Measurement Update, Using A3, and Community Engagement Check-in April 17, 2013

2 Agenda Measurement Updates A3: Homework Review and Problem Solving A3 Status of community engagement work Announcements

3 PPR methodology Why these reports matter o Medicaid population under intense scrutiny Why learn the PPR methodology? o Not all readmissions are avoidable. PPR really wants to get at potentially preventable readmissions Subsequent admission must be clinically related to original readmission and model is risk-adjusted.

4 Potentially Preventable Readmissions (PPRs) Certain admissions are excluded from consideration o On average 40% of admissions are excluded from the calculation Covers all conditions Readmission must be clinically-related to the initial hospital admission Risk-adjusted at the visit level using APR-DRGs Can be risk-adjusted at the person level using CRGs Slide by Treo

5 PPR Definitions: PPR Chains A PPR Chain is an initial discharge followed by a number of clinicallyrelated readmissions PPR 1 INITIAL ADMISSION PPR 2 One chain can have multiple readmissions associated with it Approximately 75% of PPRs come back to initial admitting facility A PPR chain terminates if a readmission meets any of the following criteria: Is outside the prescribed time window Is clinically unrelated to initial discharge Left against medical advice Is a transfer to another acute care hospital Meets discharge exclusion criteria Other trauma admission Died Slide by Treo

6 PPR Summary Report p2 Organization, Data Range & Readmit Window Readmission Overview & Readmission Frequency Included Facilities Same/Other Facility Analysis & Time to Readmission Readmission Calculation Breakdown CCNC Enrollment Slide by Treo

7 PPR Summary Report p3 Readmission Rate Analysis Time Series 3 Year Span Comparison of Hospital to NC Medicaid and the 90 th and 10 th Percentiles How are we doing over time? How do we compare? Slide by Treo

8 PPR Summary Report p4 Readmission By Discharge Status Where are they going before they come back? Medical/Surgica l Split What type of admission were they here for? Slide by Treo

9 PPR Summary Report p5 Readmission By Service Line What services did they receive while they were here? Is there a pattern? Are there areas where I need to focus attention? Slide by Treo

10 You also received two graphs comparing your hospital s readmission rates against those of other hospitals. o By bedsize and by region

11 Lean Healthcare Homework review What have you learned from your strategic A3? Do you have any questions regarding your strategic A3? Industrial Extension Service 13

12 Lean Healthcare Problem Solving A3 Industrial Extension Service 14

13 Lean Healthcare Industrial Extension Service 15

14 Lean Healthcare Step 1: Identify Problem or Need Whenever the way work happens is not ideal, or when a goal or objective is not being met, you have a problem (or, if you prefer, a need) The best problems to work on are those that arise in day-to-day work and prevent you from doing your best Industrial Extension Service 16

15 Lean Healthcare Step 2: Understand Current Situation Observe the work processes firsthand and document observations Create a diagram that shows how the work is currently done Quantify the magnitude of the problem If possible, represent the data graphically Industrial Extension Service 17

16 Lean Healthcare Step 3: Root Cause Analysis To accomplish this, do the following: First, make a list of the main problem(s). Create a diagram that shows how the work is currently done Next, ask the appropriate Why? questions until you reach the root cause A good rule-of-thumb is that you haven t reached the root cause until you ve asked Why? at least five times in series Quantify the magnitude of the problem Industrial Extension Service 18

17 Lean Healthcare Step 3: Other Root Cause Analysis Tools Drawn pictures, photographs, videos Check sheets Cause-and-effect diagrams (fishbone diagrams) Charts time, dot, stem & leaf plot Scatter diagrams Pareto charts Histograms FMEA s Industrial Extension Service 19

18 Lean Healthcare Step 4: Countermeasures Countermeasures are the changes made to the work process that address the root cause of the problem or issue First, contain the problem (e.g., stop the process, isolate nonconformance) to keep it from growing Next, develop temporary countermeasures, based upon initial observation/analysis, to enable the process to continue Finally, implement a long-term solution or countermeasure using root cause analysis tools from Step 2 Industrial Extension Service 20

19 Lean Healthcare Step 5: Develop the Target State The target condition describes how the work will get done with the proposed countermeasures in place In the A3 report, the target condition should be a diagram that illustrates how the new proposed process will work In the A3 report, the specific countermeasures should be documented with quantified expectations Industrial Extension Service 21

20 Lean Healthcare Step 6: Implementation Plan The implementation plan should include a list of the tasks required to implement countermeasures and realize the target condition For each task, include: The individual responsible Due date Expected outcome Current status Industrial Extension Service 22

21 Lean Healthcare Step 7: Follow-up Plan The follow-up plan verifies: Implementation plan is on schedule Target condition is being realized (through measurement and observation) Expected results have been achieved If not, action will need to be taken to realize desired results Industrial Extension Service 23

22 Lean Healthcare Example Industrial Extension Service 24

23 Lean Healthcare Example Industrial Extension Service 25

24 Lean Healthcare Homework 1. Select a problem the team has identified in the process. 2. Use the A3 to work through the problem identified. Industrial Extension Service 26

25 Community Engagement Check-in Questions 1. Have you had a meeting with community partners to discuss readmissions/care transitions? Y/N 2. How many partners were in attendance? 1, 2-5, 6-9, or greater than If you have had a meeting did you find there were already interventions in place within your community (besides your hospitals readmission work)? Y/N 4. Have you started the community root cause analysis work? Y/N

26 What do you need help with?

27 Collaborative Action Period Timeline April 22, 2013 Process measure data through March 2013 due in QDS May 9, 2013 Webinar: Community Engagement Progress and Updates from 2 Collaborative Teams June 13, 2013 Webinar: Connecting SSI Prevention to Preventing Readmissions July 11, rd In-person Learning Session: Location TBD

28 Contacts For more information, contact Laura Maynard, Director of Collaborative Learning at: or Dean Higgins, Project Manager at or Erica Preston-Roedder, Director of Quality Measurement, at or Linda Touvell McNeill, Care Improvement Specialist, CCME at: or