Introduction to CALNOC The Collaborative Alliance for Nursing Outcomes

Transcription

1 Introduction to CALNOC The Collaborative Alliance for Nursing Outcomes 2014 CALNOC. All rights reserved. CALNOC Mission Advance global patient care excellence, outcomes and performance measurement efforts by: Leveraging a dynamic nursing outcomes database and reporting system Providing actionable data to guide decision making, performance improvement, and public policy Conducting research to optimize patient care excellence Building leadership expertise in the use of practicebased evidence 2 1

2 CALNOC Milestones 1996 CalNOC Launched First ANA Grant 9 Hospitals First AHRQ and GBMF Grants Web-based Reports and New Measures Public Reporting 2008 CalNOC Now CALNOC (Collaborative Alliance for Nursing Outcomes) NWONE, JBI and Global Partners NQF Reendorsement CMS Registry Swedish Pilot Study CALNOC becomes a Non-Profit Corporation Nebraska Project launched GROWTH to nearly 300 hospitals in 6 states CALNOC Research Fund Grants Maternal/Child Care, Emergency Dept. Measures Medication Administration Accuracy Offering NHSN Infections HCAHP Hospital Compare Data 3 The CALNOC Advantage Leadership and Innovation Over 19 years of leadership and innovation in actionable information & research Created the 1 st database registry of nursing sensitive indicators Contributed to the development of the National Quality Forum (NQF) measures for pressure ulcer and restraint use 1 st to introduce medication administration safety measure Regulatory Compliance & Accreditation CALNOC assists hospitals in demonstrating compliance Centers for Medicare and Medicaid Services (CMS) The Joint Commission (TJC) Magnet Qualification Best Practices for Excellence in Patient Care Delivering benchmarks and best practices research Industry Leader in Nursing Registry Reporting Comprehensive, User Friendly, Customizable & Flexible Reporting Web-based tool for easy access Flexible and customizable reports by Unit, Unit Type, Facility, State, Hospital System, etc. 1/30/14 4 2

3 5 CALNOC Measurement Development: Nursing Sensi9ve Measure Evolu9on NQF TJC CMS 6 3

4 NQF 2009 Re-Endorsed 12 of the 2004 Nursing Sensitive Measures 1. Death Among Surgical Inpatients with Treatable Serious Complications 2. Pressure Ulcer Prevalence** 3. Patient Falls ** 4. Falls with Injury ** 5. Restraint Prevalence (vest and limb) ** 6. Urinary Catheter-Associated Urinary Tract Infection Rate (NHSN) ** 7. Central Line-Associated Bloodstream Infection Rate (NHSN) ** 8. Ventilator-Associated Pneumonia Rate (NHSN) 9. Skill Mix ** 10. Nursing Care Hours per Patient Day ** 11. Practice Environmental Scale- Nursing Work Index 12. Voluntary Turnover ** **CALNOC Indicators 7 Publishing Benchmarks to Improve the Industry 2010 Brown, D.S., Donaldson, N.E., Burnes Bolton, L., Aydin, C., "Nursing SensiAve Benchmarks for Hospitals to Gauge High Reliability Performance" Journal of Healthcare Quality, November/December. Table 4 Medical Surgical Benchmarks: Staffing Variables and Patient Characteristics (Percentiles) Mean SD 10% 25% 50% 75% 90 % Staffing Total Hours of Care per Patient Day RN Hours of Care per Patient Day Licensed Hours of Care per Patient Day Ratios Number of Patients per RN Number of Patients per Licensed Staff Skill Mix Percent of Care Hours by RN Percent of Care Hours by LVN Percent of Care Hours by Other Staff Percent of Care Hours by Contract Staff Sitter Hours as Percent of Total Care Hours Unit & Patient Characteristics Workload Intensity as Pct of Total Pt Days RN Voluntary Turnover Total Voluntary Turnover Percent Medical Patients Patient Age Percent Male (patient gender)

5 Participating Hospitals Generate Business Intelligence Reports Customized reports that examine patient outcomes that influence costs and reimbursement and the resources deployed to achieve outcomes. Benchmark performance against like hospitals, hospitals in the same state, other facilities in a system, Magnet hospitals and more. Compare unit-based performance within service lines. Drill down to the unit level to understand processes that affect patient safety and quality to better understand where to prioritize improvements. Identify other hospitals that are doing better to learn from their best practice. 9 CALNOC Unit Level Data Adult Acute Care: Critical Care Step Down Telemetry Medical/Surgical Pediatrics: Level 3-4 NICU Level 2 Special Care Nursery Critical Care Step Down Medical/Surgical Post Acute: Hospital-Based Skilled Nursing (SNF) Acute Rehabilitation Emergency Department Maternal/Child Care 10 5

6 Benchmarking Measures At a unit level within a hospital, or the service line, or at the hospital level, or for entire health systems " Structural Measures Hours per Pa9ent Day Skill Mix Ra9os of pa9ents to licensed staff Use of Contract Staff SiFer U9liza9on Nurse educa9on, cer9fica9on, and years of experience Staff voluntary turnover Maternal/Child Deliveries ED Encounters/Boarders Process Measures Risk Assessment for Falls, Pressure Ulcers, and Skin Protocol Implementa9on for Fall and Pressure Ulcer Preven9on Restraint Use Medica9on Safe Prac9ces Pa9ent/Bed Turnover ED Pa9ent Flow Outcome Measures Fall Rates Injury Fall Rates Hospital Acquired Pressure Ulcers Prevalence Medica9on Error Rates NHSN HAI HCAHPS 32 CUSTOM REPORT CARDS 6

7 Example Report Card: Structural Measures Compare to Selected Groups Individual Hospital to Group Comparison Report by Total Facility Service Line: Adult Acute Care Your Hospital: 16 Medians: % of Pt. with Hospital Acq. Press. Ulcers All Categories, % of Pt. with Hospital Acq. Press. Ulcers Category II+, Falls per 1000 Pt Days From JANUARY 2011 To DECEMBER 2011 Report Groups: CALNOC (N=252) Magnet (N=16) UHC (Univ HealthSys) (N=13) % of Pt. with Hospital Acq. Press. Ulcers All Categories % of Pt. with Hospital Acq. Press. Ulcers Category II+ Falls per 1000 Pt Days Your Hospital CALNOC Magnet UHC (Univ HealthSys) 14 7

8 Monitor Improvement Priorities Trend reports with control limits for quality control Determine kind of variation over time or identify that a clinical process is not stable 19 8

9 Benchmarking Reports: Understand Ranking (PercenAles) Unit Type Comparisons Facility-level Comparisons Facility s Percentile Rank 1/30/14 20 If the 2000 rate of 10.3 had continued into 2013, 10,300 of 100,000 CALNOC patients would have had HAPU. But with a 2013 rate of 0.4 HAPU --- sparing 9,900 pain and suffering. EXAMPLE That CALNOC Hospitals improve what they measure! 9

10 Target Zero SUSTAINED by half of CALNOC Hospitals! Health care providers should be relentless in their efforts to reduce the risk for injury from care, aiming for zero harm whenever possible and striving to create a system that reliably provides highquality health care for everyone. 85 National Strategy for Quality Improvement in Healthcare BUT OPPORTUNITY REMAINS: Great variation between hospital systems in HAPU rates. 10

11 National Focus on Quality, Safety, Cost, Efficiency and Effectiveness Must Include Nursing s Contribution Nursing sensitive quality measures are rapidly moving into healthcare public reporting and pay for performance. Nursing sensitive defined as processes and outcomes that are affected, provided, and/or influenced by nursing personnel, but for which nursing is not exclusively responsible. (National Quality Forum) Nursing care in hospitals is a huge contribution to acute care health status. Nursing care must also be measured and benchmarked across transitions in care and settings. Post-acute care needs collaborative champions to move forward. Ambulatory care is diverse How Can IOM Help? Synthesize Measurements: Gather the evidence and review with expert panels to determine what are the very FEW measures we should consider? Champion Meaningful Measurement: Outside the walls of the hospital is challenging for measurement development of nursing care value and impact on health status. Link Measurement and Policy: Healthcare providers can not spare resources to measure for the sake of measurement. Assure Industry Resources: New measurement development and benchmark capacity 22 11

12 APPENDIX 23 Selected CALNOC Publications 2013 Ching, JM, Long, C, Williams, BL, Blackmore, C. Using Lean to Improve MedicaAon AdministraAon Safety: In Search of the "Perfect Dose". The Joint Commission Journal on Quality and PaAent Safety, 39(5), Brown, DS & Woolosin, R. Safety Culture RelaAonships with Hospital Nursing- SensiAve Metrics. Journal for Healthcare Quality, 35(4): Spetz, J, Brown, DS, Aydin, C, & Donaldson, N. The Value of Reducing Hospital- Acquired Pressure Ucler Prevalence: An IllustraAve Analysis. Journal of Nursing AdministraAon, 43(4): Stofs, N.A., Brown, D.S., Donaldson, N., Aydin, C., Fridman, M. EliminaAng Hospital- Acquired Pressure Ulcers: Within Our Reach. Advances in Skin & Would Care, 26(1): Spetz, J., Mark, B.A., Herrera, C.N., Harless, D.W. Using Minimum Nurse Staffing RegulaAons to Measure the RelaAonship Between Nursing and Hospital Quality of Care.. Medical Care Research and Review, 70(1) Stofs, N.A., Brown, D.S., Aydin, C., Donaldson, N. Hospital Acquired Pressure Ulcer Prevalence in Adults Trends, Accomplishments, Challenges: CollaboraAve Alliance for Nursing Outcomes Benchmarking In Pressure Ulcers in America: Prevalence, Incidence, and Implica?ons for the Future, 2nd Edi?on. NaAonal Pressure Ulcer Advisory Panel (NPUAP),

13 Selected CALNOC Publications 2011 Gunningberg, L., Donaldson, N., Aydin, C., Idvall, E. Exploring variaaon in pressure ulcer prevalence in Sweden and the USA: benchmarking in acaon. Journal of Evalua?on in Clinical Prac?ce.ISSN Korst, L.M., Aydin, C.E., Signer, J.M.K., Fink, A. Hospital readiness for health informaaon exchange: Development of metrics associated with successful collaboraaon for quality improvement. Interna?onal Journal of Medical Informa?cs, Feb. 15, Donaldson, NE & Shapiro, SE. Impact of California mandated acute care nurse staffing raaos: Literature synthesis. Policy, PoliAcs and Nursing PracAce, 11(3), Brown, D.S., Aydin, C., Donaldson, N.E., Burnes Bolton, L., et al, Benchmarking for Small Hospitals: Size Didn t Mafer! Journal of Healthcare Quality, July/August Brown, D.S., Donaldson, N.E., Burnes Bolton, L., Aydin, C., "Nursing SensiAve Benchmarks for Hospitals to Gauge High Reliability Performance". Journal of Healthcare Quality, November/December. Selected CALNOC Publications 2008 Brown, D., Donaldson, N.E., Aydin, C., QuarAle Dashboards: TranslaAng Large Datasets into Performance Improvement PrioriAes" Journal for Healthcare Quality, December 2008, 30(6) Aydin C, Burnes Bolton L, Donaldson N, Brown DS, Mukerji A., Beyond Nursing Quality Measurement: The NaAon's First Regional Nursing Virtual Dashboard. In: Henricksen, K, Bafles J, Keyes MA, Grady ML, eds. Advances in PaAent Safety: New DirecAons and AlternaAve Approaches. Vol 1. Rockville, MD: Agency for Healthcare Research and Quality; 2008: Spetz J, Donaldson N, Aydin C, Brown DS. How Many Nurses per PaAent? Measurements of Nurse Staffing in Health Services Research. Health Serv Res. May Bolton, L.B., Donaldson, N.E., Rutledge, D.N., Bennef, C., Brown, D.S., (2006) The Impact of Nursing IntervenAons Outcome Measures, EffecAve IntervenAons and PrioriAes for Future Research. Medical Care Research & Review, 64, 123S- 143S. 13

14 Selected CALNOC Publications 2007 Bolton, L. B., C. Aydin, et al. "Mandated Nurse Staffing RaAos in California: A Comparison of Staffing and Nursing- SensiAve Outcomes Pre- and PostregulaAon" Policy, PoliAcs and Nursing PracAce 8(4): Donaldson, N., D. S. Brown, et al. "Leveraging nurse- related dashboard benchmarks to expedite performance improvement and document excellence." J Nurs Adm 35(4): Donaldson, N., L. Burnes Bolton, et al. "Impact of California/s licensed nurse- paaent raaos on unit level nurse staffing and paaent outcomes." Policy, PoliAcs & Nursing PracAce 6(3): Aydin, C., L. Burnes Bolton, et al., "CreaAng and analyzing a statewide nursing quality measurement database." Journal of Nursing Scholarship Brown, D. S., N. E. Donaldson, et al. (2001). "Hospital nursing benchmarks: The California Nursing Outcome CoaliAon Project." Journal for Healthcare Quality 23(4):