Webinar for NYS Managed Care Plans

Transcription

1 Webinar for NYS Managed Care Plans The Home Care Association of New York State s..screening & Intervention Tool for Sepsis - A Model for DSRIP PPS & Value Based Payment Presented by: e The NYS Department of Health The Home Care Association of New York State (HCA) IPRO Quality Improvement Organization/Network The National Sepsis Alliance The US Centers for Disease Control and Prevention (CDC)

2 Webinar Agenda and Faculty I. Welcome and Overview Welcome and Overview Al Cardillo, LMSW, Executive Vice President, Home Care Association of New York State Importance of Sepsis Care in the Context of NY State's Value Based Payment initiative Khalil Alshaer, MD, MPH, Division of Health Plan Contracting & Oversight, NYS DOH Role of the HCA Sepsis Tool in VBP/DSRIP Al Cardillo, LMSW, Executive Vice President, Home Care Association of New York State Sepsis as a National Health Emergency and Imperative of Community Prevention Raymund Dantes, MD, MPH, Medical Advisor, US CDC & Emory University Hospital Thomas Heymann, MBA, Executive Director, National Sepsis Alliance Presentation of HCA Sepsis Screen and Protocol Al Cardillo, LMSW, Executive Vice President, Home Care Association of New York State Amy Bowerman, RN, Executive Director, Senior Network Health CMS/IPRO Special Innovation Project Sara Butterfield, RN, Senior Director, Health Care Quality Improvement, IPRO Eve Bankert, MT, Quality Improvement Specialist, IPRO Questions, Answers, Discussion 2

3 Welcome and Overview Welcome to this joint webinar on sepsis prevention, early recognition and treatment through home care, and the role this can play in patient and public health, cost avoidance, and in the current window of MCO/MLTC value based payment and contracting. New York is first among any of the states or national jurisdictions, harnessing the statewide home care system in sepsis intervention; first with hospitals, and now in home care. This webinar is being conducted for all NYS manage care organizations, to engage your participation in sepsis intervention, and with an emphasis on the opportunities presented you within NYS s value based payment (VBP) model for quality, reduced morbidity and mortality, cost savings and potentially avoidable hospitalizations (PAH). This webinar is hosted by the NYS Department of Health, and co conducted by HCA, IPRO, National Sepsis Alliance, and the US Centers for Disease Control and Prevention. 3

4 Welcome and Overview This webinar will provide critical background and facts on sepsis as a health emergency, highlighting its impact on health, life, and the system at large, including catastrophic level costs. It will provide compelling data, including the facts why sepsis is a community problem, and why the involvement of home care and all providers is vital to prevention, lifesaving, and care. It will present the home care sepsis screen tool and intervention protocol innovated by the Home Care Association of New York State, in collaboration with key clinical and quality partners. It will describe the tool s role potential for MCO/provider attainment of DSRIP and VBP goals and milestones. 4

5 Welcome and Overview A major, just announced development is the NYS Health Foundation s awarding of funding to support this initiative statewide, including provider adoption, in depth training, crosssector coordination across key partners, data compilation and analysis, public outreach and education, and more. 5

6 6 Importance of Sepsis Care in the Context of NY State's Value Based Payment initiative 6

7 Delivery System Reform Incentive Payment (DSRIP) Goal DSRIP is a health delivery system transformation tool To transform the system, DSRIP will focus on the provision of high quality, integrated primary and specialty care in the community setting with hospitals used primarily for emergent and tertiary level of services DSRIP was built on the CMS and State goals in the Triple Aim: Improving quality of care Improving health Reducing costs 7

8 New York State s Value Based Payment (VBP) Goal 8

9 9 September 17, 2017 Multiple VBP Arrangement Options There is no single path towards Value Based Payments. Rather, there are a variety of options that MCOs and VBP Contractors can jointly choose. VBP Arrangement Types: Total Care for the General Population (TCGP) Integrated Primary Care (IPC) Maternity Care Health and Recovery Plans (HARP) HIV/AIDS Care Managed Long Term Care (MLTC) 9

10 10 VBP Arrangement Quality Measure Sets The MY 2017 Quality Measure Sets for TCGP/IPC, Maternity, HIV/AIDS,HARP, and MLTC VBP arrangements have been finalized and posted to the NYS DOH VBP website (Link) 10

11 11 VBP Arrangement Quality Measure Sets Quality measures for Total Care for the General Population (TCGP), Integrated Primary Care (IPC) and HIV/AIDS Care VBP arrangements, focus on: Key preventive and primary care services Behavioral health Physical health services integration Care coordination and follow up care Avoidance of inappropriate clinical practices Potentially Avoidable Complications (PACs) Quality measures for the Managed Long Term Care (MLTC) VBP arrangement focuses on: Key preventive health measures Quality of life and wellbeing Functional Improvement Personal Choice/Satisfaction Medication Review Avoidance of unnecessary emergency room visits Potentially Avoidable Hospitalization (PAH) 11

12 12 Potentially Avoidable Complications (PACs) Source: Altarum Institute. Include events that are potentially avoidable for an attributed patient in a VBP arrangement, depending on the nature of their episode of care. Include events that lead to potentially avoidable emergency department visits and hospitalizations. We are in the process of finalizing the PAC measure with Altarum. Potential implementation in MY Will be classified as Category 1 Pay for Reporting. Is intended to help providers identify gaps in care that lead to potentially avoidable events/complications, and implement strategies to help address them. 12

13 13 Potentially Avoidable Hospitalization (PAH) Source: NYS MLTC Quality Initiative. Based on data from the Statewide Planning and Research Cooperative System (SPARCS). SPARCS is an all payer hospital inpatient database of New York State hospital discharges. Tracks attributed members hospitalizations for any of the following reasons: Heart failure Respiratory infection Electrolyte imbalance Sepsis Anemia Urinary tract infection. All MLTC Level 1 VBP contracts must include the PAH measure in their VBP arrangement. 13

14 VBP PAH & PAC measures and Sepsis Care The PAH measure directly addresses one of the leading causes of in patient admissions and high hospitalization costs: Sepsis. The PAC measure also includes sepsis as a potentially avoidable complication in many VBP arrangement care episodes. Providers and MCOs should work together on exploring innovative ways to help decrease sepsis and sepsis hospitalization. Sepsis/sepsis hospitalization reduction is a Win, Win, Win situation for everyone involved. Providers win by meeting or exceed their VBP quality measure and performance targets. MCOs win by saving on the high costs of sepsis hospitalization. Most importantly, patients win by receiving higher quality proactive care. 14

15 Thank You Please send questions and feedback to: 15

16 Potential Role for MCO/Provider in DSRIP & VBP DSRIP and VBP Roadmap goals and milestones center on improved quality and reduced costs, and particularly on significant reductions in potentially avoidable hospitalizations (PAH). The targeting of sepsis addresses one of the major factors affecting quality, PAH and cost, and the HCA Sepsis Tool provides a concrete innovative, concrete means of sepsis targeting as well as targeting of other PAHs against which plan performance is to be gauged under VBP. 16

17 Potential Role for MCO/Provider in DSRIP & VBP The Sepsis DSRIP VBP connections are many and compelling. As the subsequent slides further elaborate, sepsis is: Among the leading costs of hospitalization. The #1 cause of 30 day Medicare hospital readmissions. The #1 Medicaid expense for potentially avoidable hospitalizations (excluding the HARP population where it is #2), for NYS hospitals. 17

18 Potential Role for MCO/Provider in DSRIP & VBP Sepsis is nearly double the readmission rate of the top CMS clocked readmission cause (i.e., heart failure) that is subject to hospital penalty (study published in January 2017 Journal of the American Medical Association showed that 12.2% of readmissions were caused by sepsis, compared to heart failure, pneumonia, COPD and heart attack, at 6.7%, 5%, 4.6% and 1.3%, respectively. The populations with highest sepsis prevalence are served by mainstream MCO and MLTCs. 18

19 Potential Role for MCO/Provider in DSRIP & VBP The HCA Sepsis tool directly screens for conditions targeted for PAH: Sepsis Respiratory Infections Urinary Tract Infections (UTI) Additionally, the screen tool can help identify (through its screening for symptoms such as Tachycardia, change is mental status, etc.): Electrolyte imbalance Anemia Heart failure 19

20 Potential Role for MCO/Provider in DSRIP & VBP This provides potential benefits of the tool in screening for and addressing multiple high risk conditions associated with PAHs, in addition to sepsis specifically. Also, the tool s overall intensified focus on infection and infection prevention and control adds to its potential in PAH, cost reduction, and quality. 20

21 Potential Role for MCO/Provider in DSRIP & VBP More reasons why home health: Sepsis risk factors, population prevalence, and over 80% onset in home/community illuminates both the benefit and imperative of a home and community health role in sepsis public awareness, patient education, prevention, screening, early recognition and timely intervention. Home care s unique position and credentials make it an all the more compelling role player in the sepsis effort. These include: 21

22 Potential Role for MCO/Provider in DSRIP & VBP Home care clinicians are in homes and in communities. Home care clinicians are expert educators, screeners, evaluators, interveners, and system navigators. Home care is a patient and culturallycentered, and cost effective vehicle. Home and community is the growing and future milieu of care. 22

23 Potential Role for MCO/Provider in DSRIP & VBP The next section of the webinar provides further critical background on sepsis, the imperative of prevention, early recognition and intervention, and still more reasons why sepsis is a compelling issue within DSRIP and VBP goals. 23

24 Sepsis as a National Health Emergency and Imperative of Community Prevention We are pleased to introduce next, Dr. Raymund Dantes, MD, MPH, Medical Advisor, CDC, National Healthcare Safety Network, and Assistant Professor of Medicine, Emory University Hospital, Atlanta, Georgia. Dr. Dantes will describe CDC s national emphasis on sepsis as a medical emergency, and the critical need for early identification and intervention, with 80% of sepsis cases originating in community. 24

25 National Center for Emerging and Zoonotic Infectious Diseases Raymund Dantes, MD, MPH Medical Advisor Division of Healthcare Quality Promotion Centers for Disease Control and Prevention September 29, 2017

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27 What is Sepsis? Sepsis is a complication caused by the body s overwhelming and often life threatening response to an infection. It can lead to organ failure, tissue damage, and death. Sepsis is a medical emergency. An infection that is getting worse and not treated can lead to sepsis, so urgent treatment matters.

28 Epidemiology of Sepsis Sepsis most often occurs in people: Over the age of 65, or infants less than one year of age. With chronic diseases (such as diabetes) or weakened immune systems. Sepsis is most often due to infections of the lung, urinary tract, skin, or gut. Common germs that cause sepsis are Staphylococcus aureus, E. coli, and some types of Streptococcus. Healthy people can develop sepsis from an infection, especially if not treated properly.

29 CDC Sepsis Data Sepsis begins outside the hospital for over 80% of patients 7 in 10 patients with sepsis had recently interacted with healthcare providers, or had chronic diseases requiring frequent medical care This presents a prime opportunity for both preventing infections and recognizing sepsis early to save lives Talk to your patients and their families about the symptoms of sepsis and the need to seek emergency medical care if they suspect sepsis At least 1.7 million Americans get sepsis each year

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31 CDC.gov/sepsis Materials for Healthcare Professionals Infographic: All healthcare professionals Brochure: All healthcare professionals Fact sheets: Primary care settings Long term care Hospitals and home care Emergency department and urgent care 14

32 CDC.gov/sepsis Materials for Patients and Families Brochure: All patients and families Video: All patients and families Fact Sheets: People living with chronic conditions Aging adults, their caregivers, and mothers of young children 13

33 The author of this presentation is responsible for this content and does not represent the official viewpoint of the CDC.

34 Sepsis as a National Health Emergency and Imperative of Community Prevention The National Sepsis Alliance We are pleased to introduce Mr. Thomas Heymann, Executive Director of the National Sepsis Alliance. Mr. Heymann will provide a further national overview of sepsis, the imperative of community prevention, the Alliance s collaboration with HCA, IPRO and other partners breaking new ground through this home care initiative, and the Alliance s mission and public/professional education capabilities, which can be of assistance to providers and managed care organizations. 34

35 Sepsis as a National Health Emergency National Sepsis Alliance Founded 2007, Dr. Carl Flatley Father AND Doctor Leading national sepsis advocacy organization in North America 1.5 million+ visits each year to Sepsis.org Awareness 19%, now 58%. Sepsis Alliance Awareness Survey Founded Sepsis Awareness Month in

36 Sepsis as a National Health Emergency and Imperative of Community Intervention Sepsis Alliance Mission Save Lives And Reduce Suffering By Raising Awareness of Sepsis As a Medical Emergency Awareness, Education, Prevention, Early Recognition, Treatment and Support 1. Public 2. Providers 3. Policy makers 4. Survivors Sepsis.org 36

37 Sepsis as a National Health Emergency and Imperative of Community Intervention 1.6 million cases each year in the U.S. 258,000 deaths each year more than breast cancer, prostate cancer and AIDS combined. Takes more children than cancer 18 kids each day. #1 cause of death in U.S. hospitals. #1 driver of readmission to a hospital (30 days). #1 cost of hospitalization $27B/yr. Up to 50% of sepsis survivors suffer from post sepsis syndrome (PSS). Sepsis.org 37

38 Sepsis as a National Health Emergency and Imperative of Community Intervention Commonly misunderstood as a hospital problem, CDC, and Sepsis Alliance report that over 80% of sepsis cases originate in home and community. Home care and long term care treat our population most vulnerable to sepsis. Among highest risk populations are the elderly, the chronically ill, persons with disabilities, medically fragile children, individuals with compromised immune systems, individuals with recurrent UTI and pneumonia, and others routinely within home care s patient population. Sepsis.org 38

39 Sepsis as a National Health Emergency and Imperative of Community Intervention More than 80% of sepsis cases originate in the community. Time to treatment is critical mortality increases 8% every hour that treatment is delayed. Early identification and treatment are the key to improved outcomes and reduced costs. Biggest next opportunity lies in public awareness and primary care education and training. Home care and long term care treat our population most vulnerable to sepsis. Sepsis.org 39

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41 Sepsis as a National Health Emergency and Imperative of Community Intervention We next want to introduce you to another a key sepsis resource: the Rory Staunton Foundation for Sepsis Prevention. RoryStauntonFoundationForSepsis.org 41

42 Sepsis as a National Health Emergency and Imperative of Community Intervention The Rory Staunton Foundation provides critical advocacy, education and public/professional education, and can further assist you with sepsis programing. The website, provides key information about Rory s story, sepsis and the work of the foundation and his parents Ciaran and Orlaith Staunton, particularly the development of NY s Rory s Regulations, next described. RoryStauntonFoundationForSepsis.org 42

43 Rory s Regulations NYS adopted health regulations (405.2 and 405.4) requiring beginning in 2014 hospitals caring for sepsis patients to develop and implement evidence informed sepsis protocols which describe their approach to early recognition and treatment of sepsis patients In addition, hospitals were required to report data to the state Health Department to calculate each hospital s performance on mortality rates for each hospital NYS issued a report in March 2017 on hospital performance, showing, among other details, a mortality reduction since the initiative from about 30.2% of adult patients treated for severe sepsis or septic shock, to a low of 25.4% in 2016; the report also looks to next steps building off of findings and regulations, including identification and sharing of promising practices, data collection improvement and pediatrics. 43

44 Rory s Law Just Passed by NYS Legislature Sepsis Education Programming S.4971 A by Senator Marcellino and A.6053 A by Assemblymember Nolan (passed Senate /Assembly in June; awaits deliver to Governor) Establishes a sepsis awareness, prevention and education program within the State Education Department. Requires the Commissioner of Education to collaborate with the Commissioner of Health, organizations that promote sepsis awareness, as well as other interested parties, to develop a sepsis awareness, prevention and education program. Requires that sepsis be included in school educational programming, in information to parents on sepsis, and included as part of the existing infection control education/training required of health clinicians under the State Education Law. Next step between now and December: Senate to deliver to Governor for Signature. 44

45 The HCA Sepsis Tool Al Cardillo, LMSW, Executive Vice President, HCA Sara Butterfield, RN, IPRO Eve Bankert, MT, IPRO Amy Bowerman, RN, Mohawk Valley Health System 45

46 HCA Sepsis Engagement How Started National Sepsis Alliance s awareness outreach to the health continuum in NY led HCA to query our community venue. Initial query revealed little information about sepsis identification or prevalence in home care. HCA further researched through its Quality Committee (2014), which identified crucial factors that compelled decision to further pursue, including: 46

47 HCA Sepsis Engagement How Started National morbidity, mortality, cost and hospitalization/rehospitalization data showing sepsis as a leading cause. Specific Medicare hospital readmission data showing sepsis to be #1 diagnosis for 30 day all cause readmissions for NYS hospitals and NY Medicaid data showing sepsis to be #1 for Medicaid avoidable hospitalizations for the overall Medicaid population. Existence of managed care quality improvement goals specific to sepsis being used by government in key parts of the system. Revelation of 80% of sepsis cases originating in community. 47

48 HCA Sepsis Engagement How Started Based on such indicators, HCA moved to determine potential of home care role in combating sepsis HCA investigated at the national level, across states and array of professional sources in attempt to identify home care sepsis experience, possible resources and tools related to home health/community setting; none were found, but HCA received reinforcement to pursue from all contacts. With no existing models in the country, creation of a home care sepsis tool by HCA would be a nationalfirst. 48

49 HCA Sepsis Engagement How Started Worked with NYS and national physician leader in sepsis (e.g., Dr. Martin Doerfler, Northwell, and NYS Sepsis Advisory Committee, Dr. Steven Simpson, University of Kansas, and National Sepsis Board). Consulted with NYS DOH (Office of Quality and Patient Safety, Division of Home and Community Based Services), Other (e.g., Harvard Deaconess). In 2015, HCA s Quality Committee formed Sepsis Workgroup to explore creation of an instrument for sepsis screening, early recognition and intervention via home health/community setting. 49

50 Development of HCA Sepsis Tool The HCA sepsis workgroup chaired by HCA member Amy Bowerman (a hospital, home care and managed care clinician) drafted home health screening tool and algorithm; aimed for applicability in home health/community as well as for consistency with NYS new hospital protocol for sepsis. Over 2015 and part of 2016 the HCA tool was beta tested and refined with input from state and national sepsis experts. In latter 2015, a patient education tool was created by HCA partner IPRO and added to the HCA sepsis tools. It was based on a simultaneous Centers for Medicare and Medicaid Services (CMS) sepsis special innovation project being conducted in NYS (next discussed). 50

51 Development of HCA Sepsis Tool Role of CMS/IPRO Sepsis Special Innovation Project in NYS Parallel to HCA s work on the tool, IPRO was selected to sponsor a CMS Special Innovation Project in NY regions focusing on early recognition and screening/intervention at community level. HCA sepsis tool was selected for and incorporated in the CMS/IPRO Special Innovation Project. The project is operating in two major regions of NYS with high incidence (Central NY and Broader Capital Region). 51

52 Role of CMS/IPRO Sepsis Special Innovation Project in NYS Over 9,600 home and community health clinicians have been trained on the sepsis tool. The program runs through June, The program has offered advance experience and input into the HCA sepsis tools and training, and further basis for consideration as a national model. 52

53 Role of CMS/IPRO Sepsis Special Innovation Project in NYS Albany & Syracuse Hospital Referral Regions (HRRs) Albany HRR In hospital sepsis mortality rate of 14.6% Ranks 8th in NYS Hospital Referral Regions for sepsis admissions Syracuse HRR In hospital mortality rate of 15.6% Ranks 7th in NYS Hospital Referral Regions for sepsis admissions National In hospital All Cause Mortality Rate 4.2% Source: CMS Medicare FFS Paid Claims Data 53 53

54 NYS Medicare FFS Admissions with a Diagnosis of Sepsis While Receiving Home Health Care CY 2015 Days Of Home Health Care Prior to Admission*: Less Than Seven Days 1, % Eight To Thirty Days 2, % More Than Thirty Days 3, % Highest Mortality Rate Occurs within first 5 days of hospital Stay Hospital Admissions: Opportunity to positively impact Home Health population through earlier recognition of sepsis Patients with one or more admissions: 7,304 Total number of admissions: 8,418 Hospital Utilization: Average Length of Stay: 11.7 days Total Days of Care: 99,770 Hospital Medicare FFS Expenditure: Average Expenditure Per Case: $22,486 Estimated Total Expenditure: $189 Million Source: CMS Medicare FFS Paid Claims Data 54 54

55 Role of CMS/IPRO Sepsis Special Innovation Project in NYS Facilitate education and build awareness of sepsis among pre hospital providers and caregivers. Train the Trainer format. Identify best practices and educate pre hospital providers on prompt recognition of early signs and symptoms of sepsis. Educate on the premise that Sepsis is a medical emergency. Improve processes of care transitions and sepsis treatment between pre hospital and emergency/hospital care settings as well as post acute discharge into the community. Increase public awareness of the signs, symptoms and risk 55 factors for sepsis. 55

56 Role of CMS/IPRO Sepsis Special Innovation Project in NYS IPRO Community Based Train the Trainer Sessions Home Health Agencies Clinical and non clinical staff Skilled Nursing Facilities Clinical and non clinical staff Physician Practices Clinical and non clinical staff Dialysis Centers Clinical and non clinical staff 28 Regional Train The Trainer sessions held to date 9,633 pre hospital providers and caregivers have been trained on Sepsis Awareness utilizing AQIN developed training tools 56 56

57 Assessment of Learning Measured by Pre and Post Assessment Tool 50% Increase in knowledge post training across all individuals trained 57 57

58 Role of CMS/IPRO Sepsis Special Innovation Project in NYS Community Based Sepsis Initiative Measures Number of inpatient admissions of Medicare FFS patients by stage of sepsis: 1) Sepsis; 2) Severe sepsis; 3) Septic shock. Inpatient mortality for Medicare FFS patients by stage of sepsis: 1) Sepsis; 2) Severe sepsis; 3) Septic shock. Acute Length of Stay with mortality by stage of sepsis: 1) Sepsis; 2) Severe sepsis; 3) Septic shock. Acute Length of Stay without mortality by stage of sepsis: 1) Sepsis; 2) Severe sepsis; 3) Septic shock. Reduction in 30, 60 and 180 day readmissions for Medicare FFS patients with a principal diagnosis of sepsis 58 58

59 Implementation of HCA Sepsis Tool Upon final development of our tool set, HCA initiated a prelaunch process, conducting with IPRO and partners a series of preparatory webinars for all NY home care providers and related stakeholders, covering: Sepsis clinical background and incidence. The imperative of early recognition and response. Compelling role for community health providers, with health and life savings implications for patients, and benefits to the entire health system. Review of the development and a walkthrough of the HCA sepsis initiative, tools, protocol and training for agency trainers. Guidance for agency adoption and implementation. 59

60 Implementation of HCA Sepsis Tool The preparatory webinars were conducted from September 2016 through February Webinars were recorded and made available; each webinar was a prerequisite for participation in the next; participation in ALL webinars was required for authorization to receive and use the sepsis tools. In support of this effort, CDC linked our webinars to its sepsis clinical resources site. 60

61 Implementation of HCA Sepsis Tool HCA sepsis tools were formally launched to NY s home care providers on March 31, Implemented via user agreement (UA) with providers to ensure adequate agency preparation and training, standardized use, quality control, data sharing/ evaluation, and other elements. Providers have signed up, more doing so or exploring on ongoing basis, including other state home care, health systems, medical practices, managed care, other state associations, and other. 61

62 Implementation of HCA Sepsis Tool HCA s goal in this initiative is that all NYS home care providers adopt and employ this health and lifesaving sepsis screening, education, prevention, early recognition and intervention system within their agencies, and so equipped, will work with their strategic clinical partners (physicians, hospitals, EMS, etc.) and communities in a coordinated public health front against sepsis. 62

63 Implementation of HCA Sepsis Tool Synchronization with NYS DOH HCA synchronizing with NYS Department of Health, Health Commissioner Zucker, DOH Divisions for Quality, Long Term Care, Home and Communitybased Care, Other. Multi tiered planning under way. DOH actively planning with HCA statewide outreach/ presentation to managed care organizations, managed long term care plans and others to consider incorporation. Additional steps covered later in slide deck in Next Steps section. 63

64 Home Care Screening, Algorithm, Protocol & Patient Education Tools 64

65 HCA SEPSIS TOOL AN INITIATIVE OF HCA S QUALITY COMMITTEE, SEPSIS WORKGROUP & PARTNER ORGANIZATIONS 65

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68 Sepsis Screen Tool Question Section 68 68

69 Sepsis Screen Tool Follow up Section 69

70 Sepsis Screen Tool Intervention Section 70

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75 Guidance for Training & Agency Adoption/implementation HCA implementation guidance to agencies advises: Adoption of sepsis tool and protocol within agency policies and procedures. Procedures to ensure completion of screen on every RN assessment and clinical visit, unless contraindicated by MD. Integration of tools into agency electronic health records. Training of all clinicians on sepsis and use of tools (including review of webinar series, case scenarios, additional educational material); training and education of aide staff, families, community. Incorporation in agency quality assurance/ improvement committee review process. 75

76 Guidance for Training & Agency Adoption/implementation Initial feedback rounds after first several weeks/month of implementation to ascertain any important clinical or procedural questions and ensure consistency, accuracy in screen completion; offer additional in service on sepsis/use of tool as needed. Updates to clinicians on sepsis developments; consider for annual in service; consider staff supplemental training/ updates from collaborating partners and public resources (e.g., IPRO, State Department of Health, National Sepsis Alliance, Staunton Foundation, CDC, CMS, other). Evaluation, outcome tracking, feedback for improvement. Outreach/training/education of strategic clinical/community partners (e.g., physicians, hospital, EMS, managed care orgs). 76

77 Data Compilation, Analysis, Tracking All users of the HCA tool must agree to participation in data collection and reporting. IPRO has established a HIPAA compliant portal for this sepsis tool through which user data generated by the tool will be submitted and will be used for analysis, support, evaluation and policy development by HCA and IPRO. This data also should be of important value in VBP/DSRIP. HCA plans outreach to high sepsis mortality hospitals/communities to explore home care hospital collaboratives targeting improved community awareness, prevention, early identification and mortality reduction. 77

78 Next Steps Data development/feedback on provider/patient experiences. Continued in depth training in home care. Workforce Investment Organization training opportunity NYS Health Foundation Grant Awarded to HCA to support statewide implementation, including clinical/agency training, cross sector coordination, data compilation and analysis, and other. Coordination and training with clinical partners to home care (hospitals, physicians, EMS, managed care plans, et al); sepsis response across the continuum. Coordination with NYS DOH, other state agencies, NYS Legislature (sepsis legislation) 78

79 Next Steps Continued collaboration with key partners, including National Sepsis Alliance, IPRO, Rory Staunton Foundation, Visiting Nurse Association of America (VNAA) and others; also, continued collaboration with CDC, CMS, and other sources of support. Discussion with PPS for DSRIP; also discussion with other sectors for applicability, use and benefit in other venues and populations (e.g., behavioral health, nursing home, ambulatory care). Increased public awareness and education. Application in pediatrics. Responding to inquiries/interest from around country to use/model the HCA tool. 79

80 Next Steps Tailoring Care for Sepsis Survivors Pursuing development of patient centered posttreatment transition (e.g., hospital to home) clinical pathways and home/community care plans for sepsis survivors Comprehensive Interdisciplinary Patient tailored, patient centered Integrated payment bundle, or other comprehensive model of coverage 80

81 Questions?? Khalil Alshaer, MD, MPH, NYS DOH Al Cardillo, LMSW, HCANYS Amy Bowerman, RN, Mohawk Valley Health System Sara Butterfield, RN, IPRO I.hcqis.org) Eve Bankert, MT, IPRO I.hcqis.org ) Thomas Heymann, MBA, National Sepsis Alliance (theymann@sepsis.org) Raymund Dantes, MD, MPH (vic5@cdc.gov) 81