Southeast Michigan See You in 7 Hospital Collaborative: Session 8 Webinar. Thursday, December 13 at 8 am

Transcription

1 Southeast Michigan See You in 7 Hospital Collaborative: Session 8 Webinar Thursday, December 13 at 8 am

2 Agenda Welcome and Introductions Hospital/Nursing Home Collaboration to Improve Early Follow-Up for Heart Failure Patients Crittenton Hospital Medical Center Follow-Up Questions from Session 7 Review of Updated Data MPRO, Michigan s Quality Improvement Organization Closing Adjournment

3 Title Here Subtitle Here Cardiac Outreach Program

4 Background More than 1.6 million Americans live in nursing homes. In 2006, 23.5% of people admitted to a post-acute care skilled-nursing facility were re-admitted within 30 days. These hospitalizations cost us more than $4 billion per year.

5 The Revolving Door Of Re-hospitalization From Skilled Nursing Facilities ABSTRACT Almost one-fourth of Medicare beneficiaries discharged from the hospital to a skilled nursing facility were readmitted to the hospital within thirty days; this cost Medicare $4.34 billion in Especially in an elderly population, cycling into and out of hospitals can be emotionally upsetting and can increase the likelihood of medical errors related to care coordination. Payment incentives in Medicare do not encourage providers to coordinate beneficiaries care. Revising these incentives could achieve major savings for providers and improved quality of life for beneficiaries. Vincent Mor, Orna Intrator, Zhanlian Feng, and David C. Grabowski Health Affairs, 29, no.1 (2010):57-64

6 Frequency & Cost of Skilled Nursing Facility (SNF) Re-hospitalizations, by State, 2006 State Number of SNF episodes Percent hospitalized Total rehospitalization payments ($ millions) Percent of SNF episodes with prior NH stay rehospitalized Rehospitalization payments with prior NH stay ($ millions) Michigan 65, California 122, Colorado 17,

7 Most Common Skilled Nursing Facility (SNF) Re-admission Diagnoses Congestive Heart Failure Respiratory Infection Urinary Tract Infection Sepsis Electrolyte Imbalance

8 2009 Metrics Crittenton Hospital Medical Center 30-Day Readmission Rates for Acute Myocardial Infarction and Heart Failure 25% 21.5% 22.4% 22.5% AMI HF 20% 18.1% 15% 13.5% 10.8% 11.4% 10% 7.0% 5% 0%

9 2009 MiSTAAR Initiative Michigan Action on Avoidable Re-hospitalizations Pilot started in Michigan, Massachusetts and Washington, to reduce the number of patients re-admitted within 30 days, by improving communication during the transition phase and providing additional follow-up care. MiSTAAR is about breaking down the silos across the continuum of care to improve communication between various providers, including nursing homes which is a major source of re-admissions.

10 2009 Heart Failure NP Program Assessment of all Heart Failure patients Collaborates with attending Intense patient / learner education Teachback Ensure discharge process is complete and accurate Patient call backs: 24 and 72 hours

11 Discharge Process PI team was developed in 2009 to streamline discharge process. Team developed our protocol for patients to have an appointment with attending physician within 7 days post discharge.

12 Appointments Post Discharge As of November % of our patients have no appointments made Barriers: Late day and weekend discharges. No consistency on who is making the appointments. Patient s do not want appointments made.

13 2010 Metrics Crittenton Hospital Medical Center 30-Day Readmission Rates for Acute Myocardial Infarction and Heart Failure 25% 21.5% 22.4% 22.5% AMI HF 20% 18.1% 15% 13.5% 10.8% 11.4% 10% 7.0% 5% 0% re-admissions are through October

14 Cardiopulmonary Consults in Area SNF Samer Kazziha, MD, Executive Medical Director of Cardiovascular Services at Crittenton Hospital Medical Center, collaborated with key individuals at Boulevard Health Care System, including the Director of Nursing, for initiation of Cardiopulmonary Consults in response to rising readmission rates. Service initiated Spring 2011.

15 Cardiopulmonary Consults in Area SNF Challenges to initiating service: Cooperative administrative team. Willing cardiologist and NP team. Proactive nursing staff at Boulevard Healthcare. Raising the level of education of the nursing staff at Boulevard Healthcare. Increase awareness of hospital staff on this available service at Boulevard Healthcare. Increase communication between these two sites.

16 Cardiopulmonary Consults in Area SNF Goals: Coordinate and improve patient transition from hospital to nursing home setting. Improve practitioner communication between settings (verbal and written). Improve post discharge care. Follow recommended ACC/AHA guidelines. Ensure accurate medication reconciliation. Reduce readmission rates. Both hospital and SNF. Effective Quality Review Process Both hospital and SNF

17 Cardiopulmonary Consults Patients are seen by Cardiologist and / or Pulmonologist weekly Treatment recommendations. Orders written for specific care / medications.

18 Cardiopulmonary Consults Medications Ensure patients meet the recommended ACC/AHA guidelines Diagnostic and Laboratory Testing EKGs, Echos, ABIs, Venous Dopplers, CXRs etc. Protocols initiated to prevent duplication of testing.

19 Cardiopulmonary Consults Dietary adherence Based on patient s diagnosis Daily weights with documentation in the medical record Education on Cardiovascular Disease: Facility staff Patients and Families

20 Cardiovascular Lecture Series 2012 Cardiovascular Lecture Series 2012 Physician & & Patient Outreach Program (PPOP) Straight Talk from the Doc Join us for a FREE heart healthy meal and educational lecture. Featured Speaker: Samer Kazziha, M.D., F.A.C.C Coronary & Peripheral Vascular Interventionist Executive Medical Director Cardiovascular Program, Crittenton Hospital Medical Center Associate Clinical Professor Department of Medicine, WSU School of Medicine Sterling Heights: Ike s Restaurant, Van Dyke Wednesdays: 6:15 9:00 p.m. February 29 Diabetes and Heart Disease May 23 Atrial Fibrillation (Irregular Heart Beat) What to Do? August 29 Living With Heart Failure November 28 What is Peripheral Arterial Disease Rochester: Royal Park Hotel, 600 East University Drive Wednesdays: 6:15 9:00 p.m. March 28 Atrial Fibrillation (Irregular Heart Beat) What to Do? June 20 Women and Heart Disease A New Love Affair September 26 Diabetes and Heart Disease Clarkston: Fountains Golf and Banquet Center, 6060 Maybee Road Wednesdays: 6:15 9:00 p.m. April 25 Cardiovascular Disease What Tests Should I Have and Why? July 18 Managing A Heart Attack October 24 Living With Heart Failure For the above three locations, RSVP to Gretchen at (586) or gglasius@cvcpc.com Rochester Hills: Boulevard Health Center, 3500 W. South Boulevard Sundays: 11:00 a.m. 2:00 p.m. February 5 Women and Heart Disease A New Love Affair April 22 Living With Heart Failure June 10 Cardiovascular Disease Prevention August 26 Stroke Prevention October 21 Managing A Heart Attack RSVP to Vickie at (248) ext. 57 or vickie.elliott@comcast.net Rochester: Crittenton Hospital Medical Center, 1101 West University Drive Wednesdays: 6:30 8:00 p.m. March 14 New Frontiers of Managing Deep Venous Thrombosis (DVT) September 12 Stroke Prevention Register by phone at (248) or visit To learn more about Dr. Kazziha or view program information visit:

21 Highlight of our Metrics Cardiac Risk Factors: SNF Cardiology Consults 70% 69% 60% 57% Percentage 50% 40% 30% 20% 10% 0% 10% Anemia Other Arrhy 16% CAD CMP CKD 27% 35% 24% 31% 47% COPD CVA/TIA DM HF HPL HTN 41% 37% 8% 8% Obese OSA PAD PVD 16% 18% 10% Valve disease Heart transplant 2% Series1

22 Highlight of our Metrics SNF Cardiolgy Consults by Gender 60% 60% 50% 40% Percentage 40% 30% Series1 20% 10% 0% Male Female

23 Highlight of our Metrics SNF Cardiology Consults by Age 20% 18% 18% 20% 18% 16% 14% 14% 14% 14% 12% Percentage 10% 8% Series1 6% 4% 2% 0%

24 Highlight of our Metrics Hospitalizations and Re-admissions Cardiac versus Non-Cardiac 14% 14% 12% 10% 8% 6% 4% 2% 0% Non-cardiac Non Cardiac Re-adm 2% Cardiac 4% Cardiac Re-adm 0% Series1

25 Questions??

26 Follow-Up Questions from Session 7 How do you cover the follow-up phone calls for weekend discharges? How do you follow-up with snow birds? Have you modified risk assessment tools? If so, how? Other

27 Southeast Michigan See you in 7 Hospital Collaborative Harolyn Baker, MPH Haggerty Road, Suite 100, Farmington Hills, MI

28 Objectives Provide findings on outpatient follow up visits and readmission rates to monitor and evaluate readmission focused quality improvement interventions for See You in 7 Collaborative Hospitals. 28

29 See You in 7 Collaborative Hospitals Proportion of Discharges with 7-day Follow-up Visits by Project Quarters (Feb April 2012) Median Feb-Apr 2011 May-Jul 2011 Aug-Oct 2011 Nov-Jan 2011 Feb-Apr 2012 Subgroup 28.76% 27.96% 30.74% 28.54% 32.94% Median

30 See You in 7 Collaborative Hospitals Proportion of Discharges with 7-day Follow-up Visits for diagnoses of CHF compared to All-Cause 7-day Follow-up visits, by Project Quarters (Feb April 2012) % CHF 7-Day Follow-up 35.00% % All-Cause 7-day Followup 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Feb-Apr 2011 May-Jul 2011 Aug-Oct 2011 Nov-Jan 2011 Feb-Apr

31 See You in 7 Collaborative Hospitals Proportion of Discharges with 7-day Follow-up Visits and 30-day Readmission, by Project Quarters (Feb April 2012) % CHF 7-Day Follow-up 40.00% Collaborative 30-day Readmission 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Feb-Apr 2011 May-Jul 2011 Aug-Oct 2011 Nov-Jan 2011 Feb-Apr 2012 % CHF 7-Day Follow-up 28.76% 27.96% 30.74% 28.54% 32.94% Collaborative 30-day Readmission 34.53% 34.20% 33.25% 32.48% 33.20% 31

32 See You in 7 Collaborative Hospitals Versus Statewide Proportion of Discharges with 7-day Follow-up Visits for diagnoses of CHF by Project Quarters (Feb April 2012) 34.00% 33.00% % CHF 7-Day Follow-up % Statewide CHF 7-Day Follow- Up 32.00% 31.00% 30.00% 29.00% 28.00% 27.00% 26.00% 25.00% Feb-Apr 2011 May-Jul 2011 Aug-Oct 2011 Nov-Jan 2011 Feb-Apr

33 See You in 7 Collaborative Hospitals Versus Statewide 30 day Readmission among Discharges with Primary Diagnosis of CHF, by Project Quarters (Feb April 2012) 35.00% 34.00% 33.00% 32.00% 31.00% Collaborative 30-day Readmission Statewide 30-day Readmission 30.00% 29.00% 28.00% 27.00% 26.00% Feb-Apr 2011 May-Jul 2011 Aug-Oct 2011 Nov-Jan 2011 Feb-Apr 2012 Collaborative 30-day Readmission 34.53% 34.20% 33.25% 32.48% 33.20% Statewide 30-day Readmission 30.48% 31.29% 29.86% 29.47% 31.86% 33

34 See You in 7 Collaborative Hospitals Proportion of Discharges with 7-day Follow-up Visits, by Project Quarters (Feb April % 35% UCL 30% 25% LCL 20% 15% 10% 5% 0% Feb-Apr 2011 May-Jul 2011 Aug-Oct 2011 Nov-Jan 2011 Feb-Apr 2012 Subgroup 28.76% 27.96% 30.74% 28.54% 32.94% Center 29.83% 29.83% 29.83% 29.83% 29.83% UCL 33.43% 33.54% 33.69% 33.54% 33.35% LCL 26.22% 26.12% 25.96% 26.12% 26.31% 34

35 See You in 7 Collaborative Hospitals Proportion of Discharges with 7-day Follow-up Visits for diagnoses of CHF by Project Quarters (Feb April 2012) 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% A B C D E F G H I J K 0.00% Feb-Apr 2011 May-July 2011 Aug -Oct 2011 Nov -January 2012 Feb-Apr

36 Discussion 7- day post-acute follow up rates 14.5% improvement in rate from first measured quarter (Feb-Apr 2011) Targeted movement in follow up rates for discharge with CHF as a primary diagnosis compared to all-cause follow-up Higher dispersion in Follow-up rates among See you in 7 Collaborative Hospitals compared to the statewide follow up rate 30-day Re-hospitalization 3.9% improvement rate from baseline period Collaborative has experienced 4 consecutive downward trending quarters since baseline Collaborative downward trending appears to be more stable compared to the statewide trend Hospital Specific Report High dispersion in follow up trend among hospitals 81% of hospitals experienced improvement from baseline period to current remeasurement quarter (Feb-Apr 2012)

37 Questions/Comments? Thank You Contact Information: Harolyn Baker, MPH Director, Department of Applied Epidemiology and Evaluation 37

38 MPRO s Mission: Improving quality, safety and efficiency across the healthcare continuum. This material was prepared by MPRO, the Medicare Quality Improvement Organization for Michigan, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.

39 Thank you! Next Session: Session 9 Webinar Thursday, Jan. 17 at 8:00 am Next Assignment Due Jan. 7 : Quarterly Progress Report (DOC F) Coming Soon: Survey on Roles/Resources

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