Care Transitions. Jennifer Wright, NHA, CPHQ. March 21, 2017

Transcription

1 Oregon Office of Rural Health Medicare Beneficiary Quality Improvement Project Training Series Care Transitions Jennifer Wright, NHA, CPHQ March 21, 2017

2 Agenda Overview of care transitions Emergency Department Transfer Communication (EDTC All) HCAHPS: Discharge Information Care Transitions Conclusion 2

3 Objectives This session will enable participants to Describe care transitions Explain care transitions measures Develop methods for impacting these measures 3

4 What is a care transition? CMS meaningful use definition: The movement of a patient from one setting of care (hospital, ambulatory primary care practice, ambulatory specialty care practice, long-term care, home health, rehabilitation facility) to another. The Joint Commission has defined a transition of care as the movement of a patient from one health care provider or setting to another. 4

5 The measures Emergency Department Transfer Communication (EDTC) Discharge information (HCAHPS composite 6) Care transitions (HCAHPS composite 7) 5

6 EMERGENCY DEPARTMENT TRANSFER COMMUNICATION Emergency by Taber Andrew Bain is licensed under CC BY 2.0; image unchanged 6

7 Emergency Department Transfer Communication (EDTC) This measure is used to assess the percentage of patients transferred to another health care facility whose medical record documentation indicated that all of the relevant elements were communicated to the receiving hospital within 60 minutes of discharge (administrative communication must occur before discharge/transfer). 7

8 EDTC Measure The measure is composed of 7 sub-measures that are compiled into one composite measure (EDTC-All), which are calculated from 27 data elements that are abstracted from patient transfer charts. 8

9 EDTC (continued) Denominator Description All transfers from an emergency department (ED) to another health care facility (Max sample of 45 cases) Numerator Description Number of patients transferred to another health care facility whose medical record documentation indicated that all of the relevant elements for each of the following 7 sub-measures were communicated to the receiving hospital within 60 minutes of discharge (administrative communication must be completed prior to patient transfer) 9

10 EDTC (continued) Numerator Description (continued) each of the following 7 sub-measures were communicated : EDTC-1 Administrative communication EDTC-2 Patient information EDTC-3 Vital signs EDTC-4 Medication information EDTC-5 Physician- or practitioner-generated information EDTC-6 Nurse-generated information EDTC-7 Procedures and tests 10

11 Why focus on ED transfer? CAHs frequently transfer a higher proportion of emergency department (ED) patients than larger urban facilities Reduce preventable hospital readmissions and adverse events in hospitals Communication is the root of all evil 11

12 EDTC reporting: sample size Option to sample quarterly or monthly 12

13 EDTC reporting tool 13

14 EDTC reporting when and where April 30, 2017 Patients seen Q (January, February, March) Submit data to State Office of Rural Health Data aggregated and reported for the entire state 14

15 Improving the EDTC measure Pick a low performing measure suggested goal is 90 th percentile for all measures Use Root Cause Analysis (RCA) and Plan- Do-Study-Act (PDSA)! 15

16 EDTC strategies Update paper transfer forms to ensure capture of all required data elements and documentation that the information was communicated to the next setting of care. Implement prompts and documentation in the electronic medical record (EMR) to ensure elements are captured and communicated to the receiving facility, either electronically or via a printed-paper form. 16

17 EDTC strategies (continued) Develop checklists and processes such as double sign-offs and concurrent review of records within the CAH to ensure adequate documentation and communication. Identify and implement a standardized process for documentation and transfer of information to the next setting of care. 17

18 HCAHPS SURVEY CARE TRANSITION MEASURES Ted team clipboards by TEDx NJLibraries is licensed under CC BY 2.0; image unchanged 18

19 HCAHPS Survey measures Reported through a CMS approved vendor CAHs approve vendor via Quality Net secure portal Vendor provides reports to CAHs (varies by vendor) Data is cleaned and analyzed by CMS Publicly reported on Hospital Compare website 19

20 HCAHPS Composite 6: Discharge information Percentage of patients surveyed who reported that Yes, they were given information about what to do during their recovery at home. 20

21 Discharge info data elements During this hospital stay, did doctors, nurses or other hospital staff talk with you about whether you would have the help you needed when you left the hospital? During this hospital stay, did you get information in writing about what symptoms or health problems to look out for after you left the hospital? 21

22 Discharge info populations Denominator: Random sample of adult patients across medical conditions between 48 hours and six weeks after discharge Numerator: Patients who answered "always" to composite questions 22

23 Discharge info strategies Teach-back: Research-based health literacy intervention that promotes adherence, quality, and patient safety Involves asking a patient (or family member) to explain in their own words what they need to know or do Is a way to check for understanding and, if needed, re-explain and check again 23

24 Teach-back: 10 elements of competence for using 1. Use a caring tone of voice and attitude. 2. Display comfortable body language and make eye contact. 3. Use plain language. 4. Ask the patient to explain back, using their own words. 5. Use non-shaming, open-ended questions. 24

25 Teach-back: 10 elements (cont) 6. Avoid asking questions that can be answered with a simple yes or no. 7. Emphasize that the responsibility to explain clearly is on you, the provider. 8. If the patient is not able to teach back correctly, explain again and re-check. 9. Use reader-friendly print materials to support learning. 10. Document use of and patient response to teach-back. 25

26 HCAHPS Composite 7: Care transitions Percentage of patients surveyed who Strongly Agree they understood their care when they left the hospital. 26

27 Care transitions data elements During this hospital stay, staff took my preferences and those of my family or caregiver into account in deciding what my health care needs would be when I left. When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. When I left the hospital, I clearly understood the purpose for taking each of my medications. 27

28 Care transitions population Denominator: Random sample of adult patients across medical conditions between 48 hours and six weeks after discharge. Numerator: Patients who answered strongly agree" to composite questions. 28

29 Care transitions strategies Teach-back TeamSTEPPS Handoff I PASS the BATON 29

30 Handoff elements Transfer of responsibility and accountability: You are responsible to know that the person accepting responsibility is aware that they are doing so. You are accountable until both parties are aware of the transfer of responsibility. Clarity of information: When uncertainty exists, it is your responsibility to clear up all ambiguity of responsibility before the transfer is completed. 30

31 Handoff elements (continued) Verbal communication of information: You cannot assume that the person obtaining responsibility will read or understand written or nonverbal communications. Acknowledgment by receiver: Until it is acknowledged that the handoff is understood and accepted, you cannot relinquish your responsibility. Opportunity to review: Handoffs are a good time to review and have a new pair of eyes evaluate the situation for both safety and quality. 31

32 I PASS the BATON I Introduction Introduce yourself and your role/job (include patient). P Patient Name, identifiers, age, sex, location. A Assessment Presenting chief complaint, vital signs, symptoms, and diagnosis. S Situation Current status/circumstances, including code status, level of uncertainty, recent changes, response to treatment. S Safety Concerns Critical lab values/reports, socio-economic factors, allergies, alerts (falls, isolation, etc.) 32

33 I PASS the BATON (cont) THE B Background Co-morbidities, previous episodes, current medications, family history. A Actions What actions were taken or are required? Provide brief rationale. T Timing Level of urgency and explicit timing and prioritization of actions. O Ownership Who is responsible (nurse/doctor/team)? Include patient/family responsibilities. N Next What will happen next? Anticipated changes? What is the plan? Are there contingency plans? 33

34 What we covered today Described various care transition definitions Explained the three care transition measures Enabled participants to develop methods for impacting these measures 34

35 Resources MBQIP National Rural Health Resource Center EDTC resources page html Quality improvement toolkit for EDTC Measure _Communication_Measures.pdf Interpreting MBQIP Hospital Data Reports for Quality Improvement 35

36 Resources (cont) Always Use Teach-back TeamSTEPPS 36

37 Questions 37

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39 Conclusion Evaluation will be ed Next meetings: Roundtable sharing call: Care Transitions measures April 11, 11 a.m. noon PT Webinar 4: Patient Safety and Patient Engagement Measures and Best Practices April 25, 11 a.m. noon PT 39

40 Contact Carrie Beck Project Lead Jennifer Wright