The Centers for Medicare & Medicaid Services (CMS) Partnership to Improve Dementia Care Ohio Psychotropic Medication Nursing Facility Quality Improvement Project Ohio KePRO Nursing Home Quality Care Collaborative Quality Improvement Project 2014 Prescribing guidelines Person-centered care Quality of life Gradual dose reductions Data feedback Advancing Excellence in America s Nursing Homes Campaign Quality Assurance Performance Improvement PDSA Model for Improvement Improve clinical outcomes for residents who have dementia Help your teams learn about the role of data in quality improvement Increase resident and staff satisfaction Work smarter, not harder, by integrating Advancing Excellence Campaign processes Network with other providers and stakeholders to learn cutting-edge practices Improve the quality of care in Ohio s nursing homes All material presented or referenced herein is intended for general informational purposes and is not intended to provide or replace the independent judgment of a qualified healthcare provider treating a particular patient. Ohio KePRO disclaims any representation or warranty with respect to any treatments or course of treatment based upon information provided. Publication No. 311203-OH-2165-10/2013.This material was prepared by Ohio KePRO, the Medicare Quality Improvement Organization for Ohio, 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.
IMPROVING INDIVIDUAL PATIENT CARE: Reducing the use of antipsychotic medications AREAS OF FOCUS Prescribing guidelines Gradual dose reductions Dementia care Advancing Excellence data tracking tool Performance improvement processes About the Quality Care Collaborative The Quality Care Collaborative will bring providers and stakeholders together to achieve fast-paced, dynamic, data-driven quality improvement. AIM The aim of the Quality Care Collaborative is to ensure that every nursing home resident receives the highest quality of care. The Collaborative will strive to instill quality and performance improvement practices, eliminate healthcare-acquired conditions, and dramatically improve resident satisfaction. Overview Recent research has raised concerns about the use of atypical antipsychotic (AAP) medications and benzodiazepines among older adults, especially those with dementia and those who have a PRN ( as needed ) prescription for these drugs. The State of Ohio is working with various healthcare leaders, stakeholders, subject matter experts, and professionals to evaluate and help improve prescribing of atypical AAPs and benzodiazepines to long-stay nursing facility residents who have dementia or a PRN prescription for these medications. A Partnership for Quality Improvement Over the next eight months, the State will roll out and complete a new voluntary pilot project called the Ohio Psychotropic Medication Nursing Facility Quality Improvement Project that aims to reduce the use of atypical antipsychotic (AAP) medications by 15 percent among long-term nursing facility residents with dementia or residents with a PRN prescription (where drug is administered as needed ) for AAP medications. The project will consist of two parts: (1) data and near realtime feedback reports to nursing home facilities; and (2) education and technical assistance, including training on quality improvement science and best practices. Ohio nursing facilities are invited to participate on a voluntary basis. This fact sheet offers additional information about the program offerings and expectations for nursing facilities that choose to participate in this project. Project Partners Ohio KePRO is pleased to collaborate with many partners to coordinate this initiative. Our partners include: The Advancing Excellence in America s Nursing Homes Campaign The Ohio Department of Medicaid (ODM); The Ohio Department of Aging (ODA); The Office of the State Long-Term Care Ombudsman; The Ohio Department of Mental Health and Addiction Services (OhioMHAS); Subject matter experts from Rutgers University; The Ohio Colleges of Medicine Government Resource Center (GRC); and The Centers for Medicare & Medicaid Services. Page 2 of 5
Project Expectations OHIO KEPRO AND OUR PARTNERS WILL: Provide educational programming and sharing calls. Educational webinars will help spread clinical knowledge and process improvement strategies, while sharing calls will highlight best practices and facilities successes. Provide technical assistance, utilizing a coaching approach. This may include phone calls, email support and site visits (on a limited basis). Assistance will focus on helping facilities (1) target various organizational roles, such as direct care staff, directors of nursing, administrators or prescribers, to support AAP best practices; (2) identify and overcome barriers for optimal prescribing of AAPs; (3) implement quality improvement strategies; (4) use the Advancing Excellence medication tracking tool to monitor medication use and submit summary data; (5) engage direct care staff to support person-centered care strategies; and (6) provide relevant project resources and information. Provide confidential data feedback reports that can be used to track improvements over time, test and modify interventions, and help you make data-driven decisions within your organization. Participants will receive individualized reports including (1) Facility-level graphs that show change in AAP utilization measures over time; (2) Comparative metric reports; (3) Facility compared to other participating (anonymous) organizations with similar demographic and service profiles; and (4) Facility comparisons to participating facilities in the state as a whole. Subject matter experts from Rutgers University and team members from Ohio KePRO will support interpretation and utilization of data, such as (1) setting facilitylevel goals; (2) identifying target populations; and (3) identifying high opportunity focus areas. PARTNERING NURSING HOMES AGREE TO: Submit a one-time facility profile via an online portal owned and operated by the Ohio Colleges of Medicine Government Resource Center (GRC). Profile includes information related to service demographics, prescribing practices, and organizational needs. Participate in monthly quality improvement sharing calls and provide updates to project partners. Participants are encouraged to (1) inform project partners of any technical assistance that might be needed in your facility to help accomplish the project goal; and (2) summarize any quality improvement efforts (e.g., reducing pressure ulcers) you may already be implementing in your facility; and (3) complete and submit a monthly CARES report to Ohio KePRO regarding your improvement efforts. Feedback regarding quality improvement interventions will be based on facility data, progress, and the perspectives of facilitators and peers. Allow project partners to have access to their facility s monthly Advancing Excellence summary data. Data will include summary measures used by the Advancing Excellence Campaign (see next page). NOTE: Participating facilities will be expected to start or continue using the Advancing Excellence medication tracking tool, including monthly Advancing Excellence campaign website data submission. Each month s data is to be submitted to the Advancing Excellence in America s Nursing Homes Campaign website by the 5 th day of the next month (e.g., submit data for January 2014 by December 5, 2013). Access and view reports through the GRC s online portal. The web based portal will launch in December 2013. Each participating facility will have a separate log-on account to the portal and will be able to see its own data and a statewide aggregate. Facility-specific data will be confidential; no facility will be able to view another facility s data. Data housed on this site will be obtained by the GRC from Advancing Excellence for project purposes and will not be shared with state surveyors or other regulatory bodies. Page 3 of 5
Working Smarter Not Harder, for Better Care Participation in this special program offers long-term benefits for your residents, for your staff, and for your organization. By addressing key issues related to the care of residents with dementia, your entire organization will reap the rewards of working smarter, not harder, to provide for better care for your residents. Project Deadlines ITEM TIMELINE FOR ACHIEVEMENT Sign Project Participant Agreement and Affirmation November 29, 2013 Complete an online facility profile Attend educational webinars, provide feedback, view reports, and participate in sharing calls Use the Advancing Excellence Medications Tracking Tool to collect and submit data to the Advancing Excellence Campaign Submit monthly updates (via CARES reports) on antipsychotic medication reduction improvement efforts TBD As scheduled January June 2014 By the 5 th of each month By the 7 th of each month Advancing Excellence Measures: Medications Data Tracking Tool 1. Percent of antipsychotic prescriptions written as PRN 2. Percent of residents on antipsychotics for dementing illness with associated behavioral symptoms OR dementing illness with psychotic features Number of beds Facility Profile Percent of residents by age ranges* 3. Percent of residents on multiple antipsychotics Percent of residents by gender* 4. Percent of residents with whom a Gradual Dose Reduction (GDR) was attempted with at least one medication in last 90 days 5. Percent of residents for whom GDR resulted in a dose reduction for at least one medication in last 90 days Name of pharmacy and contact information for consultant pharmacist Percent of residents by payor type (i.e., Medicare, Medicaid, insurance, etc.) 6. Percent of residents for whom GDR resulted in at least one medication being discontinued in last 90 days Percent of residents with a psychiatric diagnosis* *As reported on MDS 3.0 Facility Characteristics CASPER Report Page 4 of 5
Ohio KePRO Nursing Home Quality Care Collaborative Ohio Psychotropic Medication Nursing Facility Quality Improvement Project Project Participant Agreement and Affirmation We would like to take advantage of this no-cost opportunity to participate in Ohio Psychotropic Medication Nursing Facility Quality Improvement Project with Ohio KePRO, the Ohio Department of Medicaid, the Ohio Department of Aging, the Office of the State Long-Term Care Ombudsman, the Ohio Department of Mental Health and Addiction Services, Rutgers University, the Ohio Colleges of Medicine Government Resource Center, and the Advancing Excellence in America s Nursing Homes Campaign. As a facility that is participating in the Ohio Psychotropic Medication Nursing Facility Quality Improvement Project for FY 2014, we understand that we will receive training, benchmark data feedback, and technical assistance to design interventions, test our changes, and use our data to revise our strategies (PDSA cycle). As a participating facility, we agree to do the following: Submit a one-time facility profile online through a GRC-sponsored website; Permit the Advancing Excellence in America s Nursing Homes Campaign to share our facility s submitted data with The Ohio State University, Rutgers University, Ohio KePRO and other partners in the Ohio Psychotropic Medication Nursing Facility Quality Improvement Project on a confidential basis (for more on confidentiality and security of data, please see page 3); Take part in monthly sharing calls and participate in clinical leadership staff trainings via webinar. Join or maintain our participation in Ohio KePRO s Quality Care Collaborative. For ongoing quality improvement support during this project, send, or continue to send, monthly quality improvement updates (via CARES reports) to Ohio KePRO on your organization s progress. This information will not be disclosed by Ohio KePRO except as permitted by federal regulations. The organization agrees to work with Ohio KePRO in the Ohio Psychotropic Medication Nursing Facility Quality Improvement Project through June 30, 2014 and meet all project expectations as outlined herein. Signature of Authorized Representative Date Printed Name Job Title Organization Six-Digit Medicare Provider Number (36-XXXX) Street Address City ZIP Phone Number Extension Email Address Please complete this form and return it to Ohio KePRO. Mail to: Ohio KePRO, ATTN: Liz Simpson Rock Run Center, Suite 100, 5700 Lombardo Center Seven Hills, Ohio 44131 Or Fax: ATTN: Liz Simpson 216.447.7925 Questions? Call Leasa Novak, Ohio KePRO Project Manager at 330.651.3063. For Internal Use Only Ohio KePRO Representative Date Page 5 of 5