THE IMPORTANCE OF OUTCOME DATA IN DISEASE-SPECIFIC CERTIFICATION HEALTHSOUTH CORPORATION BECKY BRADLEY, NATIONAL DIRECTOR OF CASE MANAGEMENT AND QUALITY STANDARDS JIMMY DASCANI, CHIEF NURSING OFFICER, HEALTHSOUTH REHABILITATION HOSPITAL AT MARTIN H EALTH FIM and UDSMR are trademarks of Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.
OVERVIEW OF PRESENTATION Using FIM outcomes to define program goals, measure effectiveness, and drive overall program performance improvement in a Joint Commission Disease-Specific Certification program (DSC) The FIM instrument is an Essential Tool in Achieving DSC: Increased Quality = Improved Outcomes
HEALTHSOUTH CORPORATION Footprint 103 Hospitals in 26 States And Puerto Rico 9% of IRFs 19% of Licensed Beds 21% of Patients Served Patients Served Most Common Conditions (Q1 2014): 1.Neurological 25.0% 2.Stroke 16.7% 3.Fracture of the lower extremity 9.2% 4.Other orthopedic conditions 9.0% 5.Brain injury 8.3%
HealthSouth s Quality Model Core Quality Components
HealthSouth s Quality Model TOOLS USED TO MEASURE QUALITY NQF endorsed performance measures UDSMR benchmarks Person-and Family-Centered Care reported outcomes State of the art equipment and technology Risk data
HealthSouth s Quality Model PROCESS Evaluate Needs Identify Standards Embed the Process Innovate Own the Standard
HealthSouth s Quality Model EVALUATE THE NEEDS Solicit constituent* feedback Solicit employee input Analyze available data (e.g. survey results, quality metrics, risk management reports) * Includes patients, families, payors, regulators
HealthSouth s Quality Model IDENTIFY THE STANDARD Discern New Standards Determine Required Behavior Design Metrics Define Target Staff Design Policies and Procedures Develop and Equip Leaders
HealthSouth s Quality Model EMBED THE PROCESS Educate everyone involved Train staff Encourage behavior (recognize, reinforce) Measure performance Review the process
HealthSouth s Quality Model INNOVATE Seek opportunities to perform beyond the standard Create new processes to: Outcomes Cost Conduct Clinical Research
HealthSouth s Quality Model OWN THE STANDARD Demonstrate industry leadership Exceed patients and customers expectations Achieve recognition for quality performance Attract referrals from leading physicians Earn preferred contract terms Influence public policy
THE CHRONIC CARE MODEL SOURCE: AMERICAN COLLEGE OF PHYSICIANS Community Health System Self-Management Delivery Decision Clinical Support System Support Information Design Systems Informed, Activated Patient Productive Interactions Prepared, Proactive Practice Team Functional and Clinical Outcomes
OVERVIEW OF DISEASE-SPECIFIC CERTIFICATION The Joint Commission reviews are service-based, focused on quality, safety, and outcomes for improving clinical care Certification is voluntary, follows a 2-year recertification cycle with a required 12-month evaluation of data and performance
STEPS TO CERTIFICATION Three key steps in achieving certification: 1. Use of national standards for Program Management/Information Management/Measuring and Improving Performance (Need the FIM instrument to identify and select 4 performance improvement measures) 2. Integration of Clinical Practice Guidelines (example: AHA/ASA Stroke Guidelines) 3. Collect and Analyze Performance Measurement Data to Drive Future Improvement Activities (Using the FIM instrument is key)
PROGRAM COMPONENTS Structure JC DSC Standards 27 Consensus-based Quality & Safety of Care Process Clinical Practice Guidelines Outcome Performance Measures
STRUCTURE: DISEASE-SPECIFIC CARE STANDARDS Program Management 7 standards Delivering or Facilitating Clinical Care 6 standards Supporting Self-Management 3 standards Clinical Information Management 5 standards Performance Improvement and Measurement 6 standards
HEALTHSOUTH'S DISEASE-SPECIFIC PROGRAMS 192 - Total Joint Commission Total Disease-Specific Programs Examples Stroke Rehabilitation Hip Fracture Rehabilitation Amputee Rehabilitation Traumatic Brain Injury Spinal Cord Injury Parkinson Pulmonary
USING THE FIM INSTRUMENT TO CREATE A SUCCESSFUL PROGRAM Continuous Program Development and Improvement Using the FIM instrument Use the FIM Instrument to Identify Areas That Need Improvement Drill down details on all 18 FIM items to identify areas of opportunity and drive overall program performance Use the FIM Instrument to Develop Program Solutions and Evaluate Performance Use the FIM Instrument to Continuously Monitor Quality Improvement and Outcomes Increased Quality = Improved Outcomes
SAMPLE DATA SNAPSHOT Metrics Monitored Weekly Performance Nationally Adjusted Discharge to Community 91.7% 69.9% Discharge to Skilled Nursing 0.0% 11.8% Discharge to Acute Care 8.3% 9.8% Length of Stay 12.8 16.3 Length of Stay Efficiency (FIM Gain LOS) 2.78 2.17 Case Mix Index 1.45 1.53 Admission FIM Rating 48.5 51.1 Discharge FIM Rating 84.1 80.8 FIM Change/Gain 35.6 29.7 * Potentially correlate lower admission FIM rating with increased FIM gain, lower length of stay, higher D/C to Community rates, and other metrics
USING FIM RATINGS TO EVALUATE DSC PERFORMANCE MEASURES IN DETAIL Performance Measures Admit Score Discharge Score Total Change Nationally Adjusted Admit Score Nationally Adjusted Discharge Score Nationally Adjusted Change Bladder 1.8 4.3 2.6 2.7 4.3 1.6 Bed/Chair/ Wheelchair Transfers 2.4 4.9 2.5 2.3 4.3 2.0 Problem Solving 2.5 3.8 1.3 3.1 4.3 1.2 Benchmark your FIM results against regional, state, and national results * Provide detailed data to clinical teams and committees for focused quality improvement initiatives. Share information with referring entities to establish trust, credibility, and align program goals in the continuum of care for the benefit of the patients and communities we serve
BENEFITS OF DISEASE -SPECIFIC CERTIFICATION Improves the quality of patient care by reducing variations in practice Supports overall hospital goal of avoiding never events through improved clinical management Provides an objective assessment of clinical excellence Helps create a cohesive multidisciplinary clinical team Promotes a culture of excellence Facilitates marketing efforts and strengthens referral source relationships The Joint Commission, 2014