New England Home Health Collaborative The Use of Aspirin in Heart Disease Kathryn D. Roby, M.Ed., M.S., CHCE, CHAP QIN-QIO Home Health Consultant April 8, 2015
The New England Quality Innovation Network Quality Improvement Organization (New England QIN-QIO) Brought to you by: Healthcentric Advisors Focus areas: MA, ME, RI Qualidigm Focus areas: CT, NH, VT 2
Introducing The New England QIN-QIO Website: www.healthcarefornewengland.org 3
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Connecticut Kathy Roby kroby@qualidigm.org Home Care Plus Interim Health Care of North Haven, Inc. Utopia Home Care, Inc. Maine Welcome New Members! Doreen Bedaw dbedaw@healthcentricadvisors.org Calais Regional Hospital Home Health Home Health Visiting Nurses of Southern Maine Professional Home Nursing 8
Massachusetts Welcome New Members! Pat Donovan McLeod pdonovanmcleod@healthcentricadvisors.org Barbara Corning Davis bcorning-davis@healthcentricadvisors.org Karen Evans kevans@healthcentricadvisors.org Able Home Health, LLC Bayada Home Health Care, Inc. CareGroup Home Care Hallmark Health VNA and Hospice, Inc. Southcoast Visiting Nurse Association, Inc. VNA & Hospice of Cooley Dickinson 9
Rhode Island Welcome New Members! Brenda Jenkins bjenkins@healthcentricadvisors.org Vermont Gail Colgan gcolgan@qualidigm.org New Hampshire Georgette Verhelle georgette.verhelle@hcqis.org Leslie Molleur leslie.molleur@hcqis.org 10
The Role of Aspirin in Cardiovascular Health B P I P Best Practice Intervention Package Cardiovascular Health I - Aspirin and Blood Pressure Control How can you use this effectively without overwhelming your staff? 11
Let s Level the Playing Field: What do we know about Aspirin use in Cardiovascular Disease? 12
Aspirin as Appropriate: A Comprehension Test 1. Aspirin is a recommended cardiovascular prevention intervention for people without heart disease or stroke, although the prevention reason differs based upon gender. Which pair below matches the correct gender with the correct disease the therapy is attempting to prevent? a. Women: heart attack, Men: Stroke b. Men: heart attack, Women: Stroke c. I don t know 13
Aspirin as Appropriate: A Comprehension Test 2. Which of the following groups is aspirin recommended as primary prevention? a. Men age 45 79 b. Women age 55 79 c. Men & women age 60+ d. Both A & B 14
Aspirin as Appropriate: A Comprehension Test 3. Which of the following is the best example of secondary prevention? a. A 50 year old male with no history of cardiovascular disease taking 81 mg ASA daily b. A 60 year old diabetic female taking 81 mg ASA daily c. A 75 year old male with atrial fibrillation taking warfarin d. All of the above 15
Aspirin as Appropriate: A Comprehension Test 4. Aspirin should be used at a low dose to reduce risk of adverse reactions. All of the following are potential adverse reactions to aspirin EXCEPT: a. Bleeding b. Jaundice c. Dizziness and tinnitus d. Anemia and decreased iron concentrations 16
Aspirin as Appropriate: A Comprehension Test 5. The following statements are interventions that home health clinicians can assist with the evidence-based aspirin therapy guidelines for their patients EXCEPT: a. Screen patients to see if they are at-risk for MI or stroke and if they are currently taking aspirin or antiplatelet as preventative therapy b. Provide education to patient and family about risk factors of MI and strokes and the need to discuss with their physician or advocate for patient with physician c. Teach on the medications, adverse events, ways to be adherent with therapy, and when to notify physician of complications d. Nothing, because aspirin therapy is only for primary care settings 17
The answers are 1. Women Heart attack Men Stroke (BPIP pages 21 & 22) 2. d. Both A & B (BPIP page 21) 3. b. A 60 year old diabetic female taking 81 mg ASA daily (BPIP page 14) 4. b. Jaundice (BPIP page 27) 5. d. Nothing, because aspirin therapy is only for primary care settings. (BPIP pages 23-29) 18
Action Plan Staff Education on the role of Aspirin in C-V disease Competency Testing Three Interventions for improved patient outcomes Data Collection 19
Staff Education Pre-Test for baseline knowledge Educate staff on: Basic causes of heart disease Use of Aspirin as treatment method - how and why? Side effects, symptoms of complications Patient Education Patient Self-Management of Aspirin therapy Post-test for competency 20
Home Health Interventions for Patient Care A. Screen patients to see if they are at-risk for MI or stroke and if they are currently taking aspirin or antiplatelet as preventative therapy B. Provide education to patient and family about risk factors of MI and strokes and the need to discuss with their physician or advocate for patient with physician C. Teach on the medications, adverse events, ways to be adherent with therapy, and when to notify physician of complications 21
Risk Factor Screening 22
Why Aspirin Therapy? In men between 45-79, to reduce risk of MI In men and women over 80, prevention of MI/Stroke In women 55-79, to reduce ischemic stroke All women post-stroke, unless otherwise not recommended 23
What are the Side Effects? Gastric Upset (avoid in history of ulcer or GI bleeding) Increased risk of bleeding Increased risk of bruising Anemia 24
Patient Education Use a Self-Management Approach What is the patient s personal life goal? How do we help the patient see the relationship between compliance and meeting that goal? Use Language Appropriate Tools Incorporate your Diet and Food/Medication relationships into a culturally appropriate framework 25
Data Abstraction Tool 26
Aspirin
Making Data Collection Easier 1. Include the HHQI ASA Literature and self screening for C-V risks in admission packets 2. Insert Data Collection Tool in the chart for staff to begin on admission, complete on discharge 3. Central location for completed tools to be entered in the HHCDR 28
Million Hearts Campaign How can your agency support C-V risk reduction and medication compliance? Agency sponsored exercise (Noon time walkers) Company support of weight loss aids 29
Peer-to-Peer Sharing What is working well? Goal: to improve the outcomes of our patients episodes of care. By working together, sharing ideas, helping one another, everyone s outcomes will improve. Sharing processes, suggestions, ideas on monthly webinars 30
HHQI Cardio LAN Every third Thursday, an educational webinar is offered by HHQI related to this project Have your registered for this month s webinar? Thursday, April 16 at 2:00 PM HHQI website archived webinars 31
Q & A How can we help you? 32
Next Webinar New England Home Health Collaborative: Improving Physician-Clinician Communication Wednesday, May 13, 2015 2:00-3:00 PM 33
Contact Kathryn D. Roby, M.Ed., M.S., CHCE, CHAP QIN-QIO Home Health Consultant Phone: 860-632-3724 Fax: 860-632-5865 E-mail: kroby@qualidigm.org This material was prepared by the New England Quality Innovation Network-Quality Improvement Organization (QIN-QIO), the Medicare Quality Improvement Organization for New England, 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. 11SOWQIN_NE-6721-2015025 34