Improving Patient Outcomes through Quality Transitions

Improving Patient Outcomes through Quality Transitions

Founded in 1892, Union Hospital began as a 20 bed facility and has grown into a 380 bed not-for-profit hospital Union Hospital is a Regional Referral Center serving patients in west-central Indiana and east-central Illinois The Union Health System also includes Union Hospital Clinton and several facilities dedicated to specific service offerings, patient groups, and physician groups Union Health Systems is the largest provider of health care services between Indianapolis, IN and St. Louis, MO, providing quality care to all, regardless of ability to pay.

Pam Alexander Lennie Blythe Dr. John Bolinger Myrna Dienhart Shad Goodman Terri Hill Lori Horrall Sherri Kannmacher Dawn Jolliff Dr. Steven McDonald Amy McHenry Annette Smith Jana Smith Rhonda Smith Andrea Spendal Jeanette Spradlin Stacy Street Debbie Stuck Kristi Williams Kerry Wilson Marina Wolfe

Readmission Numbers Above National Average All Cause Medicare Readmission Rates to Union Hospital 2011 18.9% 2012 19.2% Medicare CHF Readmission Rates to Union Hospital 2011 24.8% 2012 25.8% *CHF Readmissions Identified as First Priority*

Pilot began October 1, 2012 A Registered Nurse used in Coaching Role Identification of CHF Patient on Admit and Initiation of CHF Education Began Teach Back Method of Education was Utilized Assist with Discharge Planning Coordination with Next Level of Care More Timely Follow-up with PCP Increase Communication with PCP Office

Developed as Monthly Meeting Coordination and Communication Includes: Long term care facilities Home health Care Hospices Area Agencies Durable medical equipment companies Purpose Enhance quality of care Define gaps in care Improve communication and coordination to next level of care

Universal Heart Failure Color Zone Soarian Report Built to Identify CHF Patients Heart Failure Education Packet Developed 30 Day Readmission Report Built CHF Calendar Revised to Include Monthly Tips SBAR Tool Education Collaboration with Area 7 Counsel for Aging Increased Referrals to Support Agencies

Root Cause Identification of Patient Diagnosis was Inadequate December, 2012, 37 of 54 CHF Patients Were Identified During Admission Identified Problems 1) Computer Systems Do Not Interface 2) Data Fields Free Text Rather than Discrete Fields 3) Duplication of Efforts Identifying Patients

1) Consistent Process to Identify Primary Diagnosis Upon Admission Quality of Care Improvement Appropriate Patient Education Effective Discharge Planning 2) Establish Method Where ALL Departments Use Same Process 3) Aid in the Process of Concurrent Chart Review for CMS Measures

Streamlined and Standardized the Report Generation Process All Disciplines Receive Same Report from the Same Source

Delayed End of Life Discussions Teaching Versus Motivational Interviewing Physician Buy-In Culture Difficulty in Diagnosis Recognition

Building Good Community Relationships (Partnership with Area 7) Value of Coordinated Care Ensuring Timely Inpatient Intervention as Well as Post Hospital Follow-up Need for Open/Honest End of Life Discussion

Formation of Palliative Care Team Community Support Group for CHF Patients and Caregivers Continued Community Care Transitions -Work on Gaps in Care- Integration with ACO Care Management Collaboration with ER Case Management Incorporation of Physician Advisor

40% UNION HOSPITAL CHF Readmission Rates All CHF 35% Pilot Program 30% 25% *National Average CHF Readmit -2009 20% 15% 10% 5% 0% Oct Nov Dec Jan 2013 Feb Mar Apr May

19.5% Medicare 30 day Readmissions All Diagnosis/All Cause 19.2% 19.0% 18.9% 18.5% 18.0% 17.5% 17.0% 16.9% 16.5% 16.0% 15.5% FY 2011 FY 2012 FY 2013

19.0% Medicare 30 Day Readmissions AMI 18.5% 18.0% 18.2% 18.4% 17.5% 17.0% 16.5% 16.0% 15.8% 15.5% 15.0% 14.5% 14.0% FY 2011 FY 2012 FY 2013

45.0% Medicare 30 Day Readmissions CHF FY 2013 40.0% 36.6% 38.5% 35.0% 32.5% 30.0% 25.0% 23.5% 25.6% 20.0% 20.0% 19.4% 18.8% 15.0% 13.3% 10.0% 5.0% 0.0% Sep Oct Nov Dec Jan Feb Mar Apr May

30.0% Medicare 30 Day Readmissions COPD 26.1% 26.0% 25.0% 20.0% 19.4% 15.0% 10.0% 5.0% 0.0% FY 2011 FY 2012 FY 2013

22.0% Medicare 30 Day Readmissions Pneumonia 21.8% 21.5% 21.0% 20.6% 20.5% 20.0% 19.9% 19.5% 19.0% FY 2011 FY 2012 FY 2013

o Raised Awareness Hospital Staff Physicians Community o Increased Communication Hospital Staff Physicians Community o Coordination Hospital Staff Physicians Community