Transcript State Veterans Home Presentation Behaviors

National Partnership to Improve Dementia Care
Denise F. O’Donnell, RN, MN, GCMS-BC, MASM, NHA
Nurse Consultant/ Division of Nursing Homes/Survey
and Certification Group
March 3, 2016
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Presentation Goals
Participants will:
• Be knowledgeable about the CMS National Partnership to Improve
Dementia Care in Nursing Homes and achievements to date in
improving dementia care and reducing the use of antipsychotic
medications.
• Be able to identify resources that CMS and their partners have
developed to assist facilities in improving dementia care.
• Learn about the Focused Dementia Care Surveys and how they are
impacting care.
• Be able to utilize the information shared regarding practice issues for
use in the State Veterans Homes.
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Partnership Mission
Mission:
• Improve the quality of care provided to individuals with dementia
living in nursing homes.
• Deliver health care that is person-centered, comprehensive and
interdisciplinary.
• Protect residents from being prescribed antipsychotic
medications unless there is a valid, clinical indication and a
systematic process to evaluate each individual.
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Partnership Overview
• CMS promotes a multidimensional approach through:
–Research
–Partnerships and state-based coalitions
–Surveyor guidance
–Education
–Public reporting
• The 3 R’s:
• Rethink our approach to dementia care.
• Reconnect with residents via person-centered care practices.
• Restore good health and quality of life.
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CMS Collaborative Efforts
•
Bi-Annual calls with State Coalitions
•
MLN Connects ® (Medicare Learning Network) National Provider Calls
https://www.cms.gov/Outreach-and-Education/Outreach/NPC/National-Provider-Calls-and-Events.html
•
National Partnership resource repository – Advancing Excellence
https://www.nhqualitycampaign.org/dementiaCare.aspx
http://www.cms-handinhandtoolkit.info/
•
Grants – Use of Federal Civil Monetary Penalty Funds
https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-1534.pdf
•
Focused Dementia Care Surveys
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Measuring Progress
CMS is tracking the progress of the Partnership by reviewing publicly
reported measures.
The official measure of the Partnership is the percentage of long-stay
nursing home residents receiving an antipsychotic medication,
excluding residents with Schizophrenia, Huntington's Disease or
Tourette’s Syndrome.
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Partnership Goals
• Reduce the national prevalence of antipsychotic medication use in long-stay
nursing home residents:
– Initial goal by 15%
– By 25 percent by the end of 2015
– By 30 percent by the end of 2016
• Discover ways to implement new practices:
– To enhance quality of life.
– To protect residents from substandard care.
– To promote goal-directed, person-centered care approaches.
www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2014-Press-releases-items/2014-09-19.html
http://
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Current Data Trends: Progress to Date
Source: CMS Quality Measure, based on MDS 3.0 data. For more information see the MDS 3.0 Quality Measures Users Manual
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Quarterly Prevalence of Antipsychotic Use for Long-Stay Residents,
CMS Regions 2011Q2 to 2015Q3
Source: CMS Quality Measure, based on MDS 3.0 data. For more information see the MDS 3.0 Quality Measures Users Manual
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Quarterly Prevalence of Antipsychotic Use for Long-Stay Residents,
CMS Regions 2014Q1 to 2015Q3
Region
National
2014 2015Q1 2015Q2 2015Q3
Q4
19.1% 18.68 17.96
17.43
Percentage point
difference
% Change
(2011Q4-2015Q3)
-6.44 -27.0%
Region 01 19.6 19.12
%
Region 02 16.1% 15.72
18.40
18.09
-8.13 -31.0%
14.92
14.65
-5.43 -27.0%
Region 03 17.1% 16.88
16.16
16.08
-5.73 -26.3%
Region 04 20.0 19.60
%
18.77
18.24
-7.27 -28.5%
Source: CMS Quality Measure, based on MDS 3.0 data. For more information see the MDS 3.0 Quality Measures Users Manual
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State Veterans Homes Data Q4 2015
Mean % of Reported Daily Psychoactive Drug Use (Q4 2015)
Veterans Nursing
Homes
(N=69)
All Nursing Homes
(N=14,294)
Anti-depressant (AD)
50.2%
49.2%
Anti-psychotic (AP)
17.4%
19.1%
Anti-anxiety (AX)
12.4%
15.9%
Hypnotic (HP)
2.1%
2.6%
Type of Psychoactive Drug
Data taken from CASPER and the MDS Q4 2015 for psychoactive drug use.
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Enforcement
• Analysis of survey citations as of March 2014 reflects:
- A slight increase in % of NH residents with
Schizophrenia coded on the MDS
- A small decrease in use of sedatives/hypnotics used in
facilities
-Continued reduction in antipsychotic medication
usage overall.
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2014 Focused Dementia Care Survey Pilot
• To optimize survey efficiency and effectiveness.
• To more thoroughly examine the process for prescribing antipsychotic
medication, as well as other dementia care practices in nursing homes.
• To gain new insights about surveyor knowledge, skills and attitudes
related to the care of people with dementia.
• To determine ways that the current survey process may be streamlined to
more efficiently and accurately identify and cite deficient practice.
• To recognize successful dementia care programs.
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2015 Focused Dementia Care Survey
Expansion Effort
• S&C Memo 15-31-NH invited States to conduct surveys on a
voluntary basis.
• More intensive, targeted effort to improve surveyor
effectiveness in citing poor dementia care and the
overutilization of antipsychotic medications.
• Conducted as surveys of record.
• Deficient practices were cited and standard enforcement
procedures followed, including revisits.
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Surveyor Feedback
• Facilitated compliance with dementia care
standards.
• Deficient practices were easily identified.
• Provided opportunity for surveyors to “zero-in”
on dementia care practices.
• Expected timeframe for completion of survey
was reasonable, if three surveyors participated
and no serious issues were identified.
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Challenges Identified
Surveyors identified the following as the most challenging
aspects of the process:
–Facility system problems;
–Completing necessary observations;
–Amount of time spent in educating; and
–Lack of training.
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Focused Dementia Care Survey Tools
• CMS received feedback from stakeholders and partners.
• Revised survey materials were shared via Survey &
Certification Memo 16-04-NH.
https://www.cms.gov/Medicare/Provider-Enrollment-andCertification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-16-04.pdf
• Facilities encouraged to use the tools to assess their own
practices in providing resident care.
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Next Steps
• Release of final report for 2015 Focused Dementia Care
Surveys.
• Complete additional Focused Dementia Care Surveys in
2016.
– Focus on nursing homes that continue to have high rates of
antipsychotic medication use.
• Continue review of dementia care practices in standard
survey process, both Traditional and QIS.
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State Veterans Homes
• Unique and challenging population
• Age groups
• Diagnoses
• Behavioral and psychosocial issues
• Resources
• Regulatory and survey issues
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Strategies for Success in Reducing the Use of
Antipsychotic Medications
•
•
•
•
•
•
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Commitment at all levels;
Multidisciplinary approach;
Increased knowledge for all levels of staff;
Documentation;
Utilization of all available resources;
Self monitoring; and
Research.
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Questions?
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Thank You
• For more information about the National Partnership, please visit:
https://www.cms.gov/Medicare/Provider-Enrollment-andCertification/SurveyCertificationGenInfo/National-Partnership-to-ImproveDementia-Care-in-Nursing-Homes.html
• Please send questions, via email to: [email protected]
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