Transcript Slide 1

PUTTING THE PIECES TOGETHER:
REDUCING AVOIDABLE READMISSIONS
Care Transitions Goals
Improve 30-day rehospitalization rates
• Improve AMI, PNE, and HF readmission rates
• Improve the number of physician follow-up
visits among the patients who have been
readmitted to the hospital
• Improve hospital performance of patient
satisfaction (HCAHPS) for patients receiving
information about discharge and medications
The Medicare Quality Improvement Organization for Florida
The Miami Opportunity
“Making the health care delivery system
work reliably for very sick Medicare
beneficiaries requires linking all clinical
care providers and ensuring that
transitions are thoroughly reliable. This
work can only succeed when all of the
community is engaged and working
together, so the QIOs will serve to
catalyze and coordinate the work across
all care settings in the community.”
Barry M. Straube, M.D.
Director & Chief Clinical Officer
Office of Clinical Standards & Quality for CMS
The Medicare Quality Improvement Organization for Florida
Community Readmission Rates
35.00%
6 months+
30.00%
25.00%
22.77%
22.08%
22.03%
21.65%
21.21%
21.48%
22.96%
21.13%
19.31%
20.00%
15.00%
Oct-07
Jan-08
Apr-08
Jul-08
Oct-08
Jan-09
Apr-09
Jul-09
Oct-09
Discharge to ACH Rate
Goal
Baseline
Contract Started
Interventions Started
Intervention Impact
Remeasurement starts
Remeasurement ends
Jan-10
Apr-10
Recruitment Started
NOTE: Lower better. 30-day readmission rates are unadjusted, weighted averages and are based on a 6-month
reporting period ending the specified quarter. Florida’s 30-day unadjusted readmission rate for the 6-month period
ending May 2009 = 19.04%.
Disease-Specific Readmission Rates: AMI
30.00%
25.00%
22.62%
19.79%
20.00%
22.26%
22.08%
21.08%
19.43%
19.25%
17.79%
18.25%
15.00%
10.00%
Jun-08
Sep-08
Dec-08
AMI
Mar-09
Estimated Risk-adjusted
Jun-09
Sep-09
Dec-09
Risk-adjusted Goal
NOTE: Lower better. AMI results are unadjusted, weighted averages and are based on a
3-month reporting period ending specified quarter. The AMI “unadjusted to risk-adjusted
difference” at baseline = - 2.83%. Florida’s weighted, unadjusted AMI rate for the 6-month
period ending May 2009 = 20.50%.
Mar-10
Disease-Specific Readmission Rates: CHF
35.00%
30.00%
26.46%
25.43%
25.00%
24.98%
23.98%
22.95%
22.50%
26.61%
24.13%
21.98%
20.00%
15.00%
Jun-08
Sep-08
Dec-08
HF
Mar-09
Estimated Risk-adjusted
Jun-09
Sep-09
Dec-09
Risk-adjusted Goal
NOTE: Lower better. CHF results are unadjusted, weighted averages and are based on a
3-month reporting period ending specified quarter. The CHF “unadjusted to risk-adjusted
difference” at baseline = - 2.48%. Florida’s weighted, unadjusted CHF rate for the 6-month
period ending May 2009 = 24.90%.
Mar-10
Disease-Specific Readmission Rates: PNE
30.00%
25.00%
20.94%
19.88%
19.98%
20.00%
19.90%
18.23%
17.17%
17.27%
17.19%
17.23%
15.00%
10.00%
Jun-08
Sep-08
Dec-08
PNE
Mar-09
Estimated Risk-adjusted
Jun-09
Sep-09
Dec-09
Risk-adjusted Goal
NOTE: Lower better. PNE results are unadjusted, weighted averages and are based on a
3-month reporting period ending the specified quarter. The PNE “unadjusted to risk-adjusted
difference” at baseline = - 2.71%. Florida’s weighted, unadjusted PNE rate for the 6-month
period ending May 2009 = 17.80%.
Mar-10
Physician Follow-Up Visit
50.00%
45.00%
42.88%
41.9%
40.00%
40.43%
36.85%
35.00%
35.67%
30.00%
25.00%
Jun-08
Sep-08
Dec-08
Mar-09
Jun-09
Physician Follow-Up Prior to 30-Day Rehospitalization
Sep-09
Goal
NOTE: Higher better. Results are unadjusted, weighted averages and are based
on 6-month reporting periods ending the specified quarter.
Dec-09
Improved Patient Satisfaction: Meds
79.00%
77.00%
76.21%
75.00%
74.51%
75.31%
74.54%
74.14%
73.00%
71.00%
69.00%
67.00%
65.00%
Jun-08
Sep-08
Dec-08
Mar-09
Expained Medications
Jun-09
Sep-09
Dec-09
Mar-10
Goal
NOTE: Results are unadjusted averages and are based on 12-month reporting periods ending the specified
quarter. Based on number of HCAHPS questions answered “always or usually” to question # 16 (Before
giving you any new medicine, how often did the hospital staff tell you what the medicine was for? And question
# 17 (Before giving you any new medicine, how often did the hospital staff describe possible side effects in a
way you could understand?)
Improved Patient Satisfaction: D/C Info
79.00%
76.45%
77.00%
76.93%
76.38%
75.97%
75.00%
74.93%
73.00%
71.00%
69.00%
67.00%
65.00%
Jun-08
Sep-08
Dec-08
Mar-09
Discharge Information
Jun-09
Sep-09
Dec-09
Mar-10
Goal
NOTE: Results are unadjusted averages and are based on 12-month reporting periods ending the specified
quarter. Answered “yes” to HCAHPS question # 19 (During this hospital stay, did doctors, nurses or other
hospital staff talk with you about whether you would have the help you needed when you left the hospital?)
And question # 20 (During this hospital stay, did you get information in writing about what symptoms or heath
problems to look out for after you left the hospital?)
Risk Modeling
• Based on beneficiaries' claims 2007-2008
• Tests patient characteristics to determine non-diseased
based disparities
– Age
– Gender
– Race/ethnicity
– Dual eligibility
– ESRD
– Length of stay
• Tests the impact of:
– Primary discharge diagnosis
– Services utilized during hospital stay
– Co-existing conditions defined during index hospitalization
NOTE: All diagnoses fields were classified using the CMS-HCC risk-adjustment model. Revenue & procedure
codes were classified using utilization flags developed for the Healthcare Cost & Utilization Project (H-CUP),
sponsored by the Agency for Healthcare Research & Quality (AHRQ).
The Medicare Quality Improvement Organization for Florida
Results: Patient Characteristics
• Dual eligible
• ESRD
• Longer length of stays (>5.65)
• Males (slight)
• African American (slight)
The Medicare Quality Improvement Organization for Florida
Results: Primary Discharge Diagnosis
• Congestive heart failure*
• Major psych disorders*
• Cardio-respiratory failure / shock*
• Metastatic cancer / acute leukemia#
• Chemotherapy / benign neoplasm#
• Artificial openings for feeding / elimination
* Impacts greatest number of patients
# Greatest risk for readmission
The Medicare Quality Improvement Organization for Florida
Results: Service Utilization
• Emergency department*
• EKG*
• Coronary care*
• Respiratory therapy*
• Ultrasound
• Renal Dialysis#
• Mental Health & Substance Abuse#
* Impacts greatest number of patients
# Greatest risk for readmission
The Medicare Quality Improvement Organization for Florida
Results: Co-existing Conditions
• Cardiac / Respiratory / Vascular*
• GI / GU
• Mental Health #
• Nutrition / Skin / Blood Disorders
• Cancer#
* Impacts greatest number of patients
The Medicare Quality Improvement Organization for Florida
Community QI Activities
The Medicare Quality Improvement Organization for Florida
Project’s Conceptual Framework
•
Adapted Coleman’s Care Transitions InterventionSM (CTI)
•
Addresses patient empowerment through Coleman’s 4 Pillars:
– medication reconciliation,
– physician follow-up,
– disease management,
– maintaining personal health record
•
Framework’s greatest strength - it is an intervention that is
standardized and replicable, but flexible enough to adapt to
organizational and patient needs.
•
CTI is not designed to be disease-specific, but it can easily be
applied to patients with a variety of chronic illnesses, more
specifically, those driving high readmission rates.
•
Stresses patient empowerment by increasing the patient’s
knowledge and self-care management skills
The Medicare Quality Improvement Organization for Florida
Coaching
The Medicare Quality Improvement Organization for Florida
Provider-Specific
Interventions
The Medicare Quality Improvement Organization for Florida
Collaboratives
The Medicare Quality Improvement Organization for Florida
Additional Activities
• Fifth Pillar: QIO & Alliance for Aging
Partnership (Area Agency on Aging for
Miami-Dade and Monroe Counties)
– The Community Living Program
• Sixth Pillar: QIO & Department of Elder
Affairs (DOEA) Partnership
– Nutritional support program
The Medicare Quality Improvement Organization for Florida
Contact:
Susan Stone, MSN, RN
Project Director – Care Transitions
Direct: 813.865.3526
Fax: 813.865.3546
Email: [email protected]
This material was prepared by FMQAI, the Medicare Quality Improvement Organization for Florida, under contract with the Centers for
Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services. The contents presented do not
necessarily reflect CMS policy. FL2009T2F72T20611018
The Medicare Quality Improvement Organization for Florida