Transcript ICD-10 Implementation in a 5010 Environment

CMS National Conference
on Care Transitions
December 3, 2010
1
How Project RED and
the Care Transitions Project
Reduced Readmissions in
South Texas
Robin Jones, RN
Quality Care Coordinator
Valley Baptist Medical CenterBrownsville
Jennifer Markley, RN, BSN
Senior Director, Medicare Quality
Improvement
TMF Health Quality Institute
2
CMS Care Transitions Project
• Project began in August of 2008
• Data analysis was based on 2007
Medicare claims data
• 14 communities in the U.S
• Reduce hospital readmissions
through improved quality of
patient transitions
3
CMS Care Transitions Project
• Goal is minimum 2% reduction
30-day rehospitalization rate by
28th month of the project
(November 2010)
• A comprehensive communitywide, cross-setting effort
• Yield sustainable and replicable
strategies
4
CMS Care Transitions Project
This map shows the 14 states where Care
Transitions projects are located.
5
Baseline Measurements
TABLE 1: Hospital Disposition After Inpatient
Hospitalization
Quarter 1, 2008 based on Medicare Claims Data
Region and
Provider
S etting
Harlingen Region Home Health Agency (HHA)
Home
Inpatient Rehabilitation Facility (IRF)
Long-Term Acute Care (LTAC)
Skilled Nursing Facility (SNF)
All
VBM C-B
Home Health Agency (HHA)
Home
Inpatient Rehabilitation Facility (IRF)
Long-Term Acute Care (LTAC)
Skilled Nursing Facility (SNF)
All
Number of
Discharges
Percent of
Percentage of All Discharges with Discharges with
Discharges
a 30-day Readmit a 30-day Readmit
1,109
2,736
281
180
604
4,910
22.6%
55.7%
5.7%
3.7%
12.3%
100.0%
173
648
45
29
189
1,084
15.6%
23.7%
16.0%
16.1%
31.3%
22.1%
162
387
44
41
79
713
22.7%
54.3%
6.2%
5.8%
11.1%
100.0%
22
104
4
10
26
166
13.6%
26.9%
9.1%
24.4%
32.9%
23.3%
6
Valley Baptist Medical
Center-Brownsville
• A faith based 280 bed licensed, notfor-profit acute care hospital,
including a 37 bed off-campus Psych
facility
• Level 3 designated trauma center
• JC accredited for hospital & lab and
stroke-certified
• Located on the southernmost tip of
Texas, on the border with Mexico
7
Baseline Measurements –
VBMC-B
• CT Project hospital baseline rate of
23.3% all cause 30-day readmission rate
(Q1 2008)
• 28.1% Hospital Compare heart failure
readmission rate
– Data for discharges between July 01,
2006 and June 30, 2009
– (http://www.hospitalcompare.hhs.gov)
8
Solutions
• Implementation of Project RED
−Initial focus on HF patients,
Telemetry Unit
−May 2010, expanded to all diagnoses,
Telemetry Unit
• Community-wide partnership with
downstream providers
−Use of EHR to improve hand-off
communication
−Active involvement in Regional
Workgroup meetings
9
Solutions
• Education of medical staff including
physicians
– Medication reconciliation
– Health literacy and patient safety
– Chronic kidney disease
10
Implementation
• All components of Project RED were
implemented and monitored in facility’s
30 bed Telemetry floor
−Team approach to administering all
eleven components
−Nursing, Care Management,
Pharmacy and Core Measures Team
all contributed to process
11
Teamwork
• Nursing & Care Management
– Educate the patient about his or her
diagnosis throughout the hospital
stay
– Discuss with the patient any tests or
studies that have been completed in
the hospital and discuss who will be
responsible for following up on the
results
– Review the appropriate steps for what
to do if a problem arises
12
Teamwork
• Nursing
– Provide follow-up telephone
reinforcement
– Assess degree of understanding
(teach-back)
– Provide patient with a written
discharge plan
– Make appointments for clinician
follow-up and post-discharge testing
13
Teamwork
• Care Management
– Organize the post-discharge services
– Expedite transmission of the
Discharge Resume to the physicians
and other services accepting
responsibility for the patient’s care
after discharge
14
Teamwork
• Nursing, Pharmacy & Care Management
– Confirm the Medication Plan
• Nursing/Core Measures
– Reconcile discharge plan with
national guidelines
15
Monitoring for Effectiveness
• Patients were asked a total of nine brief yes or no questions
about their perceptions. Surveys were available in English
and Spanish.
– I was taught about my diagnosis during my hospital
stay.
– I have follow-up appointments with my physicians.
– I have been told about test results or studies that have
not been completed before I go home.
– If I need home health care, medical equipment or other
help or services after I go home, it has been arranged.
– I understand what to do and who to call if a problem
arises after I am home.
16
Monitoring for Effectiveness
• Survey Questions continued:
– I have received a written discharge plan that is easy to
read and understand.
– I have received a written discharge plan that has the
information I need to take care of myself at home.
– I have a written list of my discharge medications and
know which medications are new or changed.
– When the nurses were teaching me, they asked me to
explain what I had learned in my own words.
17
Administering Patient
Surveys
• Case Management (CM) runner
sends out daily Length of Stay (LOS)
report to identify patients going
home with no services to Case
Managers, Tele Supervisor/Charge
Nurse, and Quality Assurance
• Floor staff is responsible for
completing all components of RED
prior to discharge
18
Administering Patient
Surveys
• CM runner delivers and retrieves
patient survey and forwards
completed surveys to Quality
• CM updates the LOS report daily to
reflect D/C plan and submit to CM
runner and Quality
19
Patient Survey Results
Data Averages based on 273 completed surveys
between January and September 2010
•
93% of patients surveyed said that they had received education
about their diagnoses
•
94% of patients surveyed said that they had a follow-up
appointment. 88% had a follow-up appointment scheduled within
one week post-discharge
•
99% of patients surveyed said that their written discharge plan
had the information needed for self care and that it was easy to
read and understand
20
CT Project Results
TABLE 2: Hospital Disposition After Inpatient
Hospitalization
Quarter 1, 2010 based on Medicare Claims Data
21
CT Project Results for
Harlingen HRR
FIGURE 1: Percent of Discharges with a 30-day
Readmission for HHRR
•
•
Hospital Disposition After Inpatient Hospitalization
Baseline compared to Quarter 1, 2010 based on Medicare Claims Data
22
CT Project Results for
VBMC-B
FIGURE 2: Percent of Discharges with a 30-day
Readmission for VBMC-B
•
•
Hospital Disposition After Inpatient Hospitalization
Baseline compared to Quarter 1, 2010 based on Medicare Claims Data
23
CT Project Outcome
Measures for VBMC-B
FIGURE 3: Percent of Hospital Readmission Within
30 Days
•
•
Semi-annual rate ending in Quarter 1 2010
A 3.6% decrease in all cause 30-day readmissions
26.0%
24.0%
21.9%
23.1%
23.7%
22.3%
22.2%
23.0%
21.5%
22.0%
22.6%
22.3%
20.0%
19.5%
18.0%
16.0%
14.0%
CY 2007
Baseline Q2 2008 Q3 2008 Q4 2008 Q1 2009 Q2 2009 Q3 2009 Q4 2009 Q1 2010
VBMC-B
Harlingen HRR
Target (Q1 2010)
24
CT Project Outcome
Measures for VBMC-B
FIGURE 4: O-1a: HCAHPS Medication Management
•
4-quarter rolling rate ending in the listed quarter
95%
90%
87.5%
87.5%
87.9%
89.1%
87.5%
85%
79.6%
79.6%
Q3 2009
Q4 2009
81.3%
80%
75%
70%
65%
60%
Baseline
Q3 2008
Q4 2008
Community Average
Q1 2009
Q2 2009
VBMC-B Target (Q1 2010)
Q1 2010
Baseline (Q2 2008)
VBMC-B
25
CT Project Outcome
Measures for VBMC-B
FIGURE 5: O-1b: HCAHPS Discharge Planning
•
4-quarter rolling rate ending in the listed quarter
95%
90%
85.6%
87.3%
86.2%
85.7%
83.7%
83.2%
85%
87.2%
86.6%
80%
75%
70%
Baseline
Q3 2008
Q4 2008
Community Average
Q1 2009
Q2 2009
Q3 2009
VBMC-B Target (Q1 2010)
Q4 2009
Q1 2010
Baseline (Q2 2008)
VBMC-B
26
CT Project Outcome
Measures for VBMC-B
FIGURE 6: O-2: Percent of Patients Seen by a
Physician Between DC and Readmission
80%
70%
60%
50%
48.8%
44.8%
41.5%
40%
30.7%
45.7%
45.3%
36.5%
32.0%
24.4%
30%
20%
Baseline
Q2 2008
Q3 2008
Community Average
Q4 2008
Q1 2009
Q2 2009
VBMC-B Target (Q1 2010)
Q3 2009
Q4 2009
Baseline (Q1 2008)
Q1 2010
VBMC-B
27
For more information about
Project RED, contact
• For more information about Project RED
research:
https://www.bu.edu/fammed/projectred/index.html
• For additional information about dissemination:
http://www.engineeredcare.com
• For commercial inquiries:
[email protected]
For more information, contact:
Jennifer Markley, RN, BSN,
Senior Director, Medicare Quality Improvement
TMF Health Quality Institute
Phone: 512-334-1663
E-mail: [email protected]
Care Transitions Web Site:
http://CareTransitions.tmf.org
This material was prepared by TMF Health Quality Institute, the Medicare Quality Improvement Organization for Texas,
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. 9SOW-TX-CT-10-67
29