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Pumping Cardiovascular
Health Into Action
Bonnie Hollopeter, LPN, CPHQ, CPEHR
Cindy Sun, MSN, RN, COS-C
Chad Vargas, MHA, BS
March 11, 2015
Agenda
11:30–11:40 a.m. Welcome and Endorsement from OCHCH
11:40 a.m.–12:40 p.m. Pumping Cardiovascular Health into
Action: Home Health Quality Improvement (HHQI) and Health
Services Advisory Group (HSAG)
Introduction of HSAG
HHQI/HSAG Collaboration and Business Case
Bonnie Hollopeter, LPN, CPHQ,
CPEHR, CPHIT, HSAG Quality
Improvement Lead
Cindy Sun, MSN, RN, COS-C, HHQI
Lead Cardiovascular Project
Coordinator
Peer Experience: Using Cardiovascular Health Data
Chad Vargas, MHA, HSAG Quality
Improvement Associate Director
HSAG’s No-Cost Technical Assistance to Ohio Home Health
Agencies and Call to Action
Matt Etzkorn, RN-BC, BSN, MA,
Saint Rita’s Home Health
12:40–1:00 p.m. Questions and Answers
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Beth Foster, RN, BA, CPHQ
All
Objectives
• Describe the partnership of Health Services
Advisory Group (HSAG) and Home Health
Quality Improvement (HHQI).
• Identify the quality improvement resources
and technical assistance available.
• Develop a plan for conducting quality
improvement activities for your home health
agency (HHA).
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About HSAG
• Committed to improving quality of healthcare
for more than 35 years
• Provides quality expertise to those who
deliver care and those who receive care
• Engages healthcare providers, stakeholders,
Medicare patients, families, and caregivers
• Provides technical assistance, convenes
learning and action networks (LANs), and
analyzes data for improvement
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About HSAG (cont.)
Nearly 25 percent of the
nation’s Medicare beneficiaries
HSAG is the Medicare Quality Innovation NetworkQuality Improvement (QIN-QIO) for Arizona, California,
Florida, Ohio, and the U.S. Virgin Islands.
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What is a QIN-QIO?
• Funded by the Centers for
Medicare & Medicaid Services
(CMS)
– Dedicated to improving health
quality at the community level
– Ensures people with Medicare
get the care they deserve, and
improves care for everyone
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Department of Health &
Human Services
The Centers for Medicare
& Medicaid Services
Affordable Care
Act/National
Quality
Strategy
CMS Quality
Strategy
QIN-QIO
Activities
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Goals are Aligned
Goals Are Aligned
•
•
•
•
•
•
Make care safer.
Strengthen person and
family engagement.
Promote effective
communication and
coordination of care.
Promote prevention and
treatment of chronic
disease.
Work with communities to
promote best practices of
healthy living.
Make care affordable.
What is HHQI?
Goal: Improve the quality of
care home health patients receive
Special project funded by CMS
Many networking opportunities
with 12,000+ participants
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What is HHQI? (cont’d)
Education
Free evidence-based tools and resources
Data
Customized Data Reports
Networking
Get Connected and Engage with other providers
Assistance
Need Help? We’re here for you
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Phase 3: September 2012–July 2014
Focused on quality of home health (HH) care measured by :
• Reduction of avoidable acute care hospitalizations (ACH)
• Improvement in oral medication management
• Improvement of immunization rates
• Improvement of cardiovascular health
Continued HH focus, but all care settings and patients participate
Introduced Underserved Population Network
Launched the Home Health Cardiovascular Data Registry
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HHQI Phase 4 Focus
• Cardiovascular health
• Reducing hospitalizations
• Chronic diseases,
falls prevention, and
wound care
• Reducing disparities
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HSAG and HHQI Partnership
• Home health is returning to QIO core work
after 6-year absence.
• HSAG will be working with a limited number of
HHAs in each state on the following:
• HHQI evidence-based practices
• Cardiovascular health
• Quality improvement
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Proposed Conditions of Participation (CoP)
• Federal Register published 10/06/14
• http://www.gpo.gov/fdsys/pkg/FR-2014-10-09/pdf/2014-23895.pdf
• Revision of Requirements Fact Sheet
• http://www.cms.gov/Newsroom/MediaReleaseDatabase/Factsheets/2014-Fact-sheets-items/2014-10-06-2.html
• Comment period ended 12/08/14
• No date for implementation
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Overarching CoP Changes
• Focuses on assuring the protection and
promotion of patient rights
• Enhances the process for care planning,
delivery, and coordination of services
• Streamlines regulatory requirements
• Builds a foundation for ongoing, data-driven,
agency-wide quality improvement
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Quality Assessment and Performance
Improvement (QAPI) Program
• HHA to develop, implement, and maintain an
agency-wide, data-driven QAPI program
– Preemptive planning that continuously addresses
quality improvement
– Data collected in the OASIS process, CMS-provided
patient outcome and process reports, and
numerous other industry efforts currently
underway
• Example: HHQI Reports
• Plans for sustainment after goals are met
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HSAG and HHQI: QAPI
• Experts in quality improvement (QI)
• Provide assistance for HHAs:
• Help with doing formal QI plans
• Validation and assurance expertise
• Familiar with different QI models
• Possess independent perspective of processes,
documentation, etc.
• Offer assistance with underserved populations
• No-cost
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Samples of HHQI Tools for QAPI
• Pave Your Path Webinar Series: Designing a
Systematic Approach to Quality Improvement
– 4-part recorded webinar series
– Institute for Healthcare Improvement (IHI) and HHQI
– Plan, Do, Study, Act (PDSA)-cycle approach
• Underserved Populations Primary Best Practice
Intervention Package
–
–
–
–
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Health disparities
Dual-eligible population
Underserved areas
Small HHA unique challenges
Million Hearts® Initiative
• Launched 2011
• Co-Leaders: Centers for Disease
Control and Prevention (CDC)
and CMS
• All settings
• Goal: Prevent 1 million heart
attacks and strokes by 2017
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Million Hearts®
The Million Hearts® word and logo
marks, and the Be One in a Million
Hearts® slogan and logo marks and
associated trade dress are owned by the
U.S. Department of Health and Human
Services (HHS). Use of these marks does
not imply endorsement by HHS. Use of
the Marks also does not necessarily imply
that the materials have been reviewed or
approved by HHS.
What are the ABCS?
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Cardiovascular Disease (CVD): National Impact
Heart Disease is the
#1 cause of death
Stroke is the
#4 cause of death
1 out of 3 deaths are
related to CVD
Greatest contributor
to racial disparity in
life expectancy: CVD
George, Tong, Sonnernfeld, & Hong, 2012;
Roger VL, et al. Circulation. 2012;125:e2-e220. & Heidenriech PA, et al. Circulation. 2011;123:933–4
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Heart Disease and Stroke in the U.S.
• More than 1.5 million heart attacks and strokes
occur each year
• CVD causes 1 out of every 3 deaths
– 800,00 cardiovascular disease deaths each year
– Leading cause of preventable death
– $315 billion in healthcare costs and lost productivity
• Leading contributor to racial disparities in life
expectancy: CVD
Kochanek KD, et al. Natl Vital Stat Rep. 2011;60(3). Go AS, et al. Circulation. 2012:e2–241
Heidenriech PA, et al. Circulation. 2011;123:933–4. NCHS Data Brief, June 2013.
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So Why Does it Matter?
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HHQI CV Health Improvement Initiative
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HHQI Cardiovascular Resources
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HHQI University
• Free CE courses for
nursing
• Current courses
include
– State of Cardiovascular
Health
– Blood pressure and
smoking cessation
– New classes are added
monthly
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HHQI Log-In
HHQI National Campaign Website
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HHQI: Best Practices
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BPIPs on the HHQI Website
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Join the Cardiovascular Movement page on
the HHQI Website
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Join the CardioLAN
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Earning your Cardio Milestones
Join the Progressive CardioLAN
Download Cardiovascular BPIPs and complete
Data Access registration
Close one month of required patients' data in the Home Health
Cardiovascular Data Registry (HHCDR) and download one report
Enter patient data and close a total of six months of
required patients' data for HHCDR and validate data
Achieve noted improvement in one
or more cardiovascular outcomes
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HHCDR Overview
Home Health
Cardiovascular
Data Registry
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HHCDR Overview (cont’d)
• Aligns with physician quality measures (PQRS)
• Includes patients with the following:
– Diabetes
– Hypertension
– Ischemic vascular disease
– Dyslipidemia
– Tobacco use
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HHCDR Details
• Monthly data abstraction by episode of care
• Uses Outcome and Assessment Information
Set (OASIS) data to select patients for the
agency
• Agency choses month and measure to
abstract
• Agency receives HHCDR report around day 23
of the month following the close
• Month opens on the day 15 of each month
and closes the following month on day 14
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HHCDR
What data do you need to abstract?
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Cardiovascular Measure #1
Aspirin As Appropriate (ASA)
• Did the patient take aspirin
or other antithrombotic
(clopidogrel, prasugrel, or
ticlopidine) during this
episode of care? Yes or No
• Contraindication noted in
record (check box)
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ASA Campaign Example
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Cardiovascular Measure #2
Blood Pressure Control
• What was the last blood
pressure recorded during
this episode of care?
(Record systolic, diastolic,
and date)
• Was a follow-up plan to
obtain better blood
pressure control included in
the record during this
episode of care? (Yes or No)
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Risk of Preventable Death From Heart Disease
SOURCE:
National Vital
Statistics
System, US
Census Bureau,
2008-2010.
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Will Your Efforts Make a Difference?
If every elevated systolic blood pressure was
reduced by 5 mm Hg, results would include:
• 14 percent overall reduction in mortality
due to stroke
• 9 percent reduction in mortality due to
cardiovascular heart disease
• 7 percent decrease in all-cause mortality
JNC 7 Complete, 2004
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Blood Pressure Assessment
• Accurate blood
pressure monitoring
– Steps for accuracy
– Video and article from
New England Journal of
Medicine
– Blood pressure accuracy and accurately assessing
orthostatic hypotension
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Right Equipment is Essential
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Blood Pressure Self-Monitoring
• Ambulatory blood pressure
monitoring
– Regular measurement of
blood pressure outside of
clinical setting
– Example: home monitors
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Multidisciplinary Approach
for Blood Pressure Control
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Cardiovascular Measure #3
Cholesterol Management
• Is there documentation in
the medical record that the
patient received a
cholesterol screening within
the 12 months prior to this
discharge date? (Yes or No)
• Please indicate which test
results were documented in
the patient’s record.
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Cholesterol Data
U.S. adults with diagnosed
or undiagnosed:
• Hypertension
• Hypercholesterolemia
• Diabetes
at least 1 of 3
45%
2 of 3
13%
3 of 3
3%
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Cardiovascular Measure #4
Smoking/Tobacco Screening
• During this episode of care,
was the patient screened
for tobacco use by the
home health agency? (Yes,
No, or not applicable due to
medical reason)
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Cardiovascular Measure #4
Smoking/Tobacco Screening Questions
• During this episode of care, was the
patient screened for tobacco use by
the HHA?
• Was the patient identified as a
current tobacco user?
• Did the patient receive tobacco
cessation counseling/intervention
by the HHA?
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Smoking
Most important preventable
cause of premature death in the U.S.
Increases risk of developing many chronic disorders,
including atherosclerosis, leading to heart
attack and stroke
Controlling/reversing atherosclerosis is important to
preventing future heart attacks and strokes.
AHA, 2012
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HHCDR Peer Experience
Matt Etzkorn RN-BC, BSN, MA
Quality Review Nurse
Saint Rita’s Home Health
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Leadership
Policies &
Procedures
• State agency expectation of when and who are to assess blood
pressure
• Establish standardized protocols related to blood pressure and
other ABCS.
• Revise parameter standards (e.g., < 150/90 or less).
• Modify electronic health records for easy access to trending vital
signs.
• Use standardized communication systems and tools (e.g., SBAR).
Equipment
• Ensure all staff have access to accurately working equipment.
• Accommodate for hearing impairments.
• State agency expectations for routine cleaning, inspections, and
testing.
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Leadership (cont’d)
Cardiovascular • Create a sense of urgency for integrating CV disease
prevention.
(CV)
• Select appropriate resources.
Prevention
• Use games, skits, etc. at staff meetings to convey
Culture
importance.
CV Health
Data
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• Assign staff member to abstract and enter HHCDR data.
• Review HHQI data monthly and share results with staff.
• Use Plan, Do, Study, Act (PDSA) cycles to assess and
modify CV interventions.
(start small and build)
Nursing
Accurate
Assessment
• Validate that each nurse has the right equipment.
• Ensure blood pressure measurements correctly. It sounds simple,
but is not always done.
• Assess vital sign trending at each visit or all disciplines.
Communicating
with Physicians
and
Practitioners
• Ask for patient-specific parameters or use agency-standardized
protocols.
• Use standardized effective communication methods (e.g., SBAR).
Lifestyle
Modification
Education
• Teach all lifestyle modifications often throughout episode of care.
• Acknowledge that these modifications will effect most chronic
diseases.
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Therapy
 Take blood pressure
measurement on all
visits.
 Obtain skilled nursing
referral for further
assessment and
education, if needed.
 Teach selfmanagement of
medications to
improve adherence.
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PT*
• Establish home exercise program and
provide safety education.
OT*
• Provide postural syncope education,
especially with bathing.
• Teach self-management of
medications to improve adherence.
SLP*
• Evaluate, treat, and teach on
swallowing issues with pills/fluids.
• Teach cognitive skills to improve
adherence to medications.
* Physical therapist = PT; Occupational therapist
= OT; Speech/language pathologist = SLP
Ancillary Staff
Social
Worker
HHA
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• Build community resources.
• Create food bank lists.
• Connect with local faith organizations.
• Educate on cardiac health, including diet.
• Check blood pressure accuracy and
parameters on care plans.
• Teach signs and symptoms to report.
Health and Wellness
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Agency Wellness
• BMI, cholesterol,
and blood pressure
monitoring
• Activity logs
• Lunchtime walks
• Zumba after work
• Running programs
• “Biggest Loser”
Competitions
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• Weight Watchers
at work
• Healthy snacks
• Food tips
• Recipe
exchanges
• Office salad bar
Employee Support
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Next Steps
1.
2.
3.
4.
5.
Connect with HSAG and request assistance.
Register for HHQI.
Register for Data Access.
Participate in the CardioLAN.
Abstract monthly in the Cardiovascular Data
Registry.
– www.HomeHealthQuality.org
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Next Steps (cont’d)
6. Review the cardiovascular health BPIPs.
– Begin with aspirin and blood pressure control.
– Determine if blood pressure measurements are being
taken accurately and consistently.
7. Connect with HHQI through social media
– Facebook, LinkedIn, Twitter, My HHQI Blog, Live Chat
– www.HomeHealthQuality.org
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Questions?
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Thank You!
Contact Information:
Bonnie Hollopeter, [email protected]
Chad Vargas, [email protected]
Cindy Sun, [email protected]
Matt Etzkorn, [email protected]
This material was prepared by the Centers for Medicare & Medicaid Services (CMS) and adapted by Health Services Advisory Group, the
Medicare Quality Improvement Organization for Ohio, under contract with the CMS, an agency of the U.S. Department of Health and
Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. OH-11SOW-B.1-02252015-01
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