Transcript HSAG PowerPoint Template

Seeing the Unseen
Barb Averyt, BSHA
Director, Care Coordination
Health Services Advisory Group
Arizona Readmission Rates
2013 National
Readmission
Rate for
Medicare
Fee-For-Service
(FFS) is 18%
2
Arizona
Region
Average
Rate
Northern AZ
12.9%
Southern AZ
15.1%
Western AZ
16.7%
Central Valley Phoenix
16.4%
East Valley Phoenix
West Valley Phoenix
16.9%
17.0%
Arizona rates: Medicare FFS, Hospital Readmissions:
Quarter 2 (Q2) 2013–Q1 2014
Arizona—Working Well With Each Other
• Most improved
readmission rate in the
country
• Hospital, nursing home,
and home health
agency collaboratives
across the state
• Adopted Advancing
Excellence readmission
tracking tool statewide
3
But Still More to Do
In Phoenix, West Valley…
• 36%
of patients who were readmitted returned
within 7 days of hospital discharge.
• 60%
of those who were readmitted within 7 days
did not have home health ordered when they
left the hospital.
• 28%
of those who were readmitted within 7 days
were on a high-risk medication (anticoagulant,
diabetic agent, or opioid). They did not have
home health ordered.
4
A Patient’s Story
3:00 a.m.
7:00 a.m.
10:00 a.m.
12:00 p.m.
1:00 p.m.
3:30 p.m.
4:00 p.m.
5:30 p.m.
7:00 p.m.
8:15 p.m.
8:30 p.m.
9:30 p.m.
10:00 p.m.
12:00 a.m.
1:00 a.m.
Room spinning
Explosive headache
Took vicodin for headache.
Realizes problem and need to be evaluated at the hospital.
Registered at emergency department (ED).
Threw up—Left lobby and taken to ED treatment area.
Saw ED physician assistant (PA) in the ED.
Morphine sulfate (MS) IV, 4 mg given.
CT scan
Saw ED attending physician
Lumbar puncture (LP)—failed
MS 4 mg given.
Second LP performed in radiology. Lay flat for 5 hours.
LP results shared by ED PA. Large amount of blood.
Will admit to observation and work-up.
MS 4 mg given.
A Patient’s Story (cont.)
2:30 a.m.
3:30 a.m.
4:30 a.m.
5:30 a.m.
7:30 a.m.
7:30 a.m.
8:00 a.m.
9:00 a.m.
9:30 a.m.
10:30 a.m.
12:30 p.m.
2:30 p.m.
Admitted and transferred to “good bed.”
Nurse admitted. First time patient is asked about meds.
Saw Observation PA.
Saw hospitalist #1. MS 4 mg given.
Saw neurologist.
Husband offers his version of medications (warfarin/voltaren)
to neurologist.
Given “migraine cocktail” that was ordered by neurologist.
Does not contain MS.
Ativan given in prep for magnetic resonance imaging (MRI).
MRI/MR angiography (MRA)
Back in room. Saw hospitalist #2.
MRI/MRA results shared. OK’d for discharge (DC).
Check out. Given prescriptions. Going home.
24-Hour Drug Timeline
Vicodin
taken
10:00 a.m.
MS
4 mg IV
5:30 p.m.
MS
4 mg IV
7
9:30 p.m.
MS
4 mg IV
1:00 a.m.
MS
4 mg IV
5:30 a.m.
Ativan
IV
8:00 a.m. 9:00 a.m.
Migraine
Cocktail IV
DC
Instruction
provided
Why Does This Story Matter?
• Because I’m 57. Just wait until I’m 77!
• My husband was my “advocate” and he got
confused (warfarin vs. voltaren). High anxiety
does that.
• After all the pain medication I received, was I
really capable of understanding my discharge
instructions?
8
Looking at the Opportunities
In Phoenix, West Valley…
• 36%
of patients who were readmitted, returned
within 7 days of hospital discharge.
• 60%
of those who were readmitted within 7 days
did not have home health ordered when they
left the hospital.
• 28%
of those who were readmitted within 7 days
were on a high-risk medication (anticoagulant,
diabetic agent, or opioid). They did not have
home health ordered.
9
Questions?
Thank you!
Barb Averyt, BSHA
[email protected]
This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement
Organization for Arizona, 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. Publication No. AZ-11SOW-C.3-02102015-01