PIP Process Example

1. Nursing Home Diversion ProgramBreakout Session #2 Wednesday, June 18, 20081:15 p.m. to 3:15 p.m.WELCOME!

2. PIP Process Example Evercare Health & Home Nursing Home Diversion Program May 2008 Lynn Parrish MS, ARNP Evercare Florida

3. Problem Identification • Routine review of disenrollment reports by quality staff • Reviewed quarterly to track and trend voluntary disenrollments specifically • Results graphed to compare indicators to expected results based on historical data • Graphs provide a strong visual for ease of tracking

4. Findings • An increase in total voluntary disenrollments was identified for Q1-2006 over 2005 • Data were sorted to identify most frequent reason for disenrollments • Disenrollments of enrollees in ALFs increased over previous reports • No other trends were noted in this report

5. Analysis • A graph was created of the total voluntary disenrollments from ALFs for each quarter 2005 as the baseline measurement with an annual roll-up for 2005 • To control fluctuations in population, a rate of disenrollments was calculated for each quarter

6. Disenrollment Calculations • Denominator = all enrollees who were enrolled in the plan a minimum of one month during the measurement quarter • Numerator = total number of voluntary disenrollments while in an ALF

7. p Value Calculation • Fisher's exact test • The two-tailed p value equals 0.2529    • The association between rows (groups) and columns (outcomes) is considered to be not statistically significant • www.graphpad.com/quickcalcs/chisquared1.cfm

8. Actions • A work group was convened to include contracting, provider relations and clinical staff • Q1 & Q2 2006 reports were reviewed to identify trends • The work group brainstormed to identify possible causes based on their respective views (root cause analysis) • The results were placed in an action plan format

9. Action Plan • Issues identified • Interventions were identified • Responsibilities assigned • Expected date of completion was assigned for each assignment • Re-measurement scheduled

10. Re-measurement • The interventions were implemented Quarter 3, 2006 • Quarter 4, 2006 there was a dramatic drop in the total number of voluntary disenrollments while in an ALF • The disenrollments continued to decline through Q1 & Q2 2007 until they were at the 2005 levels

11. Discussion • The interventions were not fully implemented until Q3 2006 • Q4-06 and Quarters 1, 2 & 3 of 2007 were the re-measurement periods to evaluate the outcomes from the interventions

12. Discussion • The plan identified the issue through review of total disenrollments because the numbers are small and easy to track and trend • A statistical analysis comparing the 2006 Qs 1-3 results to the 2007 Qs 1-3 results was performed • The p values were not statistically significant

13. Discussion • The resulting decline in total number of disenrollments each quarter from ALFs to 2005 baseline may not have been statistically significant but it was significant enough by the plan standards to consider the interventions a success