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Home Health Quality Improvement National Campaign II (2010-2011)

Home Health Quality Improvement National Campaign II (2010-2011). Charles P. Schade , MD, MPH Medical Epidemiologist. Acknowledgements. Co-authors of final report Shanen Wright Bethany Knowles Karen Hannah Eve Esslinger WVMI/QI analytic staff Jill Manna Yinghua Sun John Bowers

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Home Health Quality Improvement National Campaign II (2010-2011)

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  1. Home Health Quality Improvement National Campaign II (2010-2011) Charles P. Schade, MD, MPH Medical Epidemiologist

  2. Acknowledgements • Co-authors of final report • Shanen Wright • Bethany Knowles • Karen Hannah • Eve Esslinger • WVMI/QI analytic staff • Jill Manna • Yinghua Sun • John Bowers • Cynthia Pamon, Government Task Leader • Almost 5,000 participating HHAs

  3. Disclaimer The analyses upon which this publication is based were performed under Contract Modification WV0005 to the West Virginia Quality Improvement Organization Contract, HHSM-500-2008-WV9THC, funded by the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The author assumes full responsibility for the accuracy and completeness of the ideas presented. Publication number: 9SOW-WV-HH-BK-081811. App. 8/2011.

  4. Objectives of this talk Describe the HHQI National Campaign II Compare with first campaign (2007) Present results of evaluation of the campaign Discuss how the campaign’s success might inform future QI efforts involving home health and future national campaigns

  5. Background • >3 million recipients of Medicare-paid home health services in the United States each year, including: • Medical, nursing, social, or therapeutic treatment • Assistance with the essential activities of daily living • Volume increasing over time • Patients prefer to stay home when possible, but >25% of home health episodes end in rehospitalization • First HHQI national campaign (2007) reduced rehospitalization

  6. HHQI National Campaign II • Focused on home health patient care quality as measured by • ACH reduction • Improvement in oral medication management • Cross-setting initiative • Special Project funded by Centers for Medicare & Medicaid Services • Patient-centered focus • Interdisciplinary • Free tools, resources, networking

  7. Call To Action • HHQI Summit, January 13, 2010 • National, state and local stakeholders • NationalAssociationforHomeCare & Hospice (NAHC) • Alliance for Home Health Quality and Innovation • State associations, Quality Improvement Organizations (QIOs), and corporate leaders

  8. Inter-Connected Movement

  9. Cross-Setting Focus • Efforts to Unite Providers Across Settings: • Communication and sharing tools • Campaign supporter designation • Campaign physician advisory panel • Collaboration opportunities at the state level • Cross-setting steering committee • Educational resources • Registration open to all providers -- October 2010

  10. Comparison of Campaigns

  11. Comparison of Campaigns

  12. What is a Best Practice Intervention Package? Educational package Top “best practices interventions” for themes of the campaign User-friendly collection of materials designed to be flexible and functional Downloadable from the campaign website (and still available)

  13. How Participants Obtained BPIPs • Login to http://www.homehealthquality.orgto retrieve after registering • Available as a complete package or individual sections • Leadership • Disciplines • Tools/Resources

  14. BPIP Release Schedule

  15. Fundamentals of Improving ACH • January 2010 • The Fundamentals “For me, the worst part of playing golf, by far, has always been hitting the ball.”Dave Barry

  16. Hospitalization Risk Assessment • Must know your ‘at risk’population • Target interventions accordingly • Better use of resources

  17. Emergency Care Planning • Patient Emergency Plan (PEP) • Customize for your agency • Use on every patient • Modify as appropriate • Reinforce

  18. Improvement in Management of Oral Medications • April 2010 • Accurate Assessment • Medication Reconciliation • Medication Simplification • High-Alert/High Hazard Drugs

  19. Fall Prevention • July 2010 • Multifactorial and Standardized Assessment • AGS/BGS fall prevention guidelines

  20. Cross Setting I • October 2010 • Coaching • Care Transitions • Care TransitionsSM • Transitional Care Model • Project RED • Project BOOST

  21. Cross Setting II • January 2011 • Care Transitions with Chronic Care Patients • Disease Management • Self-Management Support • Telehealth

  22. Cross Setting III • April 2011 • Innovative ideas to help prepare for health care changes • Patient-Centered Medical Homes (PCMH) • Accountable Care Organizations • Functioning as a provider community • Reducing readmissions while improving quality • Medication reconciliation and medication management from a community perspective • Communication of fall risk with the multi-provider community

  23. BPIP Downloads* by 6/29/2011 *Individual download of the BPIP or one of its components

  24. Using Data to Motivate Staff • HHQI Data Reports • Agency actual data • Current • Focus on ACH and Oral Medications • Use HHQI Data Access System Resources • Description of Monthly Report • Data Reports Webinar

  25. HHQI Data Reports • Participating HHAs obtained individualized HHQI reports through a separate secure login on the HHQI Web site • We required a secure ID from the agency’s CASPER Reports for login

  26. HHQI Resources • Social Networking • HHQI STAR • Free Webinars • Home Health and Care Transitons • Making Care Transitions a Reality Through Home Health • Conversations Across the Discharge Divide • Integrating Home Care into Primary Practice to Improve Patient Outcomes

  27. Webinar Participation *Page hits to webinar site after webinar through 6/30/2011

  28. Social Networking Opportunities • Live Chat • Discussion Forums • Blogs • Twitter, Facebook

  29. Live Chat Participation

  30. Other Social Media Use* • Facebook • 12 messages • 332-1,447 impressions/view • Blog • 2,000 views • Twitter • 90 followers • 83 tweets * through 6/7/2011

  31. Project Evaluation • Registered participants • Uptake of materials/event participation • BPIP evaluations • Changes in quality measures • Program participation linked to outcomes

  32. Registered Participants • 10,865 Medicare Home Health Agencies (HCIS, 2010) • By 5/31/2011, 4,721 (43%) had registered for the campaign • Of those, 3,075 had >=10 discharges/month (1/1/2010-6/30/2011) and were included in analysis • Potentially impacted about 3 million patients

  33. BPIP User Feedback • E-mail inquiry (Zoomerang) sent to agencies downloading BPIP • BPIP-specific questions, but similar structure • Use of relevant campaign materials • Taking recommended actions • Self-assessed impact • 4 BPIPs evaluated

  34. Recommended Tool Use

  35. Actions Taken or Planned after Downloading BPIP

  36. Posting Tables and Graphs Showing Medication Management Performance

  37. Self-Reported BPIP Impact

  38. Outcomes • Quality measures generally improved • Quality performance was better in groups of agencies with more intense participation in the campaign • OASIS-B to OASIS-C transition appears to have impacted the medication management improvement measure

  39. Agencies grouped by participation • “Nonparticipants” did not sign up for the HHQI National Campaign • “Participants” signed up for the campaign, but did not download related campaign materials • “Downloaders”signed up and downloaded materials related to the BPIP • “Respondents” responded to the user evaluation related to a BPIP

  40. Acute Care Hospitalization Rate BPIP released

  41. Medication Management Improvement BPIP released No data due to OASIS-B to OASIS-C conversion

  42. Impact Assessment • ACH outcome only • Using item response theory, developed composite score for ACH evaluation responses • Divided composite score into quartiles, which we believe represented increasing levels of intensity of participation in campaign

  43. Changes in ACH and ALOS by Participation Intensity Quartile *Average length of service for home health patients in agency

  44. Cost implications Project cost $1.4 million Project cost equivalent to 127 admissions Average Medicare hospital admission cost $11,000 195 HHAs in top 2 partici- pation quartiles averaged 1,600 episodes/year 1,560 fewer readmissions than expected These HHAs reduced hospital admissions 0.5% more than lower groups

  45. Limitations • Observational study (pre-post) • Small sample size • Missing data • Confounding ACH with ALOS • Externalities

  46. Conclusions • Campaign was successful, engaging nearly 5,000 home health agencies • Agencies used campaign materials and many adopted recommended practices • Quality of care measures • Acute care hospitalization • Medication self-management • Participation intensity linked with improvement

  47. Future Challenges • Understanding and addressing disparities • Reaching smaller agencies • Accelerating improvement

  48. Questions? Comments? Thank you for coming to this presentation. Presenter e-mail: cschade@wvmi.org or see our website, www.HomeHealthQuality.org

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