Presentation on theme: "“See You in Seven” What’s Happening in Cardiac Rehab"— Presentation transcript:
1“See You in Seven” What’s Happening in Cardiac Rehab Heather Shuster, MSManager, Population Health & WellnessGenesis HealthCare System, Zanesville, OhioLean Six Sigma – Green Belt
2Hospital to Home (H2H)The H2H national quality improvement initiative is an effort to reduce cardiovascular-related hospital readmissions and improve the transition from inpatient to outpatient status for individuals hospitalized with cardiovascular disease. The H2H initiative is co-led by the American College of Cardiology (ACC) and the Institute for Healthcare Improvement (IHI).
3Hospital to Home (H2H)H2H Goal: To reduce all-cause readmission rates among patients discharged with heart failure or acute myocardial infarction by 20% by 2012.
4Hospital to Home (H2H) Why choose H2H? Nearly 20% of Medicare patients are readmitted to the hospital within 30 days of discharge, with heart failure listed as the common reason for readmission.In 2004 alone, the total cost of these readmissions was $17.4 billion.CMS reimbursement dependent on readmission rates
5Hospital to Home (H2H)“Right now hospitals, are not penalized if there are constant readmission rates from patients that have gone through the hospital.”
6Hospital to Home (H2H) H2H Focus H2H will focus on three main domains that provide opportunities for improvement:Medication Management Post-Discharge: Is the patient familiar and competent with their medications and do they have access to them?Early Follow-Up: Does the patient have a follow-up visit scheduled within a week of discharge and are they able to get there?Symptom Management: Does the patient fully comprehend the signs and symptoms that require medical attention and who to contact if they occur?
7H2H: “See You In Seven”Hospital to Home (H2H) have gathered expertise and experience around the “See You in Seven” (SY7) program, proven to reduce unnecessary hospital readmissions and improve transitions of care for patients with CHF, AMI and PTCA/PCI.The goal of SY7 is for all patients discharged with these diagnoses to start cardiac rehab or be seen at follow-up clinic within 7 days of discharge.
8H2H: “See You In Seven” Implementing a successful program: Find your Champions (RNs, Drs., Managers etc.)Develop inpatient process/staffing matrix for educating patients (Navigators, Nurse Educators)Create learning/teaching tools4. Develop process for scheduling and referring to follow-up clinic or Cardiac Rehab programs
9H2H: “See You In Seven” Find your champions (RNs, Drs., Managers etc.) - Create a committee of RNs, Drs., Managers etc. to work on developing, implementing and supporting the project.- Buy-in from the nursing staff as well as managerial/physicians is imperative to making this program successful.Develop an inpatient process/staffing matrix for educating patients (e.g. Navigators, Nurse Educators)- Less teaching for admission and discharge nurses- Navigators or Nurse Educators provide "survival skill" teachings to patients while in hospital- Set up appointment with clinic or cardiac rehab- Ensure patient compliance with follow-up appointment in clinic and/or cardiac rehab
10H2H: “See You In Seven”3. Create teaching pathways/outline to ensure standardized teaching methods and information are provided to every patient- Create patient take-home folder with educational resources/materials- Quality teaching and learning time is established with patient- Increased understanding of the materials and compliance post- discharge4. Develop process for scheduling and referring to follow-up clinic or cardiac rehab programs- Create standardized process for scheduling and referring to outpatient services- Discuss, resolve and document any barriers to keeping appointments- Patient provided with appointment reminder (e.g. Appt card) to increase compliance- Follow-up clinic or cardiac rehab program establishes appointment slots for SY7 patients
11H2H: “See You In Seven” Success Measures and Strategies The hospital discharge process is successful if:HF, AMI and PCI patients are identified prior to dischargeClinic or cardiac rehab appointment within 7 days is scheduled and documented in the medical recordPatient is provided with documentation of the scheduled appointment (e.g. appointment card).Date, time, location, provider contact information.Possible barriers to keeping appointment are identified in advance, addressed, and documented in the medical record
12H2H: “See You In Seven”The follow-up clinic or cardiac rehab appointment is successful if:Patient arrives at appointment within 7 days of discharge from hospitalDischarge summary (including summary of hospitalization, updated medication list) available to follow-up provider.Patient brings his/her medications or a medication list to appointmentReason for referral available to cardiac rehab and patient brings referral or provider prescription.
13H2H:“See You In Seven” Implementation in the Cardiac Rehab Setting Example process for transitioning patient from inpatient to outpatient:Navigator calls to schedule appointment with CR for patient within 7 days of dischargeCR staff opens appointment time and schedules SY7 patientAfter patient is discharged, CR staff will contact patient to check up and remind patient to bring medications to appointmentCR staff calls patient to remind them of appt (1 day prior)Patient arrives at CR at appointment time with medicationsPatient is oriented to the program and exercise equipment.Patient is placed on a restricted exercise prescription for the first week to allow for ample healing time and then will be transitioned for normal progression.
14H2H:“See You In Seven” Outcomes This is a new initiative for H2H due to the pending CMS reimbursements.H2H Outcomes are still being assessed.
15Supporting Research: AHA -Circulation (Reuters Health) – December 28, 2012 “Scheduling heart patients’ first cardiac rehabilitation session within 10 days of hospital discharge gets more of them to show up…”“Researchers found the earlier scheduling led to 18% increase in attendance at the first orientation appointment compared to appointments scheduled a month or more after discharge”Case Study: 148 randomized heart patients from Henry Ford Hospital in Detroit74 patients received appointments on average 8.4 days after discharge77% attended orientation appointment (n=57)74 patients received appointment on average 42 days after discharge59% attended orientation appointment (n=44)Dr. Quinn Pack, study lead author stated –“I think what actually happens is people go home and they’re scared to exercise and (they) go back to their dietary habits…and you are not able to capitalize on that habit change initiative.”Dr. Frank Richeson, Director of cardiac rehabilitation at the University of Rochester Medical Center in New York stated –“I was surprised that we didn’t know that already. Recruitment early when the iron is hot makes a lot of sense intuitively.”
16Genesis Heart & Vascular Rehab 2011 Lean Six Sigma Project – Increase units charged Goal - Increase the percentage of average YTD charged units in Cardiac Rehab from –3% in August to 0% by December 31, 2011 as compared to 2010 charged unitsDeveloped new scripting for scheduling eligible patientsRevised all handout materials to increase complianceCharging for three 30 minute education classes that were previously not charged for (CPT 93797)Started H2H “See You in Seven” ProgramWellness Coaching Sessions (3 units) for eligible clientsWorking with IT to utilize EPIC for eligible patient lists and automatic order sets
17Genesis: “See You In Seven” Started in August 2011Champions:Nurse Navigators (2012)Heart & Vascular Diagnostics (Phase I)HVR Medical DirectorAdministrationLean Six Sigma
18Genesis: “See You In Seven” Example of SY7 Referral to HVR Patient identified by AMI/PCI/HF NavigatorsPatient educated on benefitsNavigator calls HVR program to scheduleAppointment scheduled within 7 days of discharge and documented in medical record. (Automatic order on all cardiac patients in EPIC)Educator provides patient with appointment cardHVR program contacts patient to complete paperwork following dischargeHVR program calls patient 1 day prior to appointment as a reminder** Navigators would be following-up with patient as well to ensure compliance.
19Genesis: “See You In Seven” Implementation Outcomes 60 pts.66 pts.73 pts.97 pts.
25Genesis: See You In Seven Outcomes Average METs increase = 34%100% had follow-up exercise plan documentedAverage change in waist measurement = 1 inchSY7 clients with weight loss goals lost on average 2 lbs.One client lost 17 lbs.Financial Impact (Jan-June 2013)Total HVR Program profit = $37,026.80
29From the mouth one of our cardiologist to the wall of the gym…
30Genesis Heart Failure Exercise Program Clients learn how to be more physically active and feel better with exercise while successfully learning to improve their quality of life with heart failure.This self-pay program includes:Exercise and education sessionsIntermittent EKG monitoringWeight monitoringThe goals of the program include:Improve quality of lifeDecrease risks associated with HFDecrease additional hospital staysLearn sustainable lifestyle changes
31“GOING THE DISTANCE WITH P.A.D.” Clients learn how to be more physically active and feel better with exercise while successfully learning to improve their quality of life with peripheral artery disease.This self-pay program includes:Exercise and educationTreadmill walking and strength trainingOne on one health assessmentThe goals of the program include:Relieve symptoms of P.A.D.Improve walking capacityDecrease risks associated with P.A.D.Improve quality of lifeEver have to stop and rest while walking due to pain in your legs?We have developed a program just for you. Our PAD exercise program uses research based exercise programming to relieve symptoms, improve walking capacity, decrease risk associated with PAD and improve your quality of life.
32“Get a GRIP on your lifestyle” (GRIP) Clients who are at risk for chronic diseases such as diabetes, coronary artery disease, stroke etc. can begin the journey to life long lifestyle changes.Goals of the program:Reduce risk factorsEducationLifestyle modificationImproved quality of lifeGRIP – A new proactive program designed to help decrease risk of developing chronic diseases, such heart disease, stroke and diabetes. Come exercise with trained staff member and receive valuable education to help make the lifestyle changes now to reduce your risks.
33Diabetes Exercise Program Learn how to be active and feelbetter with exercise whilesuccessfully controlling yourblood sugars to get the mostout of your workoutGoals of the program:Regulate blood glucoseImproved understanding of diabetes self-managementImproved endurance and muscle strengthDecreased cardiovascular riskImproved quality of life
34Additional Resources: http://h2hquality.org Heather Shuster, MSManager, Population Health & WellnessGenesis HealthCare SystemZanesville, Ohio 43701(740)