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Leadership Opportunities
in Care Safety & Quality Improvement Programs Presented by: Adrienne Mims, MD MPH Medical Director, Alliant GMCF President – elect, AHQA May 2, 2013
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I have no relevant financial relationships to disclose.
Disclosure I have no relevant financial relationships to disclose.
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Overview Reducing Readmissions
Reducing Antipsychotic Drugs in Dementia Adverse Drug Events Improving End of Life Care
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What is the Role of the QIO?
National Quality Improvement Organization (QIO) Program - delivered locally through a network of 53 independent QIOs located in each state, District of Columbia, Puerto Rico and Virgin Islands 3-year contract (SOW) from Centers for Medicare & Medicaid Services(CMS) to build internal capacity to sustain and expand QI initiatives and protect the Medicare Trust Fund Currently in the 10th SOW
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Reducing Readmissions
To Curb Repeat Hospital Stays, Pay Doctors - Sandeep Jauhar, MD, New York Times, Dec 1, 2009, Page D6
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Transitions in Care Initiatives
The Care Transitions ProgramSM H2H Hospital to Home Medically appropriate care Poor quality care Poor communication among care providers Premature discharge Poor transition process Inappropriate discharge setting Lack of medication reconciliation Lack of information transfer to receiving facility/MD No available outpatient physician Patient/caregiver understanding Not knowing what to do for warning signs Lack of transportation Financial hardships Non-adherence to care plan Low health literacy Google search: Readmissions 750,000 results (0.32 seconds) IHI Transforming Care at the Bedside
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Association Between Quality Improvement for
Care Transitions in Communities and Rehospitalizations Among Medicare Beneficiaries JAMA. 2013;309(4): doi: /jama
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Copyright © 2012 American Medical Association. All rights reserved.
From: Association Between Quality Improvement for Care Transitions in Communities and Rehospitalizations Among Medicare Beneficiaries Figure Legend: Means (solid lines) and upper and lower control limits (dashed lines) set by the experience of Vertical dotted line indicates start of quality improvement in the intervention communities. Date of download: 1/23/2013 Copyright © 2012 American Medical Association. All rights reserved.
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Decrease Hospital Readmissions
Interventions to Decrease Hospital Readmissions Keys for Cost-effectiveness Robert E. Burke, MD; Eric A. Coleman, MD MPH Match the intensity of the readmission reduction intervention to the patient's risk of readmission Avoid commonly used interventions that have not been shown to be effective Use interventions with a lasting effect Create an effective team before implementation of any intervention Broaden the intervention to target high-risk groups for readmission who have not been the focus of previous readmission reduction efforts JAMA Internal Medicine, 2013
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What is it? Why does it matter?
Interventions to Reduce Acute Care Transfers What is it? Why does it matter? Preventing conditions from becoming severe enough to require hospitalization Managing some conditions in the NH without transfer when this is feasible and safe Improving advance care planning and the use of palliative care plans when appropriate INTERACT stands for: INTErventions to Reduce Acute Care Transfers. As such, it can help your facility in a number of ways, including: (PRESS DOWN) Recognizing and preventing conditions from becoming so severe that hospitalization is required to treat them (PRESS DOWN) By giving you a framework to manage some conditions in the nursing home that without that guidance and level of clinical knowledge and comfort you may not have once had. (PRESS DOWN) And finally, by helping you to drive improve in advance care planning so that you’re honoring the wishes of your residents as well as promoting high quality end of life care.
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Clinical Decision Tools Advance Care Planning
Communication Tools Hospitalization tracking tool "Stop and Watch" tool Review unplanned transfers SBAR Clinical Decision Tools Care paths Advance Care Planning Quality Improvement Tools (“QAPI” programs) Medically inappropriate care Poor quality care Poor communication among care providers Premature discharge Poor transition process Lack of medication reconciliation Lack of information transfer to receiving facility/MD No available outpatient physician Inappropriate discharge setting Lack of follow-up care – referrals / tests / test results Patient/caregiver understanding Not knowing what to do for warning signs Lack of transportation Financial hardships Non-adherence to care plan Low health literacy Wrong treatment Delay in diagnosis Severe adverse events Patient and family complaints Increased utilization/duplication Rehospitalizations
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Tips on Getting Started and
Keeping It Going Effective implementation is critical to long-term sustainability of the program The program cannot be effectively implemented or sustained without strong support from facility leadership
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Reducing Antipsychotic Drugs in Dementia
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Reducing Off-label Antipsychotics
Requires Change: Systems Process Personal behavior changes Workflow
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Caregiver/ Staff Behaviors Acute & Chronic Disease
Triggers Caregiver/ Staff Behaviors Depression Environmental Acute & Chronic Disease Psychosis Medications Sensory Deficits
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Behavioral Symptoms Rejection of Care Irritability
Yelling/ Calling Out Agitation/ Apathy Hoarding STOP & LISTEN What is the Target behavior? How often is it occurring & timing What are the circumstances? What may have precipitated behavior? What has already been done to modify the behavior? Wandering/Pacing
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Medication Safety
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Improving Cardiac Health
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Advance Care Planning Compassion at the bedside Providing comfort
Honoring patients’ preferences Discussion Decision Documentation Advance Care Planning is a process of having discussions, making decisions, and documenting our end-of-life treatment preferences. This process includes the patient, the family and loved ones, and the health care team.
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Advance Care Planning A discussion with loved ones
Advance Directive Living Will and Durable Power of Attorney POLST Physician Order for Life Sustaining Treatment
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Local Leadership Opportunities
Pick a cause Assemble a team Use a quality improvement approach
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This material was prepared by Alliant GMCF, the Medicare Quality Improvement Organization for Georgia, 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. 10SOW-GA-IHPC-13-17
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