1. The Impact of Pneumonia Core Measure Scores on Value Based Purchasing Financial Outcomes Presented by Brenda Lee, MSN,RN

2. Why are we focused on Pneumonia?
In FY 2010, UTHSCT compliance with the all-or-none bundle pneumonia core measure set was 85% - 20th percentile ranking (July 9, 2009 – June 30, 2010).
Value Based Purchasing Score decreasing from 83 to 23 for all core measures. Pneumonia measures are being dropped in the areas we are 100%.

7. Pneumonia: Setting a Goal
Performance Required for 95th Percentile National Ranking
Vaccinations
(P & I)
Antibiotic within 6 hrs
Initial Antibiotic Selection
Compliance Rate th
Pneumonia th
Influenza th th
Total th
ICU th
Non-ICU th
Goal Success Rate
100
Average Metric Failures/Month
1.0 (.33/.66)
.33
.66 (.50/.41)
Permitted Metric Failures /Month

8. AIM Statement
Improve compliance to 100% for all Pneumonia evidenced based performance measures by June 2011.

9. Pneumonia: Building the Team
Physicians/Inpatient Nurses
ED Medical Director/ED Physicians/ED Nurses
Internal Medicine Physicians
Pharmacists
Quality Staff

10. Pneumonia: Measuring the Problem
34 RFI’s Total

12. Pneumonia: Interventions
Revise Pulmonary Order Set (prior separate)
Revise Physician Discharge Instruction Set
Design Concurrent Review Checklist for nursing
Present core measure compliance data to staff and physicians (committee/dept level)
Printed off booklets for medical staff and made download available
Nursing/MD staff educational program/in-services

13. Pneumonia: Interventions
Address physician concerns per CDC Guidelines regarding administration of immunizations
Revise immunization protocol to align with CDC; dropping physician order to not administer as an option
Administer immunizations prior to discharge for all patients as appropriate – JUST GIVE IT!

14. Pneumonia: Barriers
Current form approval process hindered “pilot” of forms and created delay in changes
Physicians outside of team wanted a separate order set for Pneumonia patients
Nursing did not want to perform concurrent review documentation – additional work

17. Pneumonia: Interventions
Create Pneumonia Order Set
Adjust admission initial nursing assessment form to incorporate core measure requirements
Create a “pilot” plan utilizing next 5 patients with hospitalist admissions only
Post laminated Pneumonia Core Measure Antibiotic selection sheet as reference

18. Results

22. REVENUE ENHANCEMENT

25. Pneumonia: Conclusions and Next Steps
An order set and forms revisions “pilot” process is instrumental for rapid cycle change
Continue to provide feedback as cases “fall out” as soon as identified (trending)
Implement aggressive campaign with medical and nursing staff for Influenza Vaccination
Continue study to determine if order set contributes to decrease LOS and cost of care

26. Questions?