Using QAPI to Reduce Avoidable Hospital Readmissions

Using QAPI to Reduce Avoidable Hospital Readmissions Joseph M. Bestic, NHA, BA Director, Nursing Home Health Services Advisory Group of California, In...
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Using QAPI to Reduce Avoidable Hospital Readmissions Joseph M. Bestic, NHA, BA Director, Nursing Home Health Services Advisory Group of California, Inc. (HSAG of California)

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Presentation Goals • Understand the differences between Quality Assurance (QA) and Performance Improvement (PI). • Identify at least two action steps from the Quality Assurance & Performance Improvement (QAPI) at-a-Glance document that can be applied to your current QA processes for reducing avoidable hospital re-admissions. • Learn how to use data to drive QAPI projects, specifically with reducing avoidable hospital readmissions.

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The Big Picture—the Basics  The overall goal is to provide person-centered care.  Quality Assurance (QA) is focused on regulatory standards and is reactive to requirements.

 Performance Improvement (PI) is applying quality improvement methods to daily work and is continuous. It is proactive, and a facility must choose to make improvements.  The ability to think, make decisions, and take action at the system level is a prerequisite for QAPI success. 4 4

Background  The QAPI program in nursing homes (NHs) was required by the Affordable Care Act, enacted March 2010.  Legislation requires the Centers for Medicare & Medicaid Services (CMS) to establish QAPI program standards and provide technical assistance to NHs. – It is an opportunity for CMS to develop and test QAPI technical assistance tools and resources before rule promulgation.

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http://go.cms.gov/Nhqapi

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QAPI at a Glance

http://cms.gov/Medicare/Provider-Enrollment-andCertification/QAPI/Downloads/QAPIAtaGlance.pdf

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Five Elements of QAPI     

Design & Scope Governance & Leadership Feedback, Data Systems & Monitoring Performance Improvement Projects (PIPs) Systematic Analysis & Systemic Action

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QAPI Action Steps 1–6

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QAPI Action Steps 7–12

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Performance Improvement Project (PIP) steps  Use of data to prioritize projects (ex., AE Tracker)  Create a PIP team  Conduct a Root Cause Analysis (RCA)  Create a Plan of Action  Conduct PDSA Cycles  Spread 11

5 Whys Method

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Cause-and-Effect (Fishbone) Diagram

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PDSA Model for Improvement What are we trying to accomplish? How will we know that change is an improvement? What change can we make that will result in an improvement?

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QAPI Rollout Materials     

QAPI at-a-Glance QAPI news brief Introductory video CMS QAPI Web site: http://go.cms.gov/Nhqapi S&C Memo 13-37: http://www.cms.gov/Medicare/ProviderEnrollment-andCertification/SurveyCertificationGenInfo/Policyand-Memos-to-States-and-Regions.html

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References  QAPI at a Glance: A Step-by-Step Guide to Implementing QAPI in Your Nursing Home. CMS, University of Minnesota, & Stratis Health. June 7, 2013.  CMS National Nursing Home Quality Care Collaborative Learning Series: Session One. February 26, 2013.  Lyon, Debra. CMS QAPI Rollout for Nursing Homes. Advancing Excellence Webinar. June 13, 2013.  The CMS QAPI Guide: What You Need to Know A Companion to QAPI at-a-Glance. Ohio Medicare Quality Improvement Organization. 2013.

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Nursing Home (NH)-to-Hospital Readmissions: Data Discussion

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Data Discussion Using the Advancing Excellence (AE) Readmission Tracker Tool and Interventions to Reduce Acute Care Transfers (INTERACT)

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AE Safely Reduce Hospitalizations Tracking Tool  This tool is an Excel workbook that you can use to support your quality improvement project using data from acute hospital admissions, readmissions, and transfers.  You will enter information for all residents admitted from an acute care hospital and for all residents transferred to the hospital for any reason.  There are also options to record additional information that will help you examine your care processes to discover what is working well and where there are opportunities for improvement. Source: CFMC, The Medicare Quality Improvement Organization for Colorado

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Readmission Tracker Tool: INTERACT or AE INTERACT

AE

Required Fields are Identical Layout and Functionality are Identical Outcome Calculations are Identical Contains Outcomes Data (Readmit rate, ED rate, Obs. rate) Primary Clinical Reason for Transfer

Admissions to NH by: (1) Day of Week, (2) Source of Admission, and (3) Health Plan Transfer from NH to Hospital by: (1) Time, (2) Clinician, and (3) Outcome Clinical Reason for Transfer 20

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Readmission Tracker Tool: INTERACT or AE (cont’d) INTERACT

AE

No

Was a Structured Communication Tool Used to Receive Information from the Hospital?

No

Was the Information Received from the Hospital Adequate to Care for Resident?

No

Primary CONTRIBUTING Reason for Transfer

No

Documented Advance Care Planning Discussion in Past Quarter?

No

Was the Advance Care Plan Reviewed at the Time of Transfer?

No

Was a Structured Communication Tool Used at the NH to Evaluate Acute Condition?

No

Was a Structured Communication Tool Used when Transferring to the Hospital?

No

Was a Root Cause Analysis of This Transfer Completed? 21

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The Advancing Excellence (AE) Readmission Tracker Tool

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Where to Find the Tool www.noplacelikehomeca.com or http://www.nhqualitycampaign.org/star_index .aspx?controls=hospitalizationsexploregoal

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Questions? Joe Bestic, NHA, BA HSAG Director, Nursing Home [email protected] 818.265.4643 700 North Brand Blvd., Suite 370 Glendale, CA 91203 25 25

We convene providers, practitioners, and patients to build and share knowledge, spread best practices, and achieve rapid, wide-scale improvements in patient care; increases in population health; and decreases in health care costs for all Americans.

www.hsag.com This material was prepared by Health Services Advisory Group of California, Inc., the Medicare Quality Improvement Organization for California, 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. CA-10SOW-7.2-071113-02

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