Transcript Presentation Title Line 1 Presentation Title Line 2

INTERACT COLLABORATIVE
ORIENTATION SESSION
NYSHFA/IPRO PARTNERSHIP
Sara Butterfield, RN, BSN, CPHQ, CCM
Christine Stegel, RN, MS, CPHQ
NYSHFA/IPRO INTERACT Collaborative Orientation Webinar
June 11, 2013
Objectives
• Provide an overview of the collaborative guidelines
• Review how to calculate your facilities baseline
hospitalization rate
• Discuss resident hospitalization reviews completed
to date
• Establish monthly teleconference schedule - Timeline
The INTERACT
version 3.0 tools are
meant to be used
together in your
daily work in the
nursing facility
http://interact2.net
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Collaborative Mission Statement
Each skilled nursing facility that has agreed to
participate in the collaborative will implement all
components of the INTERACT Program by July
31, 2014
Collaborative Vision Statement
Through regular learning and action
teleconferences, the facility’s INTERACT team
will:
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Implement the INTERACT Program,
Share their experiences and strategies,
Trend their hospitalization rate over time,
Reduce resident acute care transfers by 10% by 07/31/2014
First Steps
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Select a team (include direct care staff) and
establish a meeting schedule
Calculate your hospitalization baseline rate
Begin using the Interact Quality Improvement
Review tool (with the next resident transfer)
Establish implementation plan (how has the
facility implemented new programs in the past one unit versus whole facility)
Establish a plan to participate in Collaborative
monthly teleconference
INTERACT Website
http://interact2.net
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Always access for most up to date version of tool
Download the Hospitalization tracking tool
Print: The Implementation Guide
Print: The Implementation Checklist
complete and fax back to Christine Stegel at
518-426-3418 by June 30, 2013
Website Tools Currently In Use
• QI Tool for Review of Acute care Transfers
• QI Summary Worksheet
• Acute Care Transfer Log Worksheet
© Florida Atlantic University 2011
CALCULATING
HOSPITALIZATION
RATES
Calculating Hospitalization Rates
INTERACT tools designed to provide clear definitions
related to rates of hospital transfers, hospitalizations
and hospital readmissions consistent with evolving
definitions used by CMS and other national
organizations.
1. Acute Care transfer Log- paper & pencil tool
2. Hospitalization Rate Tracking Tool-excel workbook
INTERACT Hospitalization
Rate Tracking Tool
Basic Hospitalization Rates
Four Basic Hospitalization Rates can be
calculated:
1. Unplanned Hospitalization rate
2. 30 day readmission rate
3. Emergency Room Visits Only
4. Transfers Resulting in Observation Stays
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Basic Hospitalization Rates
1. Unplanned Hospitalization Rate-excludes observation
stays and planned admissions
•Adjusted for census and # of days in month for comparison purposes
among facilities. (expressed in terms of 1,000 resident days)
•Each day a resident spends in the nursing home contributes one
resident day for the month.
Total resident days= Aver daily census (ADC) by days in month
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Let’s Practice
A nursing facility with an ADC of 100 will have 3000 resident
days in a 30-day month.
If that nursing facility had 9 hospitalizations for the month, the
hospitalization rate would be 3 per 1000 days.
9/3000= 3/1000
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Basic Hospitalization Rates
2. 30-Day Readmission Rate: Calculated by identifying
individual residents admitted after an inpatient stay during a
given month and following them for 30 days.
Numerator: # of inpatient hospitalizations among those
residents in denominator that occur within 30 days of
admission to your facility after an inpatient hospital stay.
Denominator: # of residents admitted to the facility who had an
inpatient hospital stay during the month.
•Residents with 2 or more 30 day readmissions in a 30 day
period counts into the N and D. Therefore 1 resident could
contribute 2 or more times to the 30 day readmission count.
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30 Day Readmission Rate Cont’d
•Includes residents who were admitted to NF within 30
days from inpatient stay at Acute Care Hospital (ACH),
Critical Access Hospital (CAH) or Acute Psychiatric
Hospital (APH).
•Only includes those discharged to ACH or CAH within
30 days not those discharged to APH or acute rehab
hospital. (only record these in transfer log)
•Planned admissions not counted.
•Admitted- inpatient or Admission- uncertain in data log
counted not observation status.
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Let’s Practice
Your census in January was 110, February 112, March 108 .
During these 3 months you had 66 admissions after an
inpatient stay at your local hospital. During the same 3
months you transferred a total of 30 of these 66 residents
back to the hospital within 30 days of their recent hospital
discharge. Of these 30, 1 was a planned admission for
colostomy revision, a 2nd was scheduled hip replacement, and
one for monthly chemo. 5 residents were admitted under
observation status.
What was your 30-day readmission rate for the
Quarter?
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Let’s Practice
Answer: 33%.
The denominator is 66.
The numerator is 22 (30 minus 3 residents with
planned admissions and then 5 admitted into
observation status)
22/66=33%
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Basic Hospitalization Rates cont’d
3. Emergency Room Visits Only:
Adjusted by ADC as in unplanned hospitalization
rate.
Residents who die in ambulance or ER are
counted in numerator.
4.Transfers Resulting in Observation Stays
 Adjusted by ADC as in unplanned
hospitalization rate.
 Count observation stays that do get changed
to inpatient status only.
Basic Hospitalization Rates cont’d
Each of the 4 rates can be tracked and trended in
different ways:
•Entire facility
•Post-acute unit
•Long stay residents
When combined with data from the QI tool, variety of
additional measures can be tracked-time, day of the week,
clinician ordering the transfer etc.
ROOT CAUSE
ANALYSIS
Review Resident Transfers – Root Cause Analysis
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Use the INTERACT Quality Improvement Tool for
review of acute care transfers
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Quality Improvement Summary Worksheet
IPRO Excel tool
Identify Improvement Opportunities
• Two ways to look for opportunities to
improve care and decrease potentially
avoidable transfers
 Population level-proactively look at trends and patterns in
order to improve performance
 Individual case level-more reactive and aimed at identifying
specific system/process breakdowns in order to improve
performance
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The QI Summary Worksheet is designed to:
1. Walk the QI team through analysis of transfers
2. Call out common reasons for transfers
Section 1: Resident Characteristics
Section 2: Acute Change in Condition & Factors
Contributing to the Transfer
Section 3: Actions taken to evaluate & manage
Change in Condition Prior to transfer
Section 4: Characteristics of the Transfer
3. Choose interventions/Focus educational and
improvement activities
Section 5: Identify opportunity for improvement
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Review Resident Transfers
Discussion of resident
review findings
Next Steps
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Download the Hospitalization tracking tool
Calculate Baseline Hospitalization Rate
Print: The Implementation Guide
Print: The Implementation Checklist
Complete both tools and fax back to Christine Stegel at
518-426-3418 by June 30, 2013
QUESTIONS
For more information
Christine Stegel, RN,MS,CPHQ
Sr. Quality Improvement Specialist
(518) 320-3513
[email protected]
Sara Butterfield, RN, BSN, CPHQ,
CCM
Senior Director
(518)426-3300 x104
[email protected]
IPRO REGIONAL OFFICE
20 Corporate Woods Boulevard
Albany, NY 12211-2370
IPRO CORPORATE HEADQUARTERS
1979 Marcus Avenue
Lake Success, NY 11042-1002
www.ipro.org
This material was prepared by IPRO, the Medicare Quality Improvement Organization for New York State, under contract with the Centers for
Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.
The contents do not necessarily reflect CMS policy. 10SOW-NY-AIM8-13-42.
Template 1/13/2012