WELCOME APRNS!! SUCCESSFUL NF LEADERSHIP WORKSHOP JULY 17 TH, THANKS FOR PARTICIPATING! Please join us in welcoming the following APRNs to our team:

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1 WELCOME APRNS!! Please join us in welcoming the following APRNs to our team: Emily Androff, ANP at Delmar Gardens North, is currently in project orientation and will be starting at the home next week Nanette Randle, FNP at NHC Healthcare, Town &Country, will start her orientation on September 8 th Sandy Natwick, FNP at Delmar Gardens West/Float, will start orientation on September 2 nd We hope to have an announcement for Delmar Gardens South very soon and are continuing to recruit for Alexian Brothers Lansdowne Village. In the meantime, many, many thanks to the APRNs from other sites who are helping at these facilities while staff is hired and oriented: Bertha Carter-Simmons, Dava McGougan, and Tiffany Nelson. A great big thank you to Bertha s, Dava s, and Tiffany s leadership teams at their respective facilities for letting us borrow some of their time! GREAT TEAM! SUCCESSFUL NF LEADERSHIP WORKSHOP JULY 17 TH, THANKS FOR PARTICIPATING! Nursing Facility Leaders, their APRNS and MOQI Team gathered for half day workshop to work on skills for success as we gain momentum in year 2 and look forward to year 3 in the MOQI Initiative. The key topics discussed were StrengthsQuest Inventory, The Heart of Change, Complexity Science Local Interaction Strategies, and Role Playing situations encountered in the Initiative. Most all participants completed the StrengthsQuest inventory of basic strengths and talents prior to the workshop. During the workshop all developed plans to help their home accomplish the MOQI Goals. Many thanks to the staff of Garden Villas (on the campus of Delmar Gardens West)! They were wonderful hosts and provided a wonderful lunch for the group. Administrators, Directors of Nursing, other key staff from facilities and their APRNs were there as a team. Scores for each facility s monthly performance on key indicators, including rates of hospitalization were provided to the group. Fun MU prizes were presented to homes achieving the June goal for the 2014 Hospital Transfer Rate per 1,000 resident days: Delmar Gardens O Fallon 1.06 Cedarcrest Manor 1.23 Alexian Brothers Sherbrook Village 1.31 Delmar Gardens North 1.53 Delmar Gardens of Meramec Valley 1.60 Grand Manor Nursing and Rehabilitation 1.63 Delmar Gardens South 1.64 Recall the Hospital Transfer Rate is the rate that CMS calculates and displays on the quarterly dashboard that we share with you at the Leadership meetings. The rate is calculated by dividing the PAGE1

2 number of hospital admissions by the number of resident days for the month, then multiplying by 1,000; so you get a rate of hospital transfer by 1,000 days. This is a way for homes to be compared as well as the performance of the 7 sites in the Initiative nationwide. For example, the latest quarterly report from CMS (Quarter ending March 31, 2014), total hospital admission rate per 1,000 resident days across all 7 CMS sites was 1.57 and our total number for the MOQI Initiative was calculated by them as So, we have to improve as a total project to meet our MOQI 1.1 goal. Your APRN will be working with you to develop specific strategies to enhance the use of INTERACT and other parts of the MOQI Initiative to help everyone achieve the MOQI Initiative goal of 1.70 for 2014 and 1.1 by JULY HOSPITAL TRANSFER RATES - CONGRATULATIONS!! Three facilities achieved and surpassed the hospital transfer rate goals for July: Alexian Brothers Sherbrook Village with 0.65! Alexian Brothers Lansdowne Village with 0.79! Delmar Gardens South with 0.98! These rates are below the project goal!! Congratulations to their leadership teams, nursing staff and APRNs!! GOOD WORK!! Just to be sure everyone saw the June and July summary reports they are attached to this newsletter. Keep up the good work and keep working on root cause of hospital transfers as they occur within your facility. If you have questions about your Performance Reports on Hospitalizations and Other Key Outcomes for the Initiative, contact Janice Dixon-Hall, who generates these reports each month. She will be glad to make a site visit to your home and explain the reports to your leadership team. She prepares the reports and sends them to facility leadership and APRNs the week after the database is complete for the prior month. RTI EVALUATION REQUEST On August 5 th you should have received an from RTI International, the evaluation contractor for the CMS Initiative to Prevent Avoidable Hospitalizations. The was sent from PAH@rti.org and it contained an invitation to complete the Year 2 questionnaire for the Initiative. This questionnaire is completely confidential and data collected by RTI are only reported in aggregate. We encourage you to complete the questionnaire, if you haven t already done so; the deadline has been extended to September 3 rd. Your feedback will provide valuable insight into this important CMS Initiative and will be used to inform future policy. If you did not receive the invitation or if you have any questions about the questionnaire or the process, please contact the RTI team directly at , extension , or by at PAH@rti.org. Thank you for your assistance! PAGE2

3 MARK YOUR CALENDARS!! WEBINAR FOR NF LEADERSHIP AND APRNS There will be a webinar on September 23 th, 10AM to 11AM, for NF Leaders and APRNs to discuss Hospital Transfer Rates, Root Cause Analysis case studies, progress with key outcomes of the MOQI Initiative. Plan to attend, and plan for your leadership teams to participate. Monday morning you were sent an invite for the webinar. You MUST REGISTER in order to attend - MOQI STAKEHOLDER ADVISORY BOARD MEETING MOQI Stakeholder Advisory Board meeting was held Thursday, July 17 th from 2 PM to 3PM at Delmar Gardens Corporate. Dr. Chuck Crecelius pointed out that the physician metrics the MOQI project is looking at include the use of antipsychotics, hospitalizations, and sliding scale insulin/diabetic management. He pointed out that in order to improve in these areas, well-trained PCPs will make a difference, continuity of care will make a difference, and physicians that can meet the quality measures/value based measures will help the nursing homes reach success. We had some meaningful and timely discussions about the communication process in transitions interims of the type of information that is transferred, who is involved in the transfer of information, and how the information is transferred. We talked about how meaningful use is being applied in the transfer of information. We talked about perhaps modifying INTERACT tools to reflect the needs of the nursing facilities. An example, Annette Richardson (Latham Mercy) revised an INTERACT tool and a tool that Delmar Gardens uses and developed a post-acute handoff tool. It was discussed that consistency across settings is needed related to DNR/Full Code, discharge summaries, and medication changes. In future meetings, we will continue to discuss meaningful use as it relates to documentation, and explore emerging models of communication as they are developed. HIT AND MHC CAR The MOQI HIT sub-committee had their first call on August 21 st. Attendees were select representatives from the nursing facilities, hospital pilot partners and MOQI team members. Topics discussed included Car implementation strategies in the homes, formal process development for Car and HIE and Mediprocity (secure texting). Thanks to all who participated! The list of Car users have been received from all 16 facilities. Thanks to all for your diligence! New individual mailboxes have been created for ½ of our homes with the others in production. At the elbow training for these users has also kicked off. Sue Shumate is visiting each home to spend time with each user to make certain they have access to their mailbox and are comfortable with the functionality. Trainings dates still need to be set for 10 of the facilities so please respond to Sue with your home s availability as soon as possible. The deadline for these trainings to be complete is September 30 th as this is when the shared mailboxes will be turned off. Incorporating how Car will be utilized in your home may be a timely topic for your next staff meeting. We are looking forward to hearing of your successes and helping you work through the challenges! In discussions with other hospital systems, it has been mentioned the desire for more consistent formatting of the discharge summary information to transfer facilities. The MOQI HIT team is working to facilitate this effort. A meeting scheduled on August 27 th will be held at Delmar Gardens Enterprise with representatives from St. Luke s, Mercy and BJC. Contact is also being made with smaller community hospitals such as Mineral Area and Parkland. Attempts are still being made to connect PAGE3

4 with Health Information folks at St. Anthony s. If anyone has a way to make and introduction for us, please contact Sue. As hospitals prepare to meet the goals of meaningful use, we will see more opportunities for electronic communication regarding patient transfer information. Our Nursing Facilities will be ready! The team will also continue to identify the physician practices commonly used by the nursing homes residents and will work with these providers to bring Car Direct to these facilities as well. Remember that an evaluation team from St. Louis University is conducting an evaluation of Missouri Health Connection; because the 16 facilities in the MOQI project are using (or beginning to use) Car , you may be contacted by SLUCOR to complete a survey about MHC. Here is more information about SLUCOR s review process: The Missouri Health Connection (MHC) has partnered with the St. Louis University Center for Outcomes and Research (SLUCOR) to conduct a formal program evaluation for the Missouri Health Exchange. MHC is requesting all of its participants to engage in program evaluation as a very important part of a feedback loop to provide insight, address issues, and inform future directions to MHC, our participants, and the Office of the National Coordinator (ONC). In fact, The Office of the National Coordinator requires this program evaluation. We are currently collecting feedback related to DIRECT services (i.e., Car ) via interviews with key stakeholders, such as you, in participating organizations and user surveys. Survey collection will begin in July. We are writing this here to remind you of the process in hopes that you will participate. Please remember that any personnel change from the assigned list of users for your facility needs to be communicated to Jane Schaefer at jschaefer@missourihealthconnection.org or Sue at shumatese@missouri.edu. CARE TRANSITIONS As we reflect on the end of the second year of the MOQI project, we emphasized the importance of having discussions about advance directives, encouraging the enactment of advance directives, and helping people to understand what an advance directive is and why it is a tool that people can use to document their wishes for the type of care they desire. A very important component of an advance directive is the selection of a substitute decision maker, someone who can speak for the resident when the resident is no longer able to speak for themselves. We will continue to encourage that residents and family members consider completing an advance directive. Moving into the third year of the MOQI project, we would like to encourage all 16 facilities to think about how to change the conversation about care and advance care planning. The leadership of the MOQI project suggests that we start with an honest discussion about each resident s goals of care. These goals of care are based on four types of treatment: preventative, curative, disease management (including pain management), and palliative. If patients are aware of these four goals of care or types of treatment, they are in a better position to manage their own care. Essentially, when residents enter a skilled nursing facility, there are three trajectories for their goals of care: 1. Recover in the nursing home, regain or improve functional ability, and return home. These residents respond to rehabilitation and return to a more independent level of functioning. 2. The goal is to maintain function while needing assistance with activities of daily living. There are multiple co-morbidities that need to be managed. The residents in this group need assistance with ADL s and have ongoing nursing care needs. PAGE4

5 3. The goal for residents who fall into this group is comfort care. They will require a different type of assistance when end of life is approaching. At this stage, education and support of the family is important as well as providing care to the resident whose condition continues to decline. When a resident is admitted to the facility, help them to establish their goals of care. These goals of care should be reviewed regularly, particularly as residents needs and functional ability change. If we can have regular and meaningful discussions with residents and families about goals of care and how these goals change over time, we are in a better position to normalize discussions about end of life care. We will be planning a series of trainings, discussions, and development of resource material to help guide these goals of care discussions. Meetings with stakeholders and nursing homes will be ongoing for safe table discussions in order to improve and enhance care transitions. These meetings will provide a better means of effective communication regarding Interact tools of transition and discharge between the stakeholders, (BJC, SSM, Mercy and SLU) and all sixteen nursing homes. Finally, we will be conducting our annual audit of resident charts for advance directives which will help us determine how we have been helpful in advance directive charting and documentation and also how we can continue to be helpful in this area. ADVANCED DIRECTIVES SUBCOMMITTEE The Advance Directive Subcommittee met on July 24 th. We discussed future training and education that we would like to sponsor. We talked about providing education to families via family meetings and articles in facility newsletters about the differences between palliative care and hospice care. Connect care that the resident is receiving to the four goals of care. Specifically, we would like to provide suggestions and tools for how to approach discussions about moving from a disease specific treatment or curative focus to a comfort and supportive treatment or palliative focus. More activities and news to follow in this area! Each of the 16 facilities should have received a toolkit that is full of information. Each facility was provided with notebooks, DVDs, and flash drives containing some excellent resources that the subcommittee identified as helpful and informative. We will be periodically updating the toolkit, notebooks, and DVDs when new information has been identified as a useful tool for the facilities. In other words, we will keep those resources coming to the facilities! The next meeting will be on August 28 th from 3 PM to 5PM at Delmar Gardens Corporate. Members of the subcommittee are Dr. Colleen Galambos, PhD, LCSW; Dr. Charles Crecelius, MD; Mike Roth, LNFA; Adrienne Holden, MSW, ACSW; Dr. Lori Popejoy, PhD, APRN, GNS-BC; Patty Abele, MSN, RN, FNP-BC; Annette Lueckenotte, MSN, RN, GCNS-BC, FNGNA; Keith Hampton, RN, APRN, Yvonne Schwandt, RN, BSN; Brigid Fernandez, Elderlaw attorney; Jan Doerr, social worker, Delmar Gardens of O Fallon; Roger Schomburg, Chaplain, Alexian Brothers Corporate; and Teresa Buehler, Voyce. Please contact Colleen if you have any issues or concerns about advance directives or if you are looking for some guidance. The subcommittee generally meets on the 4 th Thursday of the month from 3 PM to 5 PM. We are looking to expand membership on this committee. We are looking for a facility DON, ADON, or MDS coordinator from one of the 16 facilities to join the group. If you are interested or know of someone who is interested in participating in this subcommittee, please contact Colleen. PAGE5

6 UPDATES ON DATA COLLECTION/DATABASE We have added a new report to the drop down list. It s an AD Report and will show you all of your residents Advance Directives information. This way you can locate it quickly to see who needs a review, who s had a review, if something needs to be updated or changed, etc. This will be deployed in the update from Abhi this week!! As always, please contact Jess, Janice, or Sue if you have any questions or problems with the functionality of the database so it may be addressed immediately. INTERACT PROGRAM INTERACT/QIPMO Coach, Maryann Coletti, has been visiting each facility monthly, reviewing INTERACT implementation, assisting APRNs with completion of MOQI goals, reviewing progress of the implementation of goals and distributing and collecting Use and Diffusion surveys on two units in each home. There has been a noticeable increase in usage of INTERACT forms in many homes. All APRNs reviewed the Goals with leadership in their respective home and are focusing on improvements outlined in their goals document. In addition, all APRNs are moving forward with implementation of the INTERACT program and Root Cause Analysis (RCA) of hospitalizations in their respective NH. MOQI Goals for Congratulations to the following facilities with Completed Goals: Alexian Brothers Sherbrooke Village - Tiffany Nelson, APRN Cedarcrest Manor - Lisa Wilson, APRN Delmar Gardens North - Emily Androff, APRN Delmar Gardens Chesterfield - Clayton McKiddy, APRN Delmar Gardens Creve Coeur - Bertha Carter-Simmons, APRN Delmar Gardens Meramec Valley - Dava McGougan, APRN Delmar Gardens O Fallon - Keith Hampton, APRN Delmar gardens On the Green - Suping Bao, APRN PAGE6

7 Delmar Gardens West - Janine Kampelman, APRN Festus Manor - Michele Soest, APRN Grand Manor Nursing & Rehabilitation Center - Marsha Luster-Smith, APRN NHC, Desloge - JoAnn Franklin, APRN NHC, Town & Country - Nanette Randle, APRN Scenic Nursing & Rehabilitation Center - Carrie Bowling, APRN Maryann is currently working on coordinating INTERACT meetings with both the APRNs and the Champions and Co- Champions in each facility. MOQI GOALS FOR With feedback reports in place, MOQI team and APRNs will work side-by-side with NF staff to complete root cause analysis of underlying causes of hospitalizations and reduce hospitalizations for their residents - Achieve 1.7 hospital transfer rate or better per 1000 resident days 2. MOQI Team and APRNs will focus on working side by side with NF staff to implement improved care systems for mobility, hydration, and continence improvement of the NF residents 3. MOQI Team, APRNs, and NF leaders and staff will implement improved care systems that promote clear advance directives for NF residents 4. MOQI Team will reinforce Car use by all NFs for the transfer of PHI to/from NF/hospitals/primary care settings; Car use will increase steadily throughout 2014 UPCOMING MEETING!! Our next MOQI NF LEADERSHIP GROUP meeting will be on Thursday, October 16 th at Delmar Gardens Corporate (14805 North Outer 40 Road, 3 rd floor, Chesterfield, MO 63017), from 10 AM to 11:30 AM! Mark your calendars and plan to attend! Our next MOQI STAKEHOLDER ADVISORY BOARD meeting will be Thursday, October 16 th from 2 PM to 3PM. Mark your calendars and plan to attend! Delmar Gardens Corporate, North Outer 40 Road, 3 rd floor, Chesterfield, MO Feel free to join in this group as you would like! We always welcome additional perspectives. TOPICS FOR UPCOMING MOQI UPDATES; CONTACT INFORMATION If you have a particular request, please submit to Jess and we will be sure to cover it. If you would like others to be added to this communication list, please contact Jess at muellerjes@missouri.edu. WEBSITE SECTION FOR YOUR USE There is a special section on the site for us to use for the Initiative. It contains contact information, material/overviews, copies of all of the updates, etc. Use the link below or type it in and bookmark it: If there is something you would like to request be added, please Jess. Participating nursing home administrators, please share these weekly MOQI Updates with your director of nursing and other leadership staff so they start getting informed about the PAGE7