Root Cause Analysis (RCA): Identifying the Drivers of Hospital Readmissions

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1 Root Cause Analysis (RCA): Identifying the Drivers of Hospital Readmissions 1

2 Housekeeping Post your questions using the chat or Q&A box. Questions will be addressed following the Webinar. CEU instructions will be provided following the completion of today s Webinar. 2

3 Objectives Identify the importance of conducting an RCA to reduce readmissions. Identify the most common methods that hospitals use to conduct an RCA. Gain confidence in your ability to conduct an RCA. Hear from RCA experts. 3

4 Speakers Jennifer Wieckowski, MSG, Program Director, Care Transitions, Health Services Advisory Group of California, Inc., (HSAG-California) June Simmons, CEO, Partners in Care Foundation Sandy Atkins, MPA, Vice President, Institute for Change, Partners in Care Foundation Nancy Seck, MPH, BSN, RN, CPHQ, Director, Quality Management, Glendale Memorial Hospital and Health Center 4

5 The Hospital Readmission Problem Twenty percent of Medicare fee-for-service (FFS) patients are readmitted within 30 days. Two-thirds of readmissions may be avoidable. The cost to Medicare for avoidable readmissions in 2004 was $17.4 billion. 5

6 Common Drivers for Readmissions Lack of standard discharge processes Lack of patient and family engagement/activation Patients call 911/return to emergency departments instead of accessing a different type of medical service Ineffective or unreliable sharing of relevant clinical information Patients not understanding or not correctly taking medications 6

7 Interventions Care Transitions Intervention (CTI) Transitional Care Model (TCM) Better Outcomes for Older Adults through Safe Transitions (BOOST) Re-engineered Discharge ( Project RED) Interventions to Reduce Acute Care Transfers (INTERACT) 7

8 Purpose of an RCA Identify the root cause of readmissions at your hospital. Identify patterns of readmissions specific to your community and its providers. Use RCA results to guide targeting criteria and intervention selection. 8

9 Community-Based Care Transitions Program (CCTP) Application A community-specific RCA is required as part of the application process. Describe the results of the RCA that was performed. Describe how the results informed the selection of the proposed intervention and target population. 9

10 Common Application Errors The community-specific RCA is missing. The community-specific RCA is present but not explicitly tied to the methodology for targeting high-risk beneficiaries and the proposed interventions. 10

11 Using RCA to Drive Intervention Selection Poor Example 11

12 Using RCA to Drive Intervention Selection Good Example 12

13 Summary To reduce readmissions, you need: A clear understanding of your population and influencing factors for readmissions. A clear understanding of your current processes. To develop processes to address gaps in your current processes. 13

14 Rocket science is helpful, but not required. 14

15 RCA Resources 15

16 Institute for Healthcare Improvement 16

17 National Coordinating Center 17

18 Speaker Contact Information June Simmons, CEO, Partners in Care Foundation (818) , Sandy Atkins, MPA, Vice President, Institute for Change, Partners in Care Foundation (818) , Nancy Seck, MPH, BSN, RN, CPHQ, Director, Quality Management, Glendale Memorial Hospital and Health Center (818) , 18

19 Arizona Medicare Quality Improvement Organization Contact Information Barb Averyt, BSHA, Program Director, Care Transitions, HSAG (602) , California Jennifer Wieckowski, MSG, Program Director, Care Transitions, HSAG-California (818) , Florida Marie Hall, RN, Program Director, Care Transitions, FMQAI (813) , 19

20 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 healthcare costs for all Americans. This material was prepared by Health Services Advisory Group of California, Inc. (HSAG-California, HSAG, and FMQAI, the Medicare Quality Improvement Organizations for California, Arizona, and Florida, 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 Nos. CA-10SOW ; AZ-10SOW ; FL-10SOW-2012FLC

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