Planetree Patient-Centered Strategies for HCAHPS Improvement

Transcription

1 Planetree 2013 Patient-Centered Strategies for HCAHPS Improvement Presenter: Michael Lepore, PhD, Director, Research, Quality and Evaluation, Planetree May 8, 2013

2 Overview Planetree 2013 HCAHPS Basics Patient Experience as a Healthcare Priority From Improving HCAHPS Scores to Changing the Culture of Care Delivery Patient-Centered Strategies for HCAHPS Improvement

3 Planetree 2013 HCAHPS 101 Hospital Consumer Assessment of Healthcare Providers and Systems

4 HCAHPS 101 A tool that asks patients about their hospital experiences Planetree 2013 A method for collecting standardized patient experience data A method for adjusting data for equitable comparisons and benchmarking A mechanism for publicly reporting results Incentives for using to improve hospital quality of care

5 Planetree 2013 Dec publicly reported scores are based on more than 2.9 million completed surveys from patients at 3,892 hospitals Every day more than 7,900 patients complete the HCAHPS survey

6 Planetree 2013 Improving the patient experience is a priority

7 HCAHPS and the Quality Connection Planetree 2013 HCAHPS performance is more predictive of readmission rates than the objective clinical performance measures often used to assess the quality of hospital care. Boulding et al. in American Journal of Managed Care, 2011 Two overall measures of hospital performance, the overall rating of the hospital and willingness to recommend the hospital, had strong relationships with better technical performance in processes of care related to pneumonia, CHF, myocardial infarction, and for surgical care. Isaac et al. in Health Services Research, 2010

8 Elevating the importance of patient experience measures Planetree 2013 Value-Based Purchasing: Transition from pay for reporting to pay for performance Points earned for: Achievement Improvement Consistency (HCAHPS)

9 2013 Value Based Purchasing Domains Planetree 2013 Clinical Process of Care Domain (12 measures) AMI Heart Failure Pneumonia Surgical Care Improvement Healthcare Associated Infections 70% Patient Experience of Care Domain (8 measures) HCAHPS measures 7 composites & 1 global measure Does not include Likelihood to Recommend Quiet at Night and Cleanliness rolled into one composite 30%

10 Proposed 2014 Value Based Purchasing Domains Planetree % Patient Experience of Care 45% Clinical Process of Care 25% Outcomes

11 Planetree 2013 National Median VBP Score 54 Score Needed to Maximize Medicare Reimbursements Under VBP 70 HCAHPS Performance 30% of Total National Median Score on Clinical Measures Score on Clinical Measures Needed to Maximize Reimbursement National Median HCAHPS Score 21 HCAHPS Score Needed to Maximize Medicare Reimbursements

12 The heart of the matter relationships and communication. I find that if the doctors would just talk in my terms instead of these long words, that would help. I am not a doctor; these words don t mean nothing to me. -

13 A Consistent Finding: It s All About Culture Planetree 2012 High performing sites credited their success not to specific practices, but to a well-established culture of patientcentered care High performing sites had implemented a comprehensive approach to patient engagement, family involvement and staff engagement

14 Need list of members Planetree 2012 From Improving HCAHPS Scores to Changing Health Care Cultures: Planetree

15 Who is Planetree? Planetree 2012 Industry Advocate Individual Standard Setter Solution Provider Team

16 Advocating for what patients and caregivers need and want Compassionate Human Interactions Access to Meaningful Information Support & Participation of Family, Friends Healing Environment Support for body, mind & spirit Arts and Entertainment Spirituality Caring Touch Integrative Therapies Healthy Food and Nutrition Planetree 2013

17 Making the Connection Planetree 2013 Planetree Model Components Compassionate Human Interactions Access to Meaningful Information Support and Participation of Family Healing Environment Support for Body, Mind and Spirit HCAHPS Categories Communication with Nurses Communication with Physicians Responsiveness Pain Management Care Transitions Overall Satisfaction and Likelihood to Recommend Communication with Nurses Communication with Physicians Communication about Medications Care Transitions Discharge Instructions Responsiveness Discharge Instructions Cleanliness Quiet at Night Responsiveness Pain Management Quiet at Night Overall Satisfaction and Likelihood to Recommend

18 Patient-Centered Strategies for HCAHPS Improvement Planetree ) Partner with patients. 2) Create a physical environment that supports your culture. 3) Make data meaningful to staff. 4) Look beyond the hospital setting. 5) Put compassion first.

19 1. Partner with Patients and Families Patient Pathways Shared Medical Records

20 Impact of Shared Medical Record on Overall Patient Satisfaction with Care Patients who are told they could read their medical chart are more likely to be very satisfied with their overall hospital experience Very satisfied with their overall hospital experience? 90% 80% 70% 60% 50% 77.8% 69% Yes No Were you told you could read your medical chart? *Note: In a random survey of 4500 adults, 79% patients expressed interest in access (Fowles, Arch Intern Med. 2004)

21 Planetree 2013 Reviewing the chart with someone put me at ease.

22 Bedside Shift Report

23 Bedside shift report drives patient satisfaction Effects of bedside shift change at a Planetree Designated Hospital 6 months prior to implementation of bedside report 6 months after implmentation of bedside report Nurses treat you with courtesy/respect Nurses attitude toward requests Attention to special/personal needs Nurses kept you infromed Staff include you in decision re: treatment Staff worked together to care for you

24 Partnering with Patients Beyond the Bedside Invite patients to serve on hospital committees and HCAHPS improvement task forces Invite board members to round on patients prior to every board meeting Invite a patient to share his or her story (what went well, what didn t go well) to kick off every board meeting

25 2. Create a physical environment that supports your culture Why is the hospital not as humanely practical in aesthetic effect as it tries to be in physical support? Frank Lloyd Wright

26 Poor Patient Experience = Post-Hospital Syndrome Planetree 2013 CONTRIBUTING FACTORS: sleep deprivation disruption of normal circadian rhythms poor nourishment poorly controlled pain and discomfort medications that can alter cognition and physical function deconditioning due to bed rest or inactivity Krumholz, HM. N Engl J Med 368: January 10, 2013

27 Assess Your Healing Environment/Reduce Stressors Planetree 2013 EMOTIONAL SUPPORT Family overnight accommodations SLEEP SUPPORT Quiet Environment/Sleep Menus NOURISHMENT Family Kitchens/Access to Food CONNECTION TO NATURAL ENVIRONMENT Healing Gardens and Natural Light

28 Innovations in the Healing Environment: A Patient-Centered Quiet Campaign Planetree 2013

29 More Evidence The use of call lights by patients decreased by 40% following implementation of decentralized nursing stations & 24-hour visitation (Charmel, 2003)

30 3. Make data meaningful to staff. But remember, the data are not the point, patient experiences are the point! -

31 Making Data Meaningful to Staff Planetree 2013 Engage staff (and patients) in the selection of quality measures Involve staff in performance improvement efforts Give staff time to participate in improvement efforts Display data so it is easy to read and standardized Make staff aware of the data being measured Discuss in staff meetings Reinforce with postings and displays Meredith EK. Developing Frontline Staff in Performance Improvement. Nurse Leader; 2011.

32 4. Look beyond the hospital setting Planetree 2013

33 New HCAHPS Domain: Care Transitions Planetree 2013 Mandatory for patients discharged as of Jan. 2013: Question 1: The hospital staff took my preferences and those of my family or caregiver into account in deciding what my healthcare needs would be when I left the hospital. Question 2: When I left the hospital, I had a good understanding of the things I was responsible for in managing my health. Question 3: When I left the hospital, I clearly understood the purpose for taking each of my medications.

34 Patient-Centered Care Transitions Planetree 2013 Same Page Transitions Inter-Continuum Collaboratives Physician Office Hospital Physician appointments made prior to hospital discharge Discharge summary provided to patient and PCP Patient Personal Health Records Support for family caregivers Home Health Agency Skilled Facility

35 5. Put compassion first. Planetree 2013 I felt like I was interrupting them when I asked a question.

36 Compassion in Action Patient Experience training and education for staff- Middle Management Training VA New Jersey Sleep Menu Good Samaritan Hospital Patient Story Board Physician communication coaching

37 [The doctor] came in, pulled up a chair and said he wanted to talk and we talked on my terms.

38 A Measureable Framework for PCC Culture Change and HCAHPS Improvement Planetree 2013 Criteria can be downloaded at

39 Planetree Designated Hospitals and HCAHPS performance: A marker of Quality: Planetree Designated Hospitals consistently outperform the National Average on HCAHPS since public reporting of scores began.

40 Patient's Room and Bathroom Always Kept Clean Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12 CMS Reporting Period Designated Hospital Average National Average

41 Responsiveness Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12 CMS Reporting Period Designated Hospital Average National Average

42 Patients Given Information About Recovery At Home Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12 CMS Reporting Period Designated Hospital Average National Average Note: The difference is statistically significant (p<0.05).

43 Staff Always Explained About Medicines Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12 CMS Reporting Period Designated Hospital Average National Average

44 Doctors Always Communicated Well Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12 CMS Reporting Period Designated Hospital Average National Average

45 Nurses Always Communicated Well Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12 CMS Reporting Period Designated Hospital Average National Average Note: The difference is statistically significant (p<0.05).

46 Pain Was Always Well Controlled Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12 CMS Reporting Period Designated Hospital Average National Average Note: The difference is statistically significant (p<0.05).

47 Patient's Room Always Kept Quiet At Night Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12 CMS Reporting Period Designated Hospital Average National Average

48 Percent of Patients Highly Satisfied (Overall Rating 9 or 10) Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12 CMS Reporting Period Designated Hospital Average National Average Note: The difference is statistically significant (p<0.05).

49 Would Definitely Recommend Hospital to Friends and Family Mar-09 Jun-09 Sep-09 Dec-09 Mar-10 Jun-10 Sep-10 Dec-10 Mar-11 Jun-11 Sep-11 Dec-11 Mar-12 CMS Reporting Period Designated Hospital Average National Average Note: The difference is statistically significant (p<0.05).

50 The Bottom Line on VBP and Designation A preliminary analysis indicates that, as a group, Patient- Centered Designated Hospitals are poised to receive: 127% in reimbursement revenue $770,000(100% of all withheld monies plus additional revenues)

51 Resources For Your Journey Planetree 2012 Patient-Centered Care Improvement Guide Patient-Centered Hospital Designation Criteria HCAHPS Assessments

52 Questions Planetree 2012 Planetree 130 Division Street Derby, CT Michael Lepore, PhD Director of Quality, Research, & Evaluation