3/19/ , American Heart Association 1

Size: px

Start display at page:

Download "3/19/2013 2012, American Heart Association 1"

Magdalene Wilkinson
7 years ago
Views:

1 3/19/ , American Heart Association 1

2 Development of HF Performance Measures: Process, Barriers, and Spinoffs Target: Heart Failure University of New Mexico School of Medicine Division of Cardiology

3 Objectives Describe the individual components of our process for ascertainment, clinical care, clinical follow-up (care transitions), data entry, and monitoring of HF patients in the University of New Mexico Hospital system. Demonstrate how these independent parts function together collaboration and cooperation and communication. Identify the early and late barriers and spin-offs with this process or What will get in your way!

4 Target: Heart Failure An AHA initiative launched in 2010 whose purpose is to improve quality, care transitions, and outcomes for patients with heart failure with a targeted initiative and leveraging the American Heart Association s premier quality improvement suite of resources including Get With The Guidelines-Heart Failure. Provide healthcare professionals with content-rich resources and materials designed to help them advance heart failure awareness, prevention, treatment and recovery. Participants must demonstrate > 50% compliance on the following measures: Medication optimization Early follow-up and care coordination Enhanced patient education

5 Target: Heart Failure ACEI/ARB at discharge Evidence-based beta-blocker at discharge Aldosterone Antagonist at discharge Follow-up visit within 7 days Referral to disease management program Patient education (at least 60 min) Interactive workbook

6 GWTG Target: HF University of New Mexico Hospital Performance

12 The Why and How of our Performance in 2012 Start: disarray in 9/2011 due to personnel changes Goals: Quality patient care (proactive) Complete, accurate data for GWTG Provider feedback (resident education) Dr. Cox receives from Dr. Dodendorf Dr. Cox sends alert to pre-defined group (Pharm, HF clinic, Quality) Dr. Cox orders Cardiac Rehab, HF nurse educator, smoking cessation education Chief Resident Quality Monthly orientation to Cardio ward Project: HF Medication Reconciliation at Discharge PharmD does monthly orientation on Cardio ward PharmD does Medication Reconciliation checks at discharge on Cardio ward Dr. Cox meets monthly with Coding Supervisor to resolve coding discrepancies Better alignment with Quality Outcomes reports to TJC, CMS Transitions of Care Coordination of Case Mgmt (Home Health, SNF, Rehab Ctrs), HF Clinic, Care One Program, Head Nurse on Cardio ward, HF Clinic nurse Pharmacy BNP List Compiled in MSExcel list Screened in Power Chart Power Chart message to Dr. Cox HF Pt List revised Electronic data sent to Dr. Dodendorf Composite to Dr. Cox and Chief Resident Quality Dedicated data entry Periodic reports to check data Reports to Quality Chief Resident Midas alerts Lighthouse initiations Daily Admit List Admits by Dr. Cox Comparison of UHC (after Coding & Billing) data with GWTG data Indepth study of readmits

13 Barriers into Spinoffs BARRIERS INTO SPINOFFS First Fix Better Fix First Fix Better Fix Goals: Quality patient care (proactive) Complete, accurate data for GWTG Provider feedback (resident education) Barrier Barrier Quality Patient Care Proactive approach to HF identification with early notice AND clinical alerts AND subsequent dialogue re: patient care, discharge planning, and outpatient care.

14 ASCERTAINMENT OF HF PATIENTS Dr. Cox receives from Dr. Dodendorf Dr. Cox sends alert to pre-defined group (Pharm, HF clinic, Quality) Dr. Cox orders Cardiac Rehab, HF nurse educator, smoking cessation education LINE of VISIBILITY Pharmacy BNP List Compiled in MSExcel list Screened in Power Chart Power Chart message to Dr. Cox HF Pt List revised Dedicated data entry Periodic reports to check data Reports to Quality Chief Resident Midas alerts Lighthouse initiations Daily Admit List Admits by Dr. Cox

15 Real-time Activation = Clinical Alerts/Clinical Orders Cardiac Rehab Outpatient HF Clinic RN Education Patient Quality Outcomes Pharmacy HF Nurse Educator

16 Clinical efforts Chief Resident Quality Monthly orientation on Cardio ward Project: HF Medication Reconciliation at Discharge Reports to Quality Chief Resident Clinical chart reviews Possible revisions to GWTG patient list Possible coding discrepancies

17 Medication Reconciliation PharmD does monthly orientation on Cardio ward PharmD does Medication Reconciliation checks at discharge on Cardio ward Improved compliance with GWTG standards Improved compliance with TJC, CMS standards Electronic data sent to Dr. Dodendorf Composite to Dr. Cox, PharmD, & Chief Resident Quality Dr. Cox provides feedback to resident including passing the rotation

18 Coding Issues Dr. Cox receives from Dr. Dodendorf Dr. Cox sends alert to pre-defined group (Pharm, HF clinic, Quality) Dr. Cox orders Cardiac Rehab, HF nurse educator, smoking cessation education Dr. Cox meets monthly with Coding Supervisor to resolve coding discrepancies Better alignment with Quality Outcomes reports to TJC, CMS Compiled in MSExcel list Screened in Power Chart Power Chart message to Dr. Cox HF Pt List revised Dedicated data entry Periodic reports to check data Reports to Quality Chief Resident Midas alerts Lighthouse initiations Daily Admit List Admits by Dr. Cox Comparison of UHC (after Coding & Billing) data with GWTG data

19 Discharge Planning Dr. Cox receives from Dr. Dodendorf Dr. Cox sends alert to pre-defined group (Pharm, HF clinic, Quality) Dr. Cox orders Cardiac Rehab, HF nurse educator, smoking cessation education Transitions of Care Coordination of Case Mgmt (Home Health, SNF, Rehab Ctrs), HF Clinic, Care One Program, Head Nurse on Cardio ward, HF Clinic nurse Compiled in MSExcel list Screened in Power Chart Power Chart message to Dr. Cox HF Pt List revised Dedicated data entry Periodic reports to check data Reports to Quality Chief Resident Midas alerts Lighthouse initiations Daily Admit List Admits by Dr. Cox Indepth study of readmits

20 Transition in Care The 7- day follow-up scheduled at discharge The 30-day visit data are ensured by use of dictation template (created by NP at HF Clinic) and the use of dedicated database (clinical outpatient database) Medication reconciliation at each step Role of out-patient pharmacy services at HF Clinic Cardiac Rehabilitation Nurse Education at HF Clinic (1/2 day/week)

21 Start: disarray in 9/2011 due to personnel changes Repeat Look at Process Goals: Quality patient care (proactive) Complete, accurate data for GWTG Provider feedback (resident education) Dr. Cox receives from Dr. Dodendorf Dr. Cox sends alert to pre-defined group (Pharm, HF clinic, Quality) Dr. Cox orders Cardiac Rehab, HF nurse educator, smoking cessation education Chief Resident Quality Monthly orientation to Cardio ward Project: HF Medication Reconciliation at Discharge PharmD does monthly orientation on Cardio ward PharmD does Medication Reconciliation checks at discharge on Cardio ward Dr. Cox meets monthly with Coding Supervisor to resolve coding discrepancies Better alignment with Quality Outcomes reports to TJC, CMS Transitions of Care Coordination of Case Mgmt (Home Health, SNF, Rehab Ctrs), HF Clinic, Care One Program, Head Nurse on Cardio ward, HF Clinic nurse Pharmacy BNP List Compiled in MSExcel list Screened in Power Chart Power Chart message to Dr. Cox HF Pt List revised Electronic data sent to Dr. Dodendorf Composite to Dr. Cox and Chief Resident Quality Dedicated data entry Periodic reports to check data Reports to Quality Chief Resident Midas alerts Lighthouse initiations Daily Admit List Admits by Dr. Cox Comparison of UHC (after Coding & Billing) data with GWTG data Indepth study of readmits

22 This process is like braiding 3 railroad tracks First railroad track : Clinical Processes Second railroad track : Identification and Ascertainment of HF Patients Third railroad track : Chart Abstraction and Data Entry (EMR and Outcomes software) Build in redundancy and backups Expect barriers actually they are a good thing!!

23 Questions? Comments? Reactions?

Get With The Guidelines Best Practices: A look at reducing 30-day heart failure readmission rates

Get With The Guidelines Best Practices: A look at reducing 30-day heart failure readmission rates Thank you for joining the webinar! The presentation will begin shortly. *Please make sure your computer