Coordination and Medication Safety by CIMRO of Nebraska Kansas - PowerPoint PPT Presentation

Introduction to Improving Care Coordination and Medication Safety by CIMRO of Nebraska Kansas Foundation for Medical Care Quality Health Associates of North Dakota South Dakota Foundation for Medical Care July 23, 2015

Welcome and Reminders  Welcome!  Thank you for joining  Slides and recording will be available on the Great Plains Quality Innovation Network website Sally May, RN, BSN, CH-GCN Senior Quality Improvement Specialist  *6 to mute your line - Quality Health Associates of North *6 to unmute Dakota 2

Expectations Ours Yours  Attentive  Commitment to success  Open-minded  Mindfulness of demands  Actionable  Expertise  “All teach – all learn”  Support  Chat  Technical assistance  Data 3

Polling Question - 1  Which healthcare setting, agency, or long-term services or support organization best describes you? Include all that apply: • Hospital • Skilled nursing facility • Long-term care facility • Home health agency • Community pharmacy • Healthcare consumer • Other 4

Carol B.  A family perspective . . . 5

Care Coordination Paula Sitzman, RN, BSN Quality Improvement Advisor CIMRO of Nebraska 6

Great Plains Quality Innovation Network- Quality Improvement Organization  North Dakota, South Dakota, Nebraska and Kansas  A new approach to quality improvement  Each state partner working collaboratively  Multiple tasks: cardiovascular health, diabetes, healthcare-associated infections, improvement in immunization rates, health information technology, nursing home quality improvement, quality reporting, care coordination and medication safety  Five-year contract with CMS 7

Make-Up of the Great Plains QIN These four states choose to work together because of: • Commonalities of Medicare consumers • Provider characteristics • Rural and frontier issues • Similar corporate philosophies and general approaches to the QIO work These common factors are strengths in working cohesively 8

Care Coordination Goals  Reduce hospital admission and readmission rates by 20% by July 2019  Increase community tenure, as evidenced by number of nights Medicare fee-for-service beneficiaries spend at home, by 10% by July 2019  Reduce the prevalence of ADE, ED visits, observation stays, hospital admissions or readmissions as a result of the care transition process 9

Improving Care Coordination  Establish partnerships to improve communication among hospitals, skilled/LTC nursing facilities, home health agencies, pharmacists, physicians and other community stakeholders  Develop partnerships with patients and families to improve readiness for transitions of care, chronic disease self-management and to reduce medication harm 10

Drivers of Readmission  Low patient activation  Lack of standard, known process  Inadequate transfer of information 11

Example Interventions: Low Patient Activation  Teach-back  Patient and family education  Chronic disease self-management  Knowledge of medications  Medication planner  Knowledge of “red flags”  Personal health record 12

Example Interventions: Lack of Standard, Known Process  Nurse-to-nurse calls; MD-to-MD calls  SBAR  Follow-up MD appointments made before hospital discharge  Medication reconciliation by pharmacist  Medication education by pharmacist for patients with high-risk medications  Readmission risk assessment  Post discharge telephone follow-up with high-risk patients 13

Example Interventions: Inadequate Transfer of Information  Communication between senders and receivers  Medication reconciliation  Hospital discharge summary to PCP, SNF and Home Health  Patient and family involvement during transitions 14

Example Interventions: Multiple Drivers  INTERACT Quality Improvement Program  Cross-setting workgroups  Home Health Quality Improvement (HHQI) Best Practice Intervention Packages (BPIP)  Project RED (Re-engineered Discharge)  Care Transition Intervention(CTI)  Advance care planning 15

Medication Safety Jayme Steig, PharmD, RPh Quality Improvement Specialist - Pharmacy Quality Health Associates of North Dakota 16

Medication Safety  The issue nationally: Source: National Action Plan for Adverse Drug Event Prevention 17

Medication Safety  The issue regionally State Total Medicare % at High Risk for ADE Consumers Anticoagulants Diabetic Agents Opioids Total Kansas 404,445 6.7% 13.7% 14.5% 25.1% Nebraska 260,660 8.1% 12.2% 11.3% 22.9% North Dakota 97,604 8.4% 14.9% 11.1% 25.6% South Dakota 125,298 7.6% 12.6% 10.6% 22.7% United States 37,079,097 5.8% 13.3% 13.2% 23.8% Source: 2013 Medicare Part D claims analysis 18

Medication Safety Goals  Aim - Improve medication safety to reduce and prevent adverse drug events by implementing practices that align with the National Action Plan for Adverse Drug Event (ADE) Prevention  Goal – Reduce the incidence of adverse drug events by 35% by July 2019 ADE 35% reduction July 2019 19

Medication Safety - Our Approach  Practitioners: Multi-disciplinary • Pharmacies, hospitals, SNFs, home health, clinics, hospice, etc.  Community-based • Including practitioners, stakeholders, LTSS, consumers & families, etc. 20

Medication Safety – Commitment  Great Plains QIN provides: • Learning and Action Network • Facilitation • Technical assistance • Tools and best practices • Data analysis • Promote and share resources 21

Medication Safety - Commitment  Community partners: • Collaborate to identify and develop interventions for medication safety barriers in the community • Provide measurement of potential and actual ADE • Share data with Great Plains QIN 22

Medication Safety Interventions  Examples include: • Coordinate communication and medication therapy management • Medication reconciliation • Medication adherence • Consumer and family engagement • Use of HIT to screen for ADE • Implementation of treatment guidelines • Other community defined interventions 23

Medication Safety – Immediate Opportunity  Complete the Adverse Drug Event Environmental Scan • https://www.surveymonkey.com/r/GPQINADE 24

Community Approach Vanessa Lamoreaux, BA Project Manager Kansas Foundation for Medical Care 25

The Power of People “I alone cannot change the world, but I can cast a stone across the waters to create many ripples.” • Mother Teresa

Holistic Approach  Engaging all aspects of a local health reality • Encourages buy-in • Establishes sustainability • Enables efficient resource utilization • Expands impact

Dare To Be Different!  Community engagement is: • Gaining momentum across a broad spectrum of issues and funders • An opportunity to dive deep to creating lasting change

Engaging A Community  Conduct an environmental scan  Find a champion(s)  Define common goals and vision  Build the group  Affirm and reaffirm commitment through action

Community Organizing as a Movement A Movement In 3 Minutes 30

“What T o Expect” Linda Penisten, RN, OTR/L Program Manager South Dakota Foundation for Medical Care 31

“What to Expect ”  Exploring evidence-based interventions and tools  Learning through shared “lessons learned” and best practices  Celebrating successes  Working collaboratively

Polling Question - 2  Which focus would be most helpful for your community? (Answer all that apply.) • Conducting root cause analysis to better understand drivers of readmissions • Data collection and quality improvement process • Improving care coordination • Reducing adverse drug events • Coalition building and development 33

Leave in Action  Sign up for the Learning and Action Network • http://greatplainsqin.org/lan-signup-page/  View website resources • Care coordination http://greatplainsqin.org/initiatives/coordination-care/ • Medication Safety http://greatplainsqin.org/initiatives/medication-safety/  Complete the Adverse Drug Event Environmental Scan • https://www.surveymonkey.com/r/GPQINADE 34

Coming Events August 4, 2015 2:00-3:00 p.m. CT (1:00-2:00 p.m. MT) National Benefits, Local Support The QIO Program in ACTION 35

Coming Events . . . October 2015 Webinar Topic: Immunizations Hosted by: CIMRO of Nebraska 36

Questions? Thank you! 37

Contact Information Vanessa Lamoreaux Sally May vlamoreaux@kfmc.org sally.may@area-a.hcqis.org Kansas Foundation for Medical Care Jayme Steig 2947 SW Wanamaker jayme.steig@area-a.hcqis.org Drive Topeka, KS 66614-4193 Quality Health Associates of North Dakota P: 785.271.4120 3520 North Broadway Minot, ND 58703 Paula Sitzman, RN, BSN P: 701.852.4231 paula.sitzman@area-a.hcqis.org CIMRO of Nebraska Linda Penisten, RN, OTR/L 1200 Libra Drive, Suite 102 linda.penisten@area-a.hcqis.org Lincoln, Nebraska 68512 South Dakota Foundation for Medical Care P: 402.476.1399, Ext. 512 2600 West 49th Street, Suite 300 Sioux Falls, SD 57105 P: 605-444-4124 38