Implementation of Joint Commission Measures Implementation of Joint - PowerPoint PPT Presentation

Implementation of Joint Commission Measures Implementation of Joint Commission Measures for Alcohol- and Tobacco-related Inpatient Care at VA Pittsburgh Healthcare System g y Lauren M. Broyles, PhD, RN Lauren M. Broyles, PhD, RN Research Health Scientist VA Pittsburgh Healthcare System Assistant Professor of Medicine Assistant Professor of Clinical and Translational Science University of Pittsburgh Lauren.Broyles@va.gov y @ g Behavioral Health is Essential to Health Prevention Works | Treatment is Effective | People Recover

Acknowledgments • Melissa Wieland, PhD; Monica DiNardo, PhD, CRNP; Andrea Confer, BA; Karen Mancini, MHA, BSN • • Ali Sonel MD & Ira Richmond DNP MS RN Ali Sonel, MD & Ira Richmond, DNP, MS, RN • Career Development Award (CDA10-014) from the Health Services Research & Development service of the U.S. Department of Veterans Affairs f V t Aff i • VA Office of Nursing Services Pilot Program • This material is also the result of work supported with resources This material is also the result of work supported with resources and the use of facilities at the VAPHS, Pittsburgh, PA • The views expressed in this presentation do not necessarily reflect the position or policy of the Department of Veterans Affairs or the the position or policy of the Department of Veterans Affairs or the United States government

Overview • Main components of the new SUB/TOB measures from The Joint Commission (TJC) measures from The Joint Commission (TJC) • Five guiding principles • General implementation theory • Facilitators and barriers to implementation of the SUB/TOB measures at VA Pittsburgh Healthcare System (VAPHS) y ( )

• • Large academic medical center Large academic medical center • 2 campuses, 661 beds • >10,000 admissions/year • ~5500 surgeries/year • ~1300 trainees/year across disciplines • $36.4 million in research $

External Peer Review Program (EPRP) (EPRP) • Official data source for monitoring VA performance • Goal = improve quality of care • Data used primarily for quality improvement, evaluation, and benchmarking with external organizations

ORYX Program • Integrates outcomes and other performance measurement data into performance measurement data into hospital accreditation process • Public availability of performance measure d t data allows comparisons of hospital ll i f h it l performance

ORYX Measures for Substance and Tobacco Use Tobacco Use • Effective January 1, 2014 y • For all VA Medical Centers nationwide – Optional for other healthcare systems – Optional for other healthcare systems • Similar to those in VA primary care • Apply to all hospitalized patients A l t ll h it li d ti t

Alcohol screening within Admitting provider 3 days of admission Brief intervention Social worker Operationalizing counseling Substance Use M Measures IF ALCOHOL OR SUBSTANCE USE DISORDER, IF ALCOHOL OR SUBSTANCE USE DISORDER Psych consult ALSO: Social worker, based on Referral to outpatient Psych consult recs Psych consult recs treatment treatment FDA ‐ approved med for Admitting provider, based on AUD/SUD Psych consult recs Follow up contact 15 30 Follow up contact 15 ‐ 30 Primary care RNs? LPNs? days after discharge

Tobacco screening within 3 RN days of admission Operationalizing RN Brief practical counseling Tobacco Use M Measures RN + Provider Pharmacotherapy in hospital RN RN Referral for outpatient counseling/quit line Referral for outpatient counseling/quit line Provider Pharmacotherapy at discharge Follow up 7 ‐ 30 days Primary Care RN? LPN? after discharge after discharge

Timeline • Fall 2013 • January to March 2014 • January to March 2014 • April to June 2014 • July to October 2014

How did I get here? • Clinical Background • Program of Research Program of Research

Fall 2013 “The Basics” Behavioral Health is Essential to Health Prevention Works | Treatment is Effective | People Recover

Guiding Principles • Interdisciplinary • • Participatory Participatory • Patient-centered • Efficient for staff/congruent with practice • “Meaningful metrics” Meaningful metrics

Establishing the Team • Identifying and inviting stakeholders • Establishing a charter

Initial Committee Representation • Nursing (inpatient medicine and psych + primary care) • Social Work (inpatient medicine + psych) Social Work (inpatient medicine + psych) • Medicine (inpatient medicine + psych) • Substance Specialty (outpatient) S b t S i lt • Quality & Performance • Research

Literature Review • Inpatient SBIRT, tobacco cessation svcs • SBIRT implementation literature SBIRT implementation literature • General implementation theory

Supplemental Grant Funding • VA Office of Nursing Services • Formative evaluation “E “Evaluating Inpatient Alcohol/Tobacco Performance l ti I ti t Al h l/T b P f Measure Implementation” (PI: Broyles)

PRECEDE-PROCEED • Predisposing Factors – a person’s motivation to undertake a new behavior or activity; include knowledge attitudes beliefs personal preferences existing skills and knowledge, attitudes, beliefs, personal preferences, existing skills, and self-efficacy • Reinforcing Factors – follow a behavior or activity that provide continuing reward or incentive for its persistence or repetition; include social or professional support, peer influence, recognition • Enabling Factors – make it possible (or easier) for individuals or populations to change their behavior; includes programs resources and services in the social or professional includes programs, resources, and services in the social or professional environment

Aims 1) To assess the antecedent and reinforcing factors required to initiate implementation of the TJC alcohol/tobacco measures on two inpatient units at our facility (PRECEDE) 2) To assess the factors associated with successful and sustained implementation of the TJC d t i d i l t ti f th TJC alcohol/tobacco measures on two inpatient units at our facility (PROCEED) our facility (PROCEED)

Methods • 30 minute audio-recorded interviews with clinicians/administrators (10) and patients clinicians/administrators (10), and patients (5) from each of 2 pilot units • 3 time points: before during after pilot • 3 time points: before, during, after pilot implementation • Unit observations U it b ti • Rapid analysis of transcripts

January to March 2014 “Getting the Lay of the Land” Behavioral Health is Essential to Health Prevention Works | Treatment is Effective | People Recover

Initial Logistics • National VA call • C Committee meetings every 2-4 weeks itt ti 2 4 k • Learning the measures • • Understanding grant activities game plan Understanding grant activities, game plan Implementation Formative The roll-out The roll out Evaluation of the Evaluation of the Roll-out (QI) (Research)

Initial Brainstorming Existing Resources Existing Concerns and Barriers Existing Processes of Care

Deciding on Structure & Roles • By Unit? Medical / Behavioral Health Medical / Behavioral Health • By Measures? Alcohol & Tobacco • By Activities? S, BI, RT, Pharmacotx, F/U • Missing stakeholders/expertise? Missing stakeholders/expertise?

April to June 2014 “Cycling” Behavioral Health is Essential to Health Prevention Works | Treatment is Effective | People Recover

Study Interviews • Patients • Clinicians Clinicians • Administrators

False Starts and Dead Ends

Heating up

Alcohol screening within Admitting provider 3 days of admission Brief intervention Social worker Operationalizing counseling Substance Use M Measures IF ALCOHOL OR SUBSTANCE USE DISORDER, IF ALCOHOL OR SUBSTANCE USE DISORDER Psych consult ALSO: Social worker, based on Referral to outpatient Psych consult recs Psych consult recs treatment treatment FDA ‐ approved med for Admitting provider, based on AUD/SUD Psych consult recs Follow up contact 15 30 Follow up contact 15 ‐ 30 Primary care RNs? LPNs? days after discharge

July to October 2014 “Prioritizing and Plowing Forward” Behavioral Health is Essential to Health Prevention Works | Treatment is Effective | People Recover

Prioritizing • Stick to Pilot • Phase-in process • Phase I: process to address 85% of patients • Phase II: the “outliers”/unique issues – Opioid dependent patients – Critical care transfer issues

Piloting the CPRS templates • Providers: AUDIT-C and order sets • Issues of workflow intuitiveness training • Issues of workflow, intuitiveness, training • “Think-alouds” • VERC

Training • Providers in AUDIT-C • Social Workers in BI • Social Workers in BI • Nurses in Tobacco Tactics • Developing & Ordering Materials

Tobacco Tactics Sonia A. Duffy, PhD, RN VA Ann Arbor Healthcare System