Department of Health Care Finance (DHCF) and Comagine Health Nursing Facility Quality Improvement Collaborative Learning Session 2 June 26, 2019
Qualis Health & HealthInsight have joined forces to do great things. Together, we’re reimagining health care.
Comagine Health • Comagine Health, formerly Qualis Health and HealthInsight, is a national, nonprofit, health care consulting firm. We work collaboratively with patients, providers, payers and other stakeholders to reimagine, redesign and implement sustainable improvements in the health care system. • As a trusted, neutral party, we work in our communities to address key, complex health and health care delivery problems. • Serving as the Medicare Quality Improvement Organization (QIO) for Idaho, Nevada, New Mexico, Oregon, Utah and Washington.
Agenda 8:00-8:30am Registration and Sign-in 8:30-9:15am Collaborative Overview 9:15-10:00am Peer-to-Peer Sharing: Stories from the Field 10:00-10:15am Break & Visit Story Boards 10:15-10:45am The Go Wish ™ Game 10:45-11:45am Evidenced-based and Resident Centered End of Life Care 11:45am-12:15pm Team Time 12:15-12:30pm Evaluation & Wrap Up
Collaborative Overview
Collaborative Aims • Partner with DHCF staff to create “all, teach, all learn” Learning and Action Networks • Assess nursing facility readiness to participate in pay-for-performance and develop a plan of action on areas of improvement • Provide individual and group technical assistance (e.g. training, education and quality improvement consultation services) to 17 DC nursing facilities to instill high-quality, person-centered care • Engage nursing facilities in rapid-cycle improvements in areas at the system level • Ensure nursing facility staff are adequately trained to conduct MDS assessments • Conduct Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to measure resident/family experience and identify areas for improvement
Roles and Responsibilities Nursing Home Team Comagine Health Provide staff time to devote to the Provide expertise on clinical & systems content and Collaborative effort process improvement Perform pre-work activities to prepare for the Provide quality improvement coaching & training to Learning Sessions individual NFs Participate in each Learning Session and Assess gaps in care with the NF Team with improvement Outcomes Congress action planning Implement small-scale, rapid Plan-Do-Study- Provide venues for peer sharing via in person meetings, Act (PDSA) improvement cycles and submit conference calls and email groups monthly reports and data Share learnings on a regular basis with Make resources readily available, including guidelines, Collaborative faculty and peer participants clinical tools and in-service materials
Collaborative Model for Improvement Act Plan Study Do
Nursing Facility Quality Improvement Collaborative Model Project Start Date: 11/1/18 | Project End Date: 10/31/2023 WE ARE HERE! Collaborative 1: 11/1/18 - 10/31/19
Nursing Facility Collaborative 1 Schedule of Events • Pre-work – January – March 2019 • Face – to-Face Orientation Meeting – January 28, 2019 • Collaborative Handbook & Change Package Distributed to NFs – February 2019 • Individual Initial Assessment Site Visits #1 - February-March 2019 • NFs complete pre-work – February-March 2019 • Learning Session 1 – March 28, 2019 (1:00 – 4:00 pm) – Host: DHCF • Action Period 1 - March – May 2019 • In-person Training at DC Health Care Association – April 19, 2019 • Webinar #1 – National Nursing Home Quality Improvement Campaign (NNHQIC) Part 1: Overview - May 14, 2019 (1:00 – 2:00 pm) • Senior Leader Reports • Individual Technical Assistance Site Visits #2 - March – June 2019 • Learning Session 2 - June 26, 2019 (8:00 am – 12:30 pm) Host: Bridgepoint Sub-Acute Capitol Hill • Action Period 2 - June - September 2019 • Webinar #2 - National Nursing Home Quality Improvement Campaign (NNHQIC) Part 2: Staff Stability - July 9, 2019 (1:00 – 2:00 pm) - Cancelled • Webinar #3 – MDS Coding Part 1 - August 26, 2019 (10:00 am – 12:00 pm) • Webinar #4 - MDS Coding Part 2 – September 23, 2019 (10:00 am – 12:00 pm) • Senior Leader Reports • Individual Technical Assistance Site Visits #3- July – September 2019 • Outcomes Congress – October 22, 2019 (8:00 am – 12:30 pm) Host: Carroll Manor Nursing and Rehabilitation
Site Visit #2 Feedback • 15/17 Nursing Homes – Total of 124 Participants • Areas of focus/goals: • Establishing a comprehensive End of Life Program • Reducing falls • Reducing/healing pressure injuries • Decreasing the use of antipsychotics • Reducing urinary tract infections (UTIs) • Improving bowel and bladder incontinence • Improving resident dining experience • Reducing avoidable hospitalizations
Site Visit #2 Feedback (cont.) • Challenges • Time and labor intensive nature of the Prompted Voiding Program • Inconsistent implementation of Prompted Voiding Program • Documentation discrepancies • Gaining staff buy-in • Staffing and staff stability (e.g., recruiting and retaining quality staff) • Providing time in the QAPI meeting for discussion of root causes, progress towards barriers and actions to take to reach the goal(s) • Establishing a comprehensive End of Life Program • Preparing for and successfully implementing the Patient-Driven-Payment Model (PDPM) • Preventing avoidable hospitalizations • Admitting high number of residents with Stage 3 & 4 pressure injuries • Lack of communication/documentation from hospitals regarding residents admitted with pressure injuries • Identifying and healing pressure injuries on admission • MDS coding • Lack of consistent follow through on Care Plans • Dealing with major restructuring, renovations, and/or moves • Juggling multiple priorities
Site Visit #2 Feedback (cont.) • Best practices • Examples: LS2 Peer to peer sharing of four nursing homes quality improvement projects • Topics for technical assistance • Root cause analysis • MDS coding tips • QAPI • Nursing documentation • Critical thinking • Urinary Tract Infections • Antipsychotic medication reduction (e.g., gradual dose reduction) • Preventing/healing Stage 3 & 4 pressure injuries • Person-centered dementia care and managing challenging behaviors • Training on the National Nursing Home Quality Improvement Campaign (NNHQIC) website and resources • Culture change • Customer service • Staff burnout • How to integrate the Chesapeake Regional Information Systems for Patients (CRISP) into day-to-day practice/systems
DHCF Nursing Facility Quality Improvement Domains and Measures Quality of Care Quality of Utilization Infrastructure Life Resident/ Low-acuity Non-emergent Percent of high risk, long-stay residents Staff Continuing Education in Minimum Data Set (MDS) Family Emergency Department with pressure ulcers Training Experience (ED) visits Percentage of long-stay residents who End of Life All-cause 30-day RN Hours per Resident Day received an antipsychotic medication Program Readmissions Percent of long-stay residents with a Potentially Preventable Quality Assurance and Performance Improvement (QAPI) Plan urinary tract infection Hospital Admissions Percent of low risk long-stay residents who Staff Turnover lose control of their bowel or bladder Percent of long-stay residents experiencing Certified Electronic Health Record (EHR) Adoption one or more falls with major injury Enrollment and Integration in the Chesapeake Regional Information System for our Patients (CRISP) to share health information among doctor’s offices, hospitals, nursing facilities, and other healthcare organizations
Quality of Care Domain – Baseline Data Lose Control of Bowel or Bladder Source: DHCF
Quality of Life Domain • There are two measures under the Quality of Life domain: • Resident and Family Satisfaction • Use the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey to measure resident/family experience • Discharged Resident Survey • Response data is being assessed; initial report preparation underway • Long Stay Resident Survey • Data analysis and report preparation continues • Family Member Survey • Anticipate first survey questionnaire to be mailed June 18-19, 2019 • Next Steps • Ongoing report preparation for Discharged and Long Stay Resident surveys. Reports are on track for delivery by the DHCF requested timeframe of mid-July • Administration of Family Member Survey • DHCF should send reports to nursing facilities after the beginning of the fiscal year (October 1, 2019)
Quality of Life Domain (cont.) • End of Life Program • Develop a program that serves the staff, residents, and family members in preparation for the time of passing • Provide supporting documentation for the program containing details and evidence of compliance • DHCF completed all annual nursing facility site visits to evaluate compliance. Facilities should expect to receive their results no later than the first week of July.
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