RI Antipsychotic Med Reduction Challenges to the QIN-QIO 11 th - PowerPoint PPT Presentation

RI Antipsychotic Med Reduction Challenges to the QIN-QIO 11 th Statement of Work Contract Briefing Presented to the Healthcentric Advisors Board of Directors & Governance Advisory Council June 21, 2017

Task Requirements (63 engaged nursing homes) • Reduce antipsychotic medications in long stay residents to achieve a 9% relative improvement rate (statewide) • Baseline rate – 18.2% • Rate required to pass the evaluation in July 2017 – 16.6% • Current “official” rate – 17.7% (3.2% RIR) • Current “unofficial” rate - 16.7% (for Q 4 2016 & Q 1 2017) (8.4% RIR) 2

Multi-faceted Approach • Educational webinar series – 12/2015 – 8/2016 – Subject Matter Experts – Peer Mentors/Sharing of Best Practices • Affinity Group for the homes with the highest rates • Quarterly DON group – education & sharing • MDS Coordinator Group – supporting the homes in accurate coding • Onsite technical support 3

In-Depth Root Cause Analysis • A younger behavioral health population, including the most disparate residents (homeless, PTSD, high incidence of mental illness, former incarcerated) • Insufficient group home housing • Turnover has been high among quality improvement champions, leadership, and staff • RI nursing homes initially amongst the highest performers with a rate better than 33 states • Further analyses show that after removing 10 nursing homes with highest percentages of psychiatric diagnoses and younger residents we see the 2017 Q1 antipsychotic rate decrease to 15.14% and RIR increase to 17.0% 4

What Did We Learn? Positively Associated with Antipsychotic Negatively Associated with Antipsychotic Prevalence Prevalence (Adjusted Findings) (Adjusted Findings) • • Antianxiety medication Dementia • • Antidepressant medication Behavior care plans • • Psychiatric diagnoses Middle income community • • Behavioral symptoms High income community • For-profit institutions 5

Additional Interventions • Outreach to high performing QIOs • Discussion at the behavioral health coalition • Behavioral health statewide taskforce (coming late June) • Physician education (RIMs article, Medical Directors dinner) 6/15/2017 6

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