Move to Improve ProgramProcess and Results
Gina Mazza RN, BSNPartner, Fazzi Associates
Jim Culhane. MSW, MBADirector of Homecare and Personal Services
VNA of Manchester and S NH
February 20131
To identify best practice strategies for reducing avoidable hospitalizations of the home care patient.
Objective
2
76 Agencies
Size of agencies by Average Daily Census:
Mean: 230
Median: 157
# agencies less than 100: 19
# between 100 and 300: 39
# agencies greater that 300: 20
Move To Improve Project Statistics
3
For comparative analysis, agencies were divided into three categories:
Move To Improve Project Statistics
Home Health
Compare Rate Number of Agencies
Low Hospitalization Rate
(Best)16% - 27% 23
Moderate Rate Hospitalization 28% - 32% 28
High Hospitalization Rate (Poorest) 33% or greater 25
4
The Program…
• Initiated collection of baseline OASIS data
• Agency practice survey
• Focus Group
• Developed Tracker and Hospitalization Management Dashboard
• Training
5
Revised Structure
• Audit tool revised
• Dashboard revised
• Monthly Accountability/Planning Meeting
6
SafeSide™ Structure
Activity Real Time Tracking
Real Time Audits Monthly
Targeted Trend
Improvement Effort
SafeSide Components
Hosp. Dashboard
48-Hour SafeSide
Audit
SafeSide Monthly
Accountability Meetings (MAP)
No More Than 1 New Improvement per Quarter
Lead QI/PIClinical Director/
SupervisorSafeSide Lead Clinical
Director
7
Input ProcessOutcomes:
Improvement Efforts
Zealous Accountability ● Data-Driven ● Goal-OrientedMeasurable Targets and Outcomes
Project Leader
Planning and Improvement
Meeting
Fazzi’s SafeSide Outcomes ModelThe Outcome Oriented Change Model
Process Improvements
Practice Refinements
New Strategies
Education and Competency
Data Monitoring
and Tracking
Real-Time Audits
8
Leadership of Program
Lead
CEO SeniorClinical
Dir.Mid
LevelQuality
AverageOverall Reduction
-6.0% -5.0% -2.2% 0.2% -4.2%
9
Frequency of Monitoring Hospitalization Rates
How often monitor scores
Often Somewhat
moreIn-
FrequentHave not
monitored
Average Overall
Reduction-6.7% -3.2% 0.8% 0.0%
10
Results of Agencies Performing Audits
Hospitalization Grouping at
Initiation
Change in HHC Hospitalization
Rate
% Reduction of the HHC
Rate
High Rate -11 percentage points 21.5%
Moderate Rate -5.3 percentage points 15.6%
Low Rate -2.8 percentage points 10.1%
Total -6.6 percentage points 15.7%
11
Overall Results
Hospitalization Grouping at
Initiation
Change in HHC Hospitalization
Rate:First 6 Months vs.
Last 6 Months
% Reductionof their HHC
Rate
High Rate -11 percentage points 19.9%
Moderate Rate -4percentage points 13.9%
Low Rate -3 percentage points 8.2%
Total Average -6 percentage points 14.8%
12
Recommendations
1. Audit charts of hospitalized patients
●Critical to identifying core issues related to hospitalization
●Create teachable moments
2. Set clear and measureable goals and share with team
●Set stretch goals and publicize and celebrate wins
13
Recommendations
3. Accountability● Have a leader that has authority, accountability and
respect of clinicians.
4. Develop a plan for change and operationalize
●Plan, Do, Check, Act
●Don’t let daily fires distract from the focus.
14
SafeSide Hospitalization Study 2012: Key Findings
1. This patient was identified as high risk for ACH.
2. Interventions were implemented for the ACH risks identified.
15
Final Thoughts
• Act with purpose
• Make decisions based on data
• Set clear goals
• Have clear outcomes
16
Gina L. Mazza RN, BSN
413- 584-5300
17