implement medicaid programs for the reduction of avoidable visits to the emergency department beacon...
TRANSCRIPT
IIMMPPRROOVVEE Statewide Collaborative
Implement Medicaid Programs for the Reduction of
Avoidable Visits to the Emergency Department
BEACON Council Meeting September 29, 2010
Mina Chang, Ph.D., Section ChiefOhio Department of Job & Family Services
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IMPROVE Collaborative Progress Report • Background & Overview • Children Focus• Regional Collaborative Progress
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ODJFS’ external quality review organization (EQRO), Health Services Advisory Group [HSAG], conducted a program evaluation
Findings: • There is no “gold standard” regarding initiatives to reduce
avoidable visits to the ED• ODJFS strategies were consistent with those used by other states• ED utilization issues are unique to a community
Recommendation: • A Collaborative Approach: working with key community
stakeholders to identify issues and create quality solutions that are meaningful for the community.
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Setting Aims (Goals) Establishing Measures Selecting Changes (Interventions)
Testing Changes Implementing Changes
After testing a change on a small scale, learning from each test, and refining the change through several PDSA cycles, the team can implement the change on a broader scale—for example, for an entire pilot population or on an entire unit.
Improvement requires setting aims. The aim should be time-specific and measurable; it should also define the specific population of patients that will be affected.
Teams use quantitative measures to determine if a specific change actually leads to an improvement.
All improvement requires making changes, but not all changes result in improvement. Organizations therefore must identify the changes that are most likely to result in improvement.
The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change in the real work setting — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method used for action-oriented learning.
May to July 2010
August to September 2010
October to December 2010
January to March 2011
March to September 2011
Spreading Changes—Future Step
After successful implementation of a change or package of changes for a pilot population or an entire unit, the team can spread the changes to other parts of the organization or in other organizations.
Plan
Study
Act
Do
What are we trying to
accomplish?
How will we know that a change is an
improvement?
What changes can we make that will
result in improvement?
IHI: Institute for Healthcare ImprovementIHI: Institute for Healthcare Improvement
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Ohio’s overall ED utilization rates have consistently exceeded the national average
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NYU Algorithm:◦ Developed with advice of panel of ED and Primary Care
Physicians (PCPs) after examination of nearly 6,000 full ED records by panel
◦ Grouped ED visits into categories: Non-emergent Emergent Primary Care Treatable Emergent Preventable/Avoidable Emergent Not Preventable/Avoidable
Behavioral Health ED Visits Without Resulting in Hospitalization
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73% (775,846)• Non-emergent ED Visits• Primary Care Treatable• Preventable/Avoidable
Data Source: CY2008 ODJFS Administrative DataData Source: CY2008 ODJFS Administrative Data
8Data Source: CY2008 ODJFS Administrative DataData Source: CY2008 ODJFS Administrative Data
Children Hospital A B
Number of Non-Emergent/ PCP Number of Non-Emergent/ PCP treatable/ Preventable ED Visits treatable/ Preventable ED Visits (CFC)(CFC)
45,586 36,053
Percent of Regional Total Non-Percent of Regional Total Non-Emergent/ PCP treatable/ Emergent/ PCP treatable/ Preventable ED Visits (CFC)Preventable ED Visits (CFC)
27.2% 33.4%
Top 5 DiagnosesTop 5 Diagnoses1.1.
Other upper respiratory infections
Other upper respiratory infections
2.2. Otitis media and related conditions
Otitis media and related conditions
3.3. Viral infection Asthma
4.4. Allergic reactions Viral infection
5.5. Noninfectious gastroenteritis
Skin and subcutaneous tissue infections
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Data Source: CY2008 ODJFS Administrative DataData Source: CY2008 ODJFS Administrative Data
Children’s Patient Streams† – Upper Respiratory Tract Infection (URI)Children’s Patient Streams† – Upper Respiratory Tract Infection (URI)
Region Central East Central Northeast Northwest Southwest
PopulationChildren - 6
months – 6 years old - CFC
Children - 6 months - 6
years old - CFC
Children - 6 months - 6
years old - CFC
Children 2-17 years old - CFC
Children 2-17 years old -CFC
MCPFor the Stream
CareSource CareSource* Wellcare* Paramount*AmerigroupCaresource
MolinaHealth SystemFor the Stream
Nationwide Children’s Hospital*
Children’s Hospital Akron
University Hospital
Toledo Children’s Hospital
Cincinnati Children’s Hospital*
Additional Definition
ED visit during office hours,
3 or more visits to ED in 6 months
n/a n/a n/a
Downtown & Liberty
Campuses – Separate samples
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†† Patient populations: homogeneous, well defined boundaries, Patient populations: homogeneous, well defined boundaries, and a large volume to warrant interventionsand a large volume to warrant interventions
** Responsible Party for Patient Follow-up Calls Responsible Party for Patient Follow-up Calls
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Common Themes◦ Number 1 facility in each region for avoidable ED visits for CFC is
a children hospital or a hospital with children facility◦ Top two diagnoses for avoidable ED visits for CFC are URI and
Otitis Media, most prevalent among children◦ All five regions chose URI for Children as a patient stream◦ Three regions chose age group 6 mos-6 yrs old◦ Two regions chose age group 2-17 yrs old◦ All regions used patient census from ED/Health Systems to
conduct patient follow-ups◦ MCPs and health systems worked together to identify patients
and conduct patient follow ups
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Collaborative Leadership & StructureCollaborative Leadership & Structure
Southwest Regional Steering Committee –Stakeholders
Chair__________________________Hospitals/EDs__________: __________PCPs/BH____________: _____________MCPs_____________: ________________FQHC_____________________________Consumer_________________________ODJFS____________________________HSAG____________________________
Southwest Regional Steering Committee –Stakeholders
Chair__________________________Hospitals/EDs__________: __________PCPs/BH____________: _____________MCPs_____________: ________________FQHC_____________________________Consumer_________________________ODJFS____________________________HSAG____________________________
Northwest Regional Steering Committee –Stakeholders
Chair: __________________________Hospitals/EDs: ________:____________PCPs/BH____________: _____________MCPs_____________: _______________FQHC_____________________________Consumer_________________________ODJFS____________________________HSAG____________________________
Northwest Regional Steering Committee –Stakeholders
Chair: __________________________Hospitals/EDs: ________:____________PCPs/BH____________: _____________MCPs_____________: _______________FQHC_____________________________Consumer_________________________ODJFS____________________________HSAG____________________________
Northeast Regional Steering Committee –Stakeholders
Chair__________________________Hospitals/EDs__________: ___________PCPs/BH___________: ________________MCP_____________; _________________FQHC_______________________________Consumer___________________________ODJFS______________________________HSAG______________________________
Northeast Regional Steering Committee –Stakeholders
Chair__________________________Hospitals/EDs__________: ___________PCPs/BH___________: ________________MCP_____________; _________________FQHC_______________________________Consumer___________________________ODJFS______________________________HSAG______________________________
Central Regional Steering Committee –Stakeholders
Chair__________________________Hospitals/EDs__________: ______________PCPs/BH_____________: ________________MCPs_____________: __________________FQHC________________________________Consumer____________________________ODJFS_______________________________HSAG_______________________________
Central Regional Steering Committee –Stakeholders
Chair__________________________Hospitals/EDs__________: ______________PCPs/BH_____________: ________________MCPs_____________: __________________FQHC________________________________Consumer____________________________ODJFS_______________________________HSAG_______________________________
East Central Regional Steering Committee –Stakeholders
Chair__________________________Hospitals/EDs________: ______________PCPs/BH_____________: ______________MCPs_______________: _______________FQHC_______________________________Consumer___________________________ODJFS_____________________________HSAG______________________________
East Central Regional Steering Committee –Stakeholders
Chair__________________________Hospitals/EDs________: ______________PCPs/BH_____________: ______________MCPs_______________: _______________FQHC_______________________________Consumer___________________________ODJFS_____________________________HSAG______________________________
State Steering Committee
Regional Chairs/ODJFS
Facilitators: HSAG
State Steering Committee
Regional Chairs/ODJFSMedicaid/MCP Medical Directors
Facilitators: HSAG
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Developed strategies for patient stream identification and responsible parties for patient stream calls
Review patient input, determine if data are actionableYes → develop potential strategies/solutions meaningful to these patientsNo → refine patient streams, or move on to other streams
Oct
Follow up calls to patients post ED discharge, collect patient perspectives, analyze patient data
Sep
Aug
Identified at least 3 patient streams as a community priority to reduce avoidable/preventable ED visits
June
Regional Collaborative (All Five Regions)Year
2010
Status
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IMPROVE Contact
Mina Chang, Ph.D., ChiefHealth Services Research & Program Development SectionBureau of Health Services ResearchOhio Department of Job & Family Services
Phone: 614-752-4801Fax: [email protected]