quality improvement – your “gps” for success...acute care proprietary and confidential — do...

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Quality Improvement

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Define the Rationale for Participating in Quality Improvement

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1. Felder S, et al. Nutr 2015;31:1385-1393; 2. Guenter P, et al. Jt Comm J Qual Patient Saf 2015;41:469-473; 3. Rahman A, et al. Nutr Clin Pract 2015;30:709-713; 4. Corkins MR, et al. JPEN J Parent er Enteral Nutr 2014;38:186-195; 5. Tappenden KA, et al. JPEN J Parenter Enteral Nutr. 2013;37(4):482-497; 6. Somanchi M, et al. JPEN J Parenter Enteral Nutr. 2011;35(2):209-216; 7. Braunschweig C, et al. J Am Diet Assoc. 2000;100(11):1316-1322; 8. Krumholz HM. N Engl J Med 2013;100-102; 9. Agarwal E, et al. Clin Nutr 2013;32:737-745.

z

HOSPITAL ADMISSION

33% of severely malnourished patients and

38% of well-nourished patients

experience nutritional

decline7

Many patients continue to be at

nutritional risk after discharge8

Patients with malnutrition and poor food intake are at increased

risk for readmission1,9

HOSPITAL STAY

30% to 50% of hospital

patients have or are at risk of malnutrition

upon admission1-8

HOSPITAL DISCHARGE

HOSPITAL READMISSION

PREVALENCE OF MALNUTRITION


CMS REDUCES PAYMENTS FOR PREVENTABLE READMISSIONS

1. Kaiser Health News, October 2,2014. 2. 2013 HIDA Acute Care Market Report, Alexandria Va. www.HIDA.org.

• More than 2,600 hospitals penalized by CMS in FY 2014

• Fines in FY 2014 $428 million as estimated by CMS

• Penalties increase in FY 2015 to 3%: A hospital with $100 million in Medicare payments could be penalized $3 million

• 75% of hospitals subject to the Hospital Readmission Reduction Program are being penalized

• Hardest hit hospitals are in New Jersey, New York, Washington DC, Arkansas, Kentucky, Mississippi, Illinois, and Massachusetts

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Hospital Readmissions

6/6/2016 5

MALNUTRITION NEGATIVELY AFFECTS PATIENT OUTCOMES

Wound Healing

Mortality

Treatment

Malnutrition 1-4

1. Norman K ,et al. Clin Nutr. 2008; 27: 5-15; 2. Allaudeen N, et al. J Hosp Med. 2011;6(2):54-60; 3. Felder S, et al. Nutr 2015;31:1385-1393; 4. Agarwal E, et al. Clin Nutr 2013;32:737-745.

Length of Stay (LOS) in Hospital

Infections

Complications

Convalescence

Cost Quality of Life


Quality Improvement


Quality Improvement is a formal approach to the analysis of performance and systematic efforts to improve it.

http://www.hrsa.gov/quality/toolbox/methodology/developingandimplementingaqiplan/index.html

WHAT IS QUALITY IMPROVEMENT?

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http://www.google.com/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&ved=0CAcQjRw&url=http://outcomesinc.com/quality-assurance-and-quality-improvement-in-the-coding-industry/&ei=sngIVfrVLsz-yQSB5YKwAQ&bvm=bv.88198703,d.aWw&psig=AFQjCNGekgkANDiMZedUaGpQIcTY_uQGbA&ust=1426704905412034


Batalden PB, Davidoff F. What is “quality improvement” and how can it transform healthcare? Qual Saf Health care 2007; 16: 2-3.

WHAT IS THE ROLE OF QUALITY IMPROVEMENT IN HEALTHCARE?

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Linked aims of quality improvement

Everyone

Better Patient Outcomes

Better Professional

Development

Better system

performance


QI Work as Systems and Processes • To make improvements, an organization

needs to understand its own delivery system and key processes

• The concepts behind QI recognize that both resources (inputs) and activities carried out (processes) are addressed together to ensure or improve quality of care (outputs/outcomes)

• QI can be small and simple or large and complex

• QI can assume many forms and is most effective if it is individualized to meet the needs of a specific organization's health service delivery system



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INPUTS, PROCESSES AND OUTPUTS/OUTCOMES

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http://www.hrsa.gov/quality/toolbox/methodology/qualityimprovement/

RESOURCES (INPUTS)

People Infrastructure Materials Information Technology

ACTIVITIES

(PROCESSES) What is done How it is done

RESULTS (OUTPUTS OR OUTCOMES) Health services delivered Change in health behavior Change in health status Patient satisfaction


The Health Resources and Services Administration (HRSA) and the Institute of Medicine (IOM) have recently outlined goals for quality improvement (QI) in healthcare settings1. In light of these goals and the Affordable Care Act’s focus on value-based care, implementing a strong, evolving QI program has become more important than ever.



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Nutrition-focused QI projects are becoming more common because of the widespread evidence showing improved outcomes in at-risk patients receiving early, appropriate nutrition intervention.1-3 In addition to improved patient outcomes, QI initiatives can also improve hospital processes, increasing efficiency and lowering operating costs.

1. Somanchi M, et al. J Paren Enter Nutr. 2011;35(2):209-216. 2. Starke J, et al. Clin Nutr. 2011;30(2):194-201. 3. Rypkema G, et al. J Nutr Health Aging. 2004;8(2):122-127.


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Performance Improvement Project

FIVE-YEAR EVOLUTION OF A MALNUTRITION TREATMENT PROGRAM IN A COMMUNITY HOSPITAL

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Brugler L, DiPrinzio MJ, Bernstein L. The five-year evolution of a malnutrition treatment program in a community hospital. J on Qual Imp. 1999; 25(4): 191-206.

Benchmarking Study

Nutrition Screening Pilot

Malnutrition Clinical Pathway

Outcomes Studies 1 & 2


OUTCOMES OF AN EFFECTIVE NUTRITION SCREENING AND INTERVENTION PROGRAM

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Case Study: St. Francis Healthcare

Brugler L, et al. J Qual Improv. 1999;25:191-206. Clin Resour Manag. 2000;1:183-186.

60%

Identification of high-risk patients

4.5 d

Time to initial nutrition

intervention

$1000/pt

Patients at high risk for malnutrition

2.7 d

Average length of stay

44%/57%

Mortality rates*

57%

Readmission rates

77%

Complication rates

*In patient groups with highest risk for malnutrition.

A malnutrition treatment program, developed and implemented as a collaborative, interdisciplinary effort, resulted in reduced delays in initiating and achieving a therapeutic level of nutrition care for patients at a significant risk for malnutrition.


Conducted from 2008 through 2013 ; 4,467 patients

IMPROVING THE PERFORMANCE OF NUTRITION SCREENING THROUGH A SERIES OF QUALITY IMPROVEMENT INITIATIVES

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Lim S, et al. Jt Comm J Qual Patient Saf. 2014;40:178-186.

National University Hospital: Nutrition screening QI project

• Creating a new nutrition screening protocol • Training staff on how to conduct screening • Empowering nurses to refer at-risk patients directly to the dietitian • Removing question on the screening tool responsible for the majority of errors

Corrective interventions included

• Reducing screening errors • Eliminating missing or blank forms • Decreasing referral time to the dietitian • Increasing referral of at-risk patients to a dietitian

Pre-intervention audit identified 4 opportunities for improvement


IMPROVING THE PERFORMANCE OF NUTRITION SCREENING THROUGH A SERIES OF QUALITY IMPROVEMENT INITIATIVES

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Lim S, et al. Jt Comm J Qual Patient Saf. 2014;40:178-186.

Pre-Audit Identified Opportunities:

QI Demonstrated Results:

Reducing screening errors

Eliminating missing or blank forms

Increasing referral of at-risk patients to a dietitian

Decreasing referral time to the dietitian

Reduced screening errors from 33% to 5%

Reduced missing or blank forms from 8% to 1%

Decreased dietitian referral time from 7.5 days to 14 hours

Decreased non-referral of at-risk patients from 10% to 3%


WHY IS IT THE TIME RIGHT FOR QUALITY IMPROVEMENT?

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High prevalence of

hospital malnutrition

Hospital Readmissions

Reduction Program

Government and

Regulatory emphasis

Personal and Professional

Development


Review the objectives and implementation steps of Abbott Nutrition’s quality improvement program


eQIP IS A SIMPLE, TURNKEY QUALITY IMPROVEMENT PROJECT (QIP) AIMED TOWARD:

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• Painting the picture of your nutrition process in a clear and impactful way

• Identifying and closing any gaps in the nutrition process, optimizing its ability to impact your hospital’s quality goals

• Providing the ability to compare key metrics to help identify areas for needed efficiency and focus


THE ABBOTT NUTRITION eQIP

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eQIP is conducted in 3 phases to assess current nutrition care practices and determine the opportunities for improvements in hospital processes.

PHASE 1: BASELINE DATA COLLECTION

PHASE 2: IMPLEMENTATION OF NUTRITION PROCESS IMPROVEMENTS

PHASE 3: FOLLOW-UP NUTRITION PROCESS DATA COLLECT-ION AND ANALYSIS



PHASE 1: BASELINE DATA COLLECTION

1. Review the eQIP Implementation Guide to determine the scope of the project, the patient population to study, and specified time period for data collection (monthly or quarterly).

2. Determine if the current EHR system is capable of data collection or if modifications are needed to accommodate data collection.

3. Collect aggregated data according to variables in Appendix I for the specified time period.

4. Input aggregated data to the Abbott Nutrition eQIP online portal.

5. Review automatically generated data analysis report with Abbott Nutrition representative and determine what improvements to nutrition processes are warranted.

PHASE 1:

PHASE 2: PHASE 3:

PHASE 1:



PHASE 2: IMPLEMENTATION OF NUTRITION PROCESS IMPROVEMENTS

1. Based on the data analysis report from Phase 1, implement changes to your nutrition care process.

• Implement strategies from the recommended nutrition care pathway outlined at the end of this document to help improve your overall nutrition care process for adult patients at risk of malnutrition.

2. Using the same data collection procedures in Phase I, collect nutrition process data for the specified time period to compare to data from the baseline collection period.

3. Input aggregated data into the eQIP online portal and review data report with an Abbott representative and determine the impact of process improvements.

PHASE 1:

PHASE 2: PHASE 3:



PHASE 3: FOLLOW-UP NUTRITION PROCESS DATA COLLECTION AND ANALYSIS

1. Implement any further improvements indicated by the previous period’s data report and collect data for the new specified time period.

2. Submit data to the Abbott Nutrition eQIP online portal and review the data report with an Abbott representative to determine next steps.

3. Conduct periodic data collection to evaluate nutrition process performance in order to maintain desired levels of quality.

PHASE 1:

PHASE 2: PHASE 3:


FOCUS ON BEING PART OF THE TEAM




Data is the cornerstone of QI. It separates what is thought to be happening from what is really happening

• Establishes a baseline (Starting with low scores is ok)

• Reduces placement of ineffective solutions

• Allows monitoring of procedural changes to ensure that improvements are sustained

• Indicates whether changes lead to improvements

• Allows comparisons of performance across sites

FOCUS ON USE OF THE DATA

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BENEFITS OF QI

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Baseline • Establishes a

picture of where you are

Process • Redesigns RD’s

role • Gain physician and

other HCP support • Highlights

potential resource constraints

Future • Builds case for

future outcomes research


SUMMARY

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• Prevalence of malnutrition and focus on readmissions remains high in US hospitals

• Quality Improvement is key to optimal nutrition care

• Implementation of Quality Improvement can help highlight your path to success

quality improvement – your “gps” for success...acute care proprietary and confidential — do...

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