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ReACH National Demonstration Collaborative Reducing Acute Care Hospitalization Overview Penny H. Feldman, PhD ReACH Principal Investigator Visiting Nurse Service of New York Center for Home Care Policy and Research The project team gratefully acknowledges the support from AHRQ (1 U18 HS 13694) and the Robert Wood Johnson Foundation (042588)

ReACH National Demonstration Collaborative Reducing Acute Care Hospitalization

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ReACH National Demonstration Collaborative Reducing Acute Care Hospitalization. Overview Penny H. Feldman, PhD ReACH Principal Investigator Visiting Nurse Service of New York Center for Home Care Policy and Research. - PowerPoint PPT Presentation

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  • ReACH NationalDemonstration CollaborativeReducing Acute Care HospitalizationOverview

    Penny H. Feldman, PhDReACH Principal InvestigatorVisiting Nurse Service of New YorkCenter for Home Care Policy and Research

    The project team gratefully acknowledges the support from AHRQ (1 U18 HS 13694) and the Robert Wood Johnson Foundation (042588)

  • ReACH Structure and ObjectivesPartnership to advance home health care qualityVNSNY Center for Home Care Policy and Research (CHCPR)Home care QIOSC Quality Insights of PA16 QIOs169 home health agencies (HHAs) from 20 statesObjectivesTest a collaborative model for HHA practice improvementReduce acute care hospitalization rates

  • ReACH Partnership Model

  • Background2002: Partnership for Achieving Quality Homecare (PAQH) - Funded by AHRQ and RWJ2004: PAQH Diabetes Learning Collaborative: - 8 HHAs - Significant improvement in 8 of 9 measures -- 30 percentage point increase in rate of patients with glucose in target range2005: Acute Care Hospitalization (ACH) Pilot Project - QIOSC and CHCPR evidence review and best practices2005-2007: ReACH 2 seven-month waves

  • Context~8100 Medicare-certified HHAs; ~3.4m discharges Mandated OASIS assessments & publicly reported outcomesImpending pay for performance
  • ReACH Project GoalReduce acute care hospitalizations of home health patients and make substantial progress toward CMS target of 23% risk-adjusted rate (already achieved by 25% of all HHAs nationwide) For those agencies with rates at 23% or lower: sustain the rate, and identify ways to reduce it further

  • ReACH Best PracticesTarget group selection (e.g.,region, office, dx)Risk AssessmentEmergency Plans and Risk-Appropriate Care Plans Front load visits and increase contacts (phone calls; telemedicine) for high risk patientsMedication reconciliationImproved MD communication (Situation-Background-Assessment-Recommendation (SBAR))

  • ReACH EvaluationLevel 1 PerceptionsParticipant satisfaction, challenges, lessons learned Level 2 Care processesCore measures, strategies and actionsLevel 3 Results Percentage of episodes ending with hospitalizationData sourcesOn-line surveys; phone interviewsMonthly record reviews data entered on lineOASIS reports (Home Healthcare Compare)

  • ReACH Process Results

    Total patients in target group identified at risk: +17.0-8.3 Target patients with completed risk assessments: +46.0+40.6

  • ReACH Process Results+50.0+44.4Target patients with risk-specific care plans:

  • ReACH Process ResultsAverage home care visits in first two weeks for patients at-risk of hospitalization in target group:

  • ReACH Hospitalization ResultsHome care episodes resulting in acute care hospitalization for target group:

  • HHQI National ACH Campaign ResultsComparison of 7,452 Medicare-certified HHAs4,352 Early Participating (EP) Agencies972 Later Participating (LP) Agencies2,128 Non Participating (NP) AgenciesACH rate over a 12-month period:March 2007February 2008EP30.73%30.48%LP32.06%32.33%NP34.61%35.39%HHAs achieving at least 5% improvement: EP (38.4%) LP (37.9%)NP (34.6%)

  • Challenges to ReACH ImplementationQIOsVaried expertise and skillsVaried agency selection processesHHAsVaried QI experiences and skillsCompeting priorities Staff changesReACH mechanismLong-distance facultyReliance on QIOs to transmit skills/knowledgeTechnical issues related to virtual communicationEvaluationVaried target groupsVaried implementation of varied strategies and tools

  • Lessons LearnedQIOs need/demand for TA, tools, supportHHAs positive response to Collaborative Learning model Importance of face-to-face information transfer (local learning sessions) and TAEfficiencies from leveraging QIO resources Recruitment, TA, DataValue of Peer to peer reinforcement, shared experiencesWeb-based data collectionCentral resourcesLeadership involvement key

  • Collaboration Next StepsGeriatric CHAMP ProgramPromote National Framework to Advance Geriatric Home Care ExcellenceBuild geriatric capacity in significant number of HHAsAchieve significant, measurable improvement in home care for older persons through E-learning programsA National Community of Practice to support quality improvement and share the Framework findingsCorollary activities and productsCollaborations (e.g., NAHC, VNAA, state associations; QIOSCs; accrediting bodies; consumer groups)Funding Atlantic Philanthropies, John A. Hartford Foundation, California Health Care Foundation, New York State Health Foundation, others

    PAQH: a unique collaboration among home health care organizations to advance the quality of home care for key clinical issues affecting vulnerable populations. During the Diabetes Learning Collaborative, agencies successfully integrated system-level changes and codified key improvements for diabetes patients across their agencies. The lessons learned from this Collaborative directly inform the efforts for the ReACH Collaborative(Optional: ___agencies within the __ (state) participated in the ACH pilot). The initiative resulted in a set of evidence-based change strategies and an improvement framework that have been adapted for implementation during the ReACH Collaborative

    The lessons learned from this first collaborative regarding development and implementation of change strategies, training and technical assistance needs, and measurement and evaluation efforts will inform the efforts of the ReACH Collaborative.

    The Collaborative is designed to test, implement and spread key strategies to reduce hospitalization for all patients at-risk in participating agencies