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State Veteran’s Homes: Not Your “Average” Nursing Home
Turning data into information and knowledge into practice
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Use of Information Technology for Decision Support Is A Key Survival Strategy
To Meet Increasing Regulatory and Public Scrutiny
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Your Challenges
Too much data Too little information Too little time to analyze the data Too many best-practice protocols to
remember and apply at the resident level Too many issues to identify and address
with the right protocols for the right resident at the right time
EQUIP informatics can help with an evidence- based, data-driven approach to care
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Clinical Informatics for Continuous Quality Improvement
MDS Data ⇒
Information ⇒
Knowledge
Person-Centered Risk Identification
Based on Evidence/Best
Practice Protocols
Targeted Care Plan Interventions to Prevent Adverse Outcomes and
Improve Quality of Care / Life
Ongoing Evaluation of Systems, Processes and Outcomes
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EQUIP for Quality®
The only QM/QI software with complete drill down analysis:
→ national and state level → facility level → unit level (UNIQUE!)→ resident level (individualized risk profiles)
reports and graphs use the most current clinical assessment information available
Supports an evidence-based approach to inter-disciplinary, coordinated care
Focus on actionable items that improve resident outcomes, save time, enhance revenue, enable compliance with regulators and avoid litigation
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Who’s Looking at My MDS Data and Quality Outcomes?
Regulators/surveyors Payment sources The public (Nursing Home
Compare Five Star Rating System)
Lawyers and insurance agents Oversight agencies (OIG,
GAO) ME !!!
MDS
Accuracy Audit
Run MDS data logic and consistency checks before you finalize and submit your MDS files.
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Click any resident name to see audit report
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Examples of warnings:
•Resident has limitations in ROM and no OT or PT and no nursing restorative—resident may benefit from restorative program.
•Resident has pressure ulcer and NO turning/positioning program?
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Do the Medicare Math!
RUX = $564.83 RUL = $496.04
$68.79/day x 20 assessments/month x 30 days/assessment = $41,274/month
= $495,288 /year / facility
*Based on FY 2006 federal urban rates
One coding error can cost the facility thousands of $$
FACILITY CHARACTERISTICS
REPORT
Veterans Home resident population is very different from “typical nursing home” used in CMS national and state benchmarks
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1389% age 75+ vs. 78% nationally
89% male vs. 31%
nationally
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Fewer
More!
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Far more residents with no potential for discharge—long stay chronic care
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Far more hospice and end stage disease w/6 months or less life expectancy.
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Population Benchmarks Are Critical!
Using CMS Benchmarks results in
Missed opportunities to improve outcomes in care areas with higher occurrences than average nursing home population.
Missed opportunities to show superior care provided in State Veteran’s Homes nationwide.
QM/QI Suite
Easy to use—automatically highlights quality problem areas in real time
Flags priority issues affecting largest number of residents
Complete drill down capability from QM/QI report—saves time and takes QM analysis to the next level
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Can select Vet’s Home
Benchmark or Your State—
National always displayed
Report clearly identifies your likely problem areas
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Access summary, detail, graph and analysis charts directly from QM/QI Rates report. Will automatically show results for time period selected and specific problem areas flagged, unless you check other areas of interest.
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Resident QM/QI Report—Much easier to read/use!
Easily see related outcomes for comprehensive care plan approach.
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Evidence based risk
factors from research and best-practice protocols
QM Detail: Systems Perspective
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Graphs
Trend QM outcomes over time—early warning of emerging problem areas
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Appropriate Benchmark Data for Comparison Purposes Are Critical
Facility QM rates are not meaningful without some standard for comparison.
What standard of comparison?
Rates can vary widely based on resident characteristics and risk factors unless quality measures are risk adjusted.
Statewide and regional benchmark rates vary dramatically.
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Facility rate is
Facility rate is BELOW both state and national CMS
benchmark so outcome would not flag as potential issue.
BUT…facility rate is well above Vet’s Homes benchmark and
presents a quality of care issue that should be
addressed!
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Showcase care areas where Vets Homes excel and perform far better than average nursing
homes.
Analysis Charts—How Am I Doing?
Control Charts
Comparison Charts
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Control Chart
Control charts are effective quality management tools for health care organizations by helping to determine whether a process is:
“In control”—process is stable with only common cause variation; or
“Out of control”—process is unstable as special cause variation exists.
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Process Improvements Special cause variation means process is no
longer predictable within normal ranges. Facility should not make any changes in the process
until the special cause is identified and eliminated.
When process is stable, can make changes to improve future outcomes
Under a stable process Productivity is maximized Costs are minimized Future outcomes and costs are predictable
Promote Safer Care Through Use of Proactive
Risk Assessment
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Healthcare is transitioning to a model of preventive focused care delivery.
This shift creates a huge opportunity to keep residents healthier and save costs.
Predictive modeling is used extensively by health plans and in acute care and use has grown dramatically over past two years.
NOW is the time for long term care to adopt this innovative strategy to bring your quality of care to the next level.
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Predictive Technology Improves Accuracy of Resident Risk
Assessment Predictive models use wealth of resident data
(current and historical) to provide highly accurate assessment of risk for future adverse outcomes:
The EQUIP models predict more than 80% of all future falls, fractures and undetected pain; and more than 75% of future pressure ulcers.
Far exceeds accuracy of manual risk assessment tools (e.g. Braden Scale)—uses many more risk factors and properly weights the contribution to risk
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Risk Level Analysis
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Risk Score Interpretation
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And, as always, clicking on resident name will bring to resident centered risk profile listing risk factors that must be addressed to prevent adverse outcome.
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Predictive Technology Improves Accuracy of Resident Risk
Assessment EQUIP risk reports can help you
dramatically reduce long term adverse outcomes and utilization costs through early identification of high risk residents.
Risk scores allow you to stratify your population by risk levels and determine which residents have the greatest opportunity for achieving successful care interventions.
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Patient Safety ProjectNursing Home QA Falls Study
300 Bed Facility—Albany Area
”It’s Not the Full Moon!!”
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Facility Replaced Manual Fall Risk Assessment Tool with
EQUIP Fall Risk Reports in 2004
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Jan
FebMar
chApr
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June Ju
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Augus
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Septe
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Octobe
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Decem
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2005
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~ 57% Reduction in Total Falls
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“Medicare is spending billions to treat preventable injuries…average cost $1,272 per incident …interventions are not widely disseminated.” (Nov-Dec 2002 issue of Health Affairs)
“Each fall-related injury adds $5,325 to the cost of care.” (Pittsburgh Regional Healthcare Initiative, Executive
Summary, October 2005)
Average cost of fall resulting in ER visit $9,400 (excluding prescription drugs) . (AARP Pubic Policy Institute Issue Brief #56, A. Kochera,
March 2002)
Improve Quality of Care While Reducing Costs
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10%-25% of falls result in injury. (Rubenstein LZ, et al, Falls in the nursing home. Annals
of Internal Medicine 1994;121:442-451)
Case Study Example ⇒ Estimated $61,056 - $1.13 million per year cost savings!
Improve Quality of Care While Reducing Costs
Corporate Level Reports
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Example of better risk adjusted measure and impact on facility QM rate—22% lower!
Can drill down to facility and resident level directly
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National BenchmarkVeterans Homes Benchmark
One facility is above BOTH the national and Vets Home benchmarks.
The other two are below the national benchmark, but ABOVE the Vets Home benchmark—this issue would not be flagged as a quality issue unless you compared to your peers.
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Also can select peer group:
National Vets Homes, NYS Vets Homes, CMS National, Your State
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A
B
C
D
E
For this QM, facility C is well below the national benchmark, but well above the Vets Home benchmark (34.1% vs. 26.8%).
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How does your facility use EQUIP?
We use EQUIP in each of our care plan meetings. We are able to look at it as a team to get a more complete picture of the resident.
It assists us with our CQI process especially in the area of skin integrity.
It is used for the quarterly CQI meeting with the Dean of Medicine at Stony Brook University Hospital.
It prepares us for reviews within the survey process.
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How does your facility use EQUIP? Utilize to follow our monthly CMS data – QM and
comparative data easy to access and much more timely Auditing tool utilizing the QM/QI and High Risk
reports Benchmarking tool for quality improvement
What has been the most helpful feature of EQUIP for your facility?
Ease in obtaining data Ability to sort data by unit and other ways Provision of links to access reference tools, websites
etc. Posting links to the CMS updates
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Important differentiators to keep in mind:
EQUIP takes advantage of wealth of resident MDS assessment data already required to be collected --requires no new data collection or data entry.
EQUIP was developed in collaboration with and designed to be easily used by nursing staff
EQUIP provides access to experienced RNs who provide ongoing clinical support as part of the program (no extra cost for this valuable service)
EQUIP provides extensive policy info/updates and education
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Other Research & Enhancement Efforts Underway….
DHHS HRSA grant:
“The Numbers Count: Using MDS Quality Measures to Improve Resident Outcomes”
– FREE Web based training in clinical informatics
Sign up your staff today!
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Turning data into information and knowledge into practice
Questions?Christie Teigland, PhDDirector Health Informatics and ResearchNYAHSA/EQUIP150 State StreetAlbany, NY 12207
518.449.2707 x119 (work)518.810-9122 (cell)[email protected]
