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Gunnison Valley Home Health makes strides in reducing avoidable hospitalizations – Utah Home Health

Gunnison Valley Home Health has made quality a top priority. Focusing on reducing the number of patients who have to be admitted to the hospital, the agency partnered with HealthInsight, the Medicare Quality Improvement Organization for Utah and Nevada, in 2005 to participate in a national study. By identifying and tracking patients who may be at risk for hospitalization, the agency incorporated specific interventions into patient care plans to address each risk factor. In addition, the agency is collaborating with hospital physicians to improve communication.

These efforts have produced positive results. Since the start of the initiative, Gunnison Valley Home Health has reduced the percentage of patients needing to be hospitalized substantially. As of March 2007 Home Health Compare data, their hospitalization rate has dropped to 16 percent, which is 5 percent better than the state average and 12 percent better than the national average. “Our quality of care is important to us. Working with HealthInsight keeps us focused as well as helping us apply the full process for quality improvement,” said Barbara Lund, Director of Gunnison Valley Home Health.

For more information, contact Barbara Lund at 435-528-2109.

Superior Home Care achieves significant improvement in urinary incontinence among their client base – Utah Home Health

Superior Home Care in Murray, Utah worked with HealthInsight, the Medicare Quality Improvement Organization (QIO) for Utah and Nevada, to achieve a statistically significant improvement in the quality improvement measure on urinary incontinence.

Urinary incontinence is a difficult topic to discuss because of its personal nature, that affects many home health patients as well as the elderly and disabled. Incontinence can result in skin irritation, which can become a serious health problem, leading to the loss of ability to perform normal daily activities. Quality of life can be severely affected as a result of urinary incontinence.

Superior Home Care staff attended HealthInsight training in 2003 and opted to work on improving urinary incontinence among their client base. Staff and clinicians subsequently conducted an assessment to identify what parts of the care process the agency needed to address. Superior Home Care officials decided that patient care planning and interventions were not consistently addressing the problem. HealthInsight provided assistance in applying human factors principles to determine the most appropriate solutions for the identified problem. Human factors principles take into consideration how the design of tools, tasks and work environments impacts task performance.

In April 2003, after consulting with HealthInsight, the Superior Home Care team developed a plan of action that included a procedure for clinicians to follow for patient assessments, standardized care plans, staff education and patient self-management education. Within 12 months after implementing an action plan, Superior Home Care increased the number of patients who improved in urinary incontinence from 29 percent in April 2003 to 47 percent in April 2004. As of the most recent Home Health Compare data (March 2007), the outcome measure has increased to 69 percent, which is 19 percent above the national and state averages.

Home Health Services of Nevada Decreases Acute Care Hospitalization Rates Through Use of Telemonitoring Program— Nevada Home Health

Home Health Services of Nevada (HHSN) set a goal to reduce the hospitalization rate for their patients. The original plan, developed with the help of HealthInsight staff, was to reduce and sustain a 1 percent reduction from the base rate of 26.10 percent.  As of January 2008, HHSN has reduced and sustained the rate below 23 percent.

The plan of action for reducing acute care hospitalization (ACH) incorporated the existing telemonitoring program by selecting appropriate patients for monitoring, and implementing appropriate and timely responses to the data from the monitored patients. Criteria were developed by the staff to determine which patients were appropriate for monitoring. All patients admitted to services are evaluated to see if they meet these criteria.

Once a patient is chosen and is using the monitor, all data comes to a central station on a daily basis. The person watching the central station then informs the patient’s nurse case manager of that day’s results. The nurse case manager can then take appropriate actions such as calling a doctor, asking the patient for further information, or calling to assure the patient that all is well.

One of HHSN’s patients using the monitor is an 83-year-old gentleman with diabetes and heart failure. He lives alone with no support system and is quite a distance from town. Before the monitor he “bounced back and forth to the hospital quite often” according to the HHSN nurse providing care. When asked about the monitor, he responded, “It’s pretty nice, it’s more work but it helps me stay out of the hospital.”  He says, “I know my blood pressure and weight and how I’m breathing everyday so it helps me know what to eat.”  His nurse says “It gives him accountability and keeps him out of the hospital. He knows that I will call any time the numbers don’t look good. His blood sugar is much better than it used to be—this is a story of success.”

In conjunction with the telemonitoring program, HHSN implemented other strategies to prevent avoidable hospitalizations in the nine branch offices throughout  Nevada. At the branch level, all weekly case conferences are structured to include discussions about patients at risk for hospitalization and possible interventions to reduce that risk. Each day, management sends the branch offices a list of patients that are at risk for hospitalization, information provided by the Strategic Healthcare Program (SHP) and based on the agency’s OASIS data. If these patients have not already been identified as “at risk” by the nurses in the branch, they are added to the discussion.

When a patient is hospitalized, the branch office—using the ACH event tree to review the patient’s care—determines whether or not the hospitalization might have been prevented and where the failure may have occurred. The QI nurse continually evaluates the information gathered in these reviews to identify improvement opportunities in agency systems and processes.

HHSN management developed several disease specific care guidelines and added them to the software used for nursing documentation within the electronic record.  The guidelines can be readily accessed and incorporated into the care plan by the nurse while developing the patient’s care plan.

All interventions to prevent avoidable hospitalizations are monitored on a monthly basis and these data are sent to the branches as feedback on improvement efforts. The monitoring activities and reports include the following:

  • The rate of ACH per month for each branch office, including a separate report of any hospitalized patients on telemonitors.

  • The number of patients appropriate for monitoring vs. the number who are not appropriate (this is to determine if the telemonitoring system is being used to full capacity and if the service will need to expand in the future).

  • The number of weekly case conferences conducted by which branch to track compliance.

  • A simple chart to report results from event tree investigation, separated into 12 categories in order to identify any general trends.

HHSN believes that their success in reducing ACH cannot be attributed to any one intervention. It is a culmination of continued and consistent education and support for all the nurses, monitoring activities, and continuous feedback of the data, both agency-level and branch-level. It is human nature to want to compare your branch with another, which may instill an incentive to compete.

HHSN also believes that it is important not to have too many plans and interventions in place at once. They implemented a few interventions and consistently monitor the interventions and provide data feedback in easily readable charts. 

HHSN continues to advance excellence in patient care by setting and achieving higher goals.

A Success Story from HealthSouth Home Health of Henderson – NV Home Health

This agency is a member of our clinical improvement IPG (IPG-1) and used the “Taking Stock” assessment to have a better understanding of their systems and processes around reducing Acute Care Hospitalization (ACH). This information was then taken into consideration when they developed their Plan of Action (POA) using the materials provided by HealthInsight. The plan was implemented in January 2006. Intervention actions called for the adoption of a risk assessment tool to identify patients at risk and to train clinicians in the use of this tool. The agency adopted a tool focused on fall risk assessment and implemented this. The patients identified at risk from this assessment are then seen by a physical therapist within 24 hours of being identified at risk. Linda believes this has reduced the number of hospitalizations for falls (no data was collected pre- or post- to measure).

The agency is also part of a system (rehabilitation hospital) that uses computerized patient information technology. The agency has access to patient information that is important to have at the start of care before they actually call to set up the intake assessment, better preparing clinicians for the visit and to meet the patient’s needs.

The ACH rate at baseline (July 2004) was 30.94%. In August 2005, before the new computer system was implemented, the ACH rate was 29.48%. In November 2005 (prior to focus on this topic through review and implementation of the POA but after the new computer system was implemented in September/October 2005), the ACH rate was 26.95%. As of March 2006, the ACH rate is 21.96. As of October 2006, the ACH rate 18.98%.

This agency has maintained an ACH rate below 20% for the past six months and as of July 2007; their ACH rate is 15.98%. The agency’s ability to sustain the lower ACH rate indicates that systems and processes have been put into place (and remain in place) that focus on and respond to individual patient needs.

A Success Story from HealthSouth Home Health of Henderson – NV Home Health

Southern Nevada Home Health Care, located in Las Vegas, Nevada, has focused quality improvement efforts on decreasing the number of patients that had to be admitted to the hospital and on increasing the number of patients with less pain when moving around. Since beginning this focused effort in January 2006, the agency’s percent of patients admitted to the hospital went from 24.78% to 17.72% (July 07), while the state average is 25.88%. At the same time, Southern Nevada Home Health Care has increased the number of patients with less pain when moving around from 64.72% to 82.49%, with the national average at 63% and the statewide average at 62% (Home Health Compare data for Apr 06 through Mar 07).

Improvement efforts to reduce hospitalizations focused on systems and processes surrounding a complete and accurate assessment of patients at the start of care, front-loading visits for patients just discharged from the hospital, and phone calls to patients following any doctor appointments to assess for changes in treatment and address questions/concerns related to the visit.

Preventing Hospital Readmission, A Success story from Saint Mary’s Home Care Services – NV Home Health

Although Saint Mary’s Home Care Services’ rate of patients who are admitted to the hospital is below the national average, they believe they can do more for their patients. In September 2005, they implemented a new process to coordinate patient care directly from the hospital to improve safety in the home and decrease the likelihood that the patient has to be readmitted. Building on these efforts, the agency restructured their staff into care teams to improve the care processes they provide and facilitate quality improvement through the teams. They shifted from a traditional approach towards patient care to a case management model. They have implemented front-loading visits for identified patients with better utilization of services. They also have implemented a fall prevention program (with printed brochures/materials for patients) and taken a patient focus/disease management focus to their approach in patient care. The agency has also created more of a mentoring situation between the field nurses and the case managers. The continuous quality improvement approach is producing results, with Saint Mary’s Home Care Services seeing an improvement in the percentage of patients who are admitted to the hospital from 25.4 percent to 21.95 percent from the start of the program through July 2007.

The agency is also one of 27 home health agencies in the HealthInsight Quality Partners Program, a group of hospitals, nursing homes, and home health agencies that have pledged to improve the quality of health care in Nevada. These agencies have committed to work closely with HealthInsight, the Medicare Quality Improvement Organization for Utah and Nevada to reduce avoidable hospitalizations for patients receiving home health care.

For more information, contact Katie Grimm at 775-250-1531.